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Perez-Padilla R, Montes de Oca M, Thirion-Romero I, Wehrmeister FC, Lopez MV, Valdivia G, Jardim JR, Muino A, B Menezes AM. Trajectories of Spirometric Patterns, Obstructive and PRISm, in a Population-Based Cohort in Latin America. Int J Chron Obstruct Pulmon Dis 2023; 18:1277-1285. [PMID: 37366430 PMCID: PMC10290847 DOI: 10.2147/copd.s406208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Background Preserved ratio impaired spirometry (PRISm) has been associated with adverse outcomes and increased transition to other spirometric categories over time. We aimed to examine its prevalence, trajectories over time, and outcomes in a population-based sample from Latin America. Methods Data were obtained from two population-based surveys of adults from three cities in Latin America (PLATINO study), conducted on the same individuals 5-9 years after their baseline examination. We estimated the frequency of PRISm defined by FEV1/FVC≥0.70 with FEV1 <80%, describing their clinical characteristics, longitudinal transition trajectories over time, factors associated with the transition. Results At baseline, 2942 participants completed post-bronchodilator spirometry, and 2026 at both evaluations. The prevalence of normal spirometry was 78%, GOLD-stage 1 10.6%, GOLD 2-4 6.5%, and PRISm was: 5.0% (95% CI 4.2-5.8). PRISm was associated with less schooling, more reports of physician-diagnosis of COPD, wheezing, dyspnea, missing days at work, having ≥2 exacerbations in the previous year but without accelerated lung function decline. Mortality risk was significantly higher in PRISm (HR 1.97, 95% CI 1.2-3.3) and COPD GOLD 1-4 categories (HR 1.79, 95% CI 1.3-2.4) compared with normal spirometry. PRISm at baseline most frequently transitioned to another category at follow-up (46.5%); 26.7% to normal spirometry and 19.8% to COPD. The best predictors of transition to COPD were closeness of FEV1/FVC to 0.70, older age, current smoking, and a longer FET in the second assessment. Conclusion PRISm, is a heterogeneous and unstable condition prone to adverse outcomes that require adequate follow-up.
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Affiliation(s)
| | - Maria Montes de Oca
- Pulmonary Division, Hospital Universitario de Caracas, Universidad Central de Venezuela, and Centro Medico de Caracas, Caracas, Venezuela
| | | | | | | | - Gonzalo Valdivia
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose R Jardim
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Adriana Muino
- Universidad de la Republica. Hospital Maciel, Montevideo, Uruguay
| | - Ana Maria B Menezes
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - On behalf of the PLATINO Group
- National Institute of Respiratory Diseases, Mexico City, Mexico
- Pulmonary Division, Hospital Universitario de Caracas, Universidad Central de Venezuela, and Centro Medico de Caracas, Caracas, Venezuela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Universidad de la Republica. Hospital Maciel, Montevideo, Uruguay
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Fortis S, Shannon ZK, Garcia CJ, Guillamet RV, Aloe AM, Schweizer ML, Kim V, Nair R. Association of Nonobstructive Chronic Bronchitis With All-Cause Mortality: A Systematic Literature Review and Meta-analysis. Chest 2022; 162:92-100. [PMID: 35150657 DOI: 10.1016/j.chest.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/13/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The effect of nonobstructive chronic bronchitis (CB) on mortality is unclear. RESEARCH QUESTION Is nonobstructive CB associated with increased all-cause mortality? STUDY DESIGN AND METHODS We conducted a systematic literature review and meta-analysis to assess the association of nonobstructive CB and all-cause mortality. We searched for articles that included both CB and mortality in the title, abstract, or both in PubMed and EMBASE. We excluded studies in which participants demonstrated obstructive spirometry findings and studies in which CB and mortality were not defined. We used the Newcastle-Ottawa Quality Assessment Scale to assess study quality. We pooled adjusted hazard ratios (HRs) using the random effects model and inverse variance weighting. We conducted stratified analysis by the definition of CB and smoking status. We used Cochran's Q and I2 to assess for heterogeneity. We assessed publication bias by visual inspection of a funnel plot. RESULTS Of 5,014 titles identified, eight fulfilled the inclusion and exclusion criteria. Overall nonobstructive CB was associated with all-cause mortality (HR, 1.37; 95% CI, 1.26-1.50) with no statistically significant heterogeneity (P = .14; I2 = 29%). Nonobstructive CB was associated with increased mortality in studies that defined CB as any respiratory symptoms (broad definition; HR, 1.28; 95% CI, 1.10-1.48; I2 = 0%) as well as in the rest of the studies (HR, 1.40; 95% CI, 1.26-1.56; I2 = 37%). Nonobstructive CB was associated with increased mortality in ever smokers (HR, 1.49; 95% CI, 1.35-1.64; I2 = 0%), but was not associated with increased mortality in never smokers (HR, 1.22; 95% CI, 0.90-1.66), and moderate heterogeneity was found (P = .10; I2 = 49%). The funnel plot did not indicate evidence of a publication bias because it showed symmetrical distribution of studies. INTERPRETATION Nonobstructive CB is associated with increased all-cause mortality, and this association seems to be present only in current and former smokers. Further research should investigate whether this high-risk population may benefit from early therapeutic intervention. TRIAL REGISTRY PROSPERO; No.: CRD42021253596; URL: www.crd.york.ac.uk/prospero.
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Affiliation(s)
- Spyridon Fortis
- Center for Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, IA; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA; Department of Epidemiology, College of Public Health, Iowa City, IA.
| | | | - Crystal J Garcia
- Department of Epidemiology, College of Public Health, Iowa City, IA
| | - Rodrigo Vazquez Guillamet
- Division of Pulmonary, Critical Care and Occupation Medicine, Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Ariel M Aloe
- Department of Educational Measurement and Statistics, College of Education, Iowa City, IA
| | - Marin L Schweizer
- Center for Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, IA; Department of Epidemiology, College of Public Health, Iowa City, IA; Department of Internal Medicine, Division of General Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Rajeshwari Nair
- Center for Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, IA; Department of Epidemiology, College of Public Health, Iowa City, IA; Department of Internal Medicine, Division of General Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA
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Zou RH, Bon J. Reduced Dlco in GOLD I COPD: Moving Towards a Multidimensional Approach to Risk Stratification. Chest 2021; 160:791-792. [PMID: 34488950 DOI: 10.1016/j.chest.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Richard H Zou
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jessica Bon
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA; Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
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de-Torres JP, O'Donnell DE, Marín JM, Cabrera C, Casanova C, Marín M, Ezponda A, Cosio BG, Martinez C, Solanes I, Fuster A, Neder JA, Gonzalez-Gutierrez J, Celli BR. Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD. Chest 2021; 160:872-878. [PMID: 33901498 DOI: 10.1016/j.chest.2021.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored. RESEARCH QUESTION Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients? STUDY DESIGN AND METHODS GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. RESULTS A Dlco cutoff value of <60% predicted was associated with all-cause mortality (Dlco ≥ 60%: 9% vs Dlco < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with Dlco < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a Dlco < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined.
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Affiliation(s)
- Juan P de-Torres
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada.
| | - Denis E O'Donnell
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
| | - Jose M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud & CIBERES, Zaragoza, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain and Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain
| | - Marta Marín
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Borja G Cosio
- Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Mallorca, Spain, and Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Cristina Martinez
- Department of Respiratory Medicine, Hospital Central de Asturias, Oviedo, Spain
| | - Ingrid Solanes
- Pulmonary Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonia Fuster
- Pulmonary Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | - J Alberto Neder
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
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Abstract
The early stages of COPD have recently become a hot topic as many new risk factors have been proposed, but substantial knowledge gaps remain in explaining the natural history of the disease. If we are to modify the outcomes of COPD, early detection needs to play a critical role. However, we need to sort out the barriers to early detection and have a better understanding of the definition of COPD and its diagnosis and therapeutic strategies to identify and treat patients with COPD before structural changes progress. In this review, we aim to clarify the differences between early COPD, mild COPD and early detection of COPD, with an emphasis on the clinical burden and how different outcomes (quality of life, exacerbation, cost and mortality) are modified depending on which definition is used. We will summarise the evidence for the new multidimensional diagnostic approaches to detecting early pathophysiologic changes that potentially allow for future studies on COPD management strategies to halt or prevent disease development.
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Affiliation(s)
- Maria Eugenia Laucho-Contreras
- Fundación Neumológica Colombiana, Bogota, Colombia,GlaxoSmithKline, Bogota, Colombia,Maria Eugenia Laucho-Contreras, Fundación Neumológica Colombiana, Kra. 13b #161-85, Bogota 110111, Colombia. E-mail:
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