Health and Demographic Factors for Chronic Obstructive Pulmonary Disease Among Hispanic Adults in the United States: Analysis of Behavioral Risk Factor Surveillance System Survey Data

Introduction: Appropriate diagnosis and regular primary care appointments are markers of quality chronic obstructive pulmonary disease (COPD) care. Underdiagnosis of COPD has been associated with an absence of health insurance, lower socioeconomic status, and race and ethnicity. Methods: This study examined predictors of COPD using data from the Behavioral Risk Factor Surveillance System (BRFSS, 2021) to provide information for prevention messaging and interventions. Participants included Hispanic adults (n = 17,782) aged 45 years and older. Chi-square tests and a multinomial logistic regression analysis (adjusted with the BRFSS weighting variable) were used to understand how sex, income, health status, smoking behaviors, asthma morbidity, and health insurance coverage were related to having COPD. Results: Patients with poor health, lower income level, current smokers, former smokers, or asthma were more likely to report COPD. Females were more likely to report COPD than males. Patients with COPD were more likely to be without health insurance when compared to those who did not have COPD, indicating unmet medical needs. Conclusion: Studies such as this one, aiming to evaluate the relationship between COPD prevalence and predictors of health and outcomes among Hispanic patients in the United States will remain important for developing health messaging to attenuate disease progression.

Perspectives of Black Adults Living with Chronic Obstructive Pulmonary Disease on Barriers to Cardiovascular Disease Prevention

Rationale: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with chronic obstructive pulmonary disease (COPD). Black women with COPD are at elevated risk of CVD-related mortality compared with White women. CVD risk factors are undertreated in Black men and women. However, barriers to CVD prevention from the perspective of Black individuals living with COPD have not been previously identified. Objectives: To identify barriers and facilitators for CVD prevention among Black individuals living with COPD. Methods: We conducted semistructured interviews with Black participants living with COPD and attending clinics at two urban hospitals. Participants were included if they had physician-confirmed COPD diagnoses and presence of CVD or CVD risk factors. Interviews were conducted until thematic saturation was reached, with additional interviews conducted to confirm saturation. Data were analyzed using thematic analysis, iteratively revising and updating the codebook by consensus of the study team. Codes were grouped into categories, subthemes, and themes. Themes were organized using the social ecological framework into individual, interpersonal, health system, and societal levels. Results: We interviewed 30 participants of mean age 67.8 ± 8.3 years; 17 (57%) were Black women and 13 (43%) were Black men. Individual-level themes were that living with COPD and resultant multimorbidity affects CVD prevention (theme 1) and that self-efficacy and advocacy affect care received (theme 2). At the interpersonal level, supportive relationships facilitate improved access to CVD prevention (theme 3). System-level themes were that health systems are not designed to support patients with COPD and CVD (theme 4) and that health systems do not deliver effective patient education (theme 5). At the societal level, structural barriers and racism prevent access to care and adoption of a healthy lifestyle (theme 6). Conclusions: We identified barriers to CVD prevention at all levels of the socioecological framework for Black individuals living with COPD. To maximize their impact, future interventions to prevent CVD among individuals with COPD can use these findings to target barriers at multiple levels.

Race Adjustment of Pulmonary Function Tests in the Diagnosis and Management of COPD: A Scoping Review

Aim

Increasing evidence suggests that the inclusion of self-identified race in clinical decision algorithms may perpetuate longstanding inequities. Until recently, most pulmonary function tests utilized separate reference equations that are race/ethnicity based.

Purpose

We assess the magnitude and scope of the available literature on the negative impact of race-based pulmonary function prediction equations on relevant outcomes in African Americans with COPD.

Methods

We performed a scoping review utilizing an English language search on PubMed/Medline, Embase, Scopus, and Web of Science in September 2022 and updated it in December 2023. We searched for publications regarding the effect of race-specific vs race-neutral, race-free, or race-reversed lung function testing algorithms on the diagnosis of COPD and COPD-related physiologic and functional measures. Joanna Briggs Institute (JBI) guidelines were utilized for this scoping review. Eligibility criteria: The search was restricted to adults with COPD. We excluded publications on other lung disorders, non-English language publications, or studies that did not include African Americans. The search identified publications. Ultimately, six peer-reviewed publications and four conference abstracts were selected for this review.

Results

Removal of race from lung function prediction equations often had opposite effects in African Americans and Whites, specifically regarding the severity of lung function impairment. Symptoms and objective findings were better aligned when race-specific reference values were not used. Race-neutral prediction algorithms uniformly resulted in reclassifying severity in the African Americans studied.

Conclusion

The limited literature does not support the use of race-based lung function prediction equations. However, this assertion does not provide guidance for every specific clinical situation. For African Americans with COPD, the use of race-based prediction equations appears to fall short in enhancing diagnostic accuracy, classifying severity of impairment, or predicting subsequent clinical events. We do not have information comparing race-neutral vs race-based algorithms on prediction of progression of COPD. We conclude that the elimination of race-based reference values potentially reduces underestimation of disease severity in African Americans with COPD.

Asthma and Chronic Obstructive Pulmonary Disease

In the United States, asthma and chronic obstructive pulmonary disease (COPD) disproportionately affect African Americans, Puerto Ricans, and other minority groups. Compared with non-Hispanic whites, minorities have been marginalized and more frequently exposed to environmental risk factors such as tobacco smoke and outdoor and indoor pollutants. Such divergent environmental exposures, alone or interacting with heredity, lead to disparities in the prevalence, morbidity, and mortality of asthma and COPD, which are worsened by lack of access to health care. In this article, we review the burden and risk factors for racial or ethnic disparities in asthma and COPD and discuss future directions in this field.

Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples

OBJECTIVE

The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes.

METHODS

We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates.

RESULTS

Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey.

CONCLUSIONS

Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.

Cultural adaptation and validation of the Brazilian Portuguese version of the PROactive Physical Activity in COPD-clinical visit instrument for individuals with COPD

OBJECTIVE

To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version.

METHODS

A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George's Respiratory Questionnaire to evaluate criterion validity.

RESULTS

The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: "amount" domain = 0.87 (95% CI, 0.73-0.94) and "difficulty" domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin's concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = -0.63).

CONCLUSIONS

The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California

Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.

Racial Segregation and Respiratory Outcomes among Urban Black Residents with and at Risk of Chronic Obstructive Pulmonary Disease

Rationale: Racial residential segregation has been associated with worse health outcomes, but the link with chronic obstructive pulmonary disease (COPD) morbidity has not been established.Objectives: To investigate whether racial residential segregation is associated with COPD morbidity among urban Black adults with or at risk of COPD.Methods: Racial residential segregation was assessed using isolation index, based on 2010 decennial census and baseline address, for Black former and current smokers in the multicenter SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study), a study of adults with or at risk for COPD. We tested the association between isolation index and respiratory symptoms, physiologic outcomes, imaging parameters, and exacerbation risk among urban Black residents, adjusting for established COPD risk factors, including smoking. Additional mediation analyses were conducted for factors that could lie on the pathway between segregation and COPD outcomes, including individual and neighborhood socioeconomic status, comorbidity burden, depression/anxiety, and ambient pollution.Measurements and Main Results: Among 515 Black participants, those residing in segregated neighborhoods (i.e., isolation index ⩾0.6) had worse COPD Assessment Test score (β = 2.4; 95% confidence interval [CI], 0.7 to 4.0), dyspnea (modified Medical Research Council scale; β = 0.29; 95% CI, 0.10 to 0.47), quality of life (St. George's Respiratory Questionnaire; β = 6.1; 95% CI, 2.3 to 9.9), and cough and sputum (β = 0.8; 95% CI, 0.1 to 1.5); lower FEV1% predicted (β = -7.3; 95% CI, -10.9 to -3.6); higher rate of any and severe exacerbations; and higher percentage emphysema (β = 2.3; 95% CI, 0.7 to 3.9) and air trapping (β = 3.8; 95% CI, 0.6 to 7.1). Adverse associations attenuated with adjustment for potential mediators but remained robust for several outcomes, including dyspnea, FEV1% predicted, percentage emphysema, and air trapping.Conclusions: Racial residential segregation was adversely associated with COPD morbidity among urban Black participants and supports the hypothesis that racial segregation plays a role in explaining health inequities affecting Black communities.

New Zealand COPD Guidelines: Quick Reference Guide

The purpose of the Asthma and Respiratory Foundation of New Zealand's COPD Guidelines: Quick Reference Guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment, and management of chronic obstructive pulmonary disease (COPD) in clinical practice. The intended users are health professionals responsible for delivering acute and chronic COPD care in community and hospital settings, and those responsible for the training of such health professionals.

Whole genome sequence analysis of pulmonary function and COPD in 19,996 multi-ethnic participants

Chronic obstructive pulmonary disease (COPD), diagnosed by reduced lung function, is a leading cause of morbidity and mortality. We performed whole genome sequence (WGS) analysis of lung function and COPD in a multi-ethnic sample of 11,497 participants from population- and family-based studies, and 8499 individuals from COPD-enriched studies in the NHLBI Trans-Omics for Precision Medicine (TOPMed) Program. We identify at genome-wide significance 10 known GWAS loci and 22 distinct, previously unreported loci, including two common variant signals from stratified analysis of African Americans. Four novel common variants within the regions of PIAS1, RGN (two variants) and FTO show evidence of replication in the UK Biobank (European ancestry n ~ 320,000), while colocalization analyses leveraging multi-omic data from GTEx and TOPMed identify potential molecular mechanisms underlying four of the 22 novel loci. Our study demonstrates the value of performing WGS analyses and multi-omic follow-up in cohorts of diverse ancestry.

Association between Tumor Necrosis Factor-308 G/A Polymorphism and Chronic Obstructive Pulmonary Disease Risk in Chinese Population: Evidence from a Meta-Analysis

BACKGROUND

Association studies of tumor necrosis factor (TNF)-308 G/A (rs1800629) polymorphism and chronic obstructive pulmonary disease (COPD) have shown inconsistent and contradictory results among different populations. In the present study, a meta-analysis was performed to evaluate the association between TNF-308 G/A polymorphism and COPD susceptibility in Chinese population.

MATERIALS AND METHODS

Systemic assessment was performed for the published studies from PubMed, Embase, Web of Science, the Cochrane Library, Wanfang Data, and CNKI prior to July 2018. Odds ratios (ORs) with their 95% confidence intervals (CIs) were pooled using STATA software.

RESULTS

A total of eighteen studies comprising 1,817 COPD cases and 2,056 controls were included in this meta-analysis. Overall, significant results were obtained between TNF-308 G/A polymorphism and COPD risk in Chinese population (A vs. G, OR = 2.45, 95% CI: 1.93 - 3.11; AA vs. GG, OR = 4.53, 95% CI: 2.67 - 7.68; AA vs. GA + GG, OR = 3.74, 95% CI: 2.21 - 6.33; AA + GA vs. GG, OR = 2.53, 95% CI: 1.97 - 3.26) under allele and homozygote models as well as recessive and dominant models. In the subgroup analyses, TNF-308 G/A polymorphism was significantly associated with increased COPD risk both in North China and South China, as well as in population-based studies.

CONCLUSIONS

This meta-analysis indicates that TNF-308A/G polymorphism may contribute to individual suscepti-bility to COPD in Chinese population.

Donepezil plus memantine versus donepezil alone for treatment of concomitant Alzheimer's disease and chronic obstructive pulmonary disease: a retrospective observational study

Objective

To assess the clinical outcomes of donepezil plus memantine (DM) and donepezil (DO) alone in Asian patients with a concomitant diagnosis of moderate-to-severe Alzheimer’s disease and mild-to-moderate chronic obstructive pulmonary disease (AD-COPD).

Methods

We conducted a retrospective analysis of patients with AD-COPD who received either DM or DO for 6 months, or until the occurrence of unacceptable adverse events or disease progression, between June 2012 and May 2016. The primary endpoint was the score on the Standardized Mini-Mental State Examination (SMMSE). Secondary endpoints were scores on the caregiver-rated Bristol Activities of Daily Living Scale, Neuropsychiatric Inventory, Dementia Quality of Life (DEMQOL)-Proxy, and General Health Questionnaire 12.

Results

In total, 154 eligible patients received DM, whereas 156 received DO. Compared with patients who received DO, patients who received DM had significantly higher mean scores on the SMMSE by 2.1 points (95% confidence interval, 1.3–2.5). Significant between-group heterogeneity was not detected in outcomes over time. The benefits of treatment with DM were greater than those of treatment with DO, in terms of the primary endpoint. Significant differences were also detected in terms of secondary endpoints.

Conclusion

DM is more effective than DO alone for Asian patients with AD-COPD.

Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients

OBJECTIVES

Chronic obstructive pulmonary disease (COPD) is a common chronic disease with significant morbidity and mortality, particularly for Māori, which places a large burden on the New Zealand (NZ) health system. We undertook a qualitative study as part of a mixed-methods implementation research project which aimed to determine the barriers and enablers to the provision of accessible high-quality COPD care.

SETTING

Southern Health Region of NZ (Otago and Southland).

PARTICIPANTS

Thirteen health professional stakeholders and 23 patients with severe COPD (including one Māori and one Pasifika participant).

METHODS

Semistructured interviews were undertaken. A thematic analysis using the Levesque conceptual framework for access to healthcare was conducted.

RESULTS

Health professional stakeholders identified barriers to providing access to health services, in particular: availability (inadequate staffing and resourcing of specialist services and limited geographical availability of pulmonary rehabilitation), affordability (both of regular medication, medication needed for an exacerbation of COPD and the copayment charge for seeing a general practitioner) and appropriateness (a shared model of care across primary and secondary care was needed to facilitate better delivery of key interventions such as pulmonary rehabilitation and advance care planning (ACP). Māori stakeholders highlighted the importance of communication and relationships and the role of whānau (extended family) for support. Patients' accounts showed variable ability to access services through having a limited understanding of what COPD is, a limited knowledge of services they could access, being unable to attend pulmonary rehabilitation (due to comorbidities) and direct (medication and copayment charges) and indirect (transport) costs.

CONCLUSIONS

People with severe COPD experience multilevel barriers to accessing healthcare in the NZ health system along the pathway of care from diagnosis to ACP. These need to be addressed by local health services if this group of patients are to receive high-quality care.

Restrictive Spirometry Pattern, Cardiac Structure and Function, and Incident Heart Failure in African Americans. The Jackson Heart Study

RATIONALE

Although chronic obstructive pulmonary disease has been related to heart failure, the relationship between the restrictive spirometry pattern (forced vital capacity [FVC] < 80% predicted with preserved forced expiratory volume in 1 second [FEV1]/FVC ratio) and heart failure is poorly understood.

OBJECTIVES

To determine whether having a restrictive spirometry pattern is associated with incident heart failure hospitalization.

METHODS

Community-dwelling African Americans from the Jackson Heart Study (total n = 5,306; analyzed n = 4,210 with spirometry and heart failure outcome data) were grouped by restrictive spirometry (FEV1/FVC ≥ 0.70, FVC < 80%; n = 840), airflow obstruction (FEV1/FVC < 0.70; n = 341), and normal spirometry (FEV1/FVC ≥ 0.70, FVC ≥ 80%; n = 3,029) at the time of baseline examination in 2000-2004. We assessed relationships of echocardiographic parameters and biomarkers with spirometry patterns using regression models. Incident heart failure was defined as an adjudicated hospitalization for heart failure after January 1, 2005 in subjects with no self-reported heart failure history. We used multivariable-adjusted Poisson regression models and Cox proportional hazards models, with death treated as a competing risk in the Cox models, to test associations between spirometry patterns and incident heart failure. We also modeled the association of FVC% predicted with heart failure hospitalization risk using a restricted cubic spline after excluding subjects with airflow obstruction.

RESULTS

At the time of baseline spirometry, participants with restrictive spirometry had a median age of 57.2 years (interquartile range, 47.8-64.1); 38.1% were male. Compared with normal spirometry, restrictive spirometry was associated with a higher transmitral early (E) wave velocity to atrial (A) wave velocity ratio, higher pulmonary artery systolic pressure, and higher endothelin levels. After a median follow-up time of 8.0 years, 8.0% of subjects with restrictive spirometry (n = 67) had developed incident heart failure, compared with 3.8% of those with normal spirometry (n = 115) and 10.6% of those with airflow obstruction (n = 36). After risk adjustment, both a restrictive pattern (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.1-2.0) and airflow obstruction (HR, 1.7; 95% CI, 1.1-2.5) were associated with increased rates of incident heart failure hospitalization compared with normal spirometry. Using flexible modeling, the lowest hazards of heart failure hospitalization were observed around FVC 90-100%, with lower FVC% values associated with an increased incidence of heart failure.

CONCLUSIONS

Both a restrictive pattern on spirometry and airflow obstruction identify African Americans with impaired lung health at risk for heart failure.

Associations between history of chronic lung disease and non-small cell lung carcinoma in Maryland: variations by sex and race

PURPOSE

Lung cancer is a multifactorial malignancy for which some risk factors, such as chronic lung diseases, their interactions with smoking, and how they differ by race and sex, are not fully understood. We investigated the associations between chronic inflammatory lung disease and non-small cell lung carcinoma (NSCLC) and how sex and race may affect such associations.

METHODS

Using logistic regression, we analyzed 1660 lung cancer cases and 1959 population controls and estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

RESULTS

Chronic lung disease was significantly associated with higher odds of having NSCLC in never (AOR = 1.99; 95% CI = 1.19-3.34), former (AOR = 1.68; 95% CI = 1.29-2.20), and current smokers (AOR = 2.40; 95% CI = 1.62-3.57), after adjustment for relevant covariates. For each 5-year increment in chronic lung disease duration, the risk of lung cancer increased only among females (AOR = 1.07; 95% CI = 1.02-1.13). Females, but not males, with asthma were at risk for NSCLC (AOR = 2.08; 95% CI = 1.40-3.10).

CONCLUSIONS

This study provides support for chronic lung inflammation as a potential contributing factor to lung cancer risk and possible sex difference in the inflammatory events underlying disease mechanisms.

Effect and safety of roflumilast for chronic obstructive pulmonary disease in Chinese patients

BACKGROUND

This trial aimed to evaluate the efficacy and safety of roflumilast for treating Chinese patients with chronic obstructive pulmonary disease (COPD).

METHODS

A total of 120 patients with COPD were recruited and were randomly divided into 2 groups (an intervention group and a placebo group) at a 1:1 ratio. Patients received either roflumilast or placebo 500 μg once daily for a total of 12 months. The primary outcome was lung function, measured by the change from baseline of forced expiratory volume in 1 second (FEV1), FVC = forced vital capacity (FVC), and FEF25-75%. The secondary outcome measurements included the quality of life, measured with the St. George's Respiratory Questionnaire (SGRQ). All outcomes were measured at the end of 12-month treatment and 3-month follow-up after the treatment. In addition, adverse events (AEs) were also recorded during the treatment period.

RESULTS

FEV1, FVC, FEF25-75%, and SGRQ were significantly better in the intervention group than those in the placebo group at the end of 12-month treatment and 3-month follow up after treatment. Moreover, AEs were much higher with roflumilast than placebo in this study.

CONCLUSIONS

The findings suggest that roflumilast has promising effect to improve lung function in Chinese population with COPD.

Association of the IL-13 polymorphisms rs1800925 and rs20541 with chronic obstructive pulmonary disease risk: An updated meta-analysis

The aim of this study was to investigate if 2 common single nucleotide polymorphisms (SNPs) in the interleukin-13 (IL-13) gene, rs1800925 and rs20541 are associated with chronic obstructive pulmonary disease (COPD) risk.Case-control association studies were retrieved systematically from PubMed, Scopus, ISI Web of Science, China National Knowledge Infrastructure, and Wanfang databases using standardized subject terms.Eleven studies including 3077 participants (1896 cases and 1181 controls) were analyzed. Evidence for a positive association between the T allele of the IL-13 SNP rs1800925 and COPD risk was found in the overall population (odds ratio [OR] = 1.57, 95% confidence interval [95% CI]: 1.21-2.04, Pz = .001). In subgroup analysis according to ethnicity, the T allele of rs1800925 was associated with an increased risk of COPD in Asians (OR = 1.88, 95% CI: 1.23-2.87, Pz = .004) and Caucasians (OR = 1.30, 95% CI: 1.01-1.67, Pz = .041), respectively. For rs20541, the results suggested an association between rs20541 and COPD risk in Caucasians under the recessive model (OR = 2.79, 95% CI: 1.13-6.92, Pz = .026), whereas this SNP was not associated with COPD in Asians.This meta-analysis suggests that the T allele of rs1800925 is associated with the increased risk of COPD in both Asians and Caucasians, whereas rs20541 is associated with the risk of COPD in Caucasians but not in Asians.

Trends in 30-day readmission rates after COPD hospitalization, 2006-2012

BACKGROUND

Reduction in 30-day readmission rate after chronic obstructive pulmonary disease (COPD)-related hospitalization is a national objective. However, little is known about trends in readmission rates in recent years, particularly in priority populations defined by the Agency for Healthcare Research and Quality (AHRQ)(e.g., the elderly, women, racial/ethnic minorities, low-income and rural populations, and populations with chronic illnesses).

METHODS

We conducted a retrospective cohort study using data from the State Inpatient Database of eight geographically-dispersed US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington) from 2006 through 2012. We identified all COPD-related hospitalizations by patients ?40 years old. The primary outcome was any-cause readmission within 30 days of discharge from the index hospitalization for COPD.

RESULTS

From 2006 to 2012, a total of 845,465 hospitalizations at risk for 30-day readmissions were identified. Overall, 30-day readmission rate for COPD-related hospitalization decreased modestly from 20.0% in 2006 to 19.2% in 2012, an 0.8% absolute decrease (OR 0.991, 95%CI 0.989-0.995, P_trend<0.001). This modest decline remained statistically significant after adjusting for patient demographics and comorbidities (adjusted OR 0.981, 95%CI 0.977-0.984, P_trend<0.001). Similar to the overall population, the readmission rate over the 7-year period remained persistently high in most of AHRQ-defined priority populations.

CONCLUSIONS

Our observations provide a benchmark for future investigation of the impact of Hospital Readmissions Reduction Program on readmissions after COPD hospitalization. Our findings encourage researchers and policymakers to develop effective strategies aimed at reducing readmissions among patients with COPD in an already-stressed healthcare system.

[Polymorphic Variants of Glutamate Receptor (GRIK5, GRIN2B) and Serotonin Receptor (HTR2A) Genes Are Associated with Chronic Obstructive Pulmonary Disease]

Chronic obstructive pulmonary disease (COPD) is a complex chronic inflammatory disease of the respiratory system that affects primarily distal respiratory pathways and lung parenchyma. Smoking tobacco is a major risk factor for COPD. The relationship of HTR4 (rs3995090), HTR2A (rs6313), GRIK5 (rs8099939), GRIN2B (rs2268132), and CHRNB4 (rs1948) gene polymorphisms and COPD, as well as the contribution of these polymorphisms to the variations in quantitative characteristics that describe respiratory function, smoking behavior, and nicotine dependence was assessed in an ethnically homogeneous Tatar population. The polymorphisms of HTR2A (rs6313) (P = 0.026, OR = 1.42 for the CC genotype) and GRIN2B (rs2268132) (P = 0.0001, OR = 2.39 for the TT genotype) were significantly associated with increased risk of COPD. The AA genotype of GRIK5 (rs8099939) had a protective effect (P = 0.02, OR = 0.61). Importantly, the HTR2A (rs6313), GRIN2B (rs2268132), and GRIK5 (rs8099939) polymorphisms were only associated with COPD in smokers. Smoking index (pack-years) was significantly higher in carriers of the GRIK5 genotype AC (rs8099939) (P = 0.0027). The TT genotype of GRIN2B (rs2268132) was associated with COPD in subjects with high nicotine dependence according to the Fagerstrõm test (P = 0.002, OR = 2.98). The TT genotype of HTR2A (rs6313) was associated with a reduced risk of the disease in the group with moderate nicotine dependence (P = 0.02, OR = 0.22). The CC genotype of HTR2A (rs6313) and the TT genotype of GRIN2B (rs2268132) were associated with higher levels of nicotine dependence according to the Fagerstrõm test (P = 0.0011 and P = 0.037). Our results may provide insight into potential molecular mechanisms that involve the glutamate (GRIK5, GRIN2B) and serotonin (HTR2A) receptor genes in the pathogenesis of COPD.

Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients

INTRODUCTION

A low body mass index (BMI) is associated with increased mortality and low health-related quality of life in patients with COPD. The Asia-Pacific classification of BMI has a lower cutoff for overweight and obese categories compared to the World Health Organization (WHO) classification. The present study assessed patients with COPD among different BMI categories according to two BMI classification systems: WHO and Asia-Pacific.

PATIENTS AND METHODS

Patients with COPD aged 40 years or older from the Korean COPD Subtype Study cohort were selected for evaluation. We enrolled 1,462 patients. Medical history including age, sex, St George's Respiratory Questionnaire (SGRQ-C), the modified Medical Research Council (mMRC) dyspnea scale, and post-bronchodilator forced expiratory volume in 1 second (FEV₁) were evaluated. Patients were categorized into different BMI groups according to the two BMI classification systems.

RESULT

FEV₁ and the diffusing capacity of the lung for carbon monoxide (DLCO) percentage revealed an inverse "U"-shaped pattern as the BMI groups changed from underweight to obese when WHO cutoffs were applied. When Asia-Pacific cutoffs were applied, FEV₁ and DLCO (%) exhibited a linearly ascending relationship as the BMI increased, and the percentage of patients in the overweight and obese groups linearly decreased with increasing severity of the Global Initiative for Chronic Obstructive Lung Disease criteria. From the underweight to the overweight groups, SGRQ-C and mMRC had a decreasing relationship in both the WHO and Asia-Pacific classifications. The prevalence of comorbidities in the different BMI groups showed similar trends in both BMI classifications systems.

CONCLUSION

The present study demonstrated that patients with COPD who have a high BMI have better pulmonary function and health-related quality of life and reduced dyspnea symptoms. Furthermore, the Asia-Pacific BMI classification more appropriately reflects the correlation of obesity and disease manifestation in Asian COPD patients than the WHO classification.

Polymorphisms in VEGF-A are associated with COPD risk in the Chinese population from Hainan province

In this study, we examined and validated how common variants contribute to susceptibility to chronic obstructive pulmonary disease (COPD) in the Han Chinese population. Here, we genotyped 18 nucleotide polymorphisms and evaluated their association with COPD using chi-square test and genetic model analysis (246 COPD patients and 350 controls), and found three SNPs that might cause a predisposition to COPD. Both rs3025030 and rs3025033 are located on chromosome 6 in VEGF-A. We found one risk allele 'C' from rs3025030 and another 'G' from rs3025033 using the log-additive model (OR 1.40; 95% CI 1.05-5.96; P = 0.022), (OR 1.38; 95% CI 1.03-1.84; P = 0.03). We also found another risk allele 'A' of rs9296092 in gene region ZBTB9-BAK1 by the allele model (OR 2.63; 95% CI 1.27-5.45; P = 0.0078), (adjusted OR 3.53; 95% CI 1.12-11.11; P = 0.031).We found a risk haplotype 'CG' associated with the risk of COPD (OR 1.39; 95% CI 1.04-1.86; P = 0.028). Our results when compared with previous studies showed significant association between VEGF-A polymorphism and COPD. We also identified rs9296092 as a risk factor for COPD.

SERPINE1 -844 and -675 polymorphisms and chronic obstructive pulmonary disease in a Chinese Han population

Objective To investigate the association between serpin family E member 1 ( SERPINE1) -844 A/G and -675 4G/5G polymorphisms and chronic obstructive pulmonary disease (COPD) in a Chinese Han population. Method SERPINE1 -844 A/G and -675 4G/5G polymorphisms were assessed by polymerase chain reaction-restriction fragment length polymorphism sequencing of genomic DNA from patients with COPD and healthy smoking controls. Results Out of 140 patients with COPD and 100 controls, all SERPINE1 -844 and -675 polymorphisms were in Hardy-Weinberg equilibrium. Differences in SERPINE1 -675 4G and 5G allele frequencies were statistically significant between the COPD and control groups (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.00, 2.09), but there was no significant between-group difference in SERPINE1 -844 A and G allele frequencies. The SERPINE1 -675 4G/4G genotype was associated with COPD (OR 1.87, 95% CI 1.06, 3.32 [binary logistic regression]). Haplotype analysis showed that COPD was associated with SERPINE1 -844G/4G (OR 2.11, 95% CI 1.32, 3.38) and SERPINE1 -844G/5G (OR 0.66, 95% CI 0.45, 0.95). Conclusion The SERPINE1 -675 polymorphism, but not SERPINE1 -844 polymorphism, was associated with susceptibility to COPD in a Chinese Han population.

COPD-related Mortality by Sex and Race Among Adults Aged 25 and Over: United States, 2000-2014

Data from the National Vital Statistics System, Mortality •From 2000 through 2014, the age-adjusted rate for chronic obstructive pulmonary disease (COPD)-related deaths decreased 22.5% for men and 3.8% for women aged 25 and over. •Between 2000 and 2014, the COPD-related death rate decreased for both men and women aged 65-84 and for men aged 85 and over. The rate increased for both men and women aged 45-64 and for women aged 85 and over. •The age-adjusted death rate declined for white men but remained stable for white women from 2000 through 2014. •The age-adjusted death rate declined for black men but increased for black women from 2000 through 2014. •The major underlying causes of death for COPD-related deaths were COPD, heart disease, and cancer for both men and women.

Disparate Rates of Utilization and Progression to Combined Heart Failure and Chronic Obstructive Pulmonary Disease among Asians and Pacific Islanders in Hawai'i

The objectives of the study were to compare ethnic differences in the rates of emergency department (ED) visits and hospitalizations, and to examine ethnic differences in how quickly patients with either chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) developed both diseases. A large health plan in Hawai.i provided administrative data (2007 to 2010) on patients of Native Hawaiian, Japanese, Chinese, Filipino, and White race/ethnicity. The study found distinct patterns of health risks among the multi-ethnic population of patients with COPD, CHF, or both conditions. Native Hawaiians had the highest rates of ED visits and hospitalizations. Japanese, the largest ethnic group and relatively low health risks, were selected as the reference population. In adjusted regression models, Filipino patients with CHF developed COPD the most rapidly; 71% faster than Japanese patients. Compared to Japanese, Native Hawaiians with COPD transitioned to CHF 68% faster. The study highlights ethnic disparities in adverse events and disease progression in patients with COPD and CHF, with important implications for clinical practice. Health care providers may want to inform patients of ways to mitigate the risks.

Efficacy and Safety of Roflumilast in Korean Patients with COPD

PURPOSE

Roflumilast is the only oral phosphodiesterase 4 inhibitor approved to treat chronic obstructive pulmonary disease (COPD) patients [post-bronchodilator forced expiratory volume in 1 second (FEV₁) <50% predicted] with chronic bronchitis and a history of frequent exacerbations. This study evaluated the efficacy and safety of roflumilast in Korean patients with COPD and compared the efficacy based on the severity of airflow limitation.

MATERIALS AND METHODS

A post-hoc subgroup analysis was performed in Korean COPD patients participating in JADE, a 12-week, double-blinded, placebo-controlled, parallel-group, phase III trial in Asia. The primary efficacy endpoint was the mean [least-squares mean adjusted for covariates (LSMean)] change in post-bronchodilator FEV₁ from baseline to each post-randomization visit. Safety endpoints included adverse events (AEs) and changes in laboratory values, vital signs, and electrocardiograms.

RESULTS

A total of 260 Korean COPD patients were recruited, of which 207 were randomized to roflumilast (n=102) or placebo (n=105) treatment. After 12 weeks, LSMean post-bronchodilator FEV₁ increased by 43 mL for patients receiving roflumilast and decreased by 60 mL for those taking placebo. Adverse events were more common in the roflumilast group than in the placebo group; however, the types and frequency of AEs were comparable to those reported in previous studies.

CONCLUSION

Roflumilast significantly improved lung function with a tolerable safety profile in Korean COPD patients irrespective of the severity of airflow limitation.

Factors Related to Chronic Obstructive Pulmonary Disease Readmission in Taiwan

This study examines the relationships among physiological, psychological, and social factors and hospital readmission to develop a model predicting chronic obstructive pulmonary disease (COPD) readmission for 145 patients with COPD following hospital discharge at 14 days and 90 days in Taiwan. Daily functioning, comorbidity, severity of illness, self-efficacy, depressive symptoms, and perceived informal support were regressed on hospital readmission. Daily functioning was the only significant variable to predict COPD readmission at 90 days in the Taiwan population living in a rural area. Age was significantly correlated with 14 days readmission. Post hoc analyses examined differences in three ethnic groups. Mainlanders perceived less family support, had higher depressive symptoms and lower daily functioning than the majority culture Fukiens and Hakkas, or the Aborigines. The study reinforced the need for identification of cultural differences and low functioning as risk factors for early readmission so they can be addressed in discharge planning.

Differences in Health-Related Quality of Life Between New Mexican Hispanic and Non-Hispanic White Smokers

BACKGROUND

Smoking is associated with impaired health-related quality of life (HRQL) across all populations. Because decline in lung function and risk for COPD are lower in New Mexican Hispanic smokers compared with their non-Hispanic white (NHW) counterparts, the goal of this study was to ascertain whether HRQL differs between these two racial/ethnic groups and determine the factors that contribute to this difference.

METHODS

We compared the score results of the Medical Outcomes Short-Form 36 Health Survey (SF-36) and St. George's Respiratory Questionnaire (SGRQ) in 378 Hispanic subjects and 1,597 NHW subjects enrolled in the Lovelace Smokers' Cohort (LSC) from New Mexico. The associations of race/ethnicity with SGRQ and SF-36 were assessed by using multivariable regression.

RESULTS

Physical functioning (difference, -4.5; P = .0008) but not mental health or role emotional domains of the SF-36 was worse in Hispanic smokers than in their NWH counterparts in multivariable analysis. SGRQ total score and its activity and impact subscores were worse in Hispanic (vs NHW) smokers after adjustment for education level, current smoking, pack-years smoked, BMI, number of comorbidities, and FEV₁ % predicted (difference range, 2.9-5.0; all comparisons, P ≤ .001). Although the difference in the SGRQ activity domain was above the clinically important difference of four units, the total score was not.

CONCLUSIONS

New Mexican Hispanic smokers have clinically relevant, lower HRQL than their NHW counterparts. A perception of diminished physical functioning and impairment in daily life activities contribute to the poorer HRQL among Hispanic subjects.

The Association of Coronary Artery Calcium With Noncardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis

OBJECTIVES

This study sought to determine if coronary artery calcium (CAC) is associated with incident noncardiovascular disease.

BACKGROUND

CAC is considered a measure of vascular aging, associated with increased risk of cardiovascular and all-cause mortality. The relationship with noncardiovascular disease is not well defined.

METHODS

A total of 6,814 participants from 6 MESA (Multi-Ethnic Study of Atherosclerosis) field centers were followed for a median of 10.2 years. Modified Cox proportional hazards ratios accounting for the competing risk of fatal coronary heart disease were calculated for new diagnoses of cancer, pneumonia, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), deep vein thrombosis/pulmonary embolism, hip fracture, and dementia. Analyses were adjusted for age; sex; race; socioeconomic status; health insurance status; body mass index; physical activity; diet; tobacco use; number of medications used; systolic and diastolic blood pressure; total and high-density lipoprotein cholesterol; antihypertensive, aspirin, and cholesterol medication; and diabetes. The outcome was first incident noncardiovascular disease diagnosis.

RESULTS

Compared with those with CAC = 0, those with CAC >400 had an increased hazard of cancer (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.18 to 1.99), CKD (HR: 1.70; 95% CI: 1.21 to 2.39), pneumonia (HR: 1.97; 95% CI: 1.37 to 2.82), COPD (HR: 2.71; 95% CI: 1.60 to 4.57), and hip fracture (HR: 4.29; 95% CI: 1.47 to 12.50). CAC >400 was not associated with dementia or deep vein thrombosis/pulmonary embolism. Those with CAC = 0 had decreased risk of cancer (HR: 0.76; 95% CI: 0.63 to 0.92), CKD (HR: 0.77; 95% CI: 0.60 to 0.98), COPD (HR: 0.61; 95% CI: 0.40 to 0.91), and hip fracture (HR: 0.31; 95% CI: 0.14 to 0.70) compared to those with CAC >0. CAC = 0 was not associated with less pneumonia, dementia, or deep vein thrombosis/pulmonary embolism. The results were attenuated, but remained significant, after removing participants developing interim nonfatal coronary heart disease.

CONCLUSIONS

Participants with elevated CAC were at increased risk of cancer, CKD, COPD, and hip fractures. Those with CAC = 0 are less likely to develop common age-related comorbid conditions, and represent a unique population of "healthy agers."

The Influence of the Reference Values on the Interpretation of Lung Function in Children: Comparison of Global Lung Initiative 2012 and Polish 1998 Reference Values

Interpretation of spirometry strongly depends on the applied predicted values. New Global Lung Initiative (GLI) reference values have recently been published but their influence on spirometry interpretation in children has not been widely evaluated. The aim of the study was to compare the interpretation of spirometry using GLI-2012 vs. Polish-1998 reference values. Spirometry results of 315 Caucasian children aged 4-18 were analyzed. Airway obstruction was defined as FEV1/FVC<LLN (lower limit of normal: 5th percentile, -1,64 standard deviation), while restrictive ventilatory pattern as FVC<LLN and FEV1/FVC>LLN. The findings were that FEV1 and FVC expressed as GLI-2012 or Polish-1998 z-scores differed significantly (p<0.05). The mean FEV1 z-score was -0.68±1.25 vs. -0.13±1.70 and the mean FVC was -0.34±1.08 vs. 0.30±1.15 for GLI-2012 and Polish-1998, respectively. There was no difference for FEV1/FVC z-scores. Obstructive and restrictive ventilatory patterns were diagnosed in 20.3% and 7.6% children using GLI-2012 values compared with 17.5% and 3.8% when using Polish-1998 reference values, respectively. In conclusion, the use of GLI-2012 reference values in the population of Polish children increases the number of detected lung function abnormalities compared with Polish-1998 reference values.

The Incidence of Deep Vein Thrombosis in Asian Patients With Chronic Obstructive Pulmonary Disease

Most studies have focused on the prevalence of deep vein thrombosis (DVT) and pulmonary embolism in patients with chronic obstructive pulmonary disease (COPD) and acute exacerbation in Caucasian populations. DVT is supposedly less likely to occur among Asians than Caucasians, and the primary purpose of this study was to determine the actual incidence of DVT in patients with COPD in Asian populations.We enrolled patients over the age of 40 with a diagnosis of COPD (International Classification of Diseases, Ninth Revision [ICD-9]: 490-492, 496; A-code: A323 and A325) between 1998 and 2008. The index date was the date of first-time COPD diagnosis. We excluded the patients who had been diagnosed with COPD and DVT (The International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]: 453.8) before index date. The control group was frequency-matched according to age (3-year stratum), sex, and the year of admission, at a 2:1 ratio. Patients were followed from index date to when either a diagnosis of DVT was made, death occurred, December 31, 2009 was reached, or when the patients withdrew from the National Health Insurance program.The overall incidence rate of DVT was 18.78 per 10,000 person-years in patients with COPD, and the adjusted hazard ration of DVT in patients with COPD was 1.38 (95% confidence interval 1.06-1.80), which was greater than patients without COPD after adjusting for age, sex, atrial fibrillation, hypertension, diabetes, hyperlipidemia, cerebrovascular accident, congestive heart failure, lower leg fracture or surgery, and cancer.Asian patients with COPD had a higher incidence of DVT than non-COPD patients.

Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence

Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen's d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were non-adherent. Non-adherent participants were younger (p < 0.001), more likely to be Black or Hispanic (p = 0.001), to have reported low income (p = 0.02), and had fewer years of formal education (p = 0.002). In unadjusted comparisons, non-adherent participants reported being more concerned about their COPD (p = 0.011; Cohen's d = 0.43), more emotionally affected by the disease (p = 0.001; Cohen's d = 0.54), and had greater concerns about COPD medications (p < 0.001, Cohen's d = 0.81). In adjusted analyses, concerns about COPD medications independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval: 0.36-0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications.

Awareness of chronic obstructive pulmonary disease in current smokers: a nationwide survey

BACKGROUND/AIMS

Cigarette smoking is the most common risk factor for chronic obstructive pulmonary disease (COPD). However, few studies of the attitudes toward COPD of smokers, the group at risk of developing this condition, have been conducted. The purpose of this study was to explore the awareness of and attitudes toward COPD of current smokers.

METHODS

The sample consisted of 502 individuals aged 45 and older from throughout Korea who smoked at least 10 packs of cigarettes per year. Telephone interviews using a structured questionnaire were conducted with respondents.

RESULTS

First, we evaluated the health status of subjects, finding that 45.4% considered themselves to be in good health. We also asked about COPD-related symptoms, and 60.6% of subjects reported such symptoms. However, only 1.2% of subjects had been diagnosed with or treated for COPD, only 0.4% spontaneously mentioned COPD as a respiratory disease, and only 26.5% recognized COPD as a respiratory disease after seeing a list of such diseases. Television ranked as the top source of information about COPD. The willingness of 45.0% of subjects to stop smoking increased after being informed about COPD.

CONCLUSIONS

Despite having COPD-related symptoms, most smokers did not know that COPD is a respiratory disease. The attitudes of smokers toward COPD and smoking cessation varied according to socioeconomic status. In summary, a continuous effort to increase the awareness of COPD among smokers is needed. Additionally, strategies tailored according to different socioeconomic groups will also be necessary.

Hospital admissions for chronic obstructive pulmonary disease in New Zealand

AIM

To determine the number, distribution and cost of hospital admissions for chronic obstructive pulmonary disease (COPD) in New Zealand.

METHODS

National patient-level routine data on admissions with a principal diagnosis of COPD (mostly ICD-10- AN J440 and J441) were obtained for the period July 1st 2008 to June 30th 2013. Admissions with length of stay (LOS) = 90 days were excluded.

RESULTS

There were 61,516 admissions in 5 years. Admission rates and budget impact (in 2012/13 dollar values) were stable but the average length of stay (ALOS) declined from 5.09 to 4.37 days. In FY2012/13 the admission rate was 2.82 per 1000 population, with age standardised rate (ASR) 4.4- and 3.6-fold higher for Maori and Pacific peoples respectively than for European/others. For age = 15 years the ASR was 2.55 per 1000. Admission rates were higher for men than women and increased steeply with age and socioeconomic deprivation (NZDep06). The mean age at discharge was lower for Maori and Pacific peoples than for European/Others (63.4, 67.1 and 72.3 years). The mean 30-day readmission rate was 6.7%. The average LOS increased with age and was shorter for Maori (3.6 days) and Pacific peoples (3.5 days) than for European/Others (4.7 days). Admission rates varied widely across District Health Boards, and were higher in rural than urban regions. The estimated cost of admissions in FY2012/13 was $NZ59.6m.

CONCLUSIONS

Hospital admissions for COPD are costly and are over-represented in high risk groups including rural, elderly, socioeconomically deprived and Maori and Pacific peoples. Effective interventions that are targeted to high risk groups are required to improve equity and reduce the burden of COPD.

FEATURES OF CLINICAL-FUNCTIONAL MANIFESTATIONS OF CHRONIC OBSTRUCTIVE LUNG DISEASE IN COMBINATION WITH METABOLIC SYNDROME IN ETHNIC GROUPS OF THE YAKUTS AND THE RUSSIANS

AIM

Studying features of clinical-functional manifestations of chronic obstructive lung disease in the combination with metabolic syndrome in the Yakut ethnic group.

MATERIALS AND METHODS

The basic group consisted of 39 patients of Yakut nationality with chronic obstructive lung disease (COLD) in the combination with metabolic syndrome (MS), middle age of them being 53.4 ± 1.17 years. The comparison group comprised 40 patients of Russian nationality with COLD and MS with middle age 53.1 ± 1.21 years. Features of clinical manifestations and respiratory functions are studied.

RESULTS

Cough and sputum were noted in dynamics for 3 years by 64.1% of Yakut patients and 85% of the Russians, p = 0.033; the intensity of cough was marked at 30% of patients of Russian nationality and 15.4% of patients of the Yakut nationality, p = 0.01 6. The morning sputum and daily sputum within 3 months a year at the Russians in comparison with the Yakuts was marked in 95 % vs 74,4 %, p = 0.011; 80.0% vs 56.4% p = 0.024, accordingly. According to Medical Research Council (mMRC) Dyspnea Scale (Mahler et al., 1985) dyspnea has been 2.2 ± 0.09 points atthe Yakuts vs 2.7 ± 0.09 points at Russian, p = 0.002. At patients of the Yakut nationality more often exacerbations were registered 2 times a year (53.8%), at patients of Russian nationality noted 3 times a year (55%). Respiratory function manifestations have been at patients of the Yakut nationality with COLD and MS, in comparison with similar Russian patients: forced expiratory volume for a first second (FEV,) - 64,0+2,30 % vs 56,8?2,69 %, p = 0,026; forced vital capacity of lungs (FVC) - 65,0?2,45 vs 65,0?3,70, p = 0.733; FEV1/FVCL ratio being 102.5 ± 2.81 vs 87.3 ± 3.30, p = 0.000, accordingly.

CONCLUSIONS

Regardless of ethnicity the phenotype "D" has higher prevalence rate of clinical phenotype COLD in the combination with metabolic syndrome, thus at the Russians the clinical COLD is characterized by severe clinical manifestations in comparison with theYakuts, and also in both ethnic groups expiratory dysfunctions in the form of decreasing FEV1, decreasing FVC and increases of ratio FEV1/FVC > 70% are marked.

Tasmanian Aborigines step up to health: evaluation of a cardiopulmonary rehabilitation and secondary prevention program

BACKGROUND

Although the burden of cardiopulmonary diseases in the Aboriginal community is high, utilisation of rehabilitation services has been poor. We evaluated the uptake and effectiveness of a cardiovascular and pulmonary rehabilitation program specifically designed and provided for the Aboriginal community, by the Tasmanian Aboriginal Centre, for people with diagnosed chronic heart or respiratory disease and those at high risk of developing such conditions.

METHODS

Participants had established chronic obstructive pulmonary disease, ischaemic heart disease or chronic heart failure or were at high risk of developing such diseases because of multiple risk factors. Rehabilitation programs (n = 13) comprised two exercise and one education session per week over eight weeks. Data, collected at baseline and on completion, included health status, risk factors, attendance, anthropometric measurements, physical capacity and quality of life. Data from participants who attended at least one program session were analysed. Qualitative written feedback from participants and staff was analysed thematically.

RESULTS

Of 92 participants (39% with an established disease diagnosis), 72 provided follow-up data. Participants lost weight, and waist circumference decreased (mean -3.6 cm, 95% confidence interval (CI)-2.5 to -4.7). There were clinically significant improvements in six-minute walk distance (mean 55.7 m, 95% CI 37.8 to 73.7) and incremental shuttle walk (mean 106.2 m, 95% CI 79.1 to 133.2). There were clinically significant improvements in generic quality of life domains, dyspnoea and fatigue. Generally, the improvements in participants with established cardiac or respiratory diseases did not differ from that in people with risk factors. Analysis of qualitative data identified three factors that facilitated participation: support from peers and health workers, provision of transport and the program structure. Participants' awareness of improvements in their health contributed to ongoing participation and positive health outcomes, and participants would recommend the program to family and friends.

CONCLUSION

A cardiopulmonary program, which included exercise and education and met national guidelines, was designed and delivered specifically for the Aboriginal community. It increased participation in rehabilitation by Aborigines with, or at high risk of, established disease and led to positive changes in health behaviours, functional exercise capacity and health related quality of life.

Geographic disparity in chronic obstructive pulmonary disease (COPD) mortality rates among the Taiwan population

Chronic obstructive pulmonary disease (COPD) causes a high disease burden among the elderly worldwide. In Taiwan, the long-term temporal trend of COPD mortality is declining, but the geographical disparity of the disease is not yet known. Nationwide COPD age-adjusted mortality at the township level during 1999-2007 is used for elucidating the geographical distribution of the disease. With an ordinary least squares (OLS) model and geographically weighted regression (GWR), the ecologic risk factors such as smoking rate, area deprivation index, tuberculosis exposure, percentage of aborigines, density of health care facilities, air pollution and altitude are all considered in both models to evaluate their effects on mortality. Global and local Moran's I are used for examining their spatial autocorrelation and identifying clusters. During the study period, the COPD age-adjusted mortality rates in males declined from 26.83 to 19.67 per 100,000 population, and those in females declined from 8.98 to 5.70 per 100,000 population. Overall, males' COPD mortality rate was around three times higher than females'. In the results of GWR, the median coefficients of smoking rate, the percentage of aborigines, PM10 and the altitude are positively correlated with COPD mortality in males and females. The median value of density of health care facilities is negatively correlated with COPD mortality. The overall adjusted R-squares are about 20% higher in the GWR model than in the OLS model. The local Moran's I of the GWR's residuals reflected the consistent high-high cluster in southern Taiwan. The findings indicate that geographical disparities in COPD mortality exist. Future epidemiological investigation is required to understand the specific risk factors within the clustering areas.

Clinical and computed tomographic predictors of chronic bronchitis in COPD: a cross sectional analysis of the COPDGene study

BACKGROUND

Chronic bronchitis (CB) has been related to poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). From a clinical standpoint, we have shown that subjects with CB in a group with moderate to severe airflow obstruction were younger, more likely to be current smokers, male, Caucasian, had worse health related quality of life, more dyspnea, and increased exacerbation history compared to those without CB. We sought to further refine our clinical characterization of chronic bronchitics in a larger cohort and analyze the CT correlates of CB in COPD subjects. We hypothesized that COPD patients with CB would have thicker airways and a greater history of smoking, acute bronchitis, allergic rhinitis, and occupational exposures compared to those without CB.

METHODS

We divided 2703 GOLD 1-4 subjects in the Genetic Epidemiology of COPD (COPDGene®) Study into two groups based on symptoms: chronic bronchitis (CB+, n = 663, 24.5%) and no chronic bronchitis (CB-, n = 2040, 75.5%). Subjects underwent extensive clinical characterization, and quantitative CT analysis to calculate mean wall area percent (WA%) of 6 segmental airways was performed using VIDA PW2 (http://www.vidadiagnostics.com). Square roots of the wall areas of bronchi with internal perimeters 10 mm and 15 mm (Pi10 and Pi15, respectively), % emphysema, %gas trapping, were calculated using 3D Slicer (http://www.slicer.org).

RESULTS

There were no differences in % emphysema (11.4 ± 12.0 vs. 12.0 ± 12.6%, p = 0.347) or % gas trapping (35.3 ± 21.2 vs. 36.3 ± 20.6%, p = 0.272) between groups. Mean segmental WA% (63.0 ± 3.2 vs. 62.0 ± 3.1%, p < 0.0001), Pi10 (3.72 ± 0.15 vs. 3.69 ± 0.14 mm, p < 0.0001), and Pi15 (5.24 ± 0.22 vs. 5.17 ± 0.20, p < 0.0001) were greater in the CB + group. Greater percentages of gastroesophageal reflux, allergic rhinitis, histories of asthma and acute bronchitis, exposures to dusts and occupational exposures, and current smokers were seen in the CB + group. In multivariate binomial logistic regression, male gender, Caucasian race, a lower FEV1%, allergic rhinitis, history of acute bronchitis, current smoking, and increased airway wall thickness increased odds for having CB.

CONCLUSIONS

Histories of asthma, allergic rhinitis, acute bronchitis, current smoking, a lower FEV1%, Caucasian race, male gender, and increased airway wall thickness are associated with CB. These data provide clinical and radiologic correlations to the clinical phenotype of CB.

COPD phenotypes in biomass smoke- versus tobacco smoke-exposed Mexican women

We hypothesised that biomass smoke exposure is associated with an airway-predominant chronic obstructive pulmonary disease (COPD) phenotype, while tobacco-related COPD is associated with an emphysema-predominant phenotype. In this cross-sectional study, female never-smokers with COPD and biomass exposure (n=21) and female ex-cigarette smokers with COPD without biomass exposure (n=22) completed computed tomography (CT) at inspiration and expiration, pulmonary function, blood gas, exercise tolerance, and quality of life measures. Two radiologists scored the extent of emphysema and air trapping on CT. Quantitative emphysema severity and distribution and airway wall thickness were calculated using specialised software. Women in the tobacco group had significantly more emphysema than the biomass group (radiologist score 2.3 versus 0.7, p=0.001; emphysema on CT 27% versus 19%, p=0.046; and a larger size of emphysematous spaces, p=0.006). Women in the biomass group had significantly more air trapping than the tobacco group (radiologist score 2.6 and 1.5, respectively; p=0.02) and also scored lower on the symptom, activities and confidence domains of the quality of life assessment and had lower oxygen saturation at rest and during exercise (p<0.05). Biomass smoke exposure is associated with less emphysema but more air trapping than tobacco smoke exposure, suggesting an airway-predominant phenotype.

Relationship between femur neck bone mineral density and prevalent chronic obstructive pulmonary disease (COPD) or COPD mortality in older non-Hispanic white adults from NHANES III

SUMMARY

The relationship between femur neck bone mineral density (FNBMD), prevalent COPD, and COPD mortality was examined in older non-Hispanic white adults from NHANES III. FNBMD was significantly related to prevalent COPD and COPD mortality before and after adjusting for shared risk factors.

INTRODUCTION

Bone mineral density (BMD) has been linked to chronic obstructive pulmonary disease (COPD), but little is known about its relationship with COPD mortality. The present study examined the relationship between FNBMD, prevalent COPD, and COPD mortality in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).

METHODS

COPD status at baseline was defined by self-reported physician's diagnosis and by airway obstruction based on spirometry measurements in 3,275 non-Hispanic whites aged 50 years and older. COPD mortality cases were identified using linked mortality records obtained through 2006. FNBMD was measured by dual-energy x-ray absorptiometry. Multiple regression was used to examine the baseline relationship between COPD and FNBMD. Cox proportional hazards models were used to estimate the hazards ratio (HR) for COPD mortality by FNBMD.

RESULTS

Twelve percent self-reported a physician's diagnosis of COPD, 23 % had mild or moderate airway obstruction, and 9 % had severe or very severe airway obstruction. There were 180 COPD mortality cases in the sample. FNBMD was significantly lower in those with self-reported COPD diagnosis or airway obstruction before and after adjusting for shared risk factors (p < 0.05). COPD mortality risk was significantly increased for each standard deviation decline in FNBMD before (by 68 %) and after (by 26-38 %) adjusting for shared risk factors.

CONCLUSIONS

Low FNBMD was associated with both baseline COPD and future COPD mortality. Shared risk factors appeared to explain some, but not all, of these relationships.

Association of polymorphisms of the receptor for advanced glycation end products gene with COPD in the Chinese population

The receptor for advanced glycation end products (RAGE) is a cell surface molecule of the immunoglobulin superfamily that binds diverse endogenous ligands involved in the development of chronic diseases and inflammatory damage. A growing body of evidence has suggested that RAGE is involved in the development and progression of chronic obstructive pulmonary disease (COPD). The present study investigated the existence of an association among three polymorphisms (-374T/A, -429T/C, and G82S) of the RAGE gene with the risk of COPD in the Chinese population. The RAGE genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism in 216 patients with COPD and 239 age-matched healthy individuals. Our study demonstrated that the frequencies of the GS genotype and the S allele in the G82S mutation were significantly higher in COPD patients than in controls (odds ratios [OR]=1.70, 95% confidence interval [CI]: 1.15-2.50, p=0.0098 and OR=1.42, 95% CI: 1.06-1.91, p=0.023, respectively). Further stratification analysis by smoking status revealed that the presence of the GS genotype conferred a higher risk of developing COPD in current smokers (p=0.044). In contrast, mutations at -374T/A and -429T/C did not demonstrate any association with COPD, even after taking into account the patients' smoking history. Our study provides preliminary evidence that the G82S polymorphism in the RAGE gene is associated with an increased risk of COPD and that the GS genotype of the G82S variant is a risk factor for COPD in the Chinese population.

Chronic obstructive pulmonary disease readmissions at minority-serving institutions

About 20% of patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are readmitted within 30 days. High 30-day risk-standardized readmission rates after COPD exacerbations will likely place hospitals at risk for financial penalties from the Centers for Medicare and Medicaid Services starting in fiscal year 2015. Factors contributing to hospital readmissions include healthcare quality, access to care, coordination of care between hospital and ambulatory settings, and factors linked to socioeconomic resources (e.g., social support, stable housing, transportation, and food). These concerns are exacerbated at minority-serving institutions, which provide a disproportionate share of care to patients with low socioeconomic resources. Solutions tailored to the needs of minority-serving institutions are urgently needed. We recommend research that will provide the evidence base for strategies to reduce readmissions at minority-serving institutions. Promising innovative approaches include using a nontraditional healthcare workforce, such as community health workers and peer-coaches, and telemedicine. These strategies have been successfully used in other conditions and need to be studied in patients with COPD.

Pulmonary hyperinflation and left ventricular mass: the Multi-Ethnic Study of Atherosclerosis COPD Study

BACKGROUND

Left ventricular (LV) mass is an important predictor of heart failure and cardiovascular mortality, yet determinants of LV mass are incompletely understood. Pulmonary hyperinflation in chronic obstructive pulmonary disease (COPD) may contribute to changes in intrathoracic pressure that increase LV wall stress. We therefore hypothesized that residual lung volume in COPD would be associated with greater LV mass.

METHODS AND RESULTS

The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers 50 to 79 years of age who were free of clinical cardiovascular disease. LV mass was measured by cardiac magnetic resonance. Pulmonary function testing was performed according to guidelines. Regression models were used to adjust for age, sex, body size, blood pressure, and other cardiac risk factors. Among 119 MESA COPD Study participants, the mean age was 69±6 years, 55% were male, and 65% had COPD, mostly of mild or moderate severity. Mean LV mass was 128±34 g. Residual lung volume was independently associated with greater LV mass (7.2 g per 1-SD increase in residual volume; 95% confidence interval, 2.2-12; P=0.004) and was similar in magnitude to that of systolic blood pressure (7.6 g per 1-SD increase in systolic blood pressure; 95% confidence interval, 4.3-11; P<0.001). Similar results were observed for the ratio of LV mass to end-diastolic volume (P=0.02) and with hyperinflation measured as residual volume to total lung capacity ratio (P=0.009).

CONCLUSIONS

Pulmonary hyperinflation, as measured by residual lung volume or residual lung volume to total lung capacity ratio, is associated with greater LV mass.

[Chronic disease in ethnic minorities: tools for patient-centred care in diabetes, hypertension and COPD]

In the Netherlands, chronic diseases, such as diabetes mellitus and cardiovascular disease, are more common and have a poorer prognosis in patients of Surinamese, Turkish and Moroccan origin. Surinamese develop cardiovascular diseases more often and at an earlier age; it is recommended that their cardiovascular risk profile be checked at an earlier stage. Standard treatment of diabetes mellitus is less effective among ethnic minorities. Patient information that is in line with the educational level and cultural values of the patient leads to better glucose levels. Focus group research among ethnic minorities shows that lifestyle changes which conflict with their own cultural beliefs or lack support in their social environment are often not adopted. Ethnic differences in the efficacy and toxicity of drugs are mainly caused by genetically determined variations in the activity of drug metabolizing enzymes.

Detection of airflow limitation using the 11-Q and pulmonary function tests

OBJECTIVE

To investigate whether chronic obstructive pulmonary disease (COPD) screening that combines screening with questionnaires and pulmonary function testing is a useful method for the early detection of COPD.

METHODS

A total of 3,367 subjects over 50 years of age underwent COPD screening. Two thousand five hundred and seventy-two of these subjects underwent "Ningen Dock" (a Japanese-English term for annual health checkup) examinations, regularly-scheduled checkups or screenings in outpatient clinics. Of these subjects, 795 lived in one city and one town in Nagasaki Prefecture and exhibited a score of at least 5 points on the Eleven-item pre-interview questionnaire (11-Q). The prevalence of airflow limitation in each type of examination was calculated for each gender, and the odds ratios of airflow limitation with each type of examination were obtained using the subjects who underwent "Ningen Dock" examinations as the reference group.

RESULTS

The COPD prevalence was 6.5% in the "Ningen Dock" group (7.9% men, 1.8% women), 5.8% in the regularly-scheduled checkup group (7.4% men, 4.1% women), 9.8% in the screening in outpatient clinics group (12.1% men, 7.2% women) and 22.3% in the COPD screening group (31.1% men, 8.1% women), with the COPD screening group showing the highest prevalence. The odds ratios of the COPD prevalence confirmed that COPD screening is more effective for identifying airflow limitation than other types of examinations.

CONCLUSION

Conducting COPD screening with questionnaires and pulmonary function testing among the general population is a useful examination method for the early detection and treatment of COPD.

Prevalence of asthma and chronic obstructive pulmonary disease in Aboriginal and non-Aboriginal populations: a systematic review and meta-analysis of epidemiological studies

BACKGROUND

Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups.

OBJECTIVE

To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations.

METHODS

MEDLINE, Embase, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis.

RESULTS

Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]).

CONCLUSIONS

Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.

Association of matrix metalloproteinase-1 polymorphisms with risk of COPD and lung cancer and survival in lung cancer

BACKGROUND

The primary risk factor for chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC) is cigarette smoking but shared susceptibility factors, such as variations in the matrix metalloproteinase-1 (MMP1) gene, may also underlie both diseases.

MATERIALS AND METHODS

Cases with prevalent COPD (n=167), incident NSCLC (n=242), or prevalent COPD plus incident NSCLC (n=128) were compared to disease-free controls (n=338) to assess six MMP1 polymorphisms. The association between these polymorphisms and survival in NSCLC was also evaluated.

RESULTS

Rs11292517 among African-Americans [odds ratio (OR)=5.48, 95% confidence interval (CI)=1.17-25.72] and rs2071230 among Caucasians (OR=2.51, 95% CI=1.09-5.77) appeared to be associated with NSCLC risk in the presence of COPD. Rs470558 appeared to be associated with survival in NSCLC among African-Americans (hazard ratio=3.94; 95%CI=1.14-13.63). No associations remained after adjusting for multiple comparisons.

CONCLUSION

Polymorphisms in MMP1 were not consistently associated with prevalent COPD or incident NSCLC nor with survival in NSCLC.

SERPINA1 and ELA2 polymorphisms are not associated with COPD or lung cancer

BACKGROUND

Through their roles in tissue remodeling, variants in the genes that encode alpha1-antitrypsin (AAT) and neutrophil elastase (NE) were hypothesized to be associated with the risk of both chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Cases with prevalent COPD (n=145), incident NSCLC (n=203) or prevalent COPD plus NSCLC (n=118) were compared to disease-free controls (n=317), to assess two functional polymorphisms in serpin peptidase inhibitor, clade A, member 1 (SERPINA1), which encodes AAT, and eleven tagging polymorphisms in and around elastase 2 (ELA2), which encodes NE. All analyses were stratified by race.

RESULTS

Among African-Americans, the less efficient SERPINA1 variant appeared to be associated with increased risk of prevalent COPD but only in the presence of NSCLC (odds ratio=7.39; 95% confidence interval=1.03-53.21) and not after correcting for multiple comparisons.

CONCLUSION

Variations in SERPINA1 and ELA2 were not consistently or strongly associated with the risk of either COPD or NSCLC in either race.