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Lungenfunktionsprüfung im höheren Lebensalter. Z Gerontol Geriatr 2022; 55:603-612. [DOI: 10.1007/s00391-022-02070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/03/2022] [Indexed: 10/14/2022]
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BAKIRHAN S, ÖZKESKİN M, ŞAHİN S, ÖZDEN F. The predictors of the pulmonary function in community-dwelling older adults. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021; 5:23-29. [DOI: https:/doi.org/10.30621/jbachs.879109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Purpose: The aim of the study was to observe the relationship between age, body mass index (BMI), physical activity, and kyphosis angle parameters with respiratory function capacity in community-dwelling older adults and to determine the main predictor.
Methods: A prospective cross-sectional study was carried out with 70 older adults. Physical activity level was questioned with the Physical Activity Scale for Elderly (PASE). Thoracic kyphosis degrees were measured with a digital inclinometer. Pulmonary Function Test (PFT) was used to measure pulmonary function capacity. The correlation between age, BMI, PASE, thoracic kyphosis angle with parameters of PFT measurement was analyzed. In addition, a linear multivariate regression model was built to determine the main predictor.
Results: The mean age of the participants was 69.88±4.52 years. There was a low degree but a statistically significant positive correlation between BMI and FEV1 (r=0.258,p
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Affiliation(s)
| | | | | | - Fatih ÖZDEN
- MUĞLA SITKI KOÇMAN ÜNİVERSİTESİ, KÖYCEĞİZ SAĞLIK HİZMETLERİ MESLEK YÜKSEKOKULU
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Kawakami R, Nakada Y, Hashimoto Y, Ueda T, Nakagawa H, Nishida T, Onoue K, Soeda T, Watanabe M, Saito Y. Prevalence and Prognostic Significance of Pulmonary Function Test Abnormalities in Hospitalized Patients With Acute Decompensated Heart Failure With Preserved and Reduced Ejection Fraction. Circ J 2021; 85:1426-1434. [PMID: 33867406 DOI: 10.1253/circj.cj-20-1069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study evaluated the prevalence and prognostic impact of lung function abnormalities in patients with acute decompensated heart failure (ADHF) with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).Methods and Results:Of the 1,012 consecutive patients who were admitted to Nara Medical University with ADHF between 2011 and 2018, 657 routinely underwent spirometry (pulmonary function test [PFT]) before discharge. Lung function was classified as normal or abnormal (restrictive, obstructive, or mixed). Abnormal PFTs were seen in 63.0% of patients with ADHF (36.7%, 13.1%, and 13.2% for restrictive, obstructive, and mixed, respectively). The prevalence of abnormal PFT increased with age (P<0.001). Overall, abnormal PFT was an independent predictor of the composite endpoint of cardiovascular mortality or hospitalization for HF (adjusted hazard ratio [HR] 1.402; 95% confidence interval [CI] 1.039-1.914; P=0.027). Abnormal PFT (adjusted HR 2.294; 95% CI 1.368-4.064; P=0.001), as well as the restrictive (HR 2.299; 95% CI 1.322-4.175; P=0.003) and mixed (HR 2.784; 95% CI 1.399-5.581; P=0.004) patterns, were predictive of the composite endpoint in HFpEF, but not in HFrEF. CONCLUSIONS Abnormal PFT was prevalent and associated with poor outcomes in ADHF. Spirometry may be a useful tool in patients with ADHF, especially in those with HFpEF, to identify those at higher risk of a poorer outcome.
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Affiliation(s)
- Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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4
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The predictors of the pulmonary function in community-dwelling older adults. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.879109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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5
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Mycroft K, Korczynski P, Jankowski P, Kutka M, Zelazna O, Zagaja M, Wozniczko K, Szafranska U, Koltowski L, Opolski G, Krenke R, Gorska K. Active screening for COPD among hospitalized smokers - a feasibility study. Ther Adv Chronic Dis 2020; 11:2040622320971111. [PMID: 33403094 PMCID: PMC7739207 DOI: 10.1177/2040622320971111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Spirometry is a primary tool for early chronic obstructive pulmonary disease (COPD) detection in patients with risk factors, for example, cigarette smoking. The aim of this study was to evaluate the strategy of an active screening for COPD among smokers admitted to the pulmonary and cardiology department. Methods: This prospective study was conducted between February and March 2019. All hospitalized smokers aged 40 years and older completed an original questionnaire and had spirometry measurement with a bronchial reversibility test (if applicable) performed by medical students using a portable spirometer. Results: One hundred and eighty-eight patients were eligible to participate in the study. Seventy (37%) subjects refused to participate. Eventually, 116 (62%) patients were included in the final analysis and 94 (81%) performed spirometry correctly. In total, 32 (34 %) patients were found to have COPD. Nine (28%) of these patients were newly diagnosed, 89% of them had mild-to-moderate airway obstruction. Patients with newly diagnosed COPD were significantly younger [age 63 (56–64) versus 69 (64–78) years], had a longer smoking-free period [17 (13–20) versus 9 (2–12) years], had fewer symptoms and had a better lung function compared with patients with a previous diagnosis of COPD (p < 0.05 for all comparisons). Conclusion: The proposed diagnostic strategy can be successfully used to improve COPD detection in the inpatient setting. The majority of the newly diagnosed COPD patients had mild-to-moderate airway obstruction. Patients who should be particularly screened for COPD include ex-smokers with less pronounced respiratory symptoms.
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Affiliation(s)
- Katarzyna Mycroft
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Korczynski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Jankowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Mikolaj Kutka
- Students' Research Group "Alveolus", Medical University of Warsaw, Warsaw, Poland
| | - Olga Zelazna
- Students' Research Group "Alveolus", Medical University of Warsaw, Warsaw, Poland
| | - Marcin Zagaja
- Students' Research Group "Alveolus", Medical University of Warsaw, Warsaw, Poland
| | - Kornelia Wozniczko
- Students' Research Group "Alveolus", Medical University of Warsaw, Warsaw, Poland
| | - Urszula Szafranska
- Students' Research Group "Alveolus", Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Gorska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Banacha 1a, Warsaw, 02-097, Poland
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Hegendörfer E, Degryse JM. Avoiding ageism and promoting independence from reference equations in lung function testing of older adults. Eur Respir J 2020; 55:55/3/2000033. [DOI: 10.1183/13993003.00033-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 11/05/2022]
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Li F, Huang ZW, Wang XF, Xu HW, Yu H, Chen YB, Huang JA, Wang JJ, Lei W. Safety and use of pulmonary function tests: a retrospective study from a single center over seven years' clinical practice. BMC Pulm Med 2019; 19:259. [PMID: 31864318 PMCID: PMC6925499 DOI: 10.1186/s12890-019-1019-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/04/2019] [Indexed: 03/05/2023] Open
Abstract
Background To promote the utilization of pulmonary function tests (PFT) through analyzing the data of PFT during the past seven years in one large teaching hospital in China. Methods Through a retrospective analysis, the allocation of full-time staff in PFT room, the demographic characteristics of patients, cost-effectiveness of PFT, positive rate and failure rate of PFT, adverse events were analyzed. Results 1) From 2012 to 2018, the numbers of PFT showed the trend of escalation year by year. The proportion of patients receiving PFT rose from 29.0/10,000 in 2012 to 34.7/10,000 in 2018. The best allocation of PFT room was 20–25/ person / day. 2) The number of PFT provided by Department of Pulmonary and Critical Care Medicine (PCCM) accounted for 97.2, 97.1, 97.3, 97.8, 97.8, 98.0, and 98.2% of the total cases of outpatient PFT in the same year. The top three departments in the inpatient department were Department of Thoracic Surgery, Department of General Surgery, and Department of Urinary Surgery, the total cases of PFT in these three departments accounted for 65.1, 64.4, 62.1, 63.5, 62.4, 65.3 and 69.1% of the total cases of inpatient PFT in the same year. 3) Data from 2018 showed that the revenue from PFT was about 3.7 million Chinese Yuan, and that the salary of personnel and expenditure on machine maintenance and wear were about 800,000 Chinese Yuan. 4) 58.2% of the patients who had undergone PFT had ventilatory dysfunction. 5) The average failure rate of PFT in the past seven years was 1.91%. 6) The main adverse events of PFT examination were dizziness, amaurosis, limb numbness, lip numbness and falls. The incidence rates were 0.49, 0.42, 0.41, 0.39, 0.44, 0.48, and 0.45% respectively, with an average of 0.44%. Conclusions The number of PFT showed an upward trend in the past seven years, and the optimal staffing of PFT room was 20–25 cases per person per day. The positive rate of pulmonary dysfunction was 58.2%. The failure rate of PFT and the incidence of adverse events were very low, suggesting it is a simple and safe clinical examination. It’s worthy of further popularization and promotion.
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Affiliation(s)
- Fei Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Zhi-Wen Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.,Department of Respiratory Medicine, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Xiao-Fei Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Hui-Wen Xu
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Hua Yu
- Department of Respiratory Medicine, First People's Hospital of Fuzhou, Fuzhou, 344000, Jiangxi, China
| | - Yan-Bin Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Jian-An Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Jia-Jia Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Wei Lei
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
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Komal S, Simon L, Grau G, Mateu A, de la Asunción Villaverde M, de la Sierra A, Almagro P. Utility of FEV1/FEV6 index in patients with multimorbidity hospitalized for decompensation of chronic diseases. PLoS One 2019; 14:e0220491. [PMID: 31374087 PMCID: PMC6677320 DOI: 10.1371/journal.pone.0220491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/17/2019] [Indexed: 12/25/2022] Open
Abstract
Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient’s age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement.
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Affiliation(s)
- Shakeel Komal
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Lluis Simon
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Gemma Grau
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Aina Mateu
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Maria de la Asunción Villaverde
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Alex de la Sierra
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Pere Almagro
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- * E-mail:
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Melo SMD, Oliveira LAD, Wanderley JLF, Rocha RDA. Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry. ACTA ACUST UNITED AC 2019; 45:e20180232. [PMID: 31365683 PMCID: PMC6733717 DOI: 10.1590/1806-3713/e20180232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022]
Abstract
Objective: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. Methods: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. Results: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). Conclusions: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.
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Affiliation(s)
- Saulo Maia d'Avila Melo
- . Ambulatório de Pneumologia, Faculdade de Medicina, Universidade Tiradentes, Aracaju (SE) Brasil
| | | | - José Lucas Farias Wanderley
- . Residência em Anestesiologia. Hospital Universitário Professor Alberto Antunes, Universidade Federal de Alagoas, Maceió (AL) Brasil
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Ocaklı B. The Feasibility of Domiciliary Non-Invasive Mechanical Ventilation due to Chronic Respiratory Failure in Very Elderly Patients. Turk Thorac J 2019; 20:130-135. [PMID: 30958986 DOI: 10.5152/turkthoracj.2018.18119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the use of domiciliary non-invasive mechanical ventilation (NIMV) in very elderly patients (age 80 and over). MATERIALS AND METHODS This retrospective study included a total of 44 patients aged 80 years or older, who were admitted to the Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonary Intensive Care Outpatient Clinic between 2012 and 2018 and applied NIMV for chronic respiratory failure. The patients were divided into two groups: survivors (n=15) and non-survivors (n=29). Data were obtained from the retrospectively formed hospital database. The characteristics of patients, comorbidities, NIMV compliance, pulmonary function tests, and blood gas analyses were compared between the survivors and non-survivors. RESULTS From the retrospective analysis of 44 cases, the non-survivors were found to have a significantly shorter duration of domiciliary NIMV (737 days vs. 890 days, p=0.027) and lower hemoglobin concentration (11.1 g/L vs. 12.9 g/L, p=0.004). The number of comorbid conditions, pulmonary function test, and blood gas analyses results did not differ significantly between the groups. Compliance was moderate in this elderly population, at 4.9±1.9 h/day (range: 0.8-9.1 h/day). NIMV was well-tolerated in 36 of the 44 elderly patients (81.8%). Overall mortality was 65.9%. CONCLUSION Domiciliary NIMV can be of benefit to very elderly patients, and age is not an obstacle. Therefore, this population should not be excluded from this treatment solely on the basis of age.
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Affiliation(s)
- Birsen Ocaklı
- Intensive Care Unit, Health Sciences University, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
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11
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Akasheh N, Byrne D, Coss P, Conway R, Cournane S, O'Riordan D, Silke B. Lung function and outcomes in emergency medical admissions. Eur J Intern Med 2019; 59:34-38. [PMID: 30243511 DOI: 10.1016/j.ejim.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We examine the ability of pre-existing measures of Forced Expiratory Volume in 1 s (FEV1), and Diffusion Capacity for Carbon Monoxide (DLCO) to determine the subsequent 30-day mortality outcome following unselected acute medical admission. METHODS Between 2002 and 2017, we studied all emergency medical admissions (106,586 episodes in 54,928 patients) of whom 8071 were classified as respiratory. We employed logisitic multiple variable regression models to evaluate the ability of FEV1 or DLCO to predict the 30-day hospital mortality outcome. RESULTS The 30-day hospital episode mortality outcome demonstrated curvilinear relationships to the underlying FEV1 or DLCO values; adjusted for major outcome predictors, a higher FEV1 - OR 0.85 (95% CI: 0.82, 0.89) or DLCO OR 0.76 (95% CI: 0.73, 0.79) values predicted survival. The range of predicted mortalities was from 3.3% (95% CI: 2.5, 4.0) to 23.5% (95% CI: 20.8, 26.2); the FEV1 (Model1) and DLCO (Model2) outcome prediction was essentially equivalent (Chi2 = 2.9: p = 0.08). CONCLUSION The 30-day mortality outcome was clearly related to the pre-admission FEV1 and DLCO value. The outcome relationship was curvilinear. Either parameter appears a useful tool to explore hospital outcomes. Previously suggested cut-points are likely an artefact and not supported by these data.
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Affiliation(s)
- Nadim Akasheh
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland.
| | - Declan Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Peter Coss
- Pulmonary Function Laboratory, St James's Hospital, Dublin 8, Ireland
| | - Richard Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Seán Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - Bernard Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Kaur R, Kumar A, Hadda V, Kalaivani M, Nongkynrih B, Kant S, Gupta S, Vignesh D. Quality of spirometry testing in a community setting: A study among elderly persons in a rural area of Haryana. J Family Med Prim Care 2019; 8:3718-3725. [PMID: 31803679 PMCID: PMC6881915 DOI: 10.4103/jfmpc.jfmpc_719_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/17/2019] [Accepted: 10/09/2019] [Indexed: 11/04/2022] Open
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Haynes JM. Basic spirometry testing and interpretation for the primary care provider. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2018; 54:17. [PMID: 31164790 PMCID: PMC6516140 DOI: 10.29390/cjrt-2018-017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Spirometry testing plays an important role in the diagnosis and management of COPD and asthma in the primary care setting. Verifying the accuracy of the spirometer, using accurate patient demographics and appropriate reference equations, and ensuring the competency of testing personnel are key components of spirometry test interpretation. Spirometry testing plays an important role in the diagnosis and management of lung disease in the primary care setting. Spirometry interpretation should include an assessment of test quality and be based on sound statistical principals.
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Affiliation(s)
- Jeffrey M Haynes
- Pulmonary Function Laboratory, St. Joseph Hospital, Nashua, NH, USA
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14
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Trinh HKT, Ban GY, Lee JH, Park HS. Leukotriene Receptor Antagonists for the Treatment of Asthma in Elderly Patients. Drugs Aging 2017; 33:699-710. [PMID: 27709465 DOI: 10.1007/s40266-016-0401-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Elderly asthma (EA) is regarded as a distinct phenotype of asthma and is associated with age-related changes in airway structure and alterations in lung function and immune responses. EA is difficult to diagnose because of aging and co-morbidities, and overlaps with fixed airway obstructive disease. Novel modalities to differentiate between EA and chronic obstructive pulmonary disease (COPD) are necessary. A multifaceted approach, including clinical history, smoking habits, atopy, and measurement of lung function, is mandatory to differentiate asthma from COPD. There are a variety of co-morbidities with EA, of which COPD, upper airway diseases, depression, obesity, and hypertension are the most common, and these co-morbidities can affect the control status of EA. However, leukotriene receptor antagonists (LTRAs) can facilitate the management of EA, and thus addition of an LTRA to inhaled corticosteroid (ICS) monotherapy or ICS plus long-acting β2-agonist therapy improves symptoms in EA patients. LTRA treatment is safe and beneficial in patients who are unable to use inhalation devices properly or who have co-morbid diseases. Therefore, clinical studies targeting a specific population of EA patients are warranted to help achieve a better therapeutic strategy in EA patients.
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Affiliation(s)
- Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ji-Ho Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea. .,Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, South Korea.
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Abstract
Late-onset asthma is common, associated with poor outcome, underdiagnosed and undertreated, possibly due to the modifying effect of ageing on disease expression. Although the diagnostic work-up in elderly individuals suspected of having asthma follows the same steps as in younger individuals (case history and spirometry), it is important to acknowledge that elderly individuals are likely to have diminished bronchodilator reversibility and some degree of fixed airflow obstruction. Elderly individuals, therefore, often require further objective tests, including bronchial challenge testing, to objectively confirm asthma. If necessary, a trial of oral or inhaled corticosteroid might be necessary. Asthma can be diagnosed when increased airflow variability is identified in a symptomatic patient, and if the patient does not have a history of exposure, primarily smoking, known to cause chronic obstructive pulmonary disease, the diagnosis is asthma even if the patient does not have fully reversible airflow obstruction. Pharmacological therapy in patients with late-onset asthma follows international guidelines, including treatment with the lowest effective dose of inhaled corticosteroid to minimize the risk of systemic effects. However, most recommendations are based on extrapolation from findings in younger patients. Comorbidities are very common in patients with late-onset asthma and need to be taken into account in the management of the disease. In conclusion, late-onset asthma is poorly recognized and sub-optimally treated, the latter not least because elderly patients are excluded from most randomized controlled trials. Future studies should focus on the development of evidence-based guidelines for diagnosis and the pharmacological therapy of asthma in the elderly, including late-onset asthma.
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Affiliation(s)
- Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, 2650, Hvidovre, Denmark. .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Yamada Y, Ueyama M, Abe T, Araki T, Abe T, Nishino M, Jinzaki M, Hatabu H, Kudoh S. Difference in the craniocaudal gradient of the maximum pixel value change rate between chronic obstructive pulmonary disease patients and normal subjects using sub-mGy dynamic chest radiography with a flat panel detector system. Eur J Radiol 2017. [PMID: 28624018 DOI: 10.1016/j.ejrad.2017.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To compare the craniocaudal gradients of the maximum pixel value change rate (MPCR) during tidal breathing between chronic obstructive pulmonary disease (COPD) patients and normal subjects using dynamic chest radiography. MATERIALS AND METHODS This prospective study was approved by the institutional review board and all participants provided written informed consent. Forty-three COPD patients (mean age, 71.6±8.7 years) and 47 normal subjects (non-smoker healthy volunteers) (mean age, 54.8±9.8 years) underwent sequential chest radiographs during tidal breathing in a standing position using dynamic chest radiography with a flat panel detector system. We evaluated the craniocaudal gradient of MPCR. The results were analyzed using an unpaired t-test and the Tukey-Kramer method. RESULTS The craniocaudal gradients of MPCR in COPD patients were significantly lower than those in normal subjects (right inspiratory phase, 75.5±48.1 vs. 108.9±42.0s-1cm-1, P<0.001; right expiratory phase, 66.4±40.6 vs. 89.8±31.6s-1cm-1, P=0.003; left inspiratory phase, 75.5±48.2 vs. 108.2±47.2s-1cm-1, P=0.002; left expiratory phase, 60.9±38.2 vs. 84.3±29.5s-1cm-1, P=0.002). No significant differences in height, weight, or BMI were observed between COPD and normal groups. In the sub-analysis, the gradients in severe COPD patients (global initiative for chronic obstructive lung disease [GOLD] 3 or 4, n=26) were significantly lower than those in mild COPD patients (GOLD 1 or 2, n=17) for both right and left inspiratory/expiratory phases (all P≤0.005). CONCLUSIONS A decrease of the craniocaudal gradient of MPCR was observed in COPD patients. The craniocaudal gradient was lower in severe COPD patients than in mild COPD patients.
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Affiliation(s)
- Yoshitake Yamada
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Masako Ueyama
- Department of Health Care, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Japan.
| | - Takehiko Abe
- Department of Radiology, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Japan.
| | - Tetsuro Araki
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Takayuki Abe
- Department of Preventive Medicine and Public Health, Biostatistics Unit at Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan.
| | - Mizuki Nishino
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Shoji Kudoh
- Department of Respiratory Medicine, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Japan.
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17
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Anton A, Ratarasarn K. Pulmonary Function Testing and Role of Pulmonary Rehabilitation in the Elderly Population with Pulmonary Diseases. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0164-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Izzo A, Perrotta F, Cennamo A, Cerqua FS, Rinaldi L, Mazzella A, Grella E, Tranfa C, Bianco A, Stefanelli F, Mazzarella G. Spirometry in elderly laryngectomized patients: A feasibility study. Int J Surg 2016; 33 Suppl 1:S4-8. [PMID: 27255127 DOI: 10.1016/j.ijsu.2016.05.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Laryngeal cancer is the second most common respiratory neoplasm after lung cancer. Laryngectomy is a well established treatment for larynx cancers which involve relevant anatomic alterations. Spirometry is an essential investigation tool for diagnosis and severity of respiratory diseases, difficult to perform in laryngectomees. METHODS 43 consecutive laryngectomized patients were enrolled from July 2014 to March 2015. Patients fulfilling inclusion criteria underwent spirometry at baseline assessment and after two days. During the examination, the spirometer was placed directly on the stoma of the patient, through mouthpiece "Spirometry Filter 74". RESULTS At baseline, 26 eligible laryngectomees correctly performed the spirometry test with mouthpiece adhering to the stoma; 4 patients refused to perform the second spirometry after 2 days. The feasibility of spirometry examination in these patients was 100% despite difficulties in the execution of the test. The Pearson coefficient of reproducibility for FEV1, FVC and Tiffeneau Index was, respectively, 0.98, 0.94 and 0.77. DISCUSSION Spirometry in laryngectomee patients is a feasible procedure for assessment of respiratory function; despite technical difficulties in the execution of the test, our results underline the reproducibility and repeatability of the spirometry. In conclusion, when performed within dedicated respiratory pathophysiology unit, spirometry is a reliable tool in the assessment and follow up of laryngectomees.
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Affiliation(s)
- Alessandro Izzo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Fabio Perrotta
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Antonio Cennamo
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Francesco Saverio Cerqua
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Luca Rinaldi
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Antonio Mazzella
- Division of Thoracic Surgery, A.O. Dei Colli Monaldi Hospital, Naples, Italy.
| | - Edoardo Grella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Carmelindo Tranfa
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Andrea Bianco
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | | | - Gennaro Mazzarella
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Dei Colli Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
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Battaglia S, Benfante A, Spatafora M, Scichilone N. Asthma in the elderly: a different disease? Breathe (Sheff) 2016; 12:18-28. [PMID: 27064568 PMCID: PMC4818235 DOI: 10.1183/20734735.002816] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
KEY POINTS Asthma in the elderly can be difficult to identify due to modifications of its clinical features and functional characteristics.Several comorbidities are associated with asthma in the elderly, and this association differs from that observed in younger patients.In clinical practice, physicians should treat comorbidities that are correlated with asthma (i.e. rhinitis or gastro-oesophageal reflux), assess comorbidities that may influence asthma outcomes (i.e. depression or cognitive impairment) and try to prevent comorbidities related to -'drug-associated side-effects (i.e. cataracts, arrhythmias or osteoporosis)."Geriatric asthma" should be the preferred term because it implies the comprehensive and multidimensional approach to the disease in the older populations, whereas "asthma in the elderly" is only descriptive of the occurrence of the disease in this age range. EDUCATIONAL AIMS To present critical issues in performing differential diagnosis of asthma in the elderly.To offer the instrument to implement the management of asthma in the most advanced ages. Asthma is a chronic airway disease that affects all ages, but does this definition also include the elderly? Traditionally, asthma has been considered a disease of younger age, but epidemiological studies and clinical experience support the concept that asthma is as prevalent in older age as it is in the young. With the ever-increasing elderly population worldwide, the detection and proper management of the disease in old age may have a great impact from the public health perspective. Whether asthma in the elderly maintains the same characteristics as in young populations is an interesting matter. The diagnostic process in older individuals with suspected asthma follows the same steps, namely a detailed history supported by clinical examination and laboratory investigations; however, it should be recognised that elderly patients may partially lose reversibility of airway obstruction. The correct interpretation of spirometric curves in the elderly should take into account the physiological changes in the respiratory system. Several factors contribute to delaying the diagnosis of asthma in the elderly, including the age-related impairment in perception of breathlessness. The management of asthma in advanced age is complicated by the comorbidities and polypharmacotherapy, which advocate for a comprehensive approach with a multidimensional assessment. It should be emphasised that older age frequently represents an exclusion criterion for eligibility in clinical trials, and current asthma medications have rarely been tested in elderly asthmatics. Ageing is associated with pharmacokinetic changes of the medications. As a consequence, absorption, distribution, metabolism and excretion of antiasthmatic medications can be variably affected. Similarly, drug-to-drug interactions may reduce the effectiveness of inhaled medications and increase the risk of side-effects. For this reason, we propose the term "geriatric asthma" be preferred to the more generic "asthma in the elderly".
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Affiliation(s)
- Salvatore Battaglia
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Alida Benfante
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Mario Spatafora
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy; Istituto Euro-Mediterraneo di Scienza e Tecnologia, Palermo, Italy
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20
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Turkeshi E, Zelenukha D, Vaes B, Andreeva E, Frolova E, Degryse JM. Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study. NPJ Prim Care Respir Med 2015; 25:15048. [PMID: 26201999 PMCID: PMC4532161 DOI: 10.1038/npjpcrm.2015.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/17/2015] [Accepted: 06/05/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Spirometry is an important test for the diagnosis of respiratory diseases, yet it is underused especially in older adults. Several predictors of good-quality spirometry in this age group have been reported, based mainly on in/outpatients of geriatric and/or respiratory units. AIMS This study aims to assess predictors of poor-quality spirometry in community-dwelling older adults from two primary care cohorts in Russia and Belgium. METHODS Spirograms from two population-based cohort studies in Russia (CRYSTAL) and Belgium (BELFRAIL) were assessed in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) acceptability and repeatability criteria and grouped into good and poor quality. Multivariable analysis assessed the association of poor-quality spirometry with socio-demographics, functional dependency, physical and mental functioning and co-morbidities. RESULTS In all, 43.3% of the 522 BELFRAIL participants (84.71 ± 3.67 years old) and 57.7% of the 605 CRYSTAL participants (75.11 ± 5.97 years old) achieved all ATS/ERS acceptability and repeatability criteria. In both cohorts, those with poor-quality spirometry had lower cognitive function (mini-mental state examination (MMSE) ⩽ 24). After adjustment in multivariable analysis, MMSE ⩽ 24 had an odds ratio for poor-quality spirometry of 1.33 (95% CI = 0.78-2.28) in the BELFRAIL and 1.30 (95% CI = 0.88-1.91) in the CRYSTAL cohort. CONCLUSIONS In community-dwelling older adults, including those over 80 years old, impaired cognition measured by the MMSE may not be an independent predictor of poor-quality spirometry. Further research is needed in this area, and spirometry should be used more often in older adults in primary care.
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Affiliation(s)
- Eralda Turkeshi
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Dmitry Zelenukha
- Department of Family Medicine, North-Western State Medical University, St Petersburg, Russia
| | - Bert Vaes
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Elena Andreeva
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Elena Frolova
- Department of Family Medicine, North-Western State Medical University, St Petersburg, Russia
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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