51
|
Im Y, Park HY, Lee JY, Kim H, Yoo H, Kang M, Cho SJ, Hwang JH, Park YB, Cho J, Kang D, Shin SH. Impact of preserved ratio impaired spirometry on coronary artery calcium score progression: a longitudinal cohort study. ERJ Open Res 2024; 10:00819-2023. [PMID: 38259813 PMCID: PMC10801717 DOI: 10.1183/23120541.00819-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Background Preserved ratio impaired spirometry (PRISm) is associated with increased cardiovascular disease (CVD) risk and mortality. However, a causal relationship between PRISm and CVD remains unclear. We investigated the progression of coronary artery calcium (CAC) scores based on the presence of PRISm and reduced forced vital capacity (FVC). Methods This retrospective cohort study included 11 420 participants aged ≥40 years with forced expiratory volume in 1 s (FEV1)/FVC ≥0.7 who underwent at least two health screening examinations with coronary computed tomography scan between 2003 and 2020, and were without a history of CVD or interstitial lung disease. Participants with PRISm, defined as FEV1/FVC ≥0.7 and FEV1 <80% predicted, were further divided by low FVC (FVC <80% predicted). We estimated the 5-year progression rates of CAC by comparing participants with and without PRISm at baseline using mixed linear models. Results Of the 11 420 participants, 8536 (75%), 811 (7%) and 2073 (18%) had normal spirometry, PRISm with normal FVC and PRISm with low FVC, respectively. During the mean (range) follow-up of 6.0 (0.5-17.2) years, the multivariable adjusted ratio of 5-year CAC progression rates comparing participants with PRISm to those with normal spirometry was 1.08 (95% CI 1.04-1.13). This rate was higher in participants with PRISm with low FVC (1.21 (95% CI 1.12-1.30)) than in those with normal FVC. Conclusion In this longitudinal cohort study of subjects without a history of CVD, PRISm was significantly associated with CAC progression, which was more evident in the group with PRISm and low FVC.
Collapse
Affiliation(s)
- Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as first authors
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as first authors
| | - Jin-Young Lee
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as first authors
| | - Hyunsoo Kim
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mira Kang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo Jin Cho
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Hye Hwang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Bum Park
- Department of Pulmonary and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
- These authors contributed equally to this work as senior authors
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- These authors contributed equally to this work as senior authors
| |
Collapse
|
52
|
Yang S, Liao G, Tse LA. Association of preserved ratio impaired spirometry with mortality: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:230135. [PMID: 37914194 PMCID: PMC10618908 DOI: 10.1183/16000617.0135-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/04/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is prevalent within the general population. Increased mortality has been reported among subjects with PRISm, but the evidence has never been summarised. This systematic review aims to synthesise evidence on the association between PRISm and the risk of all-cause, cardiovascular and respiratory-related mortality. METHODS We systematically searched MEDLINE, Embase and Web of Science for population-based cohort studies from inception to April 2023 using the terms related to impaired spirometry and mortality. Titles and abstracts were screened to identify eligible studies that reported mortality estimates for individuals with PRISm. We excluded studies that adopted other definitions of impaired spirometry, had a specific study setting (e.g. HIV patients), had an insufficient follow-up period (<1 year) or reported duplicated data. Random-effects meta-analysis was used to produce pooled hazard ratio (HR) with 95% confidence intervals. Between-study heterogeneity was assessed with I2. RESULTS Eight studies met the inclusion criteria involving 40 699 individuals with PRISm. All included studies reported increased risk of all-cause mortality among adults with PRISm. Meta-analysis showed that PRISm was associated with an increased risk of all-cause mortality (pooled HR 1.71, 95% CI 1.51-1.93; I2=64%), cardiovascular mortality (pooled HR 1.57, 95% CI 1.44-1.72; I2=35%) and respiratory-related mortality (pooled HR 1.97, 95% CI 1.55-2.49; I2=0%). CONCLUSIONS Individuals with PRISm have a significantly increased risk of mortality compared with those with normal spirometry.
Collapse
Affiliation(s)
- Shuyuan Yang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Gengze Liao
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| |
Collapse
|
53
|
Marott JL, Ingebrigtsen TS, Çolak Y, Kankaanranta H, Bakke PS, Vestbo J, Nordestgaard BG, Lange P. Impact of the metabolic syndrome on cardiopulmonary morbidity and mortality in individuals with lung function impairment: a prospective cohort study of the Danish general population. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100759. [PMID: 38023334 PMCID: PMC10652137 DOI: 10.1016/j.lanepe.2023.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023]
Abstract
Background Whether the metabolic syndrome plays a role for the prognosis of individuals with lung function impairment (preserved ratio impaired spirometry (PRISm) or airflow limitation) is unclear. We hypothesised that the metabolic syndrome in individuals with lung function impairment is associated with increased cardiopulmonary morbidity and mortality. Methods The Copenhagen General Population Study was initiated in 2003 based on a random sample of white men and women aged 20-100 years drawn from the Danish general population. The risk of ischemic heart disease/heart failure, respiratory disease, and all-cause mortality was analysed with Cox models adjusted for age, sex, current smoking, and asthma during 15 years of follow-up. Findings Among 106,845 adults, 86,159 had normal lung function, 6126 had PRISm, and 14,560 had airflow limitation. We observed 10,448 hospital admissions for ischemic heart disease/heart failure, 21,140 for respiratory disease, and 11,125 deaths. Individuals with versus individuals without the metabolic syndrome generally had higher 5-year absolute risk of all outcomes, including within those with normal lung function, mild-moderate-severe PRISm, and very mild-mild-moderate-severe airflow limitation alike. Compared to individuals without the metabolic syndrome and with normal lung function, those with both the metabolic syndrome and severe PRISm had hazard ratios of 3.74 (95% CI: 2.53-5.55; p < 0.0001) for ischemic heart disease/heart failure, 5.02 (3.85-6.55; p < 0.0001) for respiratory disease, and 5.32 (3.76-7.54; p < 0.0001) for all-cause mortality. Corresponding hazard ratios in those with both the metabolic syndrome and severe airflow limitation were 2.89 (2.34-3.58; p < 0.0001) for ischemic heart disease/heart failure, 5.98 (5.28-6.78; p < 0.0001) for respiratory disease, and 4.16 (3.50-4.95; p < 0.0001) for all-cause mortality, respectively. The metabolic syndrome explained 13% and 27% of the influence of PRISm or airflow limitation on ischemic heart disease/heart failure and all-cause mortality. Interpretation The metabolic syndrome conferred increased risk of cardiopulmonary morbidity and mortality at all levels of lung function impairment. Funding Danish Lung Foundation, Danish Heart Foundation, Capital Region of Copenhagen, and Boehringer Ingelheim. JV is supported by the NIHR Manchester BRC.
Collapse
Affiliation(s)
- Jacob Louis Marott
- The Copenhagen City Heart Study, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
| | - Truls Sylvan Ingebrigtsen
- The Copenhagen City Heart Study, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Yunus Çolak
- The Copenhagen City Heart Study, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Internal Medicine, Respiratory Section, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
| | - Hannu Kankaanranta
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Børge Grønne Nordestgaard
- The Copenhagen City Heart Study, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Lange
- The Copenhagen City Heart Study, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Internal Medicine, Respiratory Section, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
54
|
Li G, Jankowich MD, Wu L, Lu Y, Shao L, Lu X, Fan Y, Pan CW, Wu Y, Ke C. Preserved Ratio Impaired Spirometry and Risks of Macrovascular, Microvascular Complications and Mortality Among Individuals With Type 2 Diabetes. Chest 2023; 164:1268-1280. [PMID: 37356807 DOI: 10.1016/j.chest.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND The prospective associations of preserved ratio impaired spirometry (PRISm) with new-onset macrovascular and microvascular complications and mortality among individuals with type 2 diabetes (T2D) and whether PRISm enhances the prediction ability of an established office-based risk score remain to be elucidated. RESEARCH QUESTION Can PRISm be used as a predictor of poor prognosis in individuals with T2D? STUDY DESIGN AND METHODS We included 20,047 study participants with T2D and complete data on spirometry at recruitment from the UK Biobank cohort. Multivariable Cox proportional hazards models were used to assess the associations of baseline PRISm (FEV1 to FVC ratio, ≥ 0.70; FEV1, < 80% predicted) with subsequent risks of incident stroke (any type), ischemic stroke, myocardial infarction, unstable angina, coronary heart disease, diabetic retinopathy, diabetic kidney disease, all-cause mortality, cardiovascular mortality, and respiratory mortality. RESULTS For this cohort analysis, 4,521 patients (22.55% of participants with T2D) showed comorbid PRISm at baseline. Over a median follow-up of 11.52 to 11.87 years, patients with T2D with PRISm at baseline showed higher risks than those with normal spirometry findings of various T2D complications developing and mortality; the adjusted hazard ratios for PRISm were 1.413 (95% CI, 1.187-1.681) for stroke (any type), 1.382 (95% CI, 1.129-1.690) for ischemic stroke, 1.253 (95% CI, 1.045-1.503) for myocardial infarction, 1.206 (95% CI, 1.086-1.339) for coronary heart disease, 1.311 (95% CI, 1.141-1.506) for diabetic retinopathy, 1.384 (95% CI, 1.190-1.610) for diabetic kidney disease, 1.337 (95% CI, 1.213-1.474) for all-cause mortality, 1.597 (95% CI, 1.296-1.967) for cardiovascular mortality, and 1.559 (95% CI, 1.189-2.044) for respiratory mortality, respectively. The addition of PRISm significantly improved the reclassification ability, based on the net reclassification index, of an office-based risk score by 15.53% (95% CI, 10.14%-19.63%) to 33.60% (95% CI, 20.90%-45.79%). INTERPRETATION Individuals with T2D with comorbid PRISm, accounting for a considerable proportion of the population with T2D, showed significantly increased risks of adverse macrovascular and microvascular complications and mortality.
Collapse
Affiliation(s)
- Guochen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Matthew D Jankowich
- Providence VA Medical Center, Providence, RI; Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Luying Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yanqiang Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Liping Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Xujia Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yulong Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Ying Wu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China.
| |
Collapse
|
55
|
Kogo M, Sato S, Muro S, Matsumoto H, Nomura N, Oguma T, Sunadome H, Nagasaki T, Murase K, Kawaguchi T, Tabara Y, Matsuda F, Chin K, Hirai T. Longitudinal Changes and Association of Respiratory Symptoms with Preserved Ratio Impaired Spirometry (PRISm): The Nagahama Study. Ann Am Thorac Soc 2023; 20:1578-1586. [PMID: 37560979 DOI: 10.1513/annalsats.202301-050oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023] Open
Abstract
Rationale: Subjects with preserved ratio impaired spirometry (PRISm) experience increased respiratory symptoms, although they present heterogeneous characteristics. However, the longitudinal changes in these symptoms and respiratory function are not well known. Objectives: To investigate PRISm from the viewpoint of respiratory symptoms in a longitudinal, large-scale general population study. Methods: The Nagahama study included 9,789 inhabitants, and a follow-up evaluation was conducted after 5 years. Spirometry and self-administered questionnaires regarding respiratory symptoms, including prolonged cough, sputum and dyspnea, and comorbidities were conducted. Results: In total, 9,760 subjects were analyzed, and 438 subjects had PRISm. Among the subjects with PRISm, 53% presented with respiratory symptoms; dyspnea was independently associated with PRISm. Follow-up assessment revealed that 73% of the subjects with PRISm with respiratory symptoms were consistently symptomatic, whereas 39% of the asymptomatic subjects with PRISm developed respiratory symptoms within 5 years. In addition, among subjects with respiratory symptoms without airflow limitation at baseline, PRISm was a risk factor for the development of airflow limitation independent of smoking history and comorbidities. Conclusions: This study demonstrated that 53% of the subjects with PRISm had respiratory symptoms; dyspnea was a distinct characteristic of PRISm. Approximately three-fourths of the symptomatic subjects with PRISm consistently complained of respiratory symptoms within 5 years. Together with our result that PRISm itself is an independent risk factor for the development of chronic obstructive pulmonary disease among subjects with respiratory symptoms, the clinical course of subjects with PRISm with symptoms requires careful monitoring.
Collapse
Affiliation(s)
| | - Susumu Sato
- Department of Respiratory Medicine
- Department of Respiratory Care and Sleep Control Medicine, and
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine
- Department of Respiratory Medicine and Allergology, Kindai University, Osaka, Japan
| | | | | | | | - Tadao Nagasaki
- Department of Respiratory Care and Sleep Control Medicine, and
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, and
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan; and
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Chin
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Division of Sleep Medicine, Department of Sleep Medicine and Respiratory Care, Nihon University School of Medicine, Chiyoda, Japan
| | | |
Collapse
|
56
|
Kim YS, Hwang YI, Lee JH, Park YB, Choi CW, Jung KS, Yoo KH, Lim SY, Kim JS, Choi JY. Clinical significance of normalized airflow obstruction in patients with chronic obstructive pulmonary disease. Respir Med 2023; 218:107398. [PMID: 37659437 DOI: 10.1016/j.rmed.2023.107398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND There is ongoing debate regarding the diagnostic criteria for chronic obstructive pulmonary disease (COPD); recent studies have focused on the early COPD detection and management. Here, we compared clinical features and prognosis in patients with FEV1/FVC<0.70 at baseline, according to normalized airflow obstruction status during follow-up. METHODS We used the Korea COPD Subgroup Study (KOCOSS) cohort database, a prospective nationwide observational COPD study. Normalized obstruction (NO) was defined as FEV1/FVC ≥0.7 in the 2-year follow-up period, whereas fixed obstruction (FO) was defined as FEV1/FVC <0.7. Demographic and clinical data, 1-year exacerbation risk and difference in FEV1 decline over 2 years were compared between NO and FO groups. RESULTS Among the 670 COPD patients with post-bronchodilator FEV1/FVC <0.7 in this study, 95 (14.2%) displayed NO. Compared with the FO group, the NO group had higher FEV1, and DLCO, body mass index, as well as lower Saint George Respiratory Questionnaire, Beck Depression Index, and Beck Anxiety Index. Blood eosinophil count, IgE level, and FeNO did not significantly differ between two groups. There was no significant difference in exacerbation frequency between the two groups, but the NO group had a significant increase in FEV1 compared with the FO group during follow-up. CONCLUSION Transient airflow obstruction in the NO group may represent a clinical manifestation of early COPD; close monitoring is needed for such patients.
Collapse
Affiliation(s)
- Yun Seok Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Il Hwang
- Department of Internal Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jae Ha Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 135-710, South Korea
| | - Yong Bum Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gangdong Sacred Heart Hospital, The Hallym University, South Korea
| | - Cheon Woong Choi
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Ki-Suck Jung
- Department of Internal Medicine, College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seong Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
57
|
Shin YY, Park S, Kim KJ, Rhee CK, Yoo KH, Jung KS, Lee JH. Clinical Characteristics and Medical Utilization of Smokers with Preserved Ratio Impaired Spirometry. Int J Chron Obstruct Pulmon Dis 2023; 18:2187-2194. [PMID: 37822330 PMCID: PMC10563768 DOI: 10.2147/copd.s425934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose To investigate the clinical characteristics and medical utilization of smokers with preserved ratio impaired spirometry (PRISm). Patients and Methods We used data from the Korean National Health and Nutrition Examination Survey between 2007 and 2012, linked to the Health Insurance Review and Assessment Service. Clinical characteristics and medical utilization, including inpatient admission, emergency department visit, prescribed medication, and medical cost, were retrospectively compared among three groups: normal spirometry, PRISm, and chronic obstructive pulmonary disease (COPD). Results A total of 7115 smokers were included (4743 normal spirometry, 689 PRISm, and 1683 COPD subjects). The mean age was the highest in the COPD group, followed by the PRISm and normal groups, and the proportion of women was the highest in the PRISm group. The tobacco exposure, socioeconomic status (SES), and schooling level of the PRISm group were at levels between those of the normal and COPD groups. However, the PRISm group had the highest proportion of current smokers, highest body mass index (BMI), and lowest mean FEV1 and FVC % predicted. During the study period, the medical utilization of 92 smokers (13.4%) in the PRISm group and 436 smokers (25.9%) in the COPD group was related to respiratory diseases. Emergency department visit or hospitalization and overall medical cost of the PRISm group were comparable to those of the COPD group, except for outpatient clinic visit. Old age, women, low BMI, low SES, low schooling level, high amount of tobacco exposure, wheezing, and decreased FEV1 and FVC % predicted were factors associated with medical utilization in PRISm. Conclusion Medical utilization was comparable between the PRISm and COPD groups. Smokers with PRISm who were older, women, or heavy smokers with low BMI, low SES and schooling level, wheezing, or low FEV1 and FVC might need close observation and early treatment.
Collapse
Affiliation(s)
- Yune-Young Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sojung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kyung Joo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Gyeonggi-do, Republic of Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| |
Collapse
|
58
|
Chen C, Zhang S, Yang T, Wang C, Han G. Associations between environmental heavy metals exposure and preserved ratio impaired spirometry in the U.S. adults. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:108274-108287. [PMID: 37749472 PMCID: PMC10611825 DOI: 10.1007/s11356-023-29688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/23/2023] [Indexed: 09/27/2023]
Abstract
We examined 9556 individuals aged 18 to 79 years who had information on spirometry testing and heavy metals and used multivariable logistic or linear regression to evaluate associations between serum levels of cadmium, lead, and mercury and PRISm and lung function in U.S. adults, which were conducted first in all participants, and then separately in never/former smokers and current smokers. The overall prevalence of PRISm was 7.02%. High levels of serum cadmium were significantly associated with PRISm in all individuals, no matter in never/former smokers (quartile 4 vs 1, the OR = 2.517, 95% CI = 1.376-4.604, p-trend = 0.0077) and current smokers (quartile 4 vs 1, the OR = 2.201, 95% CI = 1.265-3.830, p-trend = 0.0020). Serum lead and mercury were not significantly correlated with PRISm, regardless of smoking status. Serum cadmium was strongly correlated with lower FEV1/FVC, regardless of smoking status. Besides, serum cadmium was also significantly related to lower FVC % predicted in never/former smokers and lower FEV1% predicted in current smokers. Serum lead was strongly correlated with lower FVC % predicted and FEV1/FVC in all individuals and never/former smokers. And serum mercury was significantly associated with decrements in FVC % predicted in all individuals and current smokers. These findings demonstrate that serum cadmium is associated with a higher risk of PRISm and lower lung function, with the most significant effect on FEV1/FVC in particular. Our results also indicate that exposure to lead and mercury negatively affects lung function in never/former smokers and current smokers, respectively.
Collapse
Affiliation(s)
- Chen Chen
- National Center for Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineDepartment of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Shunan Zhang
- National Center for Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineDepartment of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| | - Ting Yang
- National Center for Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China.
| | - Chen Wang
- National Center for Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineDepartment of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Guiling Han
- National Center for Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesInstitute of Respiratory MedicineDepartment of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, People's Republic of China
| |
Collapse
|
59
|
Baugh A, Adegunsoye A, Connolly M, Croft D, Pew K, McCormack MC, Georas SN. Towards a Race-Neutral System of Pulmonary Function Test Results Interpretation. Chest 2023; 164:727-733. [PMID: 37414097 PMCID: PMC10504596 DOI: 10.1016/j.chest.2023.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 07/08/2023] Open
Abstract
It has been observed widely that, on average, Black individuals in the United States have lower FVC than White individuals, which is thought to reflect a combination of genetic, environmental, and socioeconomic factors that are difficult to disentangle. Debate therefore persists even after the American Thoracic Society's 2023 guidelines recommending race-neutral pulmonary function test (PFT) result interpretation strategies. Advocates of race-based PFT results interpretation argue that it allows for more precise measurement and will minimize disease misclassification. In contrast, recent studies have shown that low lung function in Black patients has clinical consequences. Furthermore, the use of race-based algorithms in medicine in general is increasingly being questioned for its risk of perpetuating structural health care disparities. Given these concerns, we believe it is time to adopt a race-neutral approach, but note that more research is urgently needed to understand how race-neutral approaches impact PFT results interpretation, clinical decision-making, and patient outcomes. In this brief case-based discussion, we offer a few examples of how a race-neutral PFT results interpretation strategy will impact individuals from racial and ethnic minority groups at different scenarios and stages of life.
Collapse
Affiliation(s)
- Aaron Baugh
- University of California, San Francisco, San Francisco, CA.
| | | | | | - Daniel Croft
- University of Rochester Medical Center, Rochester, NY
| | | | | | | |
Collapse
|
60
|
Moulinié J, Hayot M, Gouzi F. [The FEV 1/VC ratio to define bronchial obstruction: Should we use a fixed ratio or the lower limit of normal?]. Rev Mal Respir 2023; 40:564-571. [PMID: 37407298 DOI: 10.1016/j.rmr.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/07/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION While the screening of chronic obstructive lung diseases (COPD, asthma, etc.) constitutes a major public health issue in France and worldwide, simple spirometry appears currently as the key to meeting the challenge. Since description of the forced expiratory maneuver by Robert Tiffeneau in 1947, it has been admitted that the FEV1/VC ratio permits diagnosis obstructive pulmonary diseases. However, the diagnostic criteria for this ratio remain uncertain. The long-lasting debate between advocates of a 0.7 "fixed ratio" (FR) of 0.7 and advocates of the "lower limit of normal" (LLN) remains relevant. STATE OF THE ARTS In this general review, we describe the respective advantages of the FR and LLN criteria according to the most recently published studies, and characterize the conditions associated with discrepancies between these criteria. PERSPECTIVES AND CONCLUSIONS FR and LLN appear not to share similar diagnosis values and the use of both criteria facilitates proposal of an up-to-date interpretation and diagnosis strategy in the context of first-line spirometry, particularly for patients with FEV1/VC ratio in the "grey zone".
Collapse
Affiliation(s)
- J Moulinié
- Département de physiologie clinique, CHU de Montpellier, 34295 Montpellier, France; PhyMedExp, Inserm, CNRS, université de Montpellier, CHRU de Montpellier, Montpellier, France.
| | - M Hayot
- PhyMedExp, Inserm, CNRS, université de Montpellier, CHRU de Montpellier, Montpellier, France
| | - F Gouzi
- PhyMedExp, Inserm, CNRS, université de Montpellier, CHRU de Montpellier, Montpellier, France
| |
Collapse
|
61
|
Krishnan S, Tan WC, Farias R, Aaron SD, Benedetti A, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O'Donnell DE, Sin DD, Walker B, Bourbeau J. Impaired Spirometry and COPD Increase the Risk of Cardiovascular Disease: A Canadian Cohort Study. Chest 2023; 164:637-649. [PMID: 36871842 DOI: 10.1016/j.chest.2023.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Individuals with COPD and preserved ratio impaired spirometry (PRISm) findings in clinical settings have an increased risk of cardiovascular disease (CVD). RESEARCH QUESTION Do individuals with mild to moderate or worse COPD and PRISm findings in community settings have a higher prevalence and incidence of CVD compared with individuals with normal spirometry findings? Can CVD risk scores be improved when impaired spirometry is added? STUDY DESIGN AND METHODS The analysis was embedded in the Canadian Cohort Obstructive Lung Disease (CanCOLD). Prevalence of CVD (ischemic heart disease [IHD] and heart failure [HF]) and their incidence over 6.3 years were compared between groups with impaired and normal spirometry findings using logistic regression and Cox models, respectively, adjusting for covariables. Discrimination of the pooled cohort equations (PCE) and Framingham risk score (FRS) in predicting CVD were assessed with and without impaired spirometry. RESULTS Participants (n = 1,561) included 726 people with normal spirometry findings and 835 people with impaired spirometry findings (COPD Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1 disease, n = 408; GOLD stage ≥ 2, n = 331; PRISm findings, n = 96). Rates of undiagnosed COPD were 84% in GOLD stage 1 and 58% in GOLD stage ≥ 2 groups. Prevalence of CVD (IHD or HF) was significantly higher among individuals with impaired spirometry findings and COPD compared with those with normal spirometry findings, with ORs of 1.66 (95% CI, 1.13-2.43; P = .01∗) (∗ indicates statistical significane with P < .05) and 1.55 (95% CI, 1.04-2.31; P = .033∗), respectively. Prevalence of CVD was significantly higher in participants having PRISm findings and COPD GOLD stage ≥ 2, but not GOLD stage 1. CVD incidence was significantly higher, with hazard ratios of 2.07 (95% CI, 1.10-3.91; P = .024∗) for the impaired spirometry group and 2.09 (95% CI, 1.10-3.98; P = .024∗) for the COPD group compared to individuals with normal spirometry findings. The difference was significantly higher among individuals with COPD GOLD stage ≥ 2, but not GOLD stage 1. The discrimination for predicting CVD was low and limited when impaired spirometry findings were added to either risk score. INTERPRETATION Individuals with impaired spirometry findings, especially those with moderate or worse COPD and PRISm findings, have increased comorbid CVD compared with their peers with normal spirometry findings, and having COPD increases the risk of CVD developing.
Collapse
Affiliation(s)
- Suurya Krishnan
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Wan C Tan
- Center for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Raquel Farias
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Darcy D Marciniuk
- Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Queens University, Kingston, ON, Canada
| | - Don D Sin
- Center for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada.
| |
Collapse
|
62
|
Li G, Jankowich MD, Lu Y, Wu L, Shao L, Ke C. Preserved Ratio Impaired Spirometry, Metabolomics, and the Risk of Type 2 Diabetes. J Clin Endocrinol Metab 2023; 108:e769-e778. [PMID: 36897159 DOI: 10.1210/clinem/dgad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023]
Abstract
CONTEXT Whether baseline preserved ratio impaired spirometry (PRISm) is associated with the risk of developing type 2 diabetes (T2D) and if this association could be mediated by circulating metabolites remains to be elucidated. OBJECTIVE To measure the prospective association of PRISm with T2D and potential metabolic mediators thereof. METHODS This study used data from the UK Biobank and included 72 683 individuals without diabetes at baseline. PRISm was defined as the predicted forced expiratory volume in 1 second (FEV1) <80% and the FEV1/forced vital capacity ratio ≥0.70. Cox proportional hazards modeling was performed to assess the longitudinal relation between baseline PRISm and incident T2D. Mediation analysis was used to explore the mediation effects of circulating metabolites in the path from PRISm to T2D. RESULTS During a median follow-up of 12.06 years, 2513 participants developed T2D. Individuals who had PRISm (N = 8394) were 47% (95% CI, 33%-63%) more likely to develop T2D compared with those who had normal spirometry (N = 64 289). A total of 121 metabolites showed statistically significant mediation effects in the path from PRISm to T2D (false discovery rate <0.05). Glycoprotein acetyls, cholesteryl esters in large high-density lipoprotein (HDL), degree of unsaturation, cholesterol in large HDL, and cholesteryl esters in very large HDL were the top 5 metabolic markers, with mediation proportions (95% CI) being 11.91% (8.76%-16.58%), 11.04% (7.34%-15.55%), 10.36% (7.34%-14.71%), 9.87% (6.78%-14.09%), and 9.51% (6.33%-14.05%), respectively. A total of 11 principal components that explained 95% variance of the metabolic signatures accounted for 25.47% (20.83%-32.19%) of the relation between PRISm and T2D. CONCLUSIONS Our study revealed the association of PRISm with T2D risk and the potential roles of circulating metabolites in mediating this association.
Collapse
Affiliation(s)
- Guochen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Matthew D Jankowich
- Section of Pulmonary and Critical Care Medicine, Medical Service, Providence VA Medical Center, Providence, RI 02908, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Yanqiang Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Luying Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Liping Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, 215123, P. R. China
| |
Collapse
|
63
|
Labaki WW, Gu T, Murray S, Curtis JL, Wells JM, Bhatt SP, Bon J, Diaz AA, Hersh CP, Wan ES, Kim V, Beaty TH, Hokanson JE, Bowler RP, Arenberg DA, Kazerooni EA, Martinez FJ, Silverman EK, Crapo JD, Make BJ, Regan EA, Han MK. Causes of and Clinical Features Associated with Death in Tobacco Cigarette Users by Lung Function Impairment. Am J Respir Crit Care Med 2023; 208:451-460. [PMID: 37159910 PMCID: PMC10449063 DOI: 10.1164/rccm.202210-1887oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/08/2023] [Indexed: 05/11/2023] Open
Abstract
Rationale: Cigarette smoking contributes to the risk of death through different mechanisms. Objectives: To determine how causes of and clinical features associated with death vary in tobacco cigarette users by lung function impairment. Methods: We stratified current and former tobacco cigarette users enrolled in Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) into normal spirometry, PRISm (Preserved Ratio Impaired Spirometry), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2 COPD, and GOLD 3-4 COPD. Deaths were identified via longitudinal follow-up and Social Security Death Index search. Causes of death were adjudicated after a review of death certificates, medical records, and next-of-kin interviews. We tested associations between baseline clinical variables and all-cause mortality using multivariable Cox proportional hazards models. Measurements and Main Results: Over a 10.1-year median follow-up, 2,200 deaths occurred among 10,132 participants (age 59.5 ± 9.0 yr; 46.6% women). Death from cardiovascular disease was most frequent in PRISm (31% of deaths). Lung cancer deaths were most frequent in GOLD 1-2 (18% of deaths vs. 9-11% in other groups). Respiratory deaths outpaced competing causes of death in GOLD 3-4, particularly when BODE index ⩾7. St. George's Respiratory Questionnaire score ⩾25 was associated with higher mortality in all groups: Hazard ratio (HR), 1.48 (1.20-1.84) normal spirometry; HR, 1.40 (1.05-1.87) PRISm; HR, 1.80 (1.49-2.17) GOLD 1-2; HR, 1.65 (1.26-2.17) GOLD 3-4. History of respiratory exacerbations was associated with higher mortality in GOLD 1-2 and GOLD 3-4, quantitative emphysema in GOLD 1-2, and airway wall thickness in PRISm and GOLD 3-4. Conclusions: Leading causes of death vary by lung function impairment in tobacco cigarette users. Worse respiratory-related quality of life is associated with all-cause mortality regardless of lung function.
Collapse
Affiliation(s)
| | - Tian Gu
- Department of Biostatistics, T.H. Chan School of Public Health
| | | | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine
- Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - J. Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Craig P. Hersh
- Division of Pulmonary and Critical Care Medicine, and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Terri H. Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John E. Hokanson
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Ella A. Kazerooni
- Division of Pulmonary and Critical Care Medicine
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Edwin K. Silverman
- Division of Pulmonary and Critical Care Medicine, and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - James D. Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine and
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine and
| | | | | |
Collapse
|
64
|
Doña E, Reinoso-Arija R, Carrasco-Hernandez L, Doménech A, Dorado A, Lopez-Campos JL. Exploring Current Concepts and Challenges in the Identification and Management of Early-Stage COPD. J Clin Med 2023; 12:5293. [PMID: 37629335 PMCID: PMC10455125 DOI: 10.3390/jcm12165293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The need to improve health outcomes, as well as disease prognosis, has led clinicians and researchers to propose new ways of identifying COPD in its earliest forms. This initiative is based on the hypothesis that an earlier intervention would have a greater prognostic impact. However, the operational definition of a patient in the initial stages of the disease is complex, and there is still no unanimously accepted definition. GOLD has recently proposed different concepts to identify COPD in its early stages, such as COPD in young people or COPD with mild functional impairment. In addition, GOLD proposes two other concepts, called pre-COPD (symptomatic non-obstructive patients) and PRISm (preserved ratio with impaired spirometry), which aim to identify the patient at risk of developing this chronic airflow obstruction. However, despite the attractiveness of these concepts, none have been taken up universally by the medical community. A universally accepted identification of how to define COPD in its early stages is necessary as a preliminary step in order to design clinical trials to find out the best way to treat these patients. This review deals with these concepts of COPD at the onset of the disease, highlighting their importance and the problems involved in identifying them as therapeutic targets in real clinical practice.
Collapse
Affiliation(s)
- Esperanza Doña
- Unidad Médico-Quirúrgico de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (E.D.); (A.D.); (A.D.)
| | - Rocío Reinoso-Arija
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Sevilla, Spain; (R.R.-A.); (L.C.-H.)
| | - Laura Carrasco-Hernandez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Sevilla, Spain; (R.R.-A.); (L.C.-H.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Adolfo Doménech
- Unidad Médico-Quirúrgico de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (E.D.); (A.D.); (A.D.)
| | - Antonio Dorado
- Unidad Médico-Quirúrgico de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (E.D.); (A.D.); (A.D.)
| | - José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Sevilla, Spain; (R.R.-A.); (L.C.-H.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
65
|
Course CW, Lewis PA, Kotecha SJ, Cousins M, Hart K, Watkins WJ, Heesom KJ, Kotecha S. Characterizing the urinary proteome of prematurity-associated lung disease in school-aged children. Respir Res 2023; 24:191. [PMID: 37474963 PMCID: PMC10357627 DOI: 10.1186/s12931-023-02494-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Although different phenotypes of lung disease after preterm birth have recently been described, the underlying mechanisms associated with each phenotype are poorly understood. We, therefore, compared the urinary proteome for different spirometry phenotypes in preterm-born children with preterm- and term-born controls. METHODS Preterm and term-born children aged 7-12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) cohort, underwent spirometry and urine collection. Urine was analysed by Nano-LC Mass-Spectrometry with Tandem-Mass Tag labelling. The preterm-born children were classified into phenotypes of prematurity-associated preserved ratio impaired spirometry (pPRISm, FEV1 < lower limit of normal (LLN), FEV1/FVC ≥ LLN), prematurity-associated obstructive lung disease (POLD, FEV1 < LLN, FEV1/FVC < LLN) and preterm controls (FEV1 ≥ LLN,). Biological relationships between significantly altered protein abundances were analysed using Ingenuity Pathways Analysis software, and receiver operator characteristic curves were calculated. RESULTS Urine was analysed from 160 preterm-born children and 44 term controls. 27 and 21 were classified into the pPRISm and POLD groups, respectively. A total of 785 proteins were detected. Compared to preterm-born controls, sixteen significantly altered proteins in the pPRISm group were linked to six biological processes related to upregulation of inflammation and T-cell biology. In contrast, four significantly altered proteins in the POLD group were linked with neutrophil accumulation. Four proteins (DNASE1, PGLYRP1, B2M, SERPINA3) in combination had an area under the curve of 0.73 for pPRISm and three combined proteins (S100A8, MMP9 and CTSC) had AUC of 0.76 for POLD. CONCLUSIONS In this exploratory study, we demonstrate differential associations of the urinary proteome with pPRISm and POLD. TRIAL REGISTRATION EudraCT: 2015-003712-20.
Collapse
Affiliation(s)
- Christopher W Course
- Department of Child Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Philip A Lewis
- Proteomics Facility, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Michael Cousins
- Department of Child Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Kylie Hart
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, UK
| | - W John Watkins
- Department of Child Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Kate J Heesom
- Proteomics Facility, Faculty of Life Sciences, University of Bristol, Bristol, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK.
| |
Collapse
|
66
|
Chalmers JD, Polverino E, Crichton ML, Ringshausen FC, De Soyza A, Vendrell M, Burgel PR, Haworth CS, Loebinger MR, Dimakou K, Murris M, Wilson R, Hill AT, Menendez R, Torres A, Welte T, Blasi F, Altenburg J, Shteinberg M, Boersma W, Elborn JS, Goeminne PC, Aliberti S. Bronchiectasis in Europe: data on disease characteristics from the European Bronchiectasis registry (EMBARC). THE LANCET. RESPIRATORY MEDICINE 2023; 11:637-649. [PMID: 37105206 DOI: 10.1016/s2213-2600(23)00093-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Bronchiectasis is a heterogeneous, neglected disease with few multicentre studies exploring the causes, severity, microbiology, and treatment of the disease across Europe. This aim of this study was to describe the clinical characteristics of bronchiectasis and compare between different European countries. METHODS EMBARC is an international clinical research network for bronchiectasis. We report on a multicentre, prospective, observational, non-interventional, cohort study (the EMBARC registry) conducted across 27 European countries and Israel. Comprehensive clinical data were collected from adult patients (aged ≥18 years) at baseline and annual follow-up visits using electronic case report form. Data from individual countries were grouped into four regions (the UK, northern and western Europe, southern Europe, and central and eastern Europe according to modified EU EuroVoc classification). Follow-up data were used to explore differences in exacerbation frequency between regions using a negative binomial regression model. FINDINGS Between Jan 12, 2015, and April 12, 2022, 16 963 individuals were enrolled. Median age was 67 years (IQR 57-74), 10 335 (60·9%) participants were female and 6628 (39·1%) were male. The most common cause of bronchiectasis in all 16 963 participants was post-infective disease in 3600 (21·2%); 6466 individuals (38·1%) were classified as idiopathic. Individuals with bronchiectasis experienced a median of two exacerbations (IQR 1-4) per year and 4483 (26·4%) patients had a hospitalisation for exacerbation in the previous year. When examining the percentage of all isolated bacteria, marked differences in microbiology were seen between countries, with a higher frequency of Pseudomonas aeruginosa and lower Haemophilus influenzae frequency in southern Europe, compared with higher H influenzae in the UK and northern and western Europe. Compared with other regions, patients in central and eastern Europe had more severe bronchiectasis measured by the Bronchiectasis Severity Index (51·3% vs 35·1% in the overall cohort) and more exacerbations leading to hospitalisations (57·9% vs 26·4% in the overall cohort). Overall, patients in central and eastern Europe had an increased frequency of exacerbations (adjusted rate ratio [RR] 1·12, 95% CI 1·01-1·25) and a higher frequency of exacerbations leading to hospitalisations (adjusted RR 1·71, 1·44-2·02) compared with patients in other regions. Treatment of bronchiectasis was highly heterogeneous between regions. INTERPRETATION Bronchiectasis shows important geographical variation in causes, microbiology, severity, and outcomes across Europe. FUNDING European Union-European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative. TRANSLATIONS For the Arabic, French, German, Greek, Hebrew, Irish, Russian and Spanish translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Thorax Institute, Institute of Biomedical Research August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, UK
| | - Montserrat Vendrell
- Department of Pulmonology, Dr Trueta University Hospital, IDIBGL UdG, Girona, Spain
| | - Pierre Régis Burgel
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP and Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katerina Dimakou
- 5th Respiratory Medicine Department, General Hospital for Chest Diseases of Athens SOTIRIA, Athens, Greece
| | - Marlene Murris
- Department of Respiratory Diseases, CHU Toulouse, Toulouse, France
| | - Robert Wilson
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Adam T Hill
- Royal Infirmary of Edinburgh, Department of Respiratory Medicine, Edinburgh, Edinburgh, UK
| | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Pneumology Department, Hospital Universitario y Politécnico La Fe, Avda, Valencia, Spain
| | - Antoni Torres
- Hospital Clinic of Barcelona, Spain University of Barcelona, CIBERES, IDIBAPS, Barcelona, Spain
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany; European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Josje Altenburg
- Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
| | - Wim Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, Netherlands
| | - J Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
| | | | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
67
|
Tasch J, Abujaber S, Hattar L, Jose A, Price LL, LaCamera P, Avella H. Clinical Manifestations of Subjects With the Non-Specific Pulmonary Function Test Pattern. OPEN RESPIRATORY ARCHIVES 2023; 5:100253. [PMID: 37810424 PMCID: PMC10556774 DOI: 10.1016/j.opresp.2023.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/29/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Non-specific pattern (NSP) is a subgroup of preserved ratio impaired spirometry (PRISm) that requires a normal total lung capacity measurement. NSP has been historically classified as being an obstructive lung disease pattern. There has been heightened interest and investigation into PRISm recently as it has been associated with an increased likelihood of developing chronic obstructive pulmonary disease (COPD). Given the inherent challenges of understanding the clinical significance of the NSP, the aim of this study was to further explore the clinical characteristics of patients with this pulmonary function test pattern. Material and methods We identified 111 and 79 subjects using pre-bronchodilator (pre-BD) and post-bronchodilator (post-BD) values, respectively, that met criteria for NSP. The outpatient medical records were retrospectively reviewed for associated diagnoses that were then clustered into 'obstructive' or 'non-obstructive' groups based on the treating physician's primary pulmonary clinical diagnosis. Results Within this NSP cohort, cough, wheezing and sputum production were documented more frequently in those with an obstructive lung disease diagnosis. Whether identified using pre-BD or post-BD spirometric values, those with NSP and a positive BD response were more likely to carry an obstructive lung disease diagnosis. Conclusion Approximately one third of patients with NSP in this study were not given an obstructive lung disease diagnosis by their clinician, which supports the classification of NSP as not an exclusively obstructive lung disease pattern. However, the presence of supporting clinical symptoms, such as cough with sputum production and wheeze, and/or a positive BD response on PFT, support a diagnosis of obstruction in patients with NSP.
Collapse
Affiliation(s)
- James Tasch
- Division of Pulmonary, Critical Care and Sleep Medicine, Steward St. Elizabeth's Medical Center, Boston, MA, United States
| | - Samer Abujaber
- Division of Pulmonary, Critical Care and Sleep Medicine, Steward St. Elizabeth's Medical Center, Boston, MA, United States
| | - Laith Hattar
- Department of Medicine, Steward St. Elizabeth's Medical Center, Boston, MA, United States
| | - Aju Jose
- Department of Medicine, Steward St. Elizabeth's Medical Center, Boston, MA, United States
| | - Lori Lyn Price
- Clinical and Translational Science Institute, Tufts University, Boston, MA, United States
| | - Peter LaCamera
- Division of Pulmonary, Critical Care and Sleep Medicine, Steward St. Elizabeth's Medical Center, Boston, MA, United States
| | - Hernan Avella
- Division of Pulmonary, Critical Care and Sleep Medicine, Steward St. Elizabeth's Medical Center, Boston, MA, United States
| |
Collapse
|
68
|
Li D, Ruan Z, Xie S, Xuan S, Zhao H, Wu B. The relationship between preserved ratio impaired spirometry and mortality in the myocardial infarction survivors: a population-based cohort study. BMC Cardiovasc Disord 2023; 23:331. [PMID: 37386454 PMCID: PMC10311719 DOI: 10.1186/s12872-023-03352-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Preserved ratio impaired spirometry (PRISm) is a subtype of pulmonary function abnormality which is characterized by a proportional reduction in non-obstructive expiratory lung volume. Currently, no studies have shown a relationship between PRISm and mortality in myocardial infarction (MI) survivors. METHODS We used cohort data from U.S. adults who attended the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. According to the ratio of forced expiratory volume in the first second (FEV1) to forced vital capacity (FVC), we divided lung function into normal spirometry (FEV1/ FVC) ≥ 70%, FEV1 ≥ 80%), PRISm (FEV1/FVC ≥ 70%, FEV1 < 80%) and obstructive spirometry (FEV1/FVC < 70%). Cox regression was used to estimate the correlation between lung functions and mortality among MI patients. Kaplan-Meier survival curves compared the prognosis of MI with three different lung functions. We further verify the stability of the results by sensitivity analysis. RESULTS 411 subjects were included in our research. The mean follow-up time for the study was 105 months. Compared with normal spirometry, PRISm was significantly correlated with a greater relative risk for all-cause mortality (adjust HR 3.41, 95% confidence interval [95%CI]: 1.76-6.60, P < 0.001) and cardiovascular mortality (adjust HR 13.9, 95%CI: 2.60-74.6, P = 0.002). PRISm remains more correlated with all-cause mortality (adjust HR 2.73, 95%CI: 1.28-5.83, P = 0.009) relative to obstructive spirometry. The results are basically stable after sensitivity analysis. Kaplan-Meier survival curves showed that patients with PRISm tended to have the lowest survival during the follow-up period. CONCLUSION PRISm is an independent risk factor for all-cause and cardiovascular mortality in MI survivors. The presence of PRISm was associated with a significantly higher risk of all-cause mortality compared with obstructive spirometry.
Collapse
Affiliation(s)
- Dan Li
- The First Clinical College, Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Zhishen Ruan
- The First Clinical College, Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Shen Xie
- The First Clinical College, Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Shunchao Xuan
- The First Clinical College, Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Hengyi Zhao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Bo Wu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China.
| |
Collapse
|
69
|
Athlin Å, Lisspers K, Hasselgren M, Ställberg B, Janson C, Montgomery S, Giezeman M, Kisiel M, Nager A, Sandelowsky H, Arne M, Sundh J. Diagnostic spirometry in COPD is increasing, a comparison of two Swedish cohorts. NPJ Prim Care Respir Med 2023; 33:23. [PMID: 37264017 DOI: 10.1038/s41533-023-00345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/15/2023] [Indexed: 06/03/2023] Open
Abstract
Spirometry should be used to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). This test is not always performed, leading to possible misdiagnosis. We investigated whether the proportion of patients with diagnostic spirometry has increased over time as well as factors associated with omitted or incorrectly interpreted spirometry. Data from medical reviews and a questionnaire from primary and secondary care patients with a doctors' diagnosis of COPD between 2004 and 2010 were collected. Data were compared with a COPD cohort diagnosed between 2000 and 2003. Among 703 patients with a first diagnosis of COPD between 2004 and 2010, 88% had a diagnostic spirometry, compared with 59% (p < 0.001) in the previous cohort. Factors associated with not having diagnostic spirometry were current smoking (OR 2.21; 95% CI 1.36-3.60), low educational level (OR 1.81; 1.09-3.02) and management in primary care (OR 2.28; 1.02-5.14). The correct interpretation of spirometry results increased (75% vs 82%; p = 0.010). Among patients with a repeated spirometry, 94% had a persistent FEV1/FVC or FEV1/VC ratio <0.70.
Collapse
Affiliation(s)
- Åsa Athlin
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Mikael Hasselgren
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Björn Ställberg
- 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
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Maaike Giezeman
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
| | - Marta Kisiel
- Department of Medical Sciences, Occupational and Environment Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Nager
- Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sandelowsky
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Inst NVS, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Mats Arne
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
70
|
Lee J, Park HK, Kwon MJ, Ham SY, Gil HI, Lim SY, Song JU. The impact of insulin resistance on the association between metabolic syndrome and lung function: the Kangbuk Samsung Health Study. Diabetol Metab Syndr 2023; 15:65. [PMID: 37005609 PMCID: PMC10067203 DOI: 10.1186/s13098-023-01042-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND/OBJECTIVE Metabolic syndrome (MS) is related to lung dysfunction. However, its impact according to insulin resistance (IR) remains unknown. Therefore, we evaluated whether the relation of MS with lung dysfunction differs by IR. SUBJECT/METHODS This cross-sectional study included 114,143 Korean adults (mean age, 39.6 years) with health examinations who were divided into three groups: metabolically healthy (MH), MS without IR, and MS with IR. MS was defined as presence of any MS component, including IR estimated by HOMA-IR ≥ 2.5. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for lung dysfunction were obtained in MS, MS without IR, and MS with IR groups compared with the MH (reference) group. RESULTS The prevalence of MS was 50.7%. The percent predicted forced expiratory volume in 1 s (FEV1%) and forced vital capacity (FVC%) showed statistically significant differences between MS with IR and MH and between MS with IR and MS without IR (all P < 0.001). However, those measures did not vary between MH and MS without IR (P = 1.000 and P = 0.711, respectively). Compared to MH, MS was not at risk for FEV1% < 80% (1.103 (0.993-1.224), P = 0.067) or FVC% < 80% (1.011 (0.901-1.136), P = 0.849). However, MS with IR was clearly associated with FEV1% < 80% (1.374 (1.205-1.566) and FVC% < 80% (1.428 (1.237-1.647) (all p < 0.001), though there was no evident association for MS without IR (FEV1%: 1.078 (0.975-1.192, P = 0.142) and FVC%: 1.000 (0.896-1.116, p = 0.998)). CONCLUSION The association of MS with lung function can be affected by IR. However, longitudinal follow-up studies are required to validate our findings.
Collapse
Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Republic of Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Il Gil
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, 03181, Seoul, Republic of Korea
| | - Si-Young Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, 03181, Seoul, Republic of Korea
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, 03181, Seoul, Republic of Korea.
| |
Collapse
|
71
|
Chen J, Li K, Shao J, Lai Z, Feng Y, Liu B. The Correlation of Apolipoprotein B with Alterations in Specific Fat Depots Content in Adults. Int J Mol Sci 2023; 24:ijms24076310. [PMID: 37047284 PMCID: PMC10094599 DOI: 10.3390/ijms24076310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Body mass index (BMI) and blood biomarkers are not enough to predict cardiovascular disease risk. Apolipoprotein B was identified to be associated with cardiovascular disease (CVD) progression. The Dual-energy X-ray Absorption (DXA) results could be considered as a predictor for cardiovascular disease in a more refined way based on fat distribution. The prediction of CVD risk by simple indicators still cannot meet clinical needs. The association of ApoB with specific fat depot features remains to be explored to better co-predict cardiovascular disease risk. An amount of 5997 adults from National Health and Nutrition Examination Survey (NHANES) were enrolled. Their demographic information, baseline clinical condition, blood examination, and DXA physical examination data were collected. Multivariate regression was used to assess the correlation between ApoB and site-specific fat characteristics through different adjusted models. Smooth curve fittings and threshold analysis were used to discover the turning points with 95% confidence intervals. ApoB is positively correlated with arms percent fat, legs percent fat, trunk percent fat, android percent fat, gynoid percent fat, arm circumference and waist circumference after adjustment with covariates for age, gender, race, hypertension, diabetes, hyperlipidemia, coronary heart disease, smoking status and vigorous work activity. The smooth curve fitting and threshold analysis also showed that depot-specific fat had lower turning points of ApoB in both males and females within the normal reference range of ApoB. Meanwhile, females have a lower increase in ApoB per 1% total percent fat and android percent fat than males before the turning points, while females have a higher growth of ApoB per 1% gynoid percent fat than males. The combined specific fat-depot DXA and ApoB analysis could indicate the risk of CVD in advance of lipid biomarkers or DXA alone.
Collapse
|
72
|
Hines SE, Dement J, Cloeren M, Cranford K, Quinn PS, Ringen K. Restrictive spirometry pattern among construction trade workers. Am J Ind Med 2023; 66:484-499. [PMID: 36942569 DOI: 10.1002/ajim.23474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Spirometry-based studies of occupational lung disease have mostly focused on obstructive or mixed obstructive/restrictive outcomes. We wanted to determine if restrictive spirometry pattern (RSP) is associated with occupation and increased mortality. METHODS Study participants included 18,145 workers with demographic and smoking data and repeatable spirometry. The mortality analysis cohort included 15,445 workers with known vital status and cause of death through December 31, 2016. Stratified analyses explored RSP prevalence by demographic and clinical variables and trade. Log-binomial regression models explored RSP risk factors while controlling for important confounders such as smoking, obesity, and comorbidities. Cox regression models explored mortality risk by spirometry category. RESULTS Prevalence of RSP was very high (28.6%). Mortality hazard ratios for RSP were 1.50 for all causes, 1.86 for cardiovascular diseases, 2.31 for respiratory diseases, and 1.66 for lung cancer. All construction trades except painters, machinists, and roofers had significantly elevated risk for RSP compared to our internal reference group. RSP was significantly associated with both parenchymal and pleural changes seen by chest X-ray. CONCLUSIONS Construction trade workers are at significantly increased risk for RSP independent of obesity. Individuals with RSP are at increased risk for all-cause mortality as well as mortality attributable to respiratory diseases, cardiovascular diseases, and lung cancer. RSP deserves greater attention in occupational medicine and epidemiology.
Collapse
Affiliation(s)
- Stella E Hines
- Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John Dement
- Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Marianne Cloeren
- Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kim Cranford
- Zenith American Solutions, Covina, California, USA
| | - Patricia S Quinn
- Energy Employees Department, CPWR Center for Construction Research and Training, Silver Spring, Maryland, USA
| | - Knut Ringen
- Energy Employees Department, CPWR Center for Construction Research and Training, Silver Spring, Maryland, USA
| |
Collapse
|
73
|
Ma YH, Shen LX, Li YZ, Leng Y, Yang L, Chen SD, He XY, Zhang YR, Chen RJ, Feng JF, Tan L, Dong Q, Suckling J, David Smith A, Cheng W, Yu JT. Lung function and risk of incident dementia: A prospective cohort study of 431,834 individuals. Brain Behav Immun 2023; 109:321-330. [PMID: 36796705 DOI: 10.1016/j.bbi.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Whether lung function prospectively affects cognitive brain health independent of their overlapping factors remains largely unknown. This study aimed to investigate the longitudinal association between decreased lung function and cognitive brain health and to explore underlying biological and brain structural mechanisms. METHODS This population-based cohort included 43,1834 non-demented participants with spirometry from the UK Biobank. Cox proportional hazard models were fitted to estimate the risk of incident dementia for individuals with low lung function. Mediation models were regressed to explore the underlying mechanisms driven by inflammatory markers, oxygen-carrying indices, metabolites, and brain structures. FINDINGS During a follow-up of 3,736,181 person-years (mean follow-up 8.65 years), 5,622 participants (1.30 %) developed all-cause dementia, which consisted of 2,511 Alzheimer's dementia (AD) and 1,308 Vascular Dementia (VD) cases. Per unit decrease in lung function measure was each associated with increased risk for all-cause dementia (forced expiratory volume in 1 s [liter]: hazard ratio [HR, 95 %CI], 1.24 [1.14-1.34], P = 1.10 × 10-07; forced vital capacity [liter]: 1.16 [1.08-1.24], P = 2.04 × 10-05; peak expiratory flow [liter/min]: 1.0013 [1.0010-1.0017], P = 2.73 × 10-13). Low lung function generated similar hazard estimates for AD and VD risks. As underlying biological mechanisms, systematic inflammatory markers, oxygen-carrying indices, and specific metabolites mediated the effects of lung function on dementia risks. Besides, brain grey and white matter patterns mostly affected in dementia were substantially changed with lung function. INTERPRETATION Life-course risk for incident dementia was modulated by individual lung function. Maintaining optimal lung function is useful for healthy aging and dementia prevention.
Collapse
Affiliation(s)
- Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China; Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Ling-Xiao Shen
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Yu-Zhu Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yue Leng
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Shi-Dong Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Xiao-Yu He
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Ya-Ru Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Ren-Jie Chen
- School of Public Health, Fudan University, Shanghai, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom; School of Mathematical Sciences, Fudan University, Shanghai, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - A David Smith
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, United Kingdom
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China.
| |
Collapse
|
74
|
Zheng J, Zhou R, Zhang Y, Su K, Chen H, Li F, Hukportie DN, Niu F, Yiu KH, Wu X. Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes: A Large Prospective Cohort Study. Chest 2023; 163:610-623. [PMID: 36372304 DOI: 10.1016/j.chest.2022.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) findings are a heterogeneous condition characterized by a normal FEV1 to FVC ratio with underlying impairment of pulmonary function. Data relating to the association of baseline and trajectories of PRISm findings with diverse cardiovascular outcomes are sparse. RESEARCH QUESTION How do baseline and trajectories of PRISm findings impact subsequent cardiovascular events? STUDY DESIGN AND METHODS In the UK Biobank cohort study, we included participants free of cardiovascular disease (CVD) with spirometry (FEV1 and FVC values) at baseline (2006-2010). Participants with baseline spirometry and follow-up spirometry (2014-2020) were included in the lung function trajectory analysis. Cox proportional hazards multivariate regression was performed to evaluate the outcomes of major adverse cardiovascular events (MACEs), incident myocardial infarction (MI), stroke, heart failure (HF), and CVD mortality in association with lung function. RESULTS For baseline analysis (329,954 participants), the multivariate adjusted hazard ratios (HRs) for participants had PRISm findings (vs normal spirometry findings) were 1.26 (95% CI, 1.17-1.35) for MACE, 1.12 (95% CI, 1.01-1.25) for MI, 1.88 (95% CI, 1.72-2.05) for HF, 1.26 (95% CI, 1.13-1.40) for stroke, and 1.55 (95% CI, 1.37-1.76) for CVD mortality, respectively. A total of 22,781 participants underwent follow-up spirometry after an average of 8.9 years. Trajectory analysis showed that persistent PRISm findings (HR, 1.96; 95% CI, 1.24-3.09) and airflow obstruction (HR, 1.43; 95% CI, 1.00-2.04) was associated with a higher incidence of MACE vs consistently normal lung function. Compared with persistent PRISm findings, changing from PRISm to normal spirometry findings was associated with a lower incidence of MACE (HR, 0.42; 95% CI, 0.19-0.99). INTERPRETATION Individuals with baseline or persistent PRISm findings were at a higher risk of diverse cardiovascular outcomes even after adjusting for a wide range of confounding factors. However, individuals who transitioned from PRISm to normal findings showed a similar cardiovascular risk as those with normal lung function.
Collapse
Affiliation(s)
- Jiazhen Zheng
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangdong, China; Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China; Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong SAR, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong SAR, China
| | - Kelei Su
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Haowen Chen
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China; Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Furong Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Guangdong, China
| | - Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Fangbing Niu
- Department of Tuberculosis, Hebei Chest Hospital, Hebei, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, Guangdong, China; Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Island, Hong Kong, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China.
| |
Collapse
|
75
|
Zhang C, Wei S, Wang Y, Yu K, Jin Z, Zhang M, Ma X, Zhang C, Zhang Q, Sun K, Zhou P, Zhong Y, Ma J, Liao J, Wang G. Association between preserved ratio impaired spirometry and sleep apnea in a Chinese community. Curr Med Res Opin 2023; 39:621-626. [PMID: 36847254 DOI: 10.1080/03007995.2023.2182531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study investigated the association between obstructive sleep apnea (OSA) and preserved ratio impaired spirometry (PRISm) in a community population. METHODS Baseline data from a prospective cohort study, the Predictive Value of Combining Inflammatory Biomarkers and Rapid Decline of FEV1 for COPD (PIFCOPD), were used for cross-sectional analysis. Participants aged 40-75 years were recruited from the community and their demographic information and medical history were collected. The STOP-Bang questionnaire (SBQ) was used to assess the risk of OSA. Pulmonary function tests were performed using a portable spirometer (COPD-6) and forced expiratory volume in 1 s (FEV1) and 6 s (FEV6) were measured. Routine blood, biochemical, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 tests were also performed. The pH of the exhaled breath condensate was determined. RESULTS A total of 1183 participants were enrolled, of which 221 with PRISm and 962 with normal lung function. The neck circumference, waist-to-hip ratio, hs-CRP concentration, proportion of males, cigarette exposure, number of current smoker, high risk of OSA, and prevalence of nasal and ocular allergy symptoms were significantly higher in the PRISm group than in the non-PRISm group (p < .05). Logistic regression showed that the risk of OSA (odds ratio, 1.883; 95% confidence interval, 1.245-2.848), waist-to-hip ratio, current smoking, and prevalence of nasal allergy symptoms were independently associated with PRISm after correcting for age and sex. CONCLUSION These findings showed that OSA prevalence is independently associated with PRISm prevalence. Further studies should confirm the relationship between systemic inflammation in OSA, localized inflammation of the airways, and impaired lung function.
Collapse
Affiliation(s)
- Cheng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shanshan Wei
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yunxia Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kunyao Yu
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Zhe Jin
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Meng Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyu Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Chunbo Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Qi Zhang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kunyan Sun
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Peining Zhou
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yijue Zhong
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jing Ma
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jiping Liao
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Guangfa Wang
- The Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| |
Collapse
|
76
|
Zhou L, Yang H, Zhang Y, Li H, Zhang S, Li D, Ma Y, Hou Y, Lu W, Wang Y. Association of impaired lung function with dementia, and brain magnetic resonance imaging indices: a large population-based longitudinal study. Age Ageing 2022; 51:6834143. [PMID: 36413587 DOI: 10.1093/ageing/afac269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE to examine the association between different patterns of impaired lung function with the incident risk of dementia and magnetic resonance imaging (MRI)-based brain structural features. METHODS in UK Biobank, a total of 308,534 dementia-free participants with valid lung function measures (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]) were included. Association was assessed using Cox proportional hazards regression model. Furthermore, the association between impaired lung function and brain MRI biomarkers related to cognitive function was analysed among 30,159 participants. RESULTS during a median follow-up of 12.6 years, 3,607 incident all-cause dementia cases were recorded. Restrictive impairment (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.27-1.60) and obstructive impairment (HR, 1.28; 95% CI, 1.15-1.42) were associated with higher risk of all-cause dementia. The restricted cubic splines indicated FEV1% predicted and FVC % predicted had reversed J-shaped associations with dementia. Participants with impaired lung function have higher risks of all-cause dementia across all apolipoprotein E (APOE) risk categories, whereas associations were stronger among those of low APOE risk (P for interaction = 0.034). In addition, restrictive and obstructive impairment were linked to lower total (β: -0.075, SE: 0.021, Pfdr = 0.002; β: -0.033, SE: 0.017, Pfdr = 0.069) and frontoparietal grey matter volumes, higher white matter hyperintensity, poorer white matter integrity, lower hippocampus (β: -0.066, SE: 0.024, Pfdr = 0.017; β: -0.051, SE: 0.019, Pfdr = 0.019) and other subcortical volumes. CONCLUSIONS participants with restrictive and obstructive impairments had a higher risk of dementia. Brain MRI indices further supported adverse effects and provided insight into potential pathophysiology biomarkers.
Collapse
Affiliation(s)
- Lihui Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Huiping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Shunming Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Dun Li
- Department of Basic Integrated Medicine, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Basic Integrated Medicine, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
77
|
Ogata H, Sha K, Kotetsu Y, Enokizu-Ogawa A, Katahira K, Ishimatsu A, Taguchi K, Moriwaki A, Yoshida M. The Prognostic Performance of Lung Diffusing Capacity in Preserved Ratio Impaired Spirometry: An Observational Cohort Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2791-2799. [PMCID: PMC9627766 DOI: 10.2147/copd.s384074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Similar to chronic obstructive pulmonary disease (COPD), the diffusing capacity of the lung (DLCO) might be decreased and associated with poor prognosis in preserved ratio impaired spirometry (PRISm), a clinical entity as a prodromal phase of COPD. The aims of the present study were to evaluate the distributions of DLCO and to assess the association between DLCO and mortality among subjects with PRISm. Patients and Methods We conducted an observational cohort study at the National Hospital Organization Fukuoka National Hospital. We classified the 899 patients ≥ 40 years of age with an assessment of DLCO into five groups based on spirometry: preserved spirometry, PRISm, mild COPD, moderate COPD, and severe/very severe COPD. The prevalence of low DLCO (< 80% per predicted) was compared among the five groups. Using PRISm patients with follow-up data, we further investigated the association of low DLCO with all-cause mortality. Results The prevalence of low DLCO in the PRISm group (58.8%) was significantly higher than that in the preserved-spirometry group (21.8%), the mild-COPD group (23.5%), and the moderate-COPD group (36.0%) (all P < 0.01), and it was comparable to that in the severe/very severe-COPD group (63.2%). The results remained unchanged after adjusting for potential confounders. Among the PRISm subjects, the overall survival rate was significantly lower in the low-DLCO group than in the preserved-DLCO group (P < 0.01). The multivariable-adjusted hazard ratio (HR) for all-cause mortality was significantly higher in the low-DLCO group than in the preserved-DLCO group (HR = 10.10 (95% confidence interval 2.33–43.89)). Conclusion Diffusing capacity was more impaired in PRISm subjects than in those with preserved spirometry or mild to moderate COPD. Regarding PRISm, low DLCO was a significant risk factor for all-cause mortality. Clinicians should assess DLCO in the management of PRISm to predict the future risk of overall death.
Collapse
Affiliation(s)
- Hiroaki Ogata
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan,Correspondence: Hiroaki Ogata, Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan, Tel +81-92-565-5534, Fax +81-92-566-0702, Email
| | - Kachi Sha
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Yasuaki Kotetsu
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Aimi Enokizu-Ogawa
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Katsuyuki Katahira
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Akiko Ishimatsu
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Kazuhito Taguchi
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Atsushi Moriwaki
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Makoto Yoshida
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| |
Collapse
|
78
|
Tang X, Lei J, Li W, Peng Y, Wang C, Huang K, Yang T. The Relationship Between BMI and Lung Function in Populations with Different Characteristics: A Cross-Sectional Study Based on the Enjoying Breathing Program in China. Int J Chron Obstruct Pulmon Dis 2022; 17:2677-2692. [PMID: 36281228 PMCID: PMC9587705 DOI: 10.2147/copd.s378247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/17/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To analyze the relationship between body mass index (BMI) and lung function, which may help optimize the screening and management process for chronic obstructive pulmonary disease (COPD) in the early stages. Patients and Methods In this cross-sectional study using data from the Enjoying Breathing Program in China, participants were divided into two groups according to COPD Screening Questionnaire (COPD-SQ) scores (at risk and not at risk of COPD) and three groups based on lung function (normal lung function, preserved ratio impaired spirometry [PRISm], and obstructive lung function). Results A total of 32,033 subjects were enrolled in the current analysis. First, in people at risk of COPD, overweight and obese participants had better forced expiratory volume in one second (FEV1; overweight: 0.33 liters (l), 95% confidence interval [CI]: 0.27 to 0.38; obesity: 0.31 L, 95% CI: 0.22 to 0.39) values than the normal BMI group. Second, among people with PRISm, underweight participants had a lower FEV1 (−0.56 L, 95% CI: −0.86 to −0.26) and forced vital capacity (FVC; −0.33 L, 95% CI: −0.55 to −0.11) than participants with a normal weight, and obese participants had a higher FEV1 (0.22 L, 95% CI: 0.02 to 0.42) and FVC (0.16 L, 95% CI: 0.02 to 0.30) than participants with a normal weight. Taking normal BMI as the reference group, lower FEV1 (−0.80 L, 95% CI: −0.97 to −0.63) and FVC (−0.53 L, 95% CI: −0.64 to −0.42) were found in underweight participants with obstructive spirometry, and better FEV1 (obesity: 0.26 L, 95% CI: 0.12 to 0.40) was found in obese participants with obstructive spirometry. Conclusion Being underweight and severely obese are associated with reduced lung function. Slight obesity was shown to be a protective factor for lung function in people at risk of COPD and those with PRISm.
Collapse
Affiliation(s)
- Xingyao Tang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Capital Medical University, Beijing, 10069, People’s Republic of China
| | - Jieping Lei
- National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China,Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China
| | - Wei Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
| | - Yaodie Peng
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,Peking University Health Science Center, Beijing, 10029, People’s Republic of China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China,Correspondence: Ke Huang; Ting Yang, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China, Tel +010-8420 6275, Email ;
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
| |
Collapse
|
79
|
Tanabe N, Masuda I, Shiraishi Y, Maetani T, Hamada S, Sato A, Sato S, Hirai T. Clinical relevance of multiple confirmed preserved ratio impaired spirometry cases in adults. Respir Investig 2022; 60:822-830. [PMID: 36137930 DOI: 10.1016/j.resinv.2022.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/08/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is a common spirometry finding, but its heterogeneous manifestations and frequent transitions to airflow limitation (AFL), chronic obstructive pulmonary disease, or normal spirometry hinder establishing an appropriate management strategy. This study examined whether transition to AFL and baseline comorbidities are more frequent in subjects with definite PRISm (PRISm confirmed on both current and past two spirometry tests) versus incident PRISm (PRISm confirmed only on a current test with past normal spirometry records) than in normal spirometry. METHODS Archived medical check-up data of subjects aged ≥40 years (n = 10828) with two past spirometry records, in a Japanese hospital, were cross-sectionally analyzed. Among them, data from those with follow-up spirometry after three years (n = 6467) were used to evaluate transition to AFL. PRISm was defined as forced volume in 1 s (FEV1)/forced vital capacity ≥0.7 and % predicted FEV1 < 80%. RESULTS Overall PRISm prevalence was 6.5%. In multivariable models adjusted for age, sex, smoking status, and body mass index, definite PRISm (n = 290), but not incident PRISm (n = 183), was associated with elevated hemoglobin A1c and C-reactive protein levels, and higher rates of asthma, hypertension, hyperlipidemia, and diabetes than was consistent normal spirometry (n = 9694). The transition to AFL after three years was more frequent in definite PRISm, but not incident PRISm, than in normal spirometry (adjusted hazard ratio [95% confidence interval] = 6.21 [3.42-10.71] and 1.45 [0.23-4.73], respectively). CONCLUSIONS Multiple confirmed PRISm on past and baseline spirometry is closely associated with metabolic syndrome factors, asthma history, and future AFL development.
Collapse
Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Izuru Masuda
- Medical Examination Center, Takeda Hospital, 277 Aburanokoji-cho, Shimogyo-ku, Kyoto 600-8231, Japan
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoki Maetani
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
80
|
Small Airway Dysfunction in Chronic Bronchitis with Preserved Pulmonary Function. Can Respir J 2022; 2022:4201786. [PMID: 36060828 PMCID: PMC9433251 DOI: 10.1155/2022/4201786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/01/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Impairment of pulmonary function was evaluated in chronic bronchitis patients with preserved ratio impaired spirometry (PRISm). We retrospectively collected clinical data from 157 chronic bronchitis (CB) and 186 chronic obstructive pulmonary disease (COPD) patients between October 2014 and September 2017. These patients were assigned to three groups: control (normal pulmonary function), PRISm (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ≥ 0.7, FEV1 < 80% of predicted value), and COPD (FEV1/FVC <0.7) groups. Because small airway function was the main focus, in the COPD group, only patients in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 and 2 were included. Evaluation of pulmonary function (including impulse oscillometry) was performed and compared among these groups. Compared with the control group, the PRISm and COPD groups showed statistically significant differences in the predicted FEV1%
, maximal expiratory flow (MEF) 25%
, MEF50%
, maximal midexpiratory flow (MMEF) 25–75%
, residual volume (RV)/total lung capacity (TLC;
), FVC%
, total respiratory resistance and proximal respiratory resistance (R5-R20;
), respiratory system reactance at 5 Hz (X5;
), resonant frequency (Fres;
), and area of reactance (Ax;
). However, the predicted FEV1% and RV/TLC were similar between the PRISm and COPD groups (
and 0.122, respectively). PRISm is a nonspecific pattern of pulmonary function that indicates small airway dysfunction and may increase the risk of transformation to obstructive ventilation dysfunction. This trial is registered with ChiCTR-OCH-14004904.
Collapse
|
81
|
Alhabeeb FF, Whitmore G, Vandemheen KL, FitzGerald JM, Bergeron C, Lemière C, Boulet LP, Field SK, Penz E, McIvor RA, Gupta S, Mayers I, Bhutani M, Hernandez P, Lougheed D, Licskai CJ, Azher T, Cote A, Ainslie M, Fraser I, Mahdavian M, Aaron SD. Disease burden in individuals with symptomatic undiagnosed asthma or COPD. Respir Med 2022; 200:106917. [DOI: 10.1016/j.rmed.2022.106917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
|
82
|
Wan ES. The Clinical Spectrum of PRISm (Preserved Ratio Impaired Spirometry). Am J Respir Crit Care Med 2022; 206:524-525. [PMID: 35612910 DOI: 10.1164/rccm.202205-0965ed] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Emily S Wan
- Brigham and Women's Hospital, 1861, Channing Division of Network Medicine, Boston, Massachusetts, United States.,VA Boston Health Care System Jamaica Plain Campus, 20025, Boston, Massachusetts, United States;
| |
Collapse
|
83
|
Zhao N, Wu F, Peng J, Zheng Y, Tian H, Yang H, Deng Z, Wang Z, Li H, Wen X, Xiao S, Huang P, Dai C, Lu L, Zhou K, Chen S, Zhou Y, Ran P. Preserved ratio impaired spirometry is associated with small airway dysfunction and reduced total lung capacity. Respir Res 2022; 23:298. [PMID: 36316732 PMCID: PMC9620623 DOI: 10.1186/s12931-022-02216-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) refers to decreased forced expiratory volume in 1 s (FEV1) in the setting of preserved ratio. Little is known about the role of PRISm and its complex relation with small airway dysfunction (SAD) and lung volume. Therefore, we aimed to investigate the associations between PRISm and SAD and lung volume. METHODS We conducted a cross-sectional community-dwelling study in China. Demographic data, standard respiratory epidemiology questionnaire, spirometry, impulse oscillometry (IOS) and computed tomography (CT) data were collected. PRISm was defined as post-bronchodilator FEV1/FVC ≥ 0.70 and FEV1 < 80% predicted. Spirometry-defined SAD was defined as at least two of three of the post-bronchodilator maximal mid-expiratory flow (MMEF), forced expiratory flow 50% (FEF50), and forced expiratory flow 75% (FEF75) less than 65% of predicted. IOS-defined SAD and CT-defined gas trapping were defined by the fact that the cutoff value of peripheral airway resistance R5-R20 > 0.07 kPa/L/s and LAA- 856>20%, respectively. Analysis of covariance and logistic regression were used to determine associations between PRISm and SAD and lung volume. We then repeated the analysis with a lower limit of normal definition of spirometry criteria and FVC definition of PRISm. Moreover, we also performed subgroup analyses in ever smoker, never smoker, subjects without airway reversibility or self-reported diagnosed asthma, and subjects with CT-measured total lung capacity ≥70% of predicted. RESULTS The final analysis included 1439 subjects. PRISm had higher odds and more severity in spirometry-defined SAD (pre-bronchodilator: odds ratio [OR]: 5.99, 95% confidence interval [95%CI]: 3.87-9.27, P < 0.001; post-bronchodilator: OR: 14.05, 95%CI: 8.88-22.24, P < 0.001), IOS-defined SAD (OR: 2.89, 95%CI: 1.82-4.58, P < 0.001), and CT-air trapping (OR: 2.01, 95%CI: 1.08-3.72, P = 0.027) compared with healthy control after adjustment for confounding factors. CT-measured total lung capacity in PRISm was lower than that in healthy controls (4.15 ± 0.98 vs. 4.78 ± 1.05 L, P < 0.05), after adjustment. These results were robust in repeating analyses and subgroup analyses. CONCLUSION Our finding revealed that PRISm was associated with SAD and reduced total lung capacity. Future studies to identify the underlying mechanisms and longitudinal progression of PRISm are warranted.
Collapse
Affiliation(s)
- Ningning Zhao
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Fan Wu
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Jieqi Peng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Youlan Zheng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Heshen Tian
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Huajing Yang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Zhishan Deng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Zihui Wang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Haiqing Li
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Xiang Wen
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Shan Xiao
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Peiyu Huang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Cuiqiong Dai
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Lifei Lu
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Kunning Zhou
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Shengtang Chen
- Medical Imaging Center, Wengyuan County People’s Hospital, Shaoguan, China
| | - Yumin Zhou
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Pixin Ran
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| |
Collapse
|
84
|
Early Childhood Pneumonia Is Associated with Reduced Lung Function and Asthma in First Nations Australian Children and Young Adults. J Clin Med 2021; 10:jcm10245727. [PMID: 34945022 PMCID: PMC8706766 DOI: 10.3390/jcm10245727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Some but not all previous studies report that pneumonia in children aged less than five years is associated with lower lung function and elevated risk of respiratory disease. To date, none have explored these associations in at-risk populations such as First Nations Australians, whose incidence of early childhood pneumonia is among the highest reported in the world. Methods: This cross-sectional study included 1276 First Nations Australian children/young adults aged 5–25 years recruited from regional/remote Queensland and Northern Territory communities and schools. Associations between pneumonia and both spirometry values and asthma were investigated using linear and logistic regression. Results: Early childhood pneumonia was associated with lower FEV1 and FVC Z-scores, but not FEV1/FVC% Z-scores, when occurring before age three (FEV1 β = −0.42, [95%CI −0.79, −0.04]; FVC β = −0.62, [95%CI −1.14, −0.09]), and between three and five years (β = −0.50, [95%CI −0.88, −0.12]; β = −0.63, [95%CI −1.17, −0.10]), compared to those who never had pneumonia. Similarly, pneumonia occurring when aged before age three years (OR = 3.68, 95%CI 1.96–6.93) and three to five years (OR = 4.81, 95%CI 1.46–15.8) was associated with increased risk of asthma in later childhood. Conclusions: Early childhood pneumonia is associated with lung function deficits and increased asthma risk in later childhood/early adulthood in First Nations Australians. The disproportionate impact of pneumonia on at-risk children must be addressed as a priority.
Collapse
|