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Zaniku HR, Connolly E, Aron MB, Matanje BL, Ndambo MK, Complex Talama G, Munyaneza F, Ruderman T, Rylance J, Dullie LW, Lalitha R, Banda NPK, Muula AS. Prevalence and Associated Factors of Chronic Obstructive Pulmonary Disease Among Adults in Neno District, Malawi: A Cross-Sectional Analytical Study. Int J Chron Obstruct Pulmon Dis 2024; 19:389-401. [PMID: 38343494 PMCID: PMC10854231 DOI: 10.2147/copd.s444378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) continues to pose a global public health challenge. However, literature is scarce on the burden of COPD in Malawi. We assessed the prevalence and risk factors for COPD among adults in Neno, Malawi. Methodology We conducted a population-based analytical cross-sectional study in Neno District between December 2021 and November 2022. Using a multi-stage sampling technique, we included 525 adults aged≥40 years. All participants underwent spirometry according to the American Thoracic Society (ATS) guidelines and were interviewed using the IMPALA questionnaire. For this study, we utilized the definition of COPD as a post-bronchodilator FEV1/FVC <0.70. We collected data using Kobo collect, exported to Microsoft Excel, and analysed using R software. We used descriptive statistics and logistic regression analysis; a p-value of <0.05 was considered statistically significant. Results Out of 525 participants, 510 participants were included in the final analysis. Fifty-eight percent of the participants were females (n=296), and 62.2% (n=317) were between 40 and 49 years with a median (IQR) age of 46 (40-86). For patient characteristics, 15.1% (n=77) were current smokers, and 4.1% (n=21) had a history of pulmonary tuberculosis (PTB). Cough was the most commonly reported respiratory symptom (n=249, 48.8%). The prevalence of COPD was 10.0% (n=51) and higher (15.0%) among males compared to females (6.4%). Factors significantly associated with COPD were age 60 years and above (adjusted odds ratio [aOR] = 3.27, 95% CI: 1.48-7.34, p<0.004), ever smoked (aOR = 6.17, 95% CI:1.89-18.7, p<0.002), current smoker (aOR = 17.6, 95% CI: 8.47-38.4, p<0.001), and previous PTB (aOR = 4.42, 95% CI: 1.16-15.5, p<0.023). Conclusion The cross-sectional prevalence of COPD in rural Malawi is high, especially among males. Factors significantly associated were older age (60 years and above), cigarette smoking, and previous PTB. Longitudinal studies are needed to better understand disease etiology and progression in this setting.
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Affiliation(s)
- Haules Robbins Zaniku
- Department of Physiotherapy, Ministry of Health, Neno District Health Office, Neno, Lilongwe, Malawi
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Emilia Connolly
- Department of Partnerships and Policy, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45529, USA
| | - Moses Banda Aron
- Monitoring and Evaluation Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
- Snakebite Envenoming Department, Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Beatrice Lydia Matanje
- Clinical Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Myness Kasanda Ndambo
- Department of Health Systems and Policy, Training and Research Unit of Excellence (TRUE), Kamuzu University of Health Sciences, Lilongwe, Malawi
| | | | - Fabien Munyaneza
- Research Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Todd Ruderman
- Clinical Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Luckson Wandani Dullie
- Global Leadership Ecosystem, Partners in Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Rejani Lalitha
- Pulmonary Division, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ndaziona Peter Kwanjo Banda
- Department of Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Adamson S Muula
- Community and Environmental Health Department, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
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Mao X, Li Y, Shi P, Zhu Z, Sun J, Xue Y, Wan Z, Yang D, Ma T, Wang J, Zhu R. Analysis of sputum microbial flora in chronic obstructive pulmonary disease patients with different phenotypes during acute exacerbations. Microb Pathog 2023; 184:106335. [PMID: 37673353 DOI: 10.1016/j.micpath.2023.106335] [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: 06/22/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Increasing studies have shown that the imbalance of the respiratory microbial flora is related to the occurrence of COPD, the severity and frequency of exacerbations and mortality.However, it remains unclear how the sputum microbial flora differs during exacerbations in COPD patients manifesting emphysema phenotype, chronic bronchitis with emphysema phenotype and asthma-COPD overlap phenotype. METHODS Sputum samples were obtained from 29 COPD patients experiencing acute exacerbations who had not received antibiotics or systemic corticosteroids within the past four weeks.Patients were divided into three groups;emphysema phenotype(E);chronic bronchitis with emphysema phenotype(B+E) and asthma-COPD overlap phenotype(ACO).We utilized metagenomic Next Generation Sequencing (mNGS) technology to analyze the sputum microbial flora in COPD patients with different phenotypes during exacerbations. RESULTS There was no significant difference in alpha diversity and beta diversity among three groups.The microbial flora composition was similar in all three groups during exacerbations except for a significant increase in Streptococcus mitis in ACO.Through network analysis,we found Candidatus Saccharibacteria oral taxon TM7x and Fusobacterium necrophorum were the core nodes of the co-occurrence network in ACO and E respectively.They were positively correlated with some species and play a synergistic role.In B+E,Haemophilus pittmaniae and Klebsiella pneumoniae had a synergistic effect.Besides,some species among the three groups play a synergistic or antagonistic role.Through Spearman analysis,we found the relative abundance of Streptococcus mitis was negatively correlated with the number of hospitalizations in the past year(r = -0.410,P = 0.027).We also observed that the relative abundance of Prevotella and Prevotella melaninogenica was negatively correlated with age(r = -0.534,P = 0.003;r = -0.567,P = 0.001),while the relative abundance of Streptococcus oralis and Actinomyces odontolyticus was positively correlated with age(r = 0.570,P = 0.001;r = 0.480,P = 0.008).In addition,the relative abundance of Prevotella melaninogenica was negatively correlated with peripheral blood neutrophil ratio and neutrophil to lymphocyte ratio(r = -0.479,P = 0.009;r = -0.555,P = 0.002),while the relative abundance of Streptococcus sanguinis was positively correlated with peripheral blood neutrophil ratio and neutrophil to lymphocyte ratio (r = 0.450,P = 0.014;r = 0.501,P = 0.006).There was also a significant positive correlation between Oribacterium and blood eosinophil counts(r = 0.491,P = 0.007). CONCLUSION Overall,we analyzed the sputum microbiota of COPD patients with different phenotypes and its relationship with clinical indicators, and explored the relationships between microbiota and inflammation in COPD.We hope to alter the prognosis of patients by inhibiting specific bacterial taxa related to inflammation and using guide individualized treatment in the future research.
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Affiliation(s)
- Xiaoyan Mao
- Department of Intensive Care Unit, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, Jiangsu, 223002, China
| | - Yao Li
- Department of Respiratory and Critical Care Medicine, The Huaian Clinial College of Xuzhou Medical University, Huaian, Jiangsu, 223300, China
| | - Pengfei Shi
- Department of Respiratory and Critical Care Medicine, The Huaian Clinial College of Xuzhou Medical University, Huaian, Jiangsu, 223300, China
| | - Ziwei Zhu
- Department of Respiratory and Critical Care Medicine, The Huaian Clinial College of Xuzhou Medical University, Huaian, Jiangsu, 223300, China
| | - Juan Sun
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China
| | - Yu Xue
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China
| | - Zongren Wan
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China
| | - Dan Yang
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China
| | - Ting Ma
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China
| | - Jipeng Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China
| | - Rong Zhu
- Department of Respiratory and Critical Care Medicine, The Huaian Clinial College of Xuzhou Medical University, Huaian, Jiangsu, 223300, China.
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Van Tho N, Phan TP, Dinh-Xuan AT, Ngo QC, Lan LTT. COPD Patients with Asthma Features in Vietnam: Prevalence and Suitability for Personalized Medicine. J Pers Med 2023; 13:901. [PMID: 37373890 DOI: 10.3390/jpm13060901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
COPD patients with asthma features usually benefit from inhaled corticosteroids (ICS)-containing regimens, but their burden and diagnostic criteria remain to be established. The aims of this study were to estimate the proportion of patients with asthma features among patients with physician-diagnosed COPD and to investigate differences in clinical characteristics and current medications between COPD patients with asthma features and patients with COPD alone. A cross-sectional study was conducted at two respiratory out-patient clinics at the University Medical Center in Ho Chi Minh City and Bach Mai Hospital in Ha Noi, Vietnam. COPD patients with asthma features were identified by attending physicians following the approach recommended by the GINA/GOLD joint committee. Of the 332 patients screened, 300 were enrolled in the study. The proportion of COPD patients with asthma features was 27.3% (95% confidence interval (95% CI) 22.6-32.6%). COPD patients with asthma features were younger, with higher FEV1 values, a greater proportion of positive bronchodilator reversibility tests, higher blood eosinophil count, and were more often treated with ICS/LABA (ICS/long-acting bronchodilator beta-2 agonist) than patients with COPD alone. The prevalence of COPD patients with asthma features is particularly high in Vietnam thus requiring appropriate action plans in clinical practice.
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Affiliation(s)
- Nguyen Van Tho
- Department of Tuberculosis and Lung Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Pulmonary Functional Exploration, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thu Phuong Phan
- Department of Internal Medicine, Ha Noi Medical University, Ha Noi City, Vietnam
- Respiratory Center, Bach Mai Hospital, Ha Noi City, Vietnam
| | - Anh Tuan Dinh-Xuan
- AP-HP, Hôpital Cochin, Service de Physiologie-Explorations Fonctionnelles, Paris, France
| | - Quy Chau Ngo
- Department of Internal Medicine, Ha Noi Medical University, Ha Noi City, Vietnam
- Tam Anh General Hospital, Ha Noi City, Vietnam
| | - Le Thi Tuyet Lan
- Department of Pulmonary Functional Exploration, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Takahashi K, Kawayama T, Takamori A, Tashiro H, Kinoshita T, Takagi K, Yamasaki K, Machida K, Kawaguchi A, Yatera K, Inoue H. Efficacy and safety of once-daily single-inhaler triple therapy for mild-to-moderate chronic obstructive pulmonary disease: a study protocol for a randomised and interventional study. BMJ Open Respir Res 2023; 10:e001607. [PMID: 37197795 PMCID: PMC10441813 DOI: 10.1136/bmjresp-2022-001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Bronchodilators, including long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), are the main treatments for chronic obstructive pulmonary disease (COPD). The efficacy of triple therapy (inhaled corticosteroids/LAMA/LABA) has also been reported. However, the effect of triple therapy on patients with mild-to-moderate COPD has not yet been clarified. This study aims to investigate the safety and efficacy of triple therapy, compared with LAMA/LABA combination therapy, for lung function and health-related quality of life in patients with mild-to-moderate COPD and identify baseline characteristics and biomarkers to predict responders and non-responders to triple therapy. METHODS AND ANALYSIS This is a multicentre, prospective, open-label, randomised, parallel-group study. Mild-to-moderate patients with COPD will be randomised to receive fluticasone furoate/umeclidinium/vilanterol or umeclidinium/vilanterol for 24 weeks. A total of 668 patients will be enrolled from March 2022 to September 2023 from 38 sites in Japan. The primary endpoint is the change in the trough forced expiration volume in 1 s after 12 weeks of treatment. Secondary endpoints are responder rates based on the COPD assessment test score and the St. George's Respiratory Questionnaire total score after 24 weeks of treatment. The safety endpoint is the occurrence of any adverse events. We will also investigate safety in terms of changes in microbial colonisation in sputum and antimycobacterium avium complex antibodies. ETHICS AND DISSEMINATION The study protocol and informed consent documents were approved by the Saga University Clinical Research Review Board (approval number: CRB7180010). Written informed consent will be obtained from all patients. Recruitment of the patients began in March 2022. The results will be disseminated through scientific peer-reviewed publications and domestic and international medical conferences. TRIAL REGISTRATION NUMBERS UMIN000046812 and jRCTs031190008.
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Affiliation(s)
- Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Kinoshita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Koichi Takagi
- Division of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kentaro Machida
- Division of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hiromasa Inoue
- Division of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Kaminsky DA, Irvin CG. The Physiology of Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:575-589. [DOI: 10.1016/j.iac.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Prisco L, Moll M, Doyle TJ, Cho MH, Sparks JA. Reply. Arthritis Rheumatol 2022; 74:1096-1097. [PMID: 35133086 DOI: 10.1002/art.42086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | - Matthew Moll
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Tracey J Doyle
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Jeffrey A Sparks
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA
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Jarrell L. Asthma-COPD overlap: The NP's role in diagnosis and management. Nurse Pract 2022; 47:25-31. [PMID: 35044350 DOI: 10.1097/01.npr.0000806392.71827.cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Asthma-COPD overlap (ACO) presents in persons, especially adults, with persistent airflow limitation along with clinical symptoms reflective of both asthma and chronic obstructive pulmonary disease (COPD). It includes multiple clinical phenotypes with different underlying pathophysiology. Patients with ACO typically have a worse clinical course than those with asthma or COPD alone. This article provides an overview of diagnosis and management of this underrecognized condition.
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Affiliation(s)
- Lynda Jarrell
- Lynda Jarrell is a clinical assistant professor at the University of Texas at Arlington, Fort Worth, Tex
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