COPD prevalence in a north-eastern Italian general population

The Smokers Health Multiple ACtions (SMAC-1) Trial: Study Design and Results of the Baseline Round

BACKGROUND

Lung cancer screening with low-dose helical computed tomography (LDCT) reduces mortality in high-risk subjects. Cigarette smoking is linked to up to 90% of lung cancer deaths. Even more so, it is a key risk factor for many other cancers and cardiovascular and pulmonary diseases. The Smokers health Multiple ACtions (SMAC-1) trial aimed to demonstrate the feasibility and effectiveness of an integrated program based on the early detection of smoking-related thoraco-cardiovascular diseases in high-risk subjects, combined with primary prevention. A new multi-component screening design was utilized to strengthen the framework on conventional lung cancer screening programs. We report here the study design and the results from our baseline round, focusing on oncological findings.

METHODS

High-risk subjects were defined as being >55 years of age and active smokers or formers who had quit within 15 years (>30 pack/y). A PLCOm2012 threshold >2% was chosen. Subject outreach was streamlined through media campaign and general practitioners' engagement. Eligible subjects, upon written informed consent, underwent a psychology consultation, blood sample collection, self-evaluation questionnaire, spirometry, and LDCT scan. Blood samples were analyzed for pentraxin-3 protein levels, interleukins, microRNA, and circulating tumor cells. Cardiovascular risk assessment and coronary artery calcium (CAC) scoring were performed. Direct and indirect costs were analyzed focusing on the incremental cost-effectiveness ratio per quality-adjusted life years gained in different scenarios. Personalized screening time-intervals were determined using the "Maisonneuve risk re-calculation model", and a threshold <0.6% was chosen for the biennial round.

RESULTS

In total, 3228 subjects were willing to be enrolled. Out of 1654 eligible subjects, 1112 participated. The mean age was 64 years (M/F 62/38%), with a mean PLCOm2012 of 5.6%. Former and active smokers represented 23% and 77% of the subjects, respectively. At least one nodule was identified in 348 subjects. LDCTs showed no clinically significant findings in 762 subjects (69%); thus, they were referred for annual/biennial LDCTs based on the Maisonneuve risk (mean value = 0.44%). Lung nodule active surveillance was indicated for 122 subjects (11%). Forty-four subjects with baseline suspicious nodules underwent a PET-FDG and twenty-seven a CT-guided lung biopsy. Finally, a total of 32 cancers were diagnosed, of which 30 were lung cancers (2.7%) and 2 were extrapulmonary cancers (malignant pleural mesothelioma and thymoma). Finally, 25 subjects underwent lung surgery (2.25%). Importantly, there were zero false positives and two false negatives with CT-guided biopsy, of which the patients were operated on with no stage shift. The final pathology included lung adenocarcinomas (69%), squamous cell carcinomas (10%), and others (21%). Pathological staging showed 14 stage I (47%) and 16 stage II-IV (53%) cancers.

CONCLUSIONS

LDCTs continue to confirm their efficacy in safely detecting early-stage lung cancer in high-risk subjects, with a negligible risk of false-positive results. Re-calculating the risk of developing lung cancer after baseline LDCTs with the Maisonneuve model allows us to optimize time intervals to subsequent screening. The Smokers health Multiple ACtions (SMAC-1) trial offers solid support for policy assessments by policymakers. We trust that this will help in developing guidelines for the large-scale implementation of lung cancer screening, paving the way for better outcomes for lung cancer patients.

Effect of smoking on the development of chronic obstructive pulmonary disease in young individuals: a nationwide cohort study

Background

Cigarette smoking is an important risk factor for developing chronic obstructive pulmonary disease (COPD). However, the effect of smoking on the development of COPD in young individuals remains unclear. We aimed to evaluate the effect of smoking on COPD development in young individuals.

Methods

Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health check-up between 2009 and 2012. We defined physician-diagnosed COPD based on health insurance claims and searched the database until December 2019. We identified 6,307,576 eligible individuals, and 13,789 had newly developed COPD. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD.

Results

The incidence rate for developing COPD was 0.26/1000 person-year. The risk of developing COPD was significantly higher in current smokers [aHR 1.46, 95% confidence interval (CI) 1.39-1.53] and former smokers (aHR 1.21, 95% CI 1.14-1.29) than in non-smokers. Furthermore, the risk increased with increasing smoking amounts (≥20 pack-years, aHR 2.24; 10-20 pack-years, aHR 1.55; <10 pack-years, aHR 1.27). Female participants had a higher relative risk of developing COPD due to smoking, compared with their male counterparts.

Conclusion

Cigarette smoking increased the risk of developing COPD in young individuals. Current and heavy smokers had higher risks of developing COPD than non-smokers. Female smokers were more likely to develop COPD than male smokers.

Asthma, COPD, Respiratory, and Allergic Health Effects in an Adult Population Living near an Italian Refinery: A Cross-Sectional Study

BACKGROUND AND AIM

Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Globally, 545 million people suffer from chronic respiratory diseases with a wide geographical variability. Risk factors for asthma are both genetic and related to several environmental factors (internal and external pollutants); these also have an important role in the occurrence of COPD. The aim of this study was to describe the prevalence of asthma, COPD, and asthma/COPD overlap (ACO) in an adult population living in two municipalities located in the Po Valley.

METHODS

A standardized questionnaire on respiratory symptoms and sociodemographic characteristics was self-administered to a random sample of the adult population aged 20-64 years, living near a refinery in Northern Italy during the period between 2016 and 2019. Logistic and multinomial regression were implemented to explore factors associated with asthma, COPD, and ACO.

RESULTS

In total, 1108 subjects filled out the questionnaire, the mean age was 48.02 ± 12.34 years (range 21-68), and 53% of the respondents/participants were female. Half of the responders were non-smokers, but the frequency of current and former smokers was significantly greater in men than in women (p < 0.001). The likelihood of being a probable case of asthma decreased with increasing age and increased for smokers. Tobacco smoke was associated with the presence of COPD and ACO.

CONCLUSION

Respiratory diseases such as asthma and COPD are common in the general population, with differences among countries worldwide. Our findings show, on the basis of the main confirmed risk factor, namely smoking, that it is useful to plan target programs and actions in order to reduce smoking, thus improving the quality of life in public health.

Awareness of COPD and Its Risk Factors Among the Adult Population of the Aseer Region, Saudi Arabia

Introduction

Epidemiological studies are urgently needed to assess the prevalence of COPD in the region to determine the baseline, against which the future trends in the risk factor levels can be assessed and preventive strategies be planned to promote health among the population. Therefore, this study was undertaken to assess the awareness of COPD and its risk factors in Saudi Arabia.

Materials and Methods

The cross-sectional study was conducted among the general adult population aged 18 years and above living in the Aseer region. A minimum sample of 385 was targeted, using the Raosoft sample size calculator. An online questionnaire was prepared in both English and Arabic language using Google forms and distributed among participants through social media.

Results

It was observed that less than one-third (116, 30.12%) of the study population had ever heard about COPD. Nearly one-third spent time with smokers. Among all, 223 (57.3%) respondents had never heard and 46 (11.9%) respondents did not know anything about COPD. The majority correctly knew that the lungs are the primary organ affected by COPD (92, 79.3%). Age, sex, marital status, income, and occupation showed a significant association with COPD awareness. Nearly 41.4% knew that COPD progresses exclusively with age, COPD is more expensive for society than lung cancer (49.0%), cigarette smoking affects COPD (34.5%), COPD is fully recoverable with short-term antibiotics (35.0%), COPD lasts more than 18 months (48.1%), COPD can worsen with smoke exposure (37.4%), lead to disability (46.7%) and quitting smoking has an important role in preventing COPD (34.0%).

Conclusion

The awareness regarding the disease was low among the respondents. Only one-third correctly knew that quitting smoking has an important role in preventing COPD. This study projects an urgent need of improving awareness of COPD and its risk factors in the general population.

Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment

Chronic obstructive pulmonary disease (COPD) was traditionally thought to be caused by tobacco smoking. However, recognition of the importance of non-smoking-related risk factors for COPD has increased over the past decade, with evidence on the burden, risk factors, and clinical presentations of COPD in never-smokers. About half of all COPD cases worldwide are due to non-tobacco-related risk factors, which vary by geographical region. These factors include air pollution, occupational exposures, poorly controlled asthma, environmental tobacco smoke, infectious diseases, and low socioeconomic status. Impaired lung growth during childhood, caused by a range of early-life exposures, is associated with an increased risk of COPD. Potential mechanisms for the pathogenesis of COPD in never-smokers include inflammation, oxidative stress, airway remodelling, and accelerated lung ageing. Compared with smokers who develop COPD, never-smokers with COPD have relatively mild chronic respiratory symptoms, little or no emphysema, milder airflow limitation, and fewer comorbidities; however, exacerbations can still be frequent. Further research-including epidemiological, translational, clinical, and implementation studies-is needed to address gaps in understanding and to advance potential solutions to reduce the burden of COPD in never-smokers.

Assessment and diagnosis of chronic dyspnoea: a literature review

Dyspnoea or breathlessness is a common presenting symptom among patients attending primary care services. This review aimed to determine whether there are clinical tools that can be incorporated into a clinical decision support system for primary care for efficient and accurate diagnosis of causes of chronic dyspnoea. We searched MEDLINE, EMBASE and Google Scholar for all literature published between 1946 and 2020. Studies that evaluated a clinical algorithm for assessment of chronic dyspnoea in patients of any age group presenting to physicians with chronic dyspnoea were included. We identified 326 abstracts, 55 papers were reviewed, and eight included. A total 2026 patients aged between 20–80 years were included, 60% were women. The duration of dyspnoea was three weeks to 25 years. All studies undertook a stepwise or algorithmic approach to the assessment of dyspnoea. The results indicate that following history taking and physical examination, the first stage should include simply performed tests such as pulse oximetry, spirometry, and electrocardiography. If the patient remains undiagnosed, the second stage includes investigations such as chest x-ray, thyroid function tests, full blood count and NT-proBNP. In the third stage patients are referred for more advanced tests such as echocardiogram and thoracic CT. If dyspnoea remains unexplained, the fourth stage of assessment will require secondary care referral for more advanced diagnostic testing such as exercise tests. Utilising this proposed stepwise approach is expected to ascertain a cause for dyspnoea for 35% of the patients in stage 1, 83% by stage 3 and >90% of patients by stage 4.

Respiratory manifestations of Marfan syndrome: a narrative review

Objective

The prevalence of Marfan syndrome (MFS) is estimated to be 1 in 10,000 to 15,000 individuals, but the phenotype of MFS may not be apparent and hence its diagnosis may not be considered by clinicians. Furthermore, the effects of MFS on the lungs and breathing are underrecognized despite the high morbidity that can occur. The objective of this Narrative Review is to delineate the molecular consequences of a defective fibrillin-1 protein and the skeletal and lung abnormalities in MFS that may contribute to respiratory compromise. It is important for clinicians to be cognizant of these MFS-associated respiratory conditions, and a contemporaneous review is needed.

Background

MFS is an autosomal dominant, connective tissue disorder caused by mutations in the FIBRILLIN-1 (FBN1) gene, resulting in abnormal elastic fibers as well as increased tissue availability of transforming growth factor-beta (TGFβ), both of which lead to the protean clinical abnormalities. While these clinical characteristics are most often recognized in the cardiovascular, skeletal, and ocular systems, MFS may also cause significant impairment on the lungs and breathing.

Methods

We searched PubMed for the key words of “Marfan syndrome,” “pectus excavatum,” and “scoliosis” with that of “lung disease,” “breathing”, or “respiratory disease.” The bibliographies of identified articles were further searched for relevant articles not previously identified. Each relevant article was reviewed by one or more of the authors and a narrative review was composed.

Conclusions

Though the classic manifestations of MFS are cardiovascular, skeletal, and ocular, FBN1 gene mutation can induce a variety of effects on the respiratory system, inducing substantial morbidity and potentially increased mortality. These respiratory effects may include chest wall and spinal deformities, emphysema, pneumothorax, sleep apnea, and potentially increased incidence of asthma, bronchiectasis, and interstitial lung disease. Further research into approaches to prevent respiratory complications is needed, but improved recognition of the respiratory complications of MFS is necessary before this research is likely to occur.

Prognostic indicators for in-hospital mortality in COPD with acute exacerbation in Thailand: a retrospective cohort study

Background

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common and deteriorating event leading to in-hospital morbidity and mortality. Identification of predictors for in-hospital mortality of AECOPD patients could aid clinicians in identifying patients with a higher risk of death during their hospitalisation.

Objective

To explore potential prognostic indicators associated with in-hospital mortality of AECOPD patients.

Setting

General medical ward and medical intensive care unit of a university-affiliated tertiary care centre.

Methods

A prognostic factor research was conducted with a retrospective cohort design. All admission records of AECOPD patients between October 2015 and September 2016 were retrieved. Stratified Cox’s regression was used for the primary analysis.

Results

A total of 516 admission records of 358 AECOPD patients were included in this study. The in-hospital mortality rate of the cohort was 1.9 per 100 person-day. From stratified Cox’s proportional hazard regression, the predictors of in-hospital mortality were aged 80 years or more (HR=2.16, 95% CI: 1.26 to 3.72, p=0.005), respiratory failure on admission (HR=2.50, 95% CI: 1.12 to 5.57, p=0.025), body temperature more than 38°C (HR=2.97, 95% CI: 1.61 to 5.51, p=0.001), mean arterial pressure lower than 65 mm Hg (HR=4.01, 95% CI: 1.88 to 8.60, p<0.001), white blood cell count more than 15 x 10⁹/L (HR=3.51, 95% CI: 1.90 to 6.48, p<0.001) and serum creatinine more than 1.5 mg/dL (HR=2.08, 95% CI: 1.17 to 3.70, p=0.013).

Conclusion

Six independent prognostic indicators for in-hospital mortality of AECOPD patients were identified. All of the parameters were readily available in routine practice and can be used as an aid for risk stratification of AECOPD patients.

Factors Associated with Chronic Obstructive Pulmonary Diseases in Nepal: Evidence from a Nationally Representative Population-Based Study

Background

The Global Burden of Diseases Study 2017 predicted that chronic obstructive pulmonary disease (COPD) is the second leading cause of death, the fourth leading cause of premature death, and the third cause for DALYs lost in Nepal. However, data on the population-based prevalence of COPD in Nepal are very limited. This study aims to assess the prevalence of COPD and factors associated with the occurrence of COPD in Nepal.

Methods

From a nationally representative, population-based cross-sectional study on chronic non-communicable diseases, the prevalence of COPD and its associated factors was determined. Of 12,557 participants aged over 20 years, 8945 participants completed a questionnaire and spirometry. Eligible participants were also asked to answer a COPD diagnostic questionnaire for screening COPD cases, and if needed underwent pre-bronchodilator and post-bronchodilator spirometry. COPD was defined as a post-bronchodilator FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. Multivariate logistic regression was performed to identify factors associated with COPD. Sampling weights were used for all data analyses.

Results

The prevalence of COPD in Nepal was 11.7% (95% CI: 10.5% to 12.9 %), which increased with age, and higher in those with a low educational level, those who had smoked ≥50 pack-years, persons having a low body mass index (BMI), and residents of Karnali province. Multivariate analysis revealed that being aged 60 years and above, having a low BMI, low educational status, having smoked more than 50 pack-years, provincial distribution, and ethnicity were independent predictors of COPD.

Conclusion

COPD is a growing and serious public health issue in Nepal. Factor such as old age, cigarette smoking, low educational attainment, low BMI, ethnicity, and locality of residence (province-level variation) plays a vital role in the occurrence of COPD. Strategies aimed at targeting these risk factors through health promotion and education interventions are needed to decrease the burden of COPD.

COVID-19 and COPD

As of 11 July, 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic has infected over 12.7 million people around the world and caused more than 560,000 deaths [1]. Given the devastating impact that COVID-19 can have on the lung, it is natural to fear for patients with underlying COPD. Estimating their excess risk for contracting COVID-19 and, in particular, its more severe respiratory manifestations has been a challenging exercise in this pandemic for various reasons. First, the reporting on cases has concentrated on hospitalised and intensive care unit (ICU) patients, rather than on mild, outpatient cases. This is in part also due to the variability in testing strategies across the world, where some nations with stricter testing requirements and scarce testing resources have focused on testing only those requiring hospitalisation.

COPD patients have increased risk of severe pneumonia and poor outcomes when they develop COVID-19. This may be related to poor underlying lung reserves or increased expression of ACE-2 receptor in small airways.https://bit.ly/37dSB8l

Human rhinovirus infection and COPD: role in exacerbations and potential for therapeutic targets

INTRODUCTION

Respiratory virus infections (predominantly rhinoviruses) are the commonly identified in COPD exacerbations but debate about their role as a trigger of exacerbations continues. Experimental infection studies have provided significant new evidence establishing a causal relationship between virus infection and COPD exacerbations and contributed to a better understanding of the mechanisms of virus-induced exacerbations. However as yet no anti-viral treatments have undergone clinical trials in COPD patients.

AREAS COVERED

This review discusses the evidence for and against respiratory viruses being the main trigger of COPD exacerbations from both epidemiological studies and experimental infection studies. The host immune response to rhinovirus infection and how abnormalities in host immunity may underlie increased susceptibility to virus infection in COPD are discussed and the role of dual viral-bacterial infection in COPD exacerbations. Finally the current state of anti-viral therapy is discussed and how these may be used in the future treatment of COPD exacerbations.

EXPERT OPINION

Respiratory virus infections are the trigger of a substantial proportion of COPD exacerbations and rhinoviruses are the most common virus type. Clinical trials of anti-viral agents are needed in COPD patients to determine whether they are effective in virus-induced COPD exacerbations.

A case scenario study on adherence to COPD GOLD recommendations by general practitioners in a rural area of southern Italy: The "progetto PADRE"

The aim of the present study was to evaluate in a sample of 200 patients diagnosed with COPD and selected from the physician database of 15 general practices from Valle Telesina (Benevento, Italy) if the diagnostic-therapeutic algorithm adopted by GPs operating in a non-urban district in Southern Italy adhered to GOLD 2018 recommendations for COPD. Each patient underwent a specialist visit by an experienced chest physician that collected anamnesis, assessed mMRC and CAT scores, and performed a spirometry. In case of diagnostic doubt, a second visit was performed at the Pulmonary Rehabilitation Unit of the Istituti Clinici Scientifici Maugeri IRCCS in Telese Terme where other diagnostic tests were performed. Our results showed that GPs participating in the study often diagnosed and empirically treated COPD without a confirmative spirometry or even despite a spirometry that was not diagnostic of obstructive lung disease. Furthermore, real-life implementation of GOLD strategy, as regards patients' ABCD categorization, was poor and many patients belonging to groups A and B (39% and 48%, respectively) were over-treated and 19% of those belonging to group D were under-treated. The discrepancy between guidelines and daily clinical practice present also in this study supports the opinion of many that those who develop guidelines for the management of COPD must seriously try to understand if and why the guidelines might not reflect real life and therefore how it could be improved.

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PneumoLaus: Prevalence of Lung Function Abnormalities in a Sample of the General Population of Lausanne Abstract. Reduced lung function predicts increased mortality. The prevalence of spirometric abnormalities depends on their definition, the references values used and the use or not of bronchodilation. In the PneumoLaus study, conducted between 2014 and 2017 in a sample of the general population of Lausanne, prevalence of chronic obstruction was 3,8 %, of reversible obstruction 2,5 % and of possible restriction 2,2 %. These numbers are lower than in other population studies. Men had more abnormal spirometry results than women, and ever-smokers more than never-smokers. Two thirds of participants with chronic obstruction, most of which without respiratory symptoms, were not aware of any lung disease.

GLI 2012 equations define few spirometric anomalies in the general population: the PneumoLaus study

Background

Reduced lung function predicts increased mortality, but its prevalence may vary depending on definition considered, use of bronchodilation and applied reference values. We aimed to assess lung function abnormalities in Lausanne, Switzerland, and their association with clinical history.

Methods

In a general population sample, spirometry was performed and bronchodilation applied if the ratio forced expiratory volume in 1 s (FEV1) / forced vital capacity (FVC) or the FVC was below the lower limit of normal (LLN) according to Global Lung Function Initiative 2012 references. Results for FEV1/FVC according to the LLN were compared to the 0.7 fixed ratio. Respiratory risk factors, symptoms and self-reported respiratory diagnoses were recorded through a questionnaire.

Results

Out of the 3342 included subjects, 3.8% had chronic obstruction and 2.5% reversible obstruction when using the LLN; possible lung restriction alone was present in 1.8%, and associated with chronic obstruction in 0.4%. Ever smokers had a higher prevalence of abnormal spirometry, chronic obstruction and reversible obstruction; there was no difference with regard to possible restriction. Overall, chronic airway obstruction was found in 8.9% of current smokers, 4.6% of former smokers and 1.5% of never smokers. Only one third of participants with chronic obstruction were aware of a respiratory disease.

Conclusion

Prevalence of abnormal lung function in the population of Lausanne is low. This may be due to a low rate of ever-smokers, the application of a full bronchodilation dose, but also to inherent characteristics of this population.

Greater Access to Long Acting Beta2 Agonists Is Associated with Less Hospital Admissions Due to COPD: A Longitudinal Nation-Wide Study

PURPOSE

Long Acting Beta₂ Agonists (LABA) prevent COPD exacerbations in strictly standardized clinical trials. Our aim was to evaluate the relationship between the amount of LABA provided by the government and the trend in COPD hospital admission (HA) rate in Brazil.

METHODS

This is a longitudinal large-scale real-life study. We calculated COPD HA rate and the number of subjects per 10⁵ inhabitant who received LABA supplied by the government in each Brazilian municipality, between years 2004 and 2013. We used Poisson Multilevel Regression analysis to calculate the rate ratio between LABA dispensation rate and COPD HA rate.

RESULTS

In Brazil, COPD HA rate reduced 59% among subjects between 40 and 59 years of age and 60% among subjects older than 59 years of age. Most of the 5506 Brazilian municipalities reduced COPD HA rate [4149 (75%) municipalities & 1357 (25%) municipalities]. The dispensation of LABA was greater among municipalities that reduced COPD HA rate. In the 40-59 age group, the gap in LABA dispensation between the two groups of municipalities increased during the study period from 90.40 to 614.28 subjects per 10⁵ inhabitants. In the > 59 age group, the gap in LABA dispensation increased from 35.87 to 912.99 subjects per 10⁵ inhabitants. For each one hundred subjects who received LABA there was less one HA (RR 0.99, 95 CI 0.99-0.99).

CONCLUSIONS

COPD HA rate reduced in Brazil. LABA dispensation growth was associated with COPD HA rate reduction.

Epidemiology of chronic respiratory diseases and associated factors in the adult Italian population

Background

Detailed epidemiology of Chronic Respiratory Diseases (CRDs) and of their risk and protective factors is needed to plan preventive interventions to reduce the burden of CRDs on population health. This study determines the prevalence of doctor-diagnosed CRDs and its associated factors in the adult Italian population.

Methods

Data was collected from adults participating in the ongoing cross-sectional Italian Behavioural Risk Factor Surveillance System (PASSI) between 2013 and 2015.

Results

Among 108 705 respondents, 7.0% reported a CRD (3.4% asthma, 2.6% COPD, 1.0% Asthma-COPD Overlap Syndrome). Current smoking was more frequent in the group with CRD compared to those without (30.8% vs. 25.2%, P < 0.001), as was physical inactivity (41.9% vs. 36.4%, P 0.009) and overweight/obesity (52.4% vs. 41.4%, P 0.009). Adults with CRDs also reported appropriate perception of insufficient physical activity and excessive body weight, adopted protective behaviours and received preventive interventions more often than those without CRDs.

Conclusions

Italian adults with CRDs are more likely to be exposed to aggravating factors but are also knowledgeable of their condition and amenable to behaviour change. Since effective interventions for modifying these factors are available, there is an opportunity to reduce the significant disease burden of CRDs through specifically targeted health promotion interventions.

Prevalence and features of asthma-chronic obstructive pulmonary disease overlap in Northern Italy general population

OBJECTIVE

There is controversy about the diagnostic criteria, prevalence, symptoms, and spirometry characteristics of asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO). Recent data indicate that the fixed method for diagnosing airway obstruction (AO) may overestimate ACO prevalence in the elderly, and a variable method may be more accurate. We aimed at estimating ACO prevalence in a general population sample and comparing patient and clinical features in subjects with ACO, COPD, and asthma.

METHODS

We analyzed data from a cross-sectional study estimating COPD prevalence in randomly selected adults aged 20-79 years in Verona, Italy, and estimated prevalence and analyzed characteristics of asthma, COPD, and ACO. ACO was defined as AO (Forced Expiratory Volume in one second-FEV₁/ Forced Vital Capacity-FVC < Lower Limit of Normal-LLN), highly positive bronchodilator test (≥15% increase in FEV₁ and FVC ≥400 mL), and personal self-reported history of physician diagnosed asthma and atopy.

RESULTS

One thousand two hundred and thirty-six patients were included; 207 (16.7%) had asthma, COPD, or ACO (mean ages: 61.2, 59.7, and 57.2 years, respectively). The 3 groups had similar clinical and demographic variables; however, spirometry revealed differences between ACO and COPD patients, particularly post-bronchodilator FEV₁ reversibility, which was detected in ACO and asthma patients but not in those with COPD.

CONCLUSION

ACO prevalence in Northern Italy was estimated at 2.1%, in the range of values reported by previous studies. Marked differences between ACO and COPD revealed by spirometry may have important clinical implications in terms of treatment for patients with ACO.

Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique

Existing data on COPD prevalence are limited or totally lacking in many regions of Europe. The geographic information system inverse distance weighted (IDW) interpolation technique has proved to be an effective tool in spatial distribution estimation of epidemiological variables, when real data are few and widely separated. Therefore, in order to represent cartographically the prevalence of COPD in Europe, an IDW interpolation mapping was performed. The point prevalence data provided by 62 studies from 19 countries (21 from 5 Northern European countries, 11 from 3 Western European countries, 14 from 5 Central European countries, and 16 from 6 Southern European countries) were identified using validated spirometric criteria. Despite the lack of data in many areas (including all regions of the eastern part of the continent), the IDW mapping predicted the COPD prevalence in the whole territory, even in extensive areas lacking real data. Although the quality of the data obtained from some studies may have some limitations related to different confounding factors, this methodology may be a suitable tool for obtaining epidemiological estimates that can enable us to better address this major public health problem.

Prevalence of COPD in 6 Urban Clusters in Argentina: The EPOC.AR Study

INTRODUCTION

The prevalence of chronic obstructive pulmonary disease (COPD) has not been studied in Argentina.

OBJECTIVES

To determine the prevalence and relevant clinical characteristics of COPD in a representative sample.

MATERIAL AND METHODS

We performed a cross-sectional study in a population of adults aged ≥ 40 years randomly selected by cluster sampling in 6 urban locations. Subjects answered a structured survey and performed pre- and post-bronchodilator spirometry (PBD). COPD was defined as FEV₁/FVC ratio < 0.7 predicted value. The total prevalence was estimated for each cluster with its 95% confidence interval (CI).

RESULTS

Of 4,599 surveys and 3,999 spirometries, 3,469 were considered of adequate quality (86.8%) for our study. The prevalence of COPD was 14.5% (CI: 13.4-15.7). The distribution of COPD cases according to FEV1 (GOLD 2017) was stage 1: 38% (CI: 34-43); stage 2: 52% (CI: 47-56); stage 3: 10% (CI: 7-13); and stage 4: 1% (CI: 0-2), and according to the refined ABCD (GOLD 2017) assessment: A: 52% (CI: 47-56); B: 43% (CI: 39-48); C: 1% (CI: 0-2); D: 4% (CI: 2-6). The rate of underdiagnosis was 77.4% (CI 73.7-81.1%) and diagnostic error 60.7% (CI 55.1-66.3%). A significant association was found between COPD and age (OR 3.77 in individuals 50-59 years of age and 19.23 in those > 80 years), male gender (OR 1.62; CI 1.31-2), smoking (OR 1.95; CI 1.49-2.54), low socioeconomic status (OR 1.33; CI 1.02-1.73), and previous tuberculosis (OR 3.3; CI 1.43-7.62).

CONCLUSIONS

We estimate that more than 2.3 million Argentineans have COPD, with high rates of underdiagnosis and diagnostic error.

COPD management as a model for all chronic respiratory conditions: report of the 4th Consensus Conference in Respiratory Medicine

Background

Non-communicable diseases (NCDs) kill 40 million people each year. The management of chronic respiratory NCDs such as chronic obstructive pulmonary disease (COPD) is particularly critical in Italy, where they are widespread and represent a heavy burden on healthcare resources. It is thus important to redefine the role and responsibility of respiratory specialists and their scientific societies, together with that of the whole healthcare system, in order to create a sustainable management of COPD, which could become a model for other chronic respiratory conditions.

Methods

These issues were divided into four main topics (Training, Organization, Responsibilities, and Sustainability) and discussed at a Consensus Conference promoted by the Research Center of the Italian Respiratory Society held in Rome, Italy, 3–4 November 2016.

Results and conclusions

Regarding training, important inadequacies emerged regarding specialist training - both the duration of practical training courses and teaching about chronic diseases like COPD. A better integration between university and teaching hospitals would improve the quality of specialization. A better organizational integration between hospital and specialists/general practitioners (GPs) in the local community is essential to improve the diagnostic and therapeutic pathways for chronic respiratory patients. Improving the care pathways is the joint responsibility of respiratory specialists, GPs, patients and their caregivers, and the healthcare system. The sustainability of the entire system depends on a better organization of the diagnostic-therapeutic pathways, in which also other stakeholders such as pharmacists and pharmaceutical companies can play an important role.