51
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Mosteiro-Añón M, Mouronte-Roibas C, Fernández-Villar A. Perfil social de los pacientes que ingresan por una agudización de EPOC. Un análisis desde una perspectiva de género. Arch Bronconeumol 2020; 56:84-89. [DOI: 10.1016/j.arbres.2019.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/18/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
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52
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Fernández-García S, Represas-Represas C, Ruano-Raviña A, Mosteiro-Añón M, Mouronte-Roibas C, Fernández-Villar A. Social Profile of Patients Admitted for COPD Exacerbations. A Gender Analysis. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.arbr.2019.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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53
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Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study. NPJ Prim Care Respir Med 2019; 29:45. [PMID: 31822681 PMCID: PMC6904454 DOI: 10.1038/s41533-019-0157-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000–2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.
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54
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Trigueros JA, Riesco JA, Alcázar-Navarrete B, Campuzano A, Pérez J. Clinical Features Of Women With COPD: Sex Differences In A Cross-Sectional Study In Spain ("The ESPIRAL-ES Study"). Int J Chron Obstruct Pulmon Dis 2019; 14:2469-2478. [PMID: 31806956 PMCID: PMC6842276 DOI: 10.2147/copd.s217921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/23/2019] [Indexed: 01/14/2023] Open
Abstract
Aim This cross-sectional multicenter study was performed aimed at describing the clinical characteristics of women with COPD attended in routine daily practice in Spain. Methods and results Of a total of 1610 consecutive patients diagnosed with COPD recruited in primary care centers and pneumology services throughout Spain over a 90-day period, 17.9% (n=286) were women, with a median age of 62 years. Differences in COPD phenotypes by sex were statistically significant (P = 0.002). Males as compared with females showed a higher prevalence of non-exacerbator (47.9% vs 42.2%) and exacerbator with chronic bronchitis (22.9% vs 18.8%) phenotypes, whereas the ACOS phenotype was more common among females (21.7% vs 12.9%). The mean (SD) CAT score was similar in men than in women (20.8 [9.0] vs 21.2 [8.7], P = 0.481), as well as the impact of the disease on the quality of life according to CAT scores of <5 (no impact), 5–9 (low), 10–20 (medium), >20 (high), and >30 (very high). Sex-related differences according to smoking status were statistically significant (P < 0.001), with a higher percentage of men as compared with women in the groups of current smokers and ex-smokers; never-smokers were higher in women (9.1%) than in men (0.6%). The mean number of comorbidities was 2.01 (1.43) (95% CI 1.93–2.09) in males and 1.99 (1.42) (95% CI 1.83–2.16) (P = 0.930) in females, but cardiovascular diseases (hypertension, ischemic heart disease, chronic heart failure) were more frequent in men, whereas metabolic disorders (osteoporosis) were more frequent in women. Conclusion This study highlights the impact of COPD in women and the importance of continuing sex-based research in tobacco-related respiratory diseases.
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Affiliation(s)
| | - Juan Antonio Riesco
- Pulmonology Department, Hospital San Pedro de Alcántara, Cáceres E-10003, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Cáceres, Spain
| | - Bernardino Alcázar-Navarrete
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Cáceres, Spain.,Pulmonology Department, Hospital de Alta Resolución La Loja, Loja, Granada E-18300, Spain
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55
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Raherison-Semjen C. [Vulnerability of women to tobacco: The broncho-pulmonary consequences (asthma, COPD)]. Rev Mal Respir 2019; 36:1032-1037. [PMID: 31540739 DOI: 10.1016/j.rmr.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
Smoking remains common, with an exposure that begins early during pregnancy. It induces epigenetic changes, with a trans-generational transmission. Smoking increases the risk of uncontrolled asthma during childhood and adult life. Asthma is also associated with increased risk of a decline of lung function and chronic obstructive pulmonary disease (COPD). Women are more at risk of developing early and severe COPD. The mechanisms are currently poorly known.
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Affiliation(s)
- C Raherison-Semjen
- Inserm, pôle cardiothoracique, service des maladies respiratoires, U1219 BPH Bordeaux Population Health Research Center, université de Bordeaux, CHU de Bordeaux, avenue Magellan, 33604 Pessac, France.
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56
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Han MK, Arteaga-Solis E, Blenis J, Bourjeily G, Clegg DJ, DeMeo D, Duffy J, Gaston B, Heller NM, Hemnes A, Henske EP, Jain R, Lahm T, Lancaster LH, Lee J, Legato MJ, McKee S, Mehra R, Morris A, Prakash YS, Stampfli MR, Gopal-Srivastava R, Laposky AD, Punturieri A, Reineck L, Tigno X, Clayton J. Female Sex and Gender in Lung/Sleep Health and Disease. Increased Understanding of Basic Biological, Pathophysiological, and Behavioral Mechanisms Leading to Better Health for Female Patients with Lung Disease. Am J Respir Crit Care Med 2019; 198:850-858. [PMID: 29746147 DOI: 10.1164/rccm.201801-0168ws] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Female sex/gender is an undercharacterized variable in studies related to lung development and disease. Notwithstanding, many aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions. These may manifest as differential gene expression or peculiar organ development. Some conditions are more prevalent in women, such as asthma and insomnia, or, in the case of lymphangioleiomyomatosis, are seen almost exclusively in women. In other diseases, presentation differs, such as the higher frequency of exacerbations experienced by women with chronic obstructive pulmonary disease or greater cardiac morbidity among women with sleep-disordered breathing. Recent advances in -omics and behavioral science provide an opportunity to specifically address sex-based differences and explore research needs and opportunities that will elucidate biochemical pathways, thus enabling more targeted/personalized therapies. To explore the status of and opportunities for research in this area, the NHLBI, in partnership with the NIH Office of Research on Women's Health and the Office of Rare Diseases Research, convened a workshop of investigators in Bethesda, Maryland on September 18 and 19, 2017. At the workshop, the participants reviewed the current understanding of the biological, behavioral, and clinical implications of female sex and gender on lung and sleep health and disease, and formulated recommendations that address research gaps, with a view to achieving better health outcomes through more precise management of female patients with nonneoplastic lung disease. This report summarizes those discussions.
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Affiliation(s)
- MeiLan K Han
- 1 Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan
| | - Emilio Arteaga-Solis
- 2 Division of Pediatric Pulmonology, Columbia University Medical Center, New York, New York
| | - John Blenis
- 3 Pharmacology Ph.D. Program, Sandra and Edward Meyer Cancer Center, New York, New York
| | - Ghada Bourjeily
- 4 Department of Medicine, Brown University, Providence, Rhode Island
| | - Deborah J Clegg
- 5 Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Dawn DeMeo
- 6 Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jeanne Duffy
- 7 Department of Medicine and.,8 Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ben Gaston
- 9 Pediatric Pulmonology, Case Western Reserve University, Cleveland, Ohio
| | - Nicola M Heller
- 10 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anna Hemnes
- 11 Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth Petri Henske
- 12 Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Raksha Jain
- 13 Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tim Lahm
- 14 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lisa H Lancaster
- 15 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joyce Lee
- 16 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, Colorado
| | | | - Sherry McKee
- 18 Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Reena Mehra
- 19 Neurologic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alison Morris
- 20 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Y S Prakash
- 21 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Martin R Stampfli
- 22 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rashmi Gopal-Srivastava
- 23 Office of Rare Diseases Research, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
| | - Aaron D Laposky
- 24 Division of Lung Diseases, NHLBI/NIH, Bethesda, Maryland; and
| | | | - Lora Reineck
- 24 Division of Lung Diseases, NHLBI/NIH, Bethesda, Maryland; and
| | - Xenia Tigno
- 24 Division of Lung Diseases, NHLBI/NIH, Bethesda, Maryland; and
| | - Janine Clayton
- 25 Office of Research on Women's Health, NIH-Office of the Director, Bethesda, Maryland
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57
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Relationship between gender and survival in a real-life cohort of patients with COPD. Respir Res 2019; 20:191. [PMID: 31439045 PMCID: PMC6704674 DOI: 10.1186/s12931-019-1154-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 08/05/2019] [Indexed: 12/29/2022] Open
Abstract
Background Although COPD affects both men and women, its prevalence is increasing more rapidly in women. Disease outcomes appear different among women with more frequent dyspnea and anxiety or depression but whether this translates into a different prognosis remains to be determined. Our aim was to assess whether the greater clinical impact of COPD in women was associated with differences in 3-year mortality rates. Methods In the French Initiatives BPCO real-world cohort, 177 women were matched up to 458 menon age (within 5-year intervals) and FEV1 (within 5% predicted intervals). 3-year mortality rate and survival were analyzed. Univariate and multivariate logistic regression analyses were performed. Results For a given age and level of airflow obstruction, women with COPD had more severe dyspnea, lower BMI, and were more likely to exhibit anxiety. Nevertheless, three-year mortality rate was comparable among men and women, respectively 11.2 and 10.8%. In a multivariate model, the only factors significantly associated with mortality were dyspnea and malnutrition but not gender. Conclusion Although women with COPD experience higher levels of dyspnea and anxiety than men at comparable levels of age and FEV1, these differences do not translate into variations in 3-year mortality rates. Trial registration 04–479.
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58
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Dupin I, Thumerel M, Maurat E, Coste F, Eyraud E, Begueret H, Trian T, Montaudon M, Marthan R, Girodet PO, Berger P. Fibrocyte accumulation in the airway walls of COPD patients. Eur Respir J 2019; 54:13993003.02173-2018. [DOI: 10.1183/13993003.02173-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/28/2019] [Indexed: 12/16/2022]
Abstract
The remodelling mechanism and cellular players causing persistent airflow limitation in COPD remain largely elusive. We have recently demonstrated that circulating fibrocytes, a rare population of fibroblast-like cells produced by the bone marrow stroma, are increased in COPD patients during an exacerbation. We aimed to quantify fibrocyte density in situ in bronchial specimens from both control subjects and COPD patients, to define associations with relevant clinical, functional and computed tomography (CT) parameters, and to investigate the effect of the epithelial microenvironment on fibrocyte survival in vitro (“Fibrochir” study).A total of 17 COPD patients and 25 control subjects, all requiring thoracic surgery, were recruited. Using co-immunostaining and image analysis, we identified CD45+ FSP1+ cells as tissue fibrocytes, and quantified their density in distal and proximal bronchial specimens. Fibrocytes, cultured from the blood samples of six COPD patients, were exposed to primary bronchial epithelial cell secretions from control subjects or COPD patients.We demonstrate that fibrocytes are increased in both distal and proximal tissue specimens of COPD patients. The density of fibrocytes is negatively correlated with lung function parameters and positively correlated with bronchial wall thickness as assessed by CT scan. A high density of distal bronchial fibrocytes predicts the presence of COPD with a sensitivity of 83% and a specificity of 70%. Exposure of fibrocytes to COPD epithelial cell supernatant favours cell survival.Our results thus demonstrate an increased density of fibrocytes within the bronchi of COPD patients, which may be promoted by epithelial-derived survival-mediating factors.
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59
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Boudewijns EA, Babu GR, Salvi S, Sheikh A, van Schayck OC. Chronic obstructive pulmonary disease: a disease of old age? J Glob Health 2019; 8:020306. [PMID: 30333921 PMCID: PMC6162088 DOI: 10.7189/jogh.08.020306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Esther A Boudewijns
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Giridhara R Babu
- Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bangalore campus, Bangalore, India
| | | | - Aziz Sheikh
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Onno Cp van Schayck
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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60
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Stolz D, Kostikas K, Loefroth E, Fogel R, Gutzwiller FS, Conti V, Cao H, Clemens A. Differences in COPD Exacerbation Risk Between Women and Men: Analysis From the UK Clinical Practice Research Datalink Data. Chest 2019; 156:674-684. [PMID: 31103696 DOI: 10.1016/j.chest.2019.04.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Historically, COPD has been considered to affect mostly older men with a history of smoking; however, in recent times, its prevalence and mortality rates have steadily increased among women. OBJECTIVES The goal of this study was to systematically assess differences in COPD expression between women and men in UK primary care clinics who were newly diagnosed with COPD. METHODS This retrospective cohort study compared women and men with an incident diagnosis of COPD by using electronic medical records data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics data. The overall study period was between January 1, 2006, and February 28, 2016; patients with an incident diagnosis of COPD between January 1, 2010, and February 28, 2015, were analyzed. RESULTS A cohort of 22,429 patients were identified as incident patients and included in the study; 48% of patients with COPD were women. The risk of first moderate or severe exacerbation was 17% greater in women than in men (hazard ratio, 1.17; 95% CI, 1.12-1.23), with a median time to first exacerbation of 504 days for women and 637 days for men. These differences were more prominent in the younger age group (≥ 40 years to < 65 years), as well as in Global Initiative for Chronic Obstructive Lung Disease 2016 groups B, C, and D and in individuals with moderate to severe airflow obstruction. The annual rate of moderate or severe exacerbations was higher in women compared with men in the first, second, and third year of follow-up. CONCLUSIONS These results highlight the unmet need for appropriate identification and management of women with COPD in clinical practice.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Konstantinos Kostikas
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland; Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece.
| | | | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Hui Cao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Andreas Clemens
- Novartis Pharma AG, Basel, Switzerland; Heart Center Freiburg University, Cardiology and Angiology I, Faculty of Medicine, Freiburg, Germany
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61
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Belo LF, Rodrigues A, Paes T, Machado FVC, Schneider LP, Vicentin AP, Probst VS, Pitta F, Hernandes NA. Functional Status of Patients with COPD Assessed by London Chest Activity of Daily Living Scale: Gender Association and Validity of a Cutoff Point. Lung 2019; 197:509-516. [PMID: 31079224 DOI: 10.1007/s00408-019-00235-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Whether the difference in the impact of chronic obstructive pulmonary disease (COPD) on the functional status of men and women stems from clinical distinctions or to the measuring instrument used is unclear. Like most instruments for assessing functional limitation in COPD, the interpretation of the results of the London Chest Activity of Daily Living (LCADL) scale is limited because a lack of a valid cutoff point to this scale. For that, this study sought to compare the functional status between men and women with COPD; and propose a cutoff point for LCADL capable of discriminating the prognosis of these individuals. METHODS A sample of 138 subjects with moderate-severe COPD was evaluated by the LCADL. The percentage of the individual maximum score was used to obtain a cutoff point capable of discriminating patients with the worse prognosis according to the BODE Index. The cutoff point was also tested in an independent sample (n = 70). RESULTS Regarding the total score, domestic and leisure domains of the LCADL, men had better scores than women (P ≤ 0.01). The cutoff point found was 37% (area under the curve = 0.70, 95% confidence interval = 0.60-0.80, sensitivity = 0.55 and specificity = 0.74). Individuals who scored ≥ 37% had a worse prognosis and level of physical activities of daily living than those who scored below (P ≤ 0.02). CONCLUSION When evaluated by the LCADL, men and women with COPD present difference in the functional status. The established cutoff point (37%) adequately discriminates individuals regarding the prognosis, contributing to improve the interpretation capacity of the LCADL.
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Affiliation(s)
- Letícia Fernandes Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Antenor Rodrigues
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.,Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - Thaís Paes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Felipe Vilaça Cavallari Machado
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Lorena Paltanin Schneider
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Ana Paula Vicentin
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | | | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil.
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62
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Meneghini A, Koenigkam-Santos M, Pereira M, Tonidandel P, Terra-Filho J, Cunha F, de Menezes M, Vianna E. Biomass smoke COPD has less tomographic abnormalities but worse hypoxemia compared with tobacco COPD. Braz J Med Biol Res 2019; 52:e8233. [PMID: 31038579 PMCID: PMC6487741 DOI: 10.1590/1414-431x20198233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/07/2019] [Indexed: 11/22/2022] Open
Abstract
Special attention has emerged towards biomass smoke-induced chronic obstructive pulmonary disease (COPD), providing new knowledge for prevention and therapeutic approach of non-smoker COPD patients. However, the understanding of biomass smoke COPD is still limited and somewhat controversial. The aim of the present study was to compare COPD exclusively caused by tobacco smoking with COPD exclusively caused by environmental or occupational exposures. For this cross-sectional study, COPD patients were recruited from outpatient clinics and formed two groups: non-smoker COPD group (n=16) with exposure to biomass smoke who did not smoke cigarette and tobacco smoker COPD group (n=15) with people who did not report biomass smoke exposure. Subjects underwent pulmonary function tests, thoracic high-resolution computed tomography, 6-min walk test, and sputum induction. The non-smoker COPD group had biomass smoke exposure of 133.3±86 hour-years. The tobacco COPD group smoked 48.5±27.4 pack-years. Women were 62.5 and 66.7%, respectively, of non-smokers and smokers. The non-smoker COPD group showed higher prevalence of dyspnea, lower arterial oxygen tension (PaO2), and lower arterial oxygen saturation (SaO2%) with similar spirometry results, lung volumes, and diffusion capacity. Regarding inflammatory biomarkers, differences were detected in sputum number of lymphomononuclear cells and in sputum concentrations of interleukin (IL)-6 and IL-8 with higher values in the smoker group. Emphysema was more prevalent in the tobacco smoker group, which also showed higher relative bronchial wall thickness and lower lung density by quantitative analysis. Biomass smoke induced more hypoxemia compared to tobacco in COPD patients with similar severity.
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Affiliation(s)
- A.C. Meneghini
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M. Koenigkam-Santos
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M.C. Pereira
- Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - P.R. Tonidandel
- Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - J. Terra-Filho
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F.Q. Cunha
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M.B. de Menezes
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E.O. Vianna
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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63
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Pinkerton KE, Poindexter ME. Harmful Interruptions: Impact of Smoking Patterns on Tumorigenesis and Emphysema. Am J Respir Cell Mol Biol 2019; 59:133-134. [PMID: 29864376 DOI: 10.1165/rcmb.2018-0151ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kent E Pinkerton
- 1 Center for Health and the Environment University of California, Davis Davis, California
| | - Morgan E Poindexter
- 1 Center for Health and the Environment University of California, Davis Davis, California
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64
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What matters to people with COPD: outputs from Working Together for Change. NPJ Prim Care Respir Med 2019; 29:11. [PMID: 30979889 PMCID: PMC6461642 DOI: 10.1038/s41533-019-0124-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/11/2019] [Indexed: 11/08/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has a negative impact on people's quality of life affecting daily activities and mental and emotional well-being. Healthcare services need to understand what patients want and need. We used a co-production methodology, Working Together for Change, not previously used in a COPD setting to determine what matters to people with COPD. Forty patients took part in one-to-one discussions to identify what was working well, not working well and what was important for the future in terms of their COPD care. The responses were analysed in two one-day co-production workshops involving COPD patients, carers and professionals. The six highest priority themes around what's not working well were: 'I don't think the right hand knows what the left hand is doing', 'I can't get appointments when I want them', 'I'm not treated as a person', 'I can't do what I want to do', 'I'm anxious and depressed' and 'I can't eat well.' Professionals gained powerful insights into the difficulties of COPD through their interactions with patients in the workshops. What mattered to patients encompassed meaning, purpose and relationships beyond immediate medical needs and underlines the need for patient-centred holistic approaches to COPD care and support.
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65
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Fuentes N, Cabello N, Nicoleau M, Chroneos ZC, Silveyra P. Modulation of the lung inflammatory response to ozone by the estrous cycle. Physiol Rep 2019; 7:e14026. [PMID: 30848106 PMCID: PMC6405886 DOI: 10.14814/phy2.14026] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022] Open
Abstract
Emerging evidence suggests that sex differences exist in the control of lung innate immunity; however, the specific roles of sex hormones in the inflammatory response, and the mechanisms involved are unclear. Here, we investigated whether fluctuations in circulating hormone levels occurring in the mouse estrous cycle could affect the inflammatory response to air pollution exposure. For this, we exposed female mice (C57BL/6J, 8 weeks old) at different phases of the estrous cycle to 2 ppm of ozone or filtered air (FA) for 3 h. Following exposure, we collected lung tissue and bronchoalveolar lavage fluid (BAL), and performed lung function measurements to evaluate inflammatory responses and respiratory mechanics. We found a differential inflammatory response to ozone in females exposed in the luteal phase (metestrus, diestrus) versus the follicular phase (proestrus, estrus). Females exposed to ozone in the follicular phase had significantly higher expression of inflammatory genes, including Ccl2, Cxcl2, Ccl20, and Il6, compared to females exposed in the luteal phase (P < 0.05), and displayed differential activation of regulatory pathways. Exposure to ozone in the follicular phase also resulted in higher BAL neutrophilia, lipocalin levels, and airway resistance than exposure in the luteal phase (P < 0.05). Together, these results show that the effects of ozone exposure in the female lung are affected by the estrous cycle phase, and potentially hormonal status. Future studies investigating air pollution effects and inflammation in women should consider the menstrual cycle phase and/or circulating hormone levels.
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Affiliation(s)
- Nathalie Fuentes
- Department of PediatricsThe Pennsylvania State University College of MedicineHersheyPennsylvania
| | - Noe Cabello
- Department of PediatricsThe Pennsylvania State University College of MedicineHersheyPennsylvania
| | - Marvin Nicoleau
- Department of PediatricsThe Pennsylvania State University College of MedicineHersheyPennsylvania
| | - Zissis C. Chroneos
- Department of PediatricsThe Pennsylvania State University College of MedicineHersheyPennsylvania
| | - Patricia Silveyra
- Department of PediatricsThe Pennsylvania State University College of MedicineHersheyPennsylvania
- Biobehavioral LaboratoryThe University of North Carolina at Chapel HillChapel HillNorth Carolina
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66
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Engle ML, Monk JN, Jania CM, Martin JR, Gomez JC, Dang H, Parker JS, Doerschuk CM. Dynamic changes in lung responses after single and repeated exposures to cigarette smoke in mice. PLoS One 2019; 14:e0212866. [PMID: 30818335 PMCID: PMC6395068 DOI: 10.1371/journal.pone.0212866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Cigarette smoke is well recognized to cause injury to the airways and the alveolar walls over time. This injury usually requires many years of exposure, suggesting that the lungs may rapidly develop responses that initially protect it from this repetitive injury. Our studies tested the hypotheses that smoke induces an inflammatory response and changes in mRNA profiles that are dependent on sex and the health status of the lung, and that the response of the lungs to smoke differs after 1 day compared to 5 days of exposure. Male and female wildtype (WT) and Scnn1b-transgenic (βENaC) mice, which have chronic bronchitis and emphysematous changes due to dehydrated mucus, were exposed to cigarette smoke or sham air conditions for 1 or 5 days. The inflammatory response and gene expression profiles were analyzed in lung tissue. Overall, the inflammatory response to cigarette smoke was mild, and changes in mediators were more numerous after 1 than 5 days. βENaC mice had more airspace leukocytes than WT mice, and smoke exposure resulted in additional significant alterations. Many genes and gene sets responded similarly at 1 and 5 days: genes involved in oxidative stress responses were upregulated while immune response genes were downregulated. However, certain genes and biological processes were regulated differently after 1 compared to 5 days. Extracellular matrix biology genes and gene sets were upregulated after 1 day but downregulated by 5 days of smoke compared to sham exposure. There was no difference in the transcriptional response to smoke between WT and βENaC mice or between male and female mice at either 1 or 5 days. Taken together, these studies suggest that the lungs rapidly alter gene expression after only one exposure to cigarette smoke, with few additional changes after four additional days of repeated exposure. These changes may contribute to preventing lung damage.
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Affiliation(s)
- Michelle L. Engle
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Curriculum in Genetics and Molecular Biology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Justine N. Monk
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Pathobiology and Translational Science Graduate Program, University of North Carolina, Chapel Hill, NC, United States of America
| | - Corey M. Jania
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States of America
| | - Jessica R. Martin
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
| | - John C. Gomez
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
| | - Joel S. Parker
- Department of Genetics, University of North Carolina, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Claire M. Doerschuk
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States of America
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D'Urzo AD, Singh D, Donohue JF, Kerwin EM, Ribera A, Molins E, Chuecos F, Jarreta D, Gil EG. Efficacy of aclidinium/formoterol 400/12 µg, analyzed by airflow obstruction severity, age, sex, and exacerbation history: pooled analysis of ACLIFORM and AUGMENT. Int J Chron Obstruct Pulmon Dis 2019; 14:479-491. [PMID: 30880938 PMCID: PMC6396834 DOI: 10.2147/copd.s185502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Aclidinium/formoterol 400/12 µg is a twice-daily maintenance bronchodilator for COPD. This post hoc study evaluated aclidinium/formoterol vs aclidinium 400 µg, formoterol 12 µg, or placebo in patient subgroups. PATIENTS AND METHODS Data were pooled from two 24-week Phase III clinical trials (ACLIFORM and AUGMENT). Patients (N=3,394) were analyzed by baseline airflow obstruction severity (moderate/severe), age (<65/≥65 years), sex, and exacerbation history (0/≥1 exacerbation in the previous 12 months). Changes from baseline vs placebo and mono-therapies were evaluated: morning pre-dose (trough) and morning 1-hour post-dose FEV1, Transition Dyspnea Index (TDI), and moderate/severe exacerbation rates (healthcare resource utilization [HCRU] and EXAcerbations of Chronic pulmonary disease Tool [EXACT] criteria). RESULTS Aclidinium/formoterol improved the post-dose FEV1 vs placebo and monotherapy in all subgroups (all P<0.01) and trough FEV1 vs placebo (P<0.001) and formoterol (P<0.05) across all subgroups. Improvements in trough FEV1 were observed vs aclidinium in patients with severe airflow obstruction, patients aged <65 years, males, and patients with exacerbation history (P<0.05). Improvements in TDI were observed vs placebo in all subgroups (all P<0.001), monotherapies for patients with moderate (formoterol P<0.05) or severe airflow obstruction (aclidinium P<0.05), patients aged <65 years (aclidinium P<0.01, formoterol P<0.05), males (formoterol P<0.05), and patients with no exacerbation history (formoterol P<0.05). HCRU exacerbation rates were lower for aclidinium/formoterol vs placebo in patients with no exacerbation history (P<0.01). EXACT exacerbation rates were lower for aclidinium/formoterol in patients with moderate airflow obstruction vs placebo and aclidinium, patients aged <65 years vs placebo and ≥65 years vs formoterol, males vs placebo, and patients with no exacerbation history vs placebo (all P<0.05). CONCLUSION Aclidinium/formoterol significantly improved post-dose FEV1, trough FEV1, and TDI vs placebo across all subgroups and vs monotherapy in many subgroups. These findings further support the benefits of aclidinium/formoterol for all patients with COPD.
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Affiliation(s)
- Anthony D D'Urzo
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,
| | - Dave Singh
- Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - James F Donohue
- Division of Pulmonary Diseases & Critical Care Medicine, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC, USA
| | - Edward M Kerwin
- Clinical Research Institute of Southern Oregon, Medford, OR, USA
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Wedzicha JA, Singh D, Tsiligianni I, Jenkins C, Fucile S, Fogel R, Shen S, Goyal P, Mezzi K, Kostikas K. Treatment response to indacaterol/glycopyrronium versus salmeterol/fluticasone in exacerbating COPD patients by gender: a post-hoc analysis in the FLAME study. Respir Res 2019; 20:4. [PMID: 30621717 PMCID: PMC6325763 DOI: 10.1186/s12931-019-0972-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background The burden of chronic obstructive lung disease (COPD) is increasing in women, with recent evidence suggesting gender differences in disease characteristics and potentially in treatment outcomes. Methods FLAME was a 52-week randomized controlled trial in patients with severe-to-very-severe COPD and a history of exacerbations. In this post-hoc analysis, gender-based baseline differences and treatment outcomes between indacaterol/glycopyrronium 110/50 μg once daily (IND/GLY) and salmeterol/fluticasone 50/500 twice daily (SFC) were assessed in terms of rate of exacerbations, time-to-first exacerbation, lung function, health status, and rescue medication use. Results This post-hoc analysis included 2557 men and 805 women. Baseline characteristics differed between genders, with women being younger, having better lung function and more often experiencing ≥2 exacerbations in the previous year. Compared with SFC, IND/GLY treatment was associated with reductions in the annualized rates of moderate/severe exacerbations (rate ratio [95% CI]: 0.81 [0.73–0.91], 0.89 [0.74–1.07] in men and women, respectively). Similarly, time-to-first moderate/severe exacerbation was also delayed (hazard ratio [95% CI]: 0.79 [0.70–0.89] and 0.76 [0.63–0.91] in men and women, respectively). Results were similar for all (mild/moderate/severe) exacerbations. Improvements in lung function, health status and rescue medication use with IND/GLY vs SFC were comparable between men and women. The smaller sample size for women may account for some observed discrepancies in treatment responses. Conclusions Although there were gender differences in baseline characteristics, IND/GLY demonstrated similar trends for exacerbation prevention and lung function improvement in men and women with moderate-to-very-severe COPD and a history of exacerbations compared with SFC. Small differences in the effects seen between genders may be attributed to the different sizes of the two groups and need to be further evaluated in randomized trials that are appropriately powered for gender analysis. Trial registration Post hoc analysis of the FLAME study. ClinicalTrials.gov number: NCT01782326. Registered 1 February 2013.
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Affiliation(s)
- Jadwiga A Wedzicha
- Respiratory Division, National Heart and Lung Institute, Imperial College London, London, UK.
| | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | | | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Steven Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Medical School, Ioannina, Greece
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69
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Wakabayashi R, Motegi T, Kida K. Gender Differences in Chronic Obstructive Pulmonary Disease Using the Lung Information Needs Questionnaire. SAGE Open Nurs 2019; 5:2377960819831462. [PMID: 33415223 PMCID: PMC7774384 DOI: 10.1177/2377960819831462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/12/2018] [Accepted: 01/26/2019] [Indexed: 11/16/2022] Open
Abstract
Aim: To investigate gender-related information needs in patients with chronic obstructive pulmonary disease (COPD) using the Lung Information Needs Questionnaire (LINQ). Design: Cross-sectional, prospective cohort study. Methods: Patients with COPD receiving standardized self-management education including information regarding disease knowledge, medications, avoidance of exacerbation, smoking cessation, exercise, and nutrition were included. Gender differences were assessed by pulmonary function tests, 6-minute walking test, modified Medical Research Council dyspnea scale, Mini-Mental State Examination, St. George's Respiratory Questionnaire, and LINQ. Results: A total of 122 patients were enrolled. Females displayed significantly higher information needs for total LINQ score (p < .001), avoidance of exacerbation (p < .03), and nutrition (p < .006). Significant correlations were seen between total LINQ score and gender (p = .001), forced expiratory volume in 1 second, % predicted (p = .003), and Mini-Mental State Examination (p = .002) for male patients. In females, modified Medical Research Council dyspnea scale was correlated with the total LINQ score (p = .04).
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Affiliation(s)
- Ritsuko Wakabayashi
- College of Nursing, Kanto Gakuin
University, Yokohama, Japan
- Division of Pulmonary Medicine,
Infectious Diseases and Oncology, Department of Internal Medicine, Nippon Medical
School, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical
School, Tokyo, Japan
| | - Takashi Motegi
- Division of Pulmonary Medicine,
Infectious Diseases and Oncology, Department of Internal Medicine, Nippon Medical
School, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical
School, Tokyo, Japan
| | - Kozui Kida
- Division of Pulmonary Medicine,
Infectious Diseases and Oncology, Department of Internal Medicine, Nippon Medical
School, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical
School, Tokyo, Japan
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70
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Current Controversies in Chronic Obstructive Pulmonary Disease. A Report from the Global Initiative for Chronic Obstructive Lung Disease Scientific Committee. Ann Am Thorac Soc 2019; 16:29-39. [DOI: 10.1513/annalsats.201808-557ps] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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71
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Marco E, Sánchez-Rodríguez D, Dávalos-Yerovi VN, Duran X, Pascual EM, Muniesa JM, Rodríguez DA, Aguilera-Zubizarreta A, Escalada F, Duarte E. Malnutrition according to ESPEN consensus predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease. Clin Nutr 2018; 38:2180-2186. [PMID: 30342931 DOI: 10.1016/j.clnu.2018.09.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/09/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nutritional disorders are frequent in patients with chronic pulmonary obstructive disease (COPD) and have negative health impacts. This study aimed to explore the value of the European Society of Clinical Nutrition and Metabolism (ESPEN) definition of malnutrition (and/or its individual components) to predict hospitalizations and mortality at 2 years, and to determine the prevalence of malnutrition in COPD patients referred to pulmonary rehabilitation. METHODS The study was a prospective analysis of 118 patients with COPD free of exacerbations and/or hospital admissions in the previous two months. Main outcome variables were mortality, hospital admissions, and length of stay at 2-year follow-up; main covariates were malnutrition assessment according to the ESPEN definition and its components: unintentional weight loss, body mass index, and fat-free mass index (FFMI). Body composition was assessed by bioimpedance analysis. Kaplan-Meier survival curves and linear regression analyses were performed, adjusting for age and airflow obstruction as potential confounders. RESULTS The observed prevalence of malnutrition was 24.6%. Malnutrition was associated with increased mortality risk (HR = 3.9 [95% CI: 1.4-10.62]). FFMI was independently associated with increased mortality (HR = 17.0 [95% CI: 2.24-129.8]), which persisted after adjustment for age and lung function (adjusted HR = 13.0 [95% CI: 1.67-101.7]). Low age-related body mass index was associated with increased risk of hospital admissions. CONCLUSIONS Malnutrition according to ESPEN criteria, highly prevalent in patients with stable COPD referred to pulmonary rehabilitation, was associated with 4 times greater mortality risk after 2 years. Low FFMI was associated with a 17-fold increase in mortality risk, suggesting independent predictive value.
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Affiliation(s)
- Ester Marco
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain.
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona, Catalonia, Spain; Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Barcelona, Catalonia, Spain
| | - Vanesa N Dávalos-Yerovi
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Xavier Duran
- Methodology & Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain
| | - Eva M Pascual
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Diego A Rodríguez
- School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Barcelona, Catalonia, Spain; Respiratory Medicine Department, Parc Salut Mar (Hospital del Mar - Centre Fòrum del Hospital del Mar), Barcelona, Catalonia, Spain; Muscle and Respiratory System Research Unit (URMAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Aguilera-Zubizarreta
- Hospital Home-care Unit, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Ferran Escalada
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
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Sundh J, Åberg J, Hasselgren M, Montgomery S, Ställberg B, Lisspers K, Janson C. Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014. Eur Clin Respir J 2017; 4:1409060. [PMID: 29230274 PMCID: PMC5717719 DOI: 10.1080/20018525.2017.1409060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/18/2017] [Indexed: 11/04/2022] Open
Abstract
Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment. Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor's diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy. Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy. Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.
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Affiliation(s)
- Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Joakim Åberg
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College, London, UK
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory; Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Tsiligianni I, Mezzi K, Fucile S, Kostikas K, Shen S, Banerji D, Fogel R. Response to Indacaterol/Glycopyrronium (IND/GLY) by Sex in Patients with COPD: A Pooled Analysis from the IGNITE Program. COPD 2017; 14:375-381. [DOI: 10.1080/15412555.2017.1324837] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ioanna Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | | | | | | | - Steven Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Donald Banerji
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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