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Cestelli L, Johannessen A, Gulsvik A, Stavem K, Nielsen R. Risk Factors, Morbidity, and Mortality in Association With Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern: Clinical Relevance of Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern. Chest 2024:S0012-3692(24)05078-5. [PMID: 39209063 DOI: 10.1016/j.chest.2024.08.026] [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: 06/13/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) and restrictive spirometric pattern (RSP) are often considered interchangeable in identifying restrictive impairment in spirometry. RESEARCH QUESTION Do PRISm and RSP have different individual associations with risk factors, morbidity, and mortality? STUDY DESIGN AND METHODS In a cross-sectional and longitudinal study, including 26,091 Norwegian general population men (30 to 46 years of age), we explored the association of PRISm and RSP with smoking habits, BMI, education, respiratory symptoms, self-reported cardiopulmonary disease, and mortality after 26 years of follow-up. PRISm was defined as FEV1/FVC ≥ lower limit of normal (LLN) and FEV1 < LLN, and RSP was defined as FEV1/FVC ≥ LLN and FVC < LLN. We compared the associations of PRISm and RSP to airflow obstruction and normal spirometry, both as mutually (PRISm alone, RSP alone) and nonmutually exclusive (PRISm, RSP) categories, adjusting for age, BMI, smoking, and education. We also conducted sensitivity analyses using Global Initiative for Chronic Obstructive Lung Disease criteria to define spirometric abnormalities. RESULTS The prevalence of the mutually exclusive spirometric patterns was as follows: normal 82.4%, obstruction 11.0%, PRISm alone 1.4%, RSP alone 1.7%, and PRISm + RSP 3.5%. PRISm alone patients were frequently obese (11.2%), had active or previous tobacco use, commonly reporting cough, phlegm, wheeze, asthma, and bronchitis. RSP alone patients were both obese (14.6%) and underweight (2.9%), with increased breathlessness, but similar smoking habits to patients with normal spirometry. The prevalence of heart disease was 4.6% in PRISm alone, 2.7% in RSP alone, and 1.6% in obstruction. With normal spirometry as a reference, RSP alone had increased all-cause (hazard ratio [HR], 1.57; 95% CI, 1.21-2.04), cardiovascular (HR, 1.48; 95% CI, 0.88-2.48), diabetes (HR, 6.43; 95% CI, 1.88-21.97), and cancer (excluding lung) mortality (HR, 1.51; 95% CI, 0.95-2.42). PRISm alone had increased respiratory disease mortality (HR, 4.00; 95% CI, 1.22-13.16). Patients with PRISm + RSP had intermediate characteristics and the worst prognosis. Findings were overall confirmed with nonmutually exclusive categories and Global Initiative for Chronic Obstructive Lung Disease criteria. INTERPRETATION PRISm and RSP are spirometric patterns with distinct risk factors, morbidity, and mortality, which should be differentiated in future studies.
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Affiliation(s)
- Lucia Cestelli
- Departments of Clinical Science, University of Bergen, Bergen.
| | - Ane Johannessen
- Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Departments of Clinical Science, University of Bergen, Bergen
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Rune Nielsen
- Departments of Clinical Science, University of Bergen, Bergen; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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Choi H, Oak CH, Jung MH, Jang TW, Nam SJ, Yoon T. Trend of prevalence and characteristics of preserved ratio impaired spirometry (PRISm): Nationwide population-based survey between 2010 and 2019. PLoS One 2024; 19:e0307302. [PMID: 39042610 PMCID: PMC11265705 DOI: 10.1371/journal.pone.0307302] [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: 05/15/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE This study aimed to evaluate the prevalence, trends, and factors of preserved ratio with impaired spirometry (PRISm) by using a nationally representative sample. PATIENTS AND METHODS The datasets of the Korea National Health and Nutrition Examination Survey 2010-2019 were used: of total 32,949 participants aged ≥40 and no missing data on spirometry, 24,523 with normal, 4,623 with obstructive, and 3,803 with PRISm were identified. PRISm was defined as FEV1/FVC ≥70% and FEV1% of the predicted value (%pred) <80. PRISm-lower limit of normal (LLN) was defined when FEV1/FVC ≥LLN and FEV1 RESULTS Estimated average prevalence of PRISm was 10.4% (PRISm-LLN 11.1%). Joinpoint regression analyses found a relatively stable trend of PRISm for both fixed ratio and LLN. The multivariable-adjusted logistic regression model showed female sex, BMI ≥25 kg/m2, metabolic syndrome, hypertriglyceridemia, abdominal obesity, low HDL-choleterol, hypertension, and diabetes were associated with the increased probability of PRISm. CONCLUSION Whenever a PRISm pattern is identified in a clinical context, it may be necessary to measure absolute lung volumes to investigate underlying physiological abnormalities and to identify factors that is modifiable.
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Affiliation(s)
- Hyunji Choi
- Department of Laboratory Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Chul-Ho Oak
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Mann-Hong Jung
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Tae-Won Jang
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Sung-Jin Nam
- Division of Pulmonology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Taemin Yoon
- Center for Future Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
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Ruiz-Rull C, Jaén-Moreno MJ, del Pozo GI, Gómez C, Montiel FJ, Alcántara M, Carrión L, Chauca GM, Feu N, Guler I, Rico-Villademoros F, Camacho-Rodríguez C, Gutierrez-Rojas L, Mannino D, Sarramea F. Low lung function in Bipolar Disorder and Schizophrenia: a hidden risk. Front Physiol 2024; 15:1335798. [PMID: 38737830 PMCID: PMC11084671 DOI: 10.3389/fphys.2024.1335798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/15/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction: People with serious mental illness (SMI), such as schizophrenia and bipolar disorder, have a higher risk of premature morbidity and mortality. In the general population, impaired lung function is associated with increased morbidity and mortality. We compared lung function between people with and without serious mental illnesses using a cross-sectional study in 9 community mental health units. Methods: Subjects aged 40-70 years with a diagnosis of schizophrenia or bipolar disorder were recruited consecutively. The controls had no psychiatric diagnosis and were not receiving any psychotropics. Spirometry was performed by a trained nurse. We used the 2021 American Thoracic Society/European Respiratory Society standards for the interpretation of the spirometry results. Results: We studied 287 subjects. People with SMI (n = 169) had lower spirometry values than those without a psychiatric diagnosis (n = 118). An abnormal spirometry pattern (36.1% vs 16.9%, p < 0.001), possible restriction or non-specific (Preserved Ratio Impaired Spirometry [PRISm]) pattern (17.8% vs 7.6%, p = 0.014), and pattern of airflow obstruction or possible mixed disorder (18.3% vs 9.3%, p = 0.033) were more frequent in people with SMI. Multivariate analyses showed that the PRISm pattern was associated with abdominal circumference (odds ratio [OR] 1.05, 95%CI 1.03-1.08) and that the pattern of airflow obstruction or possible mixed disorder was associated with smoking behavior (OR 5.15, 95%CI 2.06-15.7). Conclusion: People with SMI have impaired lung function, with up to one-third of them showing an abnormal spirometry pattern. This suggests that regular monitoring of lung function and addressing modifiable risk factors, such as tobacco use and obesity, in this population is of paramount importance.
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Affiliation(s)
- Cristina Ruiz-Rull
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Centro de Salud Cruz de Caravaca, Almería, Spain
| | - María José Jaén-Moreno
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Departamento de Ciencias Morfológicas y Sociosanitarias, Universidad de Córdoba, Córdoba, Spain
| | - Gloria Isabel del Pozo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Cristina Gómez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, Jaen, Spain
| | - Francisco Javier Montiel
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, Jaen, Spain
| | - Montserrat Alcántara
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Laura Carrión
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - Geli Marie Chauca
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - Nuria Feu
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ipek Guler
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Área de Gestión de la Investigación, Córdoba, Spain
| | | | | | - Luis Gutierrez-Rojas
- Instituto de Neurociencias, Universidad de Granada, Granada, Spain
- Departamento de Psiquiatria, Universidad de Granada, Granada, Spain
| | - David Mannino
- University of Kentucky, Chief Medical Officer, COPD Foundation, Lexington, KY, United States
| | - Fernando Sarramea
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Departamento de Ciencias Morfológicas y Sociosanitarias, Universidad de Córdoba, Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
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He D, Yan M, Zhou Y, Ge H, Zhang X, Xu Y, Liu C, Ying K, Zhu Y. Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression: Evidence From a Prospective Cohort Study. Chest 2024; 165:573-582. [PMID: 37499976 DOI: 10.1016/j.chest.2023.07.020] [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: 12/28/2022] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND COPD has been found to be associated with frailty. However, longitudinal evidence for associations of COPD with frailty progression is inadequate. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm) findings. Associations of PRISm findings and their transitions with frailty progression are unclear. RESEARCH QUESTION What are the associations of PRISm findings, transitions of PRISm findings, and COPD with frailty progression? STUDY DESIGN AND METHODS To analyze the associations of PRISm findings and COPD with frailty progression, 5,901 patients were included from the English Longitudinal Study of Ageing. Patients were classified into three lung function patterns of normal spirometry (NS) findings, PRISm findings, and COPD. Frailty progression was assessed by repeated measurements of the frailty index (FI) during follow-up. Among these 5,901 patients, 3,765 patients were included to analyze the associations of PRISm findings transitions with frailty progression. PRISm findings transitions were assessed based on the changes of lung function patterns after a 4-year interval. Linear mixed-effect models were used for statistical analyses. RESULTS The median follow-up periods were 9.5 years for the analyses of PRISm findings and COPD with frailty progression and 5.8 years for PRISm findings transitions with frailty progression. When compared with participants with NS findings, patients with PRISm findings and COPD demonstrated accelerated FI progression with additional annual increases of 0.301 (95% CI, 0.211-0.392; P < .001) and 0.172 (95% CI, 0.102-0.242; P < .001), respectively. Patients who transitioned from NS findings to PRISm findings also demonstrated accelerated FI progression when compared with those with stable NS findings (β = 0.242; 95% CI, 0.008-0.476; P = .042). However, no accelerated FI progression was found in patients with PRISm findings who transitioned to NS findings (β = 0.119; 95% CI, -0.181 to 0.418; P = .438). INTERPRETATION Our findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty.
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Affiliation(s)
- Di He
- Department of Epidemiology & Biostatistics, School of Public Health, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China; Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Mengsha Yan
- Department of Epidemiology & Biostatistics, School of Public Health, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China; Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yong Zhou
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Huiqing Ge
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xuhui Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yuying Xu
- Department of Epidemiology & Biostatistics, School of Public Health, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China; Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Chengguo Liu
- Putuo District People's Hospital, Zhoushan, Zhejiang, China
| | - Kejing Ying
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China; Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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Zhang Y, Peng J, Liu L, Cui H, Zang D, Wu Z, Guo D, Liu X, Lu F, Yang J. Prevalence, characteristics and significant predictors for cardiovascular disease of patients with preserved ratio impaired spirometry: A 10-year prospective cohort study in China. Respir Med 2024; 222:107523. [PMID: 38171404 DOI: 10.1016/j.rmed.2023.107523] [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: 09/12/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Patients with preserved ratio impaired spirometry (PRIsm) have higher incidence rate of cardiovascular disease (CVD). However, few studies focused on PRIsm in China. We determined the prevalence and characteristics of patients with PRIsm in Chinese population. We also aimed to investigate the significant predictive factors of CVD in PRIsm patients. METHODS In total, 6994 subjects aged from 35 to 70 years old and free of CVD at baseline were categorized into normal (n = 3895), PRIsm (the ratio of forced expired volume in the first second (FEV1) to forced vital capacity (FVC) ≥0.7 and FEV1 <80 % predicted; n = 1997) and obstructive spirometry (FEV1:FVC<0.7; n = 1102). Cox proportional hazards multivariable regression was performed to investigate how baseline characteristics impact CVD incidence. RESULTS In participants with PRIsm, men had a 0.68-fold higher risk of CVD incidence than women (HR, 1.68; 95%CI, 1.09-2.59; p = 0.020). Our study showed that the rate of CVD incidence increased by 6.0 % with every year's increase in age (HR, 1.06; 95%CI, 1.04-1.09; p < 0.001). A 0.1 increase in FEV1/FVC was significantly associated with a 23.0 % decrease in CVD incidence (HR, 0.77; 95%CI, 0.61-0.97; p = 0.028). Family history of CVD greatly increased the risk of cardiovascular disease incidence (HR, 1.83; 95%CI, 1.18-2.83; p = 0.007). Higher BMI was also a significant risk factor of CVD incidence (HR, 1.06; 95%CI, 1.01-1.10; p = 0.013). CONCLUSION The prevalence of PRIsm in China was high. PRIsm subjects should be monitored carefully, especially for the older, male, those with higher BMI, lower FEV1/FVC and family history of CVD.
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Affiliation(s)
- Yerui Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Jie Peng
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, China
| | - Li Liu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Huiliang Cui
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Dejin Zang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhenguo Wu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Dachuan Guo
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaoyu Liu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China; Department of Cardiology, People Hospital of Huantai County, Zibo, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Shandong Academy of Medical Sciences, Jinan, China
| | - Jianmin Yang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, China; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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Carsin AE, Garcia-Aymerich J, Accordini S, Dharmage S, Leynaert B, de Las Heras M, Casas L, Caviezel S, Demoly P, Forsberg B, Gislason T, Corsico AG, Janson C, Jogi R, Martínez-Moratalla J, Nowak D, Gómez LP, Pin I, Probst-Hensch N, Raherison-Semjen C, Squillacioti G, Svanes C, Torén K, Urrutia I, Huerta I, Anto JM, Jarvis D, Guerra S. Spirometric patterns in young and middle-aged adults: a 20-year European study. Thorax 2024; 79:153-162. [PMID: 37758456 DOI: 10.1136/thorax-2022-219696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/19/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Understanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of restrictive and obstructive spirometric patterns occurring before 40 years (young onset) and between 40 and 61 years (mid-adult onset). METHODS We used data from the population-based cohort of the European Community Respiratory Health Survey (ECRHS). Prebronchodilator forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were assessed longitudinally at baseline (ECRHS1, 1993-1994) and again 20 years later (ECRHS3, 2010-2013). Spirometry patterns were defined as: restrictive if FEV1/FVC≥LLN and FVC<10th percentile, obstructive if FEV1/FVC RESULTS Among 3502 participants (mean age=30.4 (SD 5.4) at ECRHS1, 50.4 (SD 5.4) at ECRHS3), 2293 (65%) had a normal, 371 (11%) a young restrictive, 301 (9%) a young obstructive, 187 (5%) a mid-adult onset restrictive and 350 (10%) a mid-adult onset obstructive spirometric pattern. Being lean/underweight in childhood and young adult life was associated with the occurrence of the young spirometric restrictive pattern (relative risk ratio (RRR)=1.61 95% CI=1.21 to 2.14, and RRR=2.43 95% CI=1.80 to 3.29; respectively), so were respiratory infections before 5 years (RRR=1.48, 95% CI=1.05 to 2.08). The main determinants for young obstructive, mid-adult restrictive and mid-adult obstructive patterns were asthma, obesity and smoking, respectively. CONCLUSION Spirometric patterns with onset in young and mid-adult life were associated with distinct characteristics and risk factors.
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Affiliation(s)
- Anne-Elie Carsin
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
- Biometrics, RTI-Health Solutions, Barcelona, Spain
| | - Judith Garcia-Aymerich
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Univ Paris-Sud, Inserm, INSERM, Paris, France
| | - Marti de Las Heras
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
- Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Antwerpen, Belgium
| | - Seraina Caviezel
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Pascal Demoly
- Département de Pneumologie et Addictologie, University Hospital of Montpellier, Montpellier, France
- IDESP, University of Montpellier - Inserm UMR UA11, Montpellier, France
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Medical Faculty, University of Iceland, Iceland, Iceland
| | - Angelo Guido Corsico
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy, Italy
- Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo-University of Pavia, Pavia, Italy
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | | | - Dennis Nowak
- Institute and Clinic for Occupational and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, member DZL, German Centre for Lung Research, Munich, Germany
| | | | - Isabelle Pin
- Department of Pediatrics, CHU de Grenoble Alpes, Grenoble, France
- Inserm, UMR 1209, Institute for Advanced Biosciences, Grenoble, France
| | - Nicole Probst-Hensch
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, Torino, Piemonte, Italy
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kjell Torén
- Department of Occupational and Environmental, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabel Urrutia
- Pulmonology Department, Galdakao Hospital, Biocruces Bizkaia, Spain
| | - Ismael Huerta
- Epidemiological Surveillance Section, Directorate General of Public Health, Oviedo, Spain
| | - Josep Maria Anto
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Universita Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Spain
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College, London, UK
| | - Stefano Guerra
- ISGlobal, Campus mar, Barcelona, Catalunya, Spain
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Arizona, USA
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Backman H, Sawalha S, Nilsson U, Hedman L, Stridsman C, Vanfleteren LEGW, Nwaru BI, Stenfors N, Rönmark E, Lindberg A. All-cause and cause-specific mortality by spirometric pattern and sex - a population-based cohort study. Ther Adv Respir Dis 2024; 18:17534666241232768. [PMID: 38465828 DOI: 10.1177/17534666241232768] [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] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated. OBJECTIVES To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF). DESIGN Population-based prospective cohort study. METHODS Individuals with CAO [FEV1/vital capacity (VC) < 0.70], RSP [FEV1/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV1/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine-Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years. RESULTS The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31-2.02 and 1.24, 1.06-1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05-6.82 and 1.40, 1.04-1.90). The hazard of respiratory death was significant in women (3.41, 1.05-11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01-2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05-6.82) but not for cardiovascular death (1.11, 0.74-1.66), with a similar pattern in both sexes. CONCLUSION The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.
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Affiliation(s)
- Helena Backman
- Section of Sustainable Health/The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sami Sawalha
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Section of Sustainable Health/The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lowie E G W Vanfleteren
- COPD Center, Sahlgrenska University Hospital, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Center, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- Section of Sustainable Health/The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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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.
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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
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9
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Pesonen I, Johansson F, Johnsson Å, Blomberg A, Boijsen M, Brandberg J, Cederlund K, Egesten A, Emilsson ÖI, Engvall JE, Frølich A, Hagström E, Lindberg E, Malinovschi A, Stenfors N, Swahn E, Tanash H, Themudo R, Torén K, Vanfleteren LE, Wollmer P, Zaigham S, Östgren CJ, Sköld CM. High prevalence of interstitial lung abnormalities in middle-aged never-smokers. ERJ Open Res 2023; 9:00035-2023. [PMID: 37753274 PMCID: PMC10518870 DOI: 10.1183/23120541.00035-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/03/2023] [Indexed: 09/28/2023] Open
Abstract
Background Interstitial lung abnormalities (ILA) are incidental findings on chest computed tomography (CT). These patterns can present at an early stage of fibrotic lung disease. Our aim was to estimate the prevalence of ILA in the Swedish population, in particular in never-smokers, and find out its association with demographics, comorbidities and symptoms. Methods Participants were recruited to the Swedish CArdioPulmonary BioImage Study (SCAPIS), a population-based survey including men and women aged 50-64 years performed at six university hospitals in Sweden. CT scan, spirometry and questionnaires were performed. ILA were defined as cysts, ground-glass opacities, reticular abnormality, bronchiectasis and honeycombing. Findings Out of 29 521 participants, 14 487 were never-smokers and 14 380 were men. In the whole population, 2870 (9.7%) had ILA of which 134 (0.5%) were fibrotic. In never-smokers, the prevalence was 7.9% of which 0.3% were fibrotic. In the whole population, age, smoking history, chronic bronchitis, cancer, coronary artery calcium score and high-sensitive C-reactive protein were associated with ILA. Both ILA and fibrotic ILA were associated with restrictive spirometric pattern and impaired diffusing capacity of the lung for carbon monoxide. However, individuals with ILA did not report more symptoms compared with individuals without ILA. Interpretation ILA are common in a middle-aged Swedish population including never-smokers. ILA may be at risk of being underdiagnosed among never-smokers since they are not a target for screening.
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Affiliation(s)
- Ida Pesonen
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Åse Johnsson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Marianne Boijsen
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Brandberg
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Arne Egesten
- Respiratory Medicine, Allergology, and Palliative Medicine, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Össur Ingi Emilsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Jan E. Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Andreas Frølich
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Eva Swahn
- Department of Cardiology and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hanan Tanash
- Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Raquel Themudo
- Department of Clinical Science, Intervention and Technology at Karolinska Institute, Division of Medical Imaging and Technology, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lowie E.G.W. Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Suneela Zaigham
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Carl Johan Östgren
- CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - C. Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
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10
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Schiffers C, Ofenheimer A, Breyer MK, Mraz T, Lamprecht B, Burghuber OC, Hartl S, Wouters EFM, Breyer-Kohansal R. Prevalence of restrictive lung function in children and adults in the general population. Respir Med 2023; 210:107156. [PMID: 36870424 DOI: 10.1016/j.rmed.2023.107156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Restrictive lung function (RLF) is characterized by a reduced lung expansion and size. In the absence of lung volume measurements, restriction can be indirectly assessed with restrictive spirometric patterns (RSP) by spirometry. Prevalence data on RLF by the golden standard body plethysmography in the general population are scarce. Therefore, we aimed to evaluate the prevalence of RLF and RSP in the general population by body plethysmography and to determine factors influencing RLF and RSP. METHODS Pre-bronchodilation lung function data of 8891 subjects (48.0% male, age 6-82 years) have been collected in the LEAD Study, a single-centered, longitudinal, population-based study from Vienna, Austria. The cohort was categorized in the following groups based on the Global Lung Initiative reference equations: normal subjects, RLF (TLC < lower limit of normal (LLN)), RSP (FEV1/FVC ≥ LLN and a FVC < LLN), RSP only (RSP with TLC ≥ LLN). Normal subjects were considered those with FEV1, FVC, FEV1/FVC and TLC between LLN and ULN (upper limit of normal). RESULTS The prevalence of RLF and RSP in the Austrian general population is 1.1% and 4.4%. Spirometry has a positive and negative predictive value of 18.0% and 99.6% to predict a restrictive lung function. Central obesity was associated with RLF. RSP was related to smoking and underweight. CONCLUSIONS The prevalence of true restrictive lung function and RSP in the Austrian general population is lower than previously estimated. Our data confirm the need for direct lung volume measurement to diagnose true restrictive lung function.
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Affiliation(s)
| | - Alina Ofenheimer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Medical Center, Maastricht, the Netherlands
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Tobias Mraz
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Bernd Lamprecht
- Department of Pulmonology and Faculty of Medicine, Kepler University Hospital, Linz, Austria
| | - Otto Chris Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria; Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Medical Center, Maastricht, the Netherlands
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
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11
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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.
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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.
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12
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Saavedra JM, Brellenthin AG, Song BK, Lee DC, Sui X, Blair SN. Associations of cardiorespiratory fitness and body mass index with incident restrictive spirometry pattern. Br J Sports Med 2023:bjsports-2022-106136. [PMID: 36609350 PMCID: PMC10323034 DOI: 10.1136/bjsports-2022-106136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Restrictive spirometry pattern (RSP) suggests an impairment of lung function associated with a significantly increased risk of premature mortality. We evaluated the independent and joint associations of cardiorespiratory fitness (CRF) and body mass index with incident RSP. METHODS Data from the Aerobics Centre Longitudinal Study included 12 360 participants (18-82 years). CRF was assessed by maximal treadmill test and categorised into five groups. Body mass index was categorised into normal weight (<25.0 kg/m2), overweight (25.0-29.9 kg/m2) or obesity (≥30.0 kg/m2). RSP was defined as the simultaneous occurrence of forced expiratory volume in 1 s/force vital capacity ≥lower limit of normal and forced vital capacity <lower limit of normal. RESULTS There were 900 (7.3%) cases of RSP (mean follow-up: 6.9 years). Compared with category 1 ('least fit'), HRs (95% CIs) of RSP were 0.78 (0.63 to 0.96), 0.68 (0.54 to 0.86), 0.70 (0.55 to 0.88) and 0.59 (0.45 to 0.77) in categories 2, 3, 4 and 5 (most fit), respectively, after adjusting for confounders including body mass index. Compared with normal weight, HRs (95% CIs) of RSP were 1.06 (0.91 to 1.23) and 1.30 (1.03 to 1.64) in overweight and obese, respectively. However, the association between obesity and RSP was attenuated when additionally adjusting for CRF (HR 1.08, 95% CI 0.84 to 1.39). Compared with the 'unfit and overweight/obese' group, HRs (95% CIs) for RSP were 1.35 (0.98 to 1.85), 0.77 (0.63 to 0.96) and 0.70 (0.56 to 0.87) in the 'unfit and normal weight,' 'fit and overweight/obese' and 'fit and normal weight' groups, respectively. CONCLUSIONS Low CRF was associated with a greater incidence of RSP, irrespective of body mass index. Future studies are needed to explore potential underlying mechanisms of this association and to prospectively evaluate if improving CRF reduces the risk of developing RSP.
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Affiliation(s)
- Joey M Saavedra
- Department of Kinesiology, Iowa State University, Ames, Iowa, USA
| | | | - Bong Kil Song
- Department of Kinesiology, Iowa State University, Ames, Iowa, USA
| | - Duck-Chul Lee
- Department of Kinesiology, Iowa State University, Ames, Iowa, USA
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Steven N Blair
- Departments of Exercise Science and Epidemiology & Biostatistics, University of South Carolina, Columbia, South Carolina, USA
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13
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Cortes-Telles A, Figueroa-Hurtado E, Ortiz-Farias DL, Zavorsky GS. Clinical predictors of lung function in patients recovering from mild COVID-19. BMC Pulm Med 2022; 22:294. [PMID: 35909118 PMCID: PMC9339191 DOI: 10.1186/s12890-022-02086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Few studies have assessed lung function in Hispanic subjects recovering from mild COVID-19. Therefore, we examined the prevalence of impaired pulmonary diffusing capacity for carbon monoxide (DLCO) as defined by values below the lower limit of normal (< LLN, < 5th percentile) or less than 80% of predicted in Hispanics recovering from mild COVID-19. We also examined the prevalence of a restrictive spirometric pattern as defined by the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) being ≥ LLN with the FVC being < LLN. Finally, we evaluated previous studies to find factors correlated to impaired DLCO post-COVID-19.
Methods In this observational study, adult patients (n = 146) with mild COVID-19 were recruited from a long-term follow-up COVID-19 clinic in Yucatan, Mexico, between March and August 2021. Spirometry, DLCO, and self-reported signs/symptoms were recorded 34 ± 4 days after diagnosis. Results At post-evaluation, 20% and 30% of patients recovering from COVID-19 were classified as having a restrictive spirometric pattern and impaired DLCO, respectively; 13% had both. The most prevalent reported symptoms were fatigue (73%), a persistent cough (43%), shortness of breath (42%) and a blocked/runny nose (36%). Increased age and a restrictive spirometric pattern increased the probability of having an impaired DLCO while having a blocked nose and excessive sweating decreased the likelihood. The proportion of patients with previous mild COVID-19 and impaired DLCO increased by 13% when the definition of impaired DLCO was < 80% predicted instead of below the LLN. When comparing previous studies, having severe COVID-19 increased the proportion of those with impaired DLCO by 21% compared to those with mild COVID-19. Conclusions One-third of patients with mild COVID-19 have impaired DLCO thirty-four days post-diagnosis. The criteria that define impaired DLCO and the severity of COVID-19 disease affects the proportion of those with impaired DLCO at follow-up. One-fifth of patients have a restrictive spirometric pattern. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02086-9.
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14
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Kim BG, Choi YS, Shin SH, Lee K, Um SW, Kim H, Jeon YJ, Lee J, Cho JH, Kim HK, Kim J, Shim YM, Jeong BH. Mortality and lung function decline in patients who develop chronic pulmonary aspergillosis after lung cancer surgery. BMC Pulm Med 2022; 22:436. [PMID: 36418999 PMCID: PMC9682797 DOI: 10.1186/s12890-022-02253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Lung cancer surgery is reported as a risk factor for chronic pulmonary aspergillosis (CPA). However, limited data are available on its clinical impact. We aimed to determine the effect of developed CPA after lung cancer surgery on mortality and lung function decline. METHODS We retrospectively identified the development of CPA after lung cancer surgery between 2010 and 2016. The effect of CPA on mortality was evaluated using multivariable Cox proportional hazard analyses. The effect of CPA on lung function decline was evaluated using multiple linear regression analyses. RESULTS During a median follow-up duration of 5.01 (IQR, 3.41-6.70) years in 6777 patients, 93 developed CPA at a median of 3.01 (IQR, 1.60-4.64) years. The development of CPA did not affect mortality in multivariable analysis. However, the decline in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were greater in patients with CPA than in those without (FVC, - 71.0 [- 272.9 to - 19.4] vs. - 10.9 [- 82.6 to 57.9] mL/year, p < 0.001; FEV1, - 52.9 [- 192.2 to 3.9] vs. - 20.0 [- 72.6 to 28.6] mL/year, p = 0.010). After adjusting for confounding factors, patients with CPA had greater FVC decline (β coefficient, - 103.6; 95% CI - 179.2 to - 27.9; p = 0.007) than those without CPA. However, the FEV1 decline (β coefficient, - 14.4; 95% CI - 72.1 to 43.4; p = 0.626) was not significantly different. CONCLUSION Although the development of CPA after lung cancer surgery did not increase mortality, the impact on restrictive lung function deterioration was profound.
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Affiliation(s)
- Bo-Guen Kim
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Yong Soo Choi
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Hye Shin
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Kyungjong Lee
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Sang-Won Um
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Hojoong Kim
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Yeong Jeong Jeon
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junghee Lee
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- grid.264381.a0000 0001 2181 989XDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- grid.264381.a0000 0001 2181 989XDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
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15
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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.
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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
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16
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Cause-specific Death in Chronic Airway Obstruction and Restrictive Spirometric Pattern. Ann Am Thorac Soc 2022; 19:1783-1787. [DOI: 10.1513/annalsats.202203-243rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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17
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Sobel M, Navas-Acien A, Powers M, Grau-Perez M, Goessler W, Best LG, Umans J, Oelsner EC, Podolanczuk A, Sanchez TR. Environmental-level exposure to metals and metal-mixtures associated with spirometry-defined lung disease in American Indian adults: Evidence from the Strong Heart Study. ENVIRONMENTAL RESEARCH 2022; 207:112194. [PMID: 34653410 PMCID: PMC8810711 DOI: 10.1016/j.envres.2021.112194] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND American Indians have a higher burden of chronic lung disease compared to the US average. Several metals are known to induce chronic lung disease at high exposure levels; however, less is known about the role of environmental-level metal exposure. We investigated respiratory effects of exposure to single metals and metal-mixtures in American Indians who participated in the Strong Heart Study. METHODS We included 2077 participants with data on 6 metals (As, Cd, Mo, Se, W, Zn) measured from baseline urine samples (1989-1991) and who underwent spirometry testing at follow-up (1993-1995). We used generalized linear regression to assess associations of single metals with spirometry-defined measures of airflow limitation and restrictive ventilatory pattern, and continuous spirometry. We used Bayesian Kernel Machine Regression to investigate the joint effects of the metal-mixture. Sensitivity analyses included stratifying by smoking status and diabetes. RESULTS Participants were 40% male, with median age 55 years. 21% had spirometry-defined airflow limitation, and 14% had a restrictive ventilatory pattern. In individual metal analyses, Cd was associated with higher odds of airflow limitation and lower FEV1 and FEV1/FVC. Mo was associated with higher odds of restrictive ventilatory pattern and lower FVC. Metal-mixtures analyses confirmed these models. In smoking stratified analyses, the overall metal-mixture was linearly and positively associated with airflow limitation among non-smokers; Cd was the strongest contributor. For restrictive ventilatory pattern, the association with the overall metal-mixture was strong and linear among participants with diabetes and markedly attenuated among participants without diabetes. Among those with diabetes, Mo and Zn were the major contributors. CONCLUSIONS Environmental-level exposure to several metals was associated with higher odds of spirometry-defined lung disease in an American Indian population. Exposure to multiple metals, including Cd and Mo, may have an under-recognized adverse role on the respiratory system.
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Affiliation(s)
- Marisa Sobel
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 West 168th St. NY, NY, 10032, USA.
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 West 168th St. NY, NY, 10032, USA.
| | - Martha Powers
- Department of Sociology and Anthropology, Northeastern University, 1135 Tremont Street, 900 Renaissance Park, Boston, MA, 02115, USA.
| | - Maria Grau-Perez
- Biomedical Research Institute of Valencia (INCLIVA), C. de Menéndez y Pelayo, 4, 46010, Valencia, Spain.
| | - Walter Goessler
- Institute of Chemistry, Universität Graz, Universitätsplatz 3, 8010, Graz, Austria.
| | - Lyle G Best
- Missouri Breaks Industries Research, 118 South Willow St, Eagle Butte, SD, 57625, USA.
| | - Jason Umans
- Division of Nephrology and Hypertension, Department of Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, D.C, USA.
| | - Elizabeth C Oelsner
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA.
| | - Anna Podolanczuk
- Pulmonary Critical Care Medicine, Weill Cornell Medicine, 425 E 61st St, New York, NY, 10065, USA.
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, 722 West 168th St. NY, NY, 10032, USA.
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18
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Martinez-Arnau FM, Buigues C, Fonfría-Vivas R, Cauli O. Respiratory function correlates with fat mass index and blood triglycerides in institutionalized older individuals. Endocr Metab Immune Disord Drug Targets 2022; 22:1029-1039. [PMID: 35352657 DOI: 10.2174/1871530322666220329150813] [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: 11/17/2021] [Revised: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated the relationship between respiratory function measured by spirometry analysis and anthropometric variables (skeletal and fat mass) and nutritional status in the institutionalized elderly, particularly at high risk of adverse outcomes after respiratory infections and malnutrition. DESIGN A multicenter cross-sectional study with quantitative approach among older people institutionalized living in nursing homes. METHODS Respiratory function was assessed by measuring the forced vital capacity, forced expiratory volume in the first second, the ratio between FEV1 and FVC (FEV1/FVC), and peak expiratory flow in percentage by means of spirometric analysis (values of the forced expiratory volume measured during the first second of the forced breath (FEV1) and forced vital capacity (FVC)). Nutritional assessment and anthropometry analysis were done to evaluate under or over nutrition/weight. RESULTS There was a significant (p<0.05) and positive correlation between FEV1 and skeletal muscle mass index, whereas fat mass index correlated significantly (p<0.01) with the FEV1/FVC index. FEV1/FVC values were both significantly (p<0.05) associated with high body mass index and triglyceride levels in blood. The prevalence of individuals with ventilator restrictive pattern (FEV1/FVC>70% with FEV1 and FVC<80%) was 27.6% and 12 individuals (21.1%) receive daily bronchodilators as part of the pharmacological treatment for respiratory disorders. A logistic regression was performed to identify predictors of restrictive respiratory pattern. The following variables were entered into the model: age group, female gender, Charlson comorbidity index, body-mass index (BMI), fat mass index, skeletal muscle mass index, total cholesterol and triglycerides concentration. The model was statistically significant (p < 0.05; R2 = 0.39), correctly classifying 70.0% of cases, with a sensitivity of 89.3% and a specificity of 50.0%. Area under curve was 0.71 (IC95% 0.54-0.88; p=0.023). The highest OR for restrictive respiratory pattern were for BMI (OR=5.09) and triglycerides concentration in blood (>150 mg/dl) (OR=5.59). CONCLUSION The relationship between a restrictive pattern of respiratory function and fat mass which deserves future investigation to manage these parameters as possible modifiable factor of altered respiratory function in overweight institutionalized older individuals.
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Affiliation(s)
- Francisco Miguel Martinez-Arnau
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
| | - Cristina Buigues
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
| | - Rosa Fonfría-Vivas
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
| | - Omar Cauli
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
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19
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Eze JN, Ozoh OB, Otuu FC, Shu EN, Anyaehie BU. Respiratory symptoms and lung function among inmates in a Nigerian prison: a cross sectional study. BMC Pulm Med 2022; 22:84. [PMID: 35287649 PMCID: PMC8918425 DOI: 10.1186/s12890-022-01882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Prisoners in low- and middle-income countries are vulnerable to poor lung health from multiple adverse conditions confronted within the prison such as overcrowding, poor ventilation and exposure to second hand smoke. Evidence for poor lung health in this disadvantaged group is needed to inform policy on prison conditions in this region. We assessed the respiratory symptoms and lung function measured by spirometry among prisoners in Enugu, Nigeria and explored the associations between them.
Methods This was a cross‑sectional study among prison inmates aged 16–76 years. We assessed frequency of respiratory symptoms in the preceding one-year, previous respiratory diagnosis, tobacco smoking status and spirometry. The relationships between respiratory symptoms, smoking status and spirometry pattern were determined using the Chi‑square test. Results Of 245 participants, 170 (69.4%) reported at least one respiratory symptom. In all, 214 (87.3%) performed spirometry and 173 (80.8%) had good quality spirometry tests. Using the Global Lung Function Initiative (GLI) predicted values for ‘African Americans’, spirometry results were abnormal in 41 (23.7%) of the participants and when the GLI reference values for ‘Other’ ethnic groups was applied, 78 (45.1%) had abnormal results. Restrictive impairment was most common occurring in 21 (12.1%) and 59 (34.1%) respectively based on the two reference values, and obstructive pattern was found in 18 (10.4%) and 13 (7.5%) respectively. There was no significant association between abnormal spirometry pattern and presence of respiratory symptoms or smoking status. No previous diagnosis for asthma, or bronchitis/chronic obstructive pulmonary disease (COPD) had been made in any of the participants. Conclusions We reported high rates of respiratory symptoms and abnormal lung function with under-diagnosis of chronic respiratory diseases among inmates in Enugu prison. The restrictive abnormalities based on GLI equations remain unexplained. There is need for improvement in prison facilities that promote lung health and enhanced access to diagnosis and treatment of respiratory non-communicable disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01882-7.
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Affiliation(s)
- Joy Nkiru Eze
- Department of Paediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, 400001, Nigeria.
| | - Obianuju Beatrice Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | | | - Elvis Neba Shu
- Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Bond Ugochukwu Anyaehie
- Department of Human Physiology, Faculty of Basic Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
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20
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Wan ES, Hokanson JE, Regan EA, Young KA, Make BJ, DeMeo DL, Mason SE, San Jose Estepar R, Crapo JD, Silverman EK. Significant Spirometric Transitions and Preserved Ratio Impaired Spirometry Among Ever Smokers. Chest 2022; 161:651-661. [PMID: 34592319 PMCID: PMC8941606 DOI: 10.1016/j.chest.2021.09.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Emerging data from longitudinal studies suggest that preserved ratio impaired spirometry (PRISm), defined by proportionate reductions in FEV1 and FVC, is a heterogeneous population with frequent transitions to other lung function categories relative to individuals with normal and obstructive spirometry. Controversy regarding the clinical significance of these transitions exists (eg, whether transitions merely reflect measurement variability or noise). RESEARCH QUESTION Are individuals with PRISm enriched for transitions associated with substantial changes in lung function? STUDY DESIGN AND METHODS Current and former smokers enrolled in the Genetic Epidemiology of COPD (COPDGene) study with spirometry available in phases 1 through 3 (enrollment, 5-year follow-up, and 10-year follow-up) were analyzed. Postbronchodilator lung function categories were as follows: PRISm (FEV1 < 80% predicted with FEV1/FVC ratio ≥ 0.7), Global Initiative for Chronic Obstructive Lung Disease grade 0 (FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7), and obstruction (FEV1/FVC < 0.7). Significant transition status was affirmative if a subject belonged to two or more spirometric categories and had > 10% change in FEV1 % predicted and/or FVC % predicted between consecutive visits. Ever-PRISm was present if a subject had PRISm at any visit. Logistic regression examined the association between significant transitions and ever-PRISm status, adjusted for age, sex, race, FEV1 % predicted, current smoking, pack-years, BMI, and ever-positive bronchodilator response. RESULTS Among subjects with complete data (N = 1,775) over 10.1 ± 0.4 years of follow-up, the prevalence of PRISm remained consistent (10.4%-11.3%) between phases 1 through 3, but nearly one-half of subjects with PRISm transitioned into or out of PRISm at each visit. Among all subjects, 19.7% had a significant transition; ever-PRISm was a significant predictor of significant transitions (unadjusted OR, 10.3; 95% CI, 7.9-13.5; adjusted OR, 14.9; 95% CI, 10.9-20.7). Results were similar with additional adjustment for radiographic emphysema and gas trapping, when lower limit of normal criteria were used to define lung function categories, and when FEV1 alone (regardless of change in FVC % predicted) was used to define significant transitions. INTERPRETATION PRISm is an unstable group, with frequent significant transitions to both obstruction and normal spirometry over time. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT000608764; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA,Pulmonary & Critical Care Section, VA Boston Healthcare System, Boston, MA,CORRESPONDENCE TO: Emily S. Wan, MD, MPH
| | - John E. Hokanson
- University of Colorado, Denver, CO,Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - Elizabeth A. Regan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO,National Jewish Health, Denver, CO
| | - Kendra A. Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | | | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Stefanie E. Mason
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | | | | | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
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21
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Myrberg T, Lindberg A, Eriksson B, Hedman L, Stridsman C, Lundbäck B, Rönmark E, Backman H. Restrictive spirometry versus restrictive lung function using the GLI reference values. Clin Physiol Funct Imaging 2022; 42:181-189. [PMID: 35225428 PMCID: PMC9311670 DOI: 10.1111/cpf.12745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Restrictive lung function may indicate various underlying diseases. The aim of this study was to evaluate the accuracy of different restrictive spirometry patterns (RSPs) to identify restrictive lung function (total lung capacity [TLC] < lower limit of normal [LLN]) according to reference values by the Global Lung Function Initiative (GLI) in a wide age-ranged, general population sample. METHODS A general population sample (n = 607, age 23-72 years, smokers 18.8%) with proper dynamic spirometry and TLC measurements, was included. Accuracy of two main categories of RSP to identify TLC < LLN were evaluated: traditional RSPs (definition 1: FVC < 80% of predicted and FEV1 /FVC ≥ 0.7 and definition 2: FVC < LLN and FEV1 /FVC ≥ LLN) and RSPs defined by Youden's method (definition 3: FVC < 85.5% of predicted and FEV1 /FVC ≥ LLN and definition 4: FVC Z-score < -1.0 and FEV1 /FVC ≥ LLN). RESULTS The prevalence of restrictive lung function (TLC < LLN) was 5.3%. The most accurate cut-offs for FVC to identify TLC < LLN were 85.5% for FVC% of predicted, and -1.0 for FVC Z-score. The traditional RSP definitions 1 and 2 had higher specificity (95.0% and 96.9%) but substantially lower sensitivity compared to RSP definitions 3 and 4. CONCLUSION Based on the GLI reference values, the RSP definition FVC < LLN and FEV1 /FVC ≥ LLN yielded the highest specificity and may appropriately be used to rule out restrictive lung function. The RSP definition with the most favourable trade-off between sensitivity and specificity, FVC < 85.5% of predicted and FEV1 /FVC ≥ LLN, may serve as an alternative with higher sensitivity for screening.
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Affiliation(s)
- Tomi Myrberg
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Berne Eriksson
- Department of Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
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22
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Kulbacka-Ortiz K, Triest FJJ, Franssen FME, Wouters EFM, Studnicka M, Vollmer WM, Lamprecht B, Burney PGJ, Amaral AFS, Vanfleteren LEGW. Restricted spirometry and cardiometabolic comorbidities: results from the international population based BOLD study. Respir Res 2022; 23:34. [PMID: 35177082 PMCID: PMC8855577 DOI: 10.1186/s12931-022-01939-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background Whether restricted spirometry, i.e. low Forced Vital Capacity (FVC), predicts chronic cardiometabolic disease is not definitely known. In this international population-based study, we assessed the relationship between restricted spirometry and cardiometabolic comorbidities. Methods A total of 23,623 subjects (47.5% males, 19.0% current smokers, age: 55.1 ± 10.8 years) from five continents (33 sites in 29 countries) participating in the Burden of Obstructive Lung Disease (BOLD) study were included. Restricted spirometry was defined as post-bronchodilator FVC < 5th percentile of reference values. Self-reports of physician-diagnosed cardiovascular disease (CVD; heart disease or stroke), hypertension, and diabetes were obtained through questionnaires. Results Overall 31.7% of participants had restricted spirometry. However, prevalence of restricted spirometry varied approximately ten-fold, and was lowest (8.5%) in Vancouver (Canada) and highest in Sri Lanka (81.3%). Crude odds ratios for the association with restricted spirometry were 1.60 (95% CI 1.37–1.86) for CVD, 1.53 (95% CI 1.40–1.66) for hypertension, and 1.98 (95% CI 1.71–2.29) for diabetes. After adjustment for age, sex, education, Body Mass Index (BMI) and smoking, the odds ratios were 1.54 (95% CI 1.33–1.79) for CVD, 1.50 (95% CI 1.39–1.63) for hypertension, and 1.86 (95% CI 1.59–2.17) for diabetes. Conclusion In this population-based, international, multi-site study, restricted spirometry associates with cardiometabolic diseases. The magnitude of these associations appears unattenuated when cardiometabolic risk factors are taken into account.
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Affiliation(s)
- Katarzyna Kulbacka-Ortiz
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Filip J J Triest
- CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, AZ Sint-Lucas, Gent, Belgium.,Department of Respiratory Medicine, MUMC+, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Frits M E Franssen
- CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, MUMC+, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Emiel F M Wouters
- CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.,Department of Respiratory Medicine, MUMC+, Maastricht University Medical Centre, Maastricht, the Netherlands.,Ludwig Boltzman Institute for Lung Health, Vienna, Austria
| | - Michael Studnicka
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | | | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler-University-Hospital, Linz, Austria.,Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Peter G J Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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23
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Higbee DH, Granell R, Davey Smith G, Dodd JW. Prevalence, risk factors, and clinical implications of preserved ratio impaired spirometry: a UK Biobank cohort analysis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:149-157. [PMID: 34739861 DOI: 10.1016/s2213-2600(21)00369-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is defined as a FEV1 of less than 80% predicted and a FEV1/forced vital capacity (FVC) ratio of 0·70 or higher. Previous research has indicated that PRISm is associated with respiratory symptoms and is a precursor of chronic obstructive pulmonary disease (COPD). However, these findings are based on relatively small selective cohorts with short follow-up. We aimed to determine the prevalence, risk factors, clinical implications, and mortality of PRISm in a large adult general population. METHODS For this cohort analysis, we used data from the UKBiobank to assess PRISm prevalence, risk factors and associated symptoms, and associated comorbidities in a large adult population. Participants with spirometry deemed acceptable by an investigator (best measure FEV1 and FVC values) at baseline were included. Participants were excluded if they did not have acceptable spirometry or were missing data on body-mass index or smoking status. Control spirometry was defined as a FEV1 of 80% or more predicted and a FEV1/FVC ratio of 0·70 or higher. Airflow obstruction was defined as a FEV1/FVC ratio of less than 0·70. We used multivariable regression to determine risk factors for PRISm and associated comorbidities. Individuals who lived within close proximity to an assessment centre were invited for follow-up, with repeat spirometry. Only participants who had been included at baseline were examined in follow-up. This allowed for a longitudinal analysis of PRISm over time and risk factors for transition to airflow obstruction. We also did the survival analysis for a 12-year period. FINDINGS Participants were recruited by UK Biobank between Dec 19, 2006, and Oct 10, 2010. We included 351 874 UK Biobank participants (189 247 women and 162 627 men) in our study, with a median follow-up of 9·0 years (IQR 8·0-10·0). 38 639 (11·0%) of 351 874 participants had PRISm at baseline. After adjustment, PRISm was strongly associated with obesity (odds ratio [OR] 2·40 [2·26-2·55], p<0·0001), current smoking (1·48 [1·36-1·62], p<0·0001), and patient reported doctor-diagnosed asthma (1·76 [1·66-1·88], p<0·0001). Other risk factors identified included female sex, being overweight, trunk fat mass, and trunk fat percentage. PRISm was strongly associated with symptoms and comorbidity including increased risk of breathlessness (adjusted OR 2·0 [95% CI 1·91-2·14], p<0·0001) and cardiovascular disease (adjusted OR 1·71 [1·64-1·83], p<0·0001 for heart attack). Longitudinal analysis showed that 241 (12·2%) of 1973 participants who had PRISm at baseline had transitioned to airflow obstruction consistent with COPD. PRISm was associated with increased all-cause mortality (adjusted hazard ratio 1·61 [95% CI 1·53-1·69], p<0·0001) versus control participants. INTERPRETATION PRISm was associated with breathlessness, multimorbidity, and increased risk of death, which does not seem to be explained by smoking, obesity, or existing lung disease. Although for many patients PRISm is transient, it is important to understand which individuals are at risk of progressive lung function abnormalities. Further research into the genetic, structural and functional pathophysiology of PRISm is warranted. FUNDING UK Medical Research Council and University of Bristol.
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Affiliation(s)
- Daniel H Higbee
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Raquel Granell
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - James W Dodd
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK.
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24
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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.
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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
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25
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Frenzel S, Bis JC, Gudmundsson EF, O’Donnell A, Simino J, Yaqub A, Bartz TM, Brusselle GGO, Bülow R, DeCarli CS, Ewert R, Gharib SA, Ghosh S, Gireud-Goss M, Gottesman RF, Ikram MA, Knopman DS, Launer LJ, London SJ, Longstreth W, Lopez OL, Melo van Lent D, O’Connor G, Satizabal CL, Shrestha S, Sigurdsson S, Stubbe B, Talluri R, Vasan RS, Vernooij MW, Völzke H, Wiggins KL, Yu B, Beiser AS, Gudnason V, Mosley T, Psaty BM, Wolters FJ, Grabe HJ, Seshadri S. Associations of Pulmonary Function with MRI Brain Volumes: A Coordinated Multi-Study Analysis. J Alzheimers Dis 2022; 90:1073-1083. [PMID: 36213999 PMCID: PMC9712227 DOI: 10.3233/jad-220667] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies suggest poor pulmonary function is associated with increased burden of cerebral white matter hyperintensities and brain atrophy among elderly individuals, but the results are inconsistent. OBJECTIVE To study the cross-sectional associations of pulmonary function with structural brain variables. METHODS Data from six large community-based samples (N = 11,091) were analyzed. Spirometric measurements were standardized with respect to age, sex, height, and ethnicity using reference equations of the Global Lung Function Initiative. Associations of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and their ratio FEV1/FVC with brain volume, gray matter volume, hippocampal volume, and volume of white matter hyperintensities were investigated using multivariable linear regressions for each study separately and then combined using random-effect meta-analyses. RESULTS FEV1 and FVC were positively associated with brain volume, gray matter volume, and hippocampal volume, and negatively associated with white matter hyperintensities volume after multiple testing correction, with little heterogeneity present between the studies. For instance, an increase of FVC by one unit was associated with 3.5 ml higher brain volume (95% CI: [2.2, 4.9]). In contrast, results for FEV1/FVC were more heterogeneous across studies, with significant positive associations with brain volume, gray matter volume, and hippocampal volume, but not white matter hyperintensities volume. Associations of brain variables with both FEV1 and FVC were consistently stronger than with FEV1/FVC, specifically with brain volume and white matter hyperintensities volume. CONCLUSION In cross-sectional analyses, worse pulmonary function is associated with smaller brain volumes and higher white matter hyperintensities burden.
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Affiliation(s)
- Stefan Frenzel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Adrienne O’Donnell
- Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jeannette Simino
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Traci M. Bartz
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Guy G. O. Brusselle
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Charles S. DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, CA, USA
- Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology, University of California-Davis, Davis, CA, USA
| | - Ralf Ewert
- Department of Internal Medicine B, Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Sina A. Gharib
- Center for Lung Biology, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Saptaparni Ghosh
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
| | - Monica Gireud-Goss
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
| | - Rebecca F. Gottesman
- Stroke, Cognition, and Neuroepidemiology (SCAN) section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Lenore J. Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA
| | - Stephanie J. London
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA
| | - W.T. Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Oscar L. Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debora Melo van Lent
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
| | - George O’Connor
- Framingham Heart Study, Framingham, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
- Department of Population Health Sciences, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
| | - Srishti Shrestha
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Beate Stubbe
- Department of Internal Medicine B, Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Rajesh Talluri
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ramachandran S. Vasan
- Framingham Heart Study, Framingham, MA, USA
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alexa S. Beiser
- Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Neurology, Boston School of Medicine, Boston, MA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thomas Mosley
- Gertrude C. Ford Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Neurology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Disease (DZNE), partner site Rostock/Greifswald, Germany
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University Schoolof Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer and Neurodegenerative Diseases, The University of Texas Health Science Center at San Antonio, SanAntonio, TX, USA
- Department of Neurology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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26
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Wang G, Hallberg J, Charalampopoulos D, Sanahuja MC, Breyer-Kohansal R, Langhammer A, Granell R, Vonk JM, Mian A, Olvera N, Laustsen LM, Rönmark E, Abellan A, Agusti A, Arshad SH, Bergström A, Boezen HM, Breyer MK, Burghuber O, Bolund AC, Custovic A, Devereux G, Donaldson GC, Duijts L, Esplugues A, Faner R, Ballester F, Garcia-Aymerich J, Gehring U, Haider S, Hartl S, Backman H, Holloway JW, Koppelman GH, Lertxundi A, Holmen TL, Lowe L, Mensink-Bout SM, Murray CS, Roberts G, Hedman L, Schlünssen V, Sigsgaard T, Simpson A, Sunyer J, Torrent M, Turner S, Van den Berge M, Vermeulen RCH, Vikjord SAA, Wedzicha JA, Maitland van der Zee AH, Melén E. Spirometric phenotypes from early childhood to young adulthood: a Chronic Airway Disease Early Stratification study. ERJ Open Res 2021; 7:00457-2021. [PMID: 34881328 PMCID: PMC8646001 DOI: 10.1183/23120541.00457-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts. Methods We studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV1/FVC z-score ≥LLN, and FVC z-score <LLN. Results The prevalence of obstructive and restrictive phenotypes varied from 3.2–10.9% and 1.8–7.7%, respectively, without clear age trends. A diagnosis of asthma (adjusted odds ratio (aOR=2.55, 95% CI 2.14–3.04), preterm birth (aOR=1.84, 1.27–2.66), maternal smoking during pregnancy (aOR=1.16, 95% CI 1.01–1.35) and family history of asthma (aOR=1.44, 95% CI 1.25–1.66) were associated with a higher prevalence of obstructive, but not restrictive, phenotype across ages (5–25 years). A higher current body mass index (BMI was more often observed in those with the obstructive phenotype but less in those with the restrictive phenotype (aOR=1.05, 95% CI 1.03–1.06 and aOR=0.81, 95% CI 0.78–0.85, per kg·m−2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24, 95% CI 1.05–1.46). Conclusion Obstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with the obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes. Obstructive and restrictive phenotypes are present from childhood to adulthood but without age trends. Established risk factors for airway disease are associated with the obstructive phenotype, whereas low BMI is associated with the restrictive.https://bit.ly/3BMoMtI
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Affiliation(s)
- Gang Wang
- Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China.,Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Shared first authors
| | - Jenny Hallberg
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Shared first authors
| | - Dimitrios Charalampopoulos
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maribel Casas Sanahuja
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Dept of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
| | - Arnulf Langhammer
- Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | - Raquel Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judith M Vonk
- Dept of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Annemiek Mian
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Núria Olvera
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Institut d'investigacions biomediques August Pi I Sunyer, Barcelona, Spain
| | - Lisbeth Mølgaard Laustsen
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Eva Rönmark
- Dept of Public Health and Clinical Medicine, Section for Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Alicia Abellan
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Alvar Agusti
- Institut d'investigacions biomediques August Pi I Sunyer, Barcelona, Spain.,Respiratory Institute, Hospital Clinic, Univ. Barcelona, Barcelona, Spain.,CIBERESP (ISCiii), Barcelona, Spain
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - H Marike Boezen
- Dept of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Dept of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
| | - Otto Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Anneli Clea Bolund
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ana Esplugues
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Nursing Department, Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain.,Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Rosa Faner
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ferran Ballester
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Nursing Department, Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain.,Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sadia Haider
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Dept of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Helena Backman
- Dept of Public Health and Clinical Medicine, Section for Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - John W Holloway
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gerard H Koppelman
- University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands.,Dept of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands
| | - Aitana Lertxundi
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Dept of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, Spain.,BIODONOSTIA Health Research Institute, Donostia-San Sebastian, Spain
| | - Turid Lingaas Holmen
- Dept of Public Health and General Practice, HUNT Research Center, NTNU, Levanger, Norway
| | - Lesley Lowe
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, UK.,Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sara M Mensink-Bout
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, UK.,Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Roberts
- David Hide Asthma and Allergy Research Centre, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Linnea Hedman
- Dept of Public Health and Clinical Medicine, Section for Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Vivi Schlünssen
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, UK.,Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,IMIM-Parc Salut Mar, Barcelona, Spain
| | | | - Stephen Turner
- Royal Aberdeen Children's Hospital NHS Grampian, Aberdeen, UK
| | - Maarten Van den Berge
- University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands.,Dept of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sigrid Anna Aalberg Vikjord
- Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway.,Dept of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Anke H Maitland van der Zee
- Dept of Respiratory Medicine, Amsterdam University Medical Centers (UMC), University of Amsterdam.,Pediatric Respiratory Medicine, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,Shared last authors
| | - Erik Melén
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Shared last authors
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He D, Sun Y, Gao M, Wu Q, Cheng Z, Li J, Zhou Y, Ying K, Zhu Y. Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging. Front Med (Lausanne) 2021; 8:755855. [PMID: 34859011 PMCID: PMC8631955 DOI: 10.3389/fmed.2021.755855] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Preserved ratio impaired spirometry (PRISm), characterized by the decreased forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) with a preserved FEV1/FVC ratio, is highly prevalent and heterogeneous. We aimed to identify the subtypes of PRISm and examine their differences in clinical characteristics, long-term mortality risks, and longitudinal transition trajectories. Methods: A total of 6,616 eligible subjects were included from the English longitudinal study of aging. Two subtypes of the PRISm were identified as mild PRISm (either of FEV1 and FVC <80% predicted value, FEV1/FVC ≥0.7) and severe PRISm (both FEV1 and FVC <80% predicted values, FEV1/FVC ≥0.7). Normal spirometry was defined as both FEV1 and FVC ≥80% predicted values and FEV1/FVC ≥0.7. Hazard ratios (HRs) and 95% CIs were calculated by the multiple Cox regression models. Longitudinal transition trajectories were described with repeated spirometry data. Results: At baseline, severe PRISm had increased respiratory symptoms, including higher percentages of phlegm, wheezing, dyspnea, chronic bronchitis, and emphysema than mild PRISm. After an average of 7.7 years of follow-up, severe PRISm significantly increased the risks of all-cause mortality (HR=1.91, 95%CI = 1.58–2.31), respiratory mortality (HR = 6.02, 95%CI = 2.83–12.84), and CVD mortality (HR = 2.11, 95%CI = 1.42–3.13) compared with the normal spirometry, but no significantly increased risks were found for mild PRISm. In the two longitudinal transitions, mild PRISm tended to transition toward normal spirometry (40.2 and 54.7%), but severe PRISm tended to maintain the status (42.4 and 30.4%) or transition toward Global Initiative for Chronic Obstructive Lung Disease (GOLD)2–4 (28.3 and 33.9%). Conclusion: Two subtypes of PRISm were identified. Severe PRISm had increased respiratory symptoms, higher mortality risks, and a higher probability of progressing to GOLD2–4 than mild PRISm. These findings provided new evidence for the stratified management of PRISm.
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Affiliation(s)
- Di He
- Department of Respiratory Diseases, Sir Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, China.,Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yilan Sun
- Department of Respiratory and Critical Care Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Musong Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Qiong Wu
- Department of Respiratory Diseases, Sir Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, China.,Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Zongxue Cheng
- Department of Respiratory Diseases, Sir Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, China.,Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Jun Li
- Department of Respiratory Diseases, Sir Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, China.,Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Yong Zhou
- Department of Respiratory Diseases, Sir Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, China
| | - Kejing Ying
- Department of Respiratory Diseases, Sir Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, China
| | - Yimin Zhu
- Department of Respiratory Diseases, Sir Run Shaw Hospital Affiliated to School of Medicine, Zhejiang University, Hangzhou, China.,Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
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Mannino DM. Insights into the Spectrum of Chronic Lower Respiratory Disease: Low Lung Function Is Still Bad. Am J Respir Crit Care Med 2021; 204:873-874. [PMID: 34379999 PMCID: PMC8534620 DOI: 10.1164/rccm.202107-1637ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- David M Mannino
- University of Kentucky College of Medicine University of Kentucky Lexington, Kentucky
- COPD Foundation Miami, Florida
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29
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Zeng X, Liu D, An Z, Li H, Song J, Wu W. Obesity parameters in relation to lung function levels in a large Chinese rural adult population. Epidemiol Health 2021; 43:e2021047. [PMID: 34353001 PMCID: PMC8602009 DOI: 10.4178/epih.e2021047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/03/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The association between obesity parameters and lung function indicators in the general Chinese rural adult population remains unclear. METHODS In total, 8,284 Chinese adults aged 20 years to 80 years old from Xinxiang were recruited. Obesity-related parameters, including body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waistto-height ratio (WHtR), body fat percentage (BFP), basal metabolism, and visceral fat index, and lung function parameters such as forced vital capacity and forced expiratory volume in first second were measured. RESULTS The total prevalence of obesity defined by BMI, WC, WHR, WHtR, and BFP was 23.2%, 58.2%, 66.7%, 69.2%, and 56.5%, respectively. Spearman correlation analyses showed significant correlations between all obesity-related parameters and lung function. Linear regression analyses further demonstrated that BMI, WHtR, BFP, and general obesity defined using those indicators were negatively associated with lung function, while WC, WHR, and central obesity defined accordingly were positively associated with lung function. The relationship between general obesity and lung function was more evident in women than in men, while the link between central obesity and lung function was more obvious in men than in women. CONCLUSIONS Obesity is closely related to lung function in the general Chinese adult population. Weight control and loss are important strategies to improve lung function and respiratory health.
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Affiliation(s)
- Xiang Zeng
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, Henan, China.,Laboratory of Environmental Medicine and Developmental Toxicology, Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, Guangdong, China
| | - Dongling Liu
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, China
| | - Zhen An
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, Henan, China
| | - Huijun Li
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, Henan, China
| | - Jie Song
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, Henan, China
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, 601 Jinsui Road, Xinxiang 453003, Henan, China
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30
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Kim J, Lee CH, Lee HY, Kim H. Association between Comorbidities and Preserved Ratio Impaired Spirometry: Using the Korean National Health and Nutrition Examination Survey IV-VI. Respiration 2021; 101:25-33. [PMID: 34320510 DOI: 10.1159/000517599] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) patients have more frequent respiratory symptoms and an increased risk of mortality. However, studies on comorbidities in these patients are lacking. OBJECTIVES We investigated the association between PRISm and comorbidities using the Korea National Health and Nutrition Examination Survey (KNHANES). METHOD This cross-sectional study included participants aged ≥50 years from the KNHANES (2007-2015). Participants who did not undergo spirometry or performed inadequately were excluded. We classified participants into 3 groups according to spirometry: PRISm (forced expiratory volume in one second [FEV1] /forced vital capacity [FVC] ≥ 0.7 and FEV1 <80%), chronic obstructive pulmonary disease (COPD) (FEV1/ FVC <0.7), and normal. Multivariate logistic regression analyses were used to evaluate the risk of comorbidities in the PRISm group compared to that in the normal group. RESULT The study included 17,515 participants: 12,777 (73.0%), 1,563 (8.9%), and 3,175 (18.1%) in normal, PRISm, and COPD groups, respectively. After adjustment for known risk factors of each disease, hypertension (adjusted odds ratio [95% confidence interval]; 1.31 [1.14-1.50]), diabetes (1.51 [1.29-1.78]), hypercholesterolemia (1.20 [1.04-1.37]), obesity (1.31 [1.15-1.48]), ischemic heart disease (1.58 [1.13-2.22]), chronic renal disease (2.31 [1.09-4.88]), and thyroid disease (1.41 [1.09-1.83]) risks were significantly higher in the PRISm group than in the normal group. The average number of comorbidities was 2.45 in the PRISm group, which was higher than that in the normal (2.1) and COPD (2.03) groups (p < 0.05). CONCLUSION The number of comorbidities was significantly higher in the PRISm group than in others. Hypertension, diabetes, obesity, ischemic heart disease, chronic renal disease, and thyroid disease were associated with PRISm after adjustment for risk factors.
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Affiliation(s)
- Joohae Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea, .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea,
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ha Youn Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Serim Hospital, Incheon, Republic of Korea
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.,Institute for Sustainable Development, Seoul National University, Seoul, Republic of Korea
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Marott JL, Ingebrigtsen TS, Çolak Y, Vestbo J, Lange P. Trajectory of Preserved Ratio Impaired Spirometry: Natural History and Long-Term Prognosis. Am J Respir Crit Care Med 2021; 204:910-920. [PMID: 34233141 DOI: 10.1164/rccm.202102-0517oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Natural history of Preserved Ratio Impaired Spirometry (PRISm), often defined as FEV1/FVC≥lower limit of normal and FEV1<80% of predicted value, is not well-described. OBJECTIVE To investigate natural history and long-term prognosis of PRISm trajectories: persistent PRISm trajectory (individuals with PRISm both as young and as middle-aged); normal-to-PRISm trajectory (individuals developing PRISm from normal spirometry in young adulthood); and PRISm-to-normal trajectory (individuals recovering from PRISm in young adulthood by normalizing spirometry while middle-aged). METHODS We followed 1160 individuals aged 20-40 years from the Copenhagen City Heart Study from 1976-83 until 2001-03 to determine their lung function trajectory: 72 had persistent PRISm trajectory, 76 normal-to-PRISm trajectory, 155 PRISm-to-normal trajectory, and 857 had normal trajectory. From 2001-03 until 2018, we determined risk of cardiopulmonary disease and death. MEASUREMENTS AND MAIN RESULTS We recorded 198 admissions for heart disease, 143 for pneumonia, and 64 for COPD, and 171 deaths. Compared to individuals with normal trajectory, hazards ratios for individuals with persistent PRISm trajectory were 1.55 (95% CI, 0.91-2.65) for heart disease admission, 2.86 (1.70-4.83) for pneumonia admission, 6.57 (3.41-12.66) for COPD admission, and 3.68 (2.38-5.68) for all-cause mortality. Corresponding hazards ratios for individuals with normal-to-PRISm trajectory were 1.91 (1.24-2.95), 2.74 (1.70-4.42), 6.03 (3.41-10.64), and 2.96 (1.94-4.51), respectively. Prognosis of individuals with PRISm-to-normal trajectory did not differ from those with normal trajectory. CONCLUSIONS PRISm in middle-aged individuals is associated with increased risk of cardiopulmonary disease and all-cause mortality, but individuals who recover from PRISm during their adult life are no longer at increased risk.
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Affiliation(s)
- Jacob Louis Marott
- Frederiksberg Hospital, The Copenhagen City Heart Study, Copenhagen, Denmark
| | | | - Yunus Çolak
- Herlev and Gentofte Hospital, Copenhagen University Hospital , Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev, Denmark
| | - Jørgen Vestbo
- The University of Manchester, 5292, Division of Infection, Immunity and Respiratory Medicine, Manchester, United Kingdom of Great Britain and Northern Ireland.,Manchester University NHS Foundation Trust, 5293, North West Lung Centre, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Peter Lange
- University of Copenhagen, Department of Public Health, Copenhagen, Denmark.,HVidovre Hospital, Respiratory Medicine, Hvidovre, Denmark;
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Spirometric restrictive ventilatory pattern and type 2 diabetes mellitus in a tertiary hospital in Cameroon: A comparative study. Respir Med Res 2021; 79:100816. [PMID: 33640845 DOI: 10.1016/j.resmer.2021.100816] [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: 07/17/2020] [Revised: 12/20/2020] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective of this study was to assess the association between spirometric restrictive ventilatory pattern (sRVP) and type 2 diabetes mellitus (T2DM) and investigate factors associated with sRVP in subjects with T2DM. MATERIALS AND METHODS In this comparative cross-sectional study, subjects with T2DM (diabetes group) were compared to a group of subjects without diabetes (non-diabetes group) from December 2018 to March 2019 (4months) at the National Obesity Center of the Yaoundé Central Hospital. sRVP was defined as the ratio of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) above the lower limit of normal, and FVC<80% of predicted values. Logistic regression was used to identify factors associated with sRVP. RESULTS Overall 277 subjects were included in each group. The prevalence [95% confidence interval (95% CI)] of sRVP in the diabetes and non-diabetes groups was 39.4 (33.6-45.1) % and 34.3 (28.9-40.1) %, P=0.218. After multivariate analysis, we did not find an independent association between s sRVP and T2DM [odds ratio (95% CI): 1.13 (0.79-1.63), P=0.418]. The only independent factor associated with sRVP in subjects with T2DM was the presence of chronic vascular complications [odds ratio (95% CI): 1.99 (1.11-3.55), P=0.019]. CONCLUSION One-third of patients with type 2 diabetes mellitus have sRVP. There is no independent association between sRVP and T2DM. The presence of chronic vascular complications is associated with sRVP in T2DM. Diagnosis of sRVP in subjects with T2DM presenting chronic vascular complications would help to provide a holistic management.
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Lee MK, Kim SB, Lee JH, Lee SJ, Kim SH, Lee WY, Yong SJ, Lee JH, Shin B. Association between airflow limitation and prognosis in patients with chronic pulmonary aspergillosis. J Thorac Dis 2021; 13:681-688. [PMID: 33717541 PMCID: PMC7947530 DOI: 10.21037/jtd-20-1815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Previous studies have shown that reduced levels of lung function, characterized by forced expiratory volume in 1 second (FEV1), are associated with higher respiratory events and mortality in general population and some chronic lung diseases. Chronic pulmonary aspergillosis (CPA) is a destructive, fatal lung disease caused by Aspergillus infection in non-immunocompromised patients with suboptimal pulmonary function. However, there is limited information on the status and features of CPA according to FEV1. Methods We performed a retrospective observational study to investigate the FEV1 and airflow limitation in patients with CPA between March 2017 and February 2019 at a tertiary hospital in South Korea. Results Of the 144 CPA patients, 104 underwent spirometry, demonstrating median forced vital capacity (FVC) and FEV1 of 2.35 L (68%) and 1.43 L (62%), respectively. Among them, 56 patients had airflow limitation on PFT, with median FVC, and FEV1 of 2.47 L (73%) and 1.11 L (47%), respectively. Low body mass index (BMI) (20.1 vs. 22.1 kg/m2; P=0.011), breathlessness (60% vs. 20%; P=0.002), and bilateral pulmonary lesions (33.3% vs. 4%; P=0.006) were more common in patients with moderate to very severe airflow limitation than in those with normal to mild airflow limitation. Conclusions Moderate to very severe airflow limitation was observed in 43.3% of patients with CPA. Additionally, low BMI, breathlessness, and bilateral pulmonary lesions contributing to poor prognosis were more common in patients with moderate to very severe airflow limitation than in those with normal to mild airflow limitation. Our findings suggest that airflow limitation can be associated with the prognosis of CPA. Further investigations are needed to demonstrate the clinical significance of this association.
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Affiliation(s)
- Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sae Byol Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Suk Joong Yong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jong-Han Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Beomsu Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Health-Related Quality of Life and Related Factors in Persons with Preserved Ratio Impaired Spirometry: Data from the Korea National Health and Nutrition Examination Surve. ACTA ACUST UNITED AC 2020; 57:medicina57010004. [PMID: 33374629 PMCID: PMC7822493 DOI: 10.3390/medicina57010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 01/04/2023]
Abstract
Background and Objectives: preserved ratio impaired spirometry (PRISm) is a common spirometric pattern that causes respiratory symptoms, systemic inflammation, and mortality. However, its impact on health-related quality of life (HRQOL) and its associated factors remain unclear. We aimed to identify these HRQOL-related factors and investigate the differences in HROOL between persons with PRISm and those with normal lung function. Materials and Methods: we reviewed the Korea National Health and Nutrition Examination Survey data from 2008 to 2013 to evaluate the HRQOL of persons with PRISm, as measured while using the Euro Quality of Life-5D (EQ-5D) and identify any influencing factors. PRISm was defined as pre-bronchodilator forced expiratory volume in 1 s (FEV1) <80% predicted and FEV1 to forced vital capacity (FVC) ratio (FEV1/FVC) ≥0.7. Individuals with FEV1 ≥80% predicted and FEV1/FVC ≥0.7 were considered as Controls. Results: of the 27,824 participants over the age of 40 years, 1875 had PRISm. The age- and sex-adjusted EQ-5D index was lower in the PRISm group than in the control group (PRISm, 0.930; control, 0.941; p = 0.005). The participants with PRISm showed a significantly higher prevalence of hypertension (p < 0.001), diabetes (p < 0.001), obesity (p < 0.001), low physical activity (p = 0.001), ever-smoker (p < 0.001), and low income (p = 0.034) than those in the control group. In participants with PRISm, lower EQ-5D index scores were independently associated with old age (p = 0.002), low income (p < 0.001), low education level (p < 0.001), and no economic activity (p < 0.001). Three out of five EQ-5D dimensions (mobility, self-care, and usual activity) indicated a higher proportion of dissatisfied participants in the PRISm group than the control group. Conclusions: the participants with PRISm were identified to have poor HRQOL when compared to those without PRISm. Old age and low socioeconomic status play important roles in HRQOL deterioration in patients with PRISm. By analyzing risk factors that are associated with poor HRQOL, early detection and intervention of PRISm can be done in order to preserve patients’ quality of life.
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Carsin AE, Keidel D, Fuertes E, Imboden M, Weyler J, Nowak D, Heinrich J, Erquicia SP, Martinez-Moratalla J, Huerta I, Sanchez JL, Schaffner E, Caviezel S, Beckmeyer-Borowko A, Raherison C, Pin I, Demoly P, Leynaert B, Cerveri I, Squillacioti G, Accordini S, Gislason T, Svanes C, Toren K, Forsberg B, Janson C, Jogi R, Emtner M, Real FG, Jarvis D, Guerra S, Dharmage SC, Probst-Hensch N, Garcia-Aymerich J. Regular Physical Activity Levels and Incidence of Restrictive Spirometry Pattern: A Longitudinal Analysis of 2 Population-Based Cohorts. Am J Epidemiol 2020; 189:1521-1528. [PMID: 32510134 DOI: 10.1093/aje/kwaa087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/26/2022] Open
Abstract
We estimated the association between regular physical activity and the incidence of restrictive spirometry pattern. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and physical activity were assessed in 2 population-based European cohorts (European Community Respiratory Health Survey: n = 2,757, aged 39-67 years; and Swiss Study on Air Pollution and Lung and Heart Diseases in Adults: n = 2,610, aged 36-82 years) first in 2000-2002 and again approximately 10 years later (2010-2013). Subjects with restrictive or obstructive spirometry pattern at baseline were excluded. We assessed the association of being active at baseline (defined as being physically active at least 2-3 times/week for ≥1 hour) with restrictive spirometry pattern at follow-up (defined as a postbronchodilation FEV1/FVC ratio of at least the lower limit of normal and FVC of <80% predicted) using modified Poisson regression, adjusting for relevant confounders. After 10 years of follow-up, 3.3% of participants had developed restrictive spirometry pattern. Being physically active was associated with a lower risk of developing this phenotype (relative risk = 0.76, 95% confidence interval: 0.59, 0.98). This association was stronger among those who were overweight and obese than among those of normal weight (P for interaction = 0.06). In 2 large European studies, adults practicing regular physical activity were at lower risk of developing restrictive spirometry pattern over 10 years.
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Impact of the severity of restrictive spirometric pattern on nutrition, physical activity, and quality of life: results from a nationally representative database. Sci Rep 2020; 10:19672. [PMID: 33184440 PMCID: PMC7661506 DOI: 10.1038/s41598-020-76777-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/03/2020] [Indexed: 12/29/2022] Open
Abstract
The general disease burden associated with the restrictive spirometric pattern (RSP) is substantial. However, the impact of RSP by its severity on general health problems and quality of life has not been well elucidated. This study aimed to analyse nutrition, physical activity, and quality of life in subjects who participated in the Korea National Health and Nutrition Examination Survey 2007–2016 according to severity of RSP. Participants were classified as subjects with normal spirometry, those with mild-to-moderate RSP, and those with severe RSP. Poor quality of life was defined as 25th percentile value on the EuroQoL five dimensions (Eq5D) questionnaire index, i.e., 0.90. This study included 23,615 subjects composed of 20,742 with normal spirometry, 2758 with mild-to-moderate RSP, and 115 with severe RSP. The subjects with severe RSP were more likely to have attained lower education levels, had a lower total caloric intake, had less physical activity, had experienced a higher prevalence of comorbidities, and poorer quality of life than those with normal spirometry (P < 0.001 for all). In multivariable analysis, subjects with a mild-to-moderate RSP and severe RSP were more likely to show decreased total calories (coefficient for change in calorie = − 56.6 kcal and − 286.7 kcal, respectively) than those with normal spirometry; subjects with mild-to-moderate RSP and those with severe RSP were 1.26 times and 1.96 times more likely, respectively, to have a poorer quality of life than those with normal spirometry. Additionally, subjects with mild-to-moderate RSP and those with severe RSP were 0.84 times and 0.36 times less likely, respectively, to have high-intensity physical activity than those with normal spirometry in univariable analysis. The trends of a poorer quality of life and physical activity were only significant in the male subgroups. In conclusion, our study revealed that the severity of general health problems and quality of life reductions are correlated with the severity of RSP, especially in males.
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Effect of Subcutaneous Insulin on Spirometric Maneuvers in Patients with Type 1 Diabetes: A Case-Control Study. J Clin Med 2020; 9:jcm9051249. [PMID: 32344939 PMCID: PMC7287574 DOI: 10.3390/jcm9051249] [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: 03/27/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 01/24/2023] Open
Abstract
In order to compare spirometric maneuvers in adults according to the presence of type 1 diabetes, a case-control study including 75 patients with type 1 diabetes and 75 controls matched by sex, age, and body mass index were designed. In addition, 75 patients with type 1 diabetes were added to examine the potential the impact of subcutaneous insulin therapy on pulmonary function. Lung function measurements were assessed according to the global initiative for chronic obstructive lung disease guidelines. Basal insulin included long-acting insulin analogues and the delivered background insulin in patients with pump therapy. Bolus insulin included rapid-acting insulin analogues and the delivered insulin to cover postprandial hyperglycemias. Patients with type 1 diabetes showed lower spirometric values in comparison to the control group, together with a higher prevalence of forced expiratory volume in the first second (FEV1) <80% (10.7% vs. 2.7%, p = 0.044) and restrictive ventilatory pattern (10.7% vs. 0%, p = 0.006) The dose of basal insulin (U/kg/day) showed a negative correlation with forced vital capacity (FVC) (r = −0.205, p = 0.012) and FEV1 (r = −0.182, p = 0.026). The optimal cut-off value for identifying patients with a restrictive spirometric pattern was 0.5 U/kg/day of basal insulin. Additionally, basal insulin (U/kg/day) independently predicted the presence of both a restrictive spirometric pattern (OR = 77.1 (3.2 to 1816.6), p = 0.007) and an abnormal FEV1 (OR = 29.9 (1.5 to 562.8), p = 0.023). In patients with type 1 diabetes, higher basal insulin dosage seems to be related with an impairment of pulmonary function.
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Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease. Sci Rep 2020; 10:5169. [PMID: 32198360 PMCID: PMC7083974 DOI: 10.1038/s41598-020-61932-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/17/2020] [Indexed: 11/09/2022] Open
Abstract
One quarter of individuals with Preserved Ratio Impaired Spirometry (PRISm) will develop airflow obstruction, but there are no established methods to identify these individuals. We examined the utility of FVC/TLC in identifying features of obstructive lung disease. The ratio of post-bronchodilator FVC and TLCCT from chest CT (FVC/TLCCT) among current and former smokers with PRISm (FEV1/FVC ≥ 0.7 and FEV1 < 80%) in COPDGene was used to stratify subjects into quartiles: very high, high, low, and very low. We examined the associations between FVC/TLCCT quartiles and (1) baseline characteristics, (2) respiratory exacerbations, (3) progression to COPD at 5 years, and (4) all-cause mortality. Among participants with PRISm at baseline (n = 1,131), the very low FVC/TLCCT quartile was associated with increased gas trapping and emphysema, and higher rates of progression to COPD at 5 years (36% versus 17%; p < 0.001) relative to the very high quartile. The very low FVC/TLCCT quartile was associated with increased total (IRR = 1.65; 95% CI [1.07–2.54]) and severe (IRR = 2.24; 95% CI [1.29–3.89]) respiratory exacerbations. Mortality was lower in the very high FVC/TLCCT quartile relative to the other quartiles combined. Reduced FVC/TLCCT ratio in PRISm is associated with increased symptoms, radiographic emphysema and gas trapping, exacerbations, and progression to COPD.
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Torén K, Schiöler L, Brisman J, Malinovschi A, Olin AC, Bergström G, Bake B. Restrictive spirometric pattern and true pulmonary restriction in a general population sample aged 50 - 64 years. BMC Pulm Med 2020; 20:55. [PMID: 32106839 PMCID: PMC7045734 DOI: 10.1186/s12890-020-1096-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is low diagnostic accuracy of the proxy restrictive spirometric pattern (RSP) to identify true pulmonary restriction. This knowledge is based on patients referred for spirometry and total lung volume determination by plethysmograpy, single breath nitrogen washout technique or gas dilution and selected controls. There is, however, a lack of data from general populations analyzing whether RSP is a valid proxy for true pulmonary restriction. We have validated RSP in relation to true pulmonary restriction in a general population where we have access to measurements of total lung capacity (TLC) and spirometry. METHODS The data was from the Swedish CArdioPulmonary bioImage Study (SCAPIS Pilot), a general population-based study, comprising 983 adults aged 50-64. All subjects answered a respiratory questionnaire. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained before and after bronchodilation. TLC and residual volume (RV) was recorded using a body plethysmograph. All lung function values are generally expressed as percent predicted (% predicted) or in relation to lower limits of normal (LLN). True pulmonary restriction was defined as TLC < LLN5 defined as a Z score < - 1.645, i e the fifth percentile. RSP was defined as FEV1/FVC ≥ LLN and FVC < LLN after bronchodilation. Specificity, sensitivity, positive and negative likelihood ratios were calculated, and 95% confidence intervals (CIs) were calculated. RESULTS The prevalence of true pulmonary restriction was 5.4%, and the prevalence of RSP was 3.4%. The sensitivity of RSP to identify true pulmonary restriction was 0.34 (0.20-0.46), the corresponding specificity was 0.98 (0.97-0.99), and the positive likelihood ratio was 21.1 (11.3-39.4) and the negative likelihood ratio was 0.67 (0.55-0.81). CONCLUSIONS RSP has low accuracy for identifying true pulmonary restriction. The results support previous observations that RSP is useful for ruling out true pulmonary restriction.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden
| | - Jonas Brisman
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Bake
- Department of Medicine/Lung Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Increase in Airway Obstruction between 1993 and 2012 in Switzerland. An Observational Study. Ann Am Thorac Soc 2020; 17:457-465. [PMID: 31991089 DOI: 10.1513/annalsats.201907-542oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Most studies determining the prevalence of airway obstruction are limited to short time periods.Objectives: Because temporal trends of obstruction in populations are largely unknown, we determined the prevalence of airway obstruction over 20 years in yearly general population samples in Switzerland between 1993 and 2012.Methods: We analyzed data of 85,789 participants aged 35 years and older who provided spirometric measurements as part of the LuftiBus lung function campaign. We linked data from the 2003-2012 period to the Swiss National Cohort to adjust for annual population differences. Spirometry was performed without bronchodilation, according to American Thoracic Society guidelines. We used Global Lung Initiative (GLI) and Hankinson reference equations to identify obstruction.Results: Obstruction prevalence increased between 1993 and 2012 from 6.1% (95% confidence interval [CI], 5.5 to 6.7) to 15.6% (95% CI, 13.8 to 17.3) based on GLI estimates and from 5.3% (95% CI, 4.7 to 5.9) to 15.4% (95% CI, 13.6 to 17.1) based on Hankinson estimates. When adjusted for participant demographics, air pollutant and occupational exposures, altitude, and season, the prevalence ratios of obstruction were 1.54 (95% CI, 1.22 to 1.93) and 1.65 (95% CI, 1.33 to 2.04) for GLI- and Hankinson-defined airway obstruction, respectively, for 2012 compared with 2003.Conclusions: Though prebronchodilator measurements likely overestimate the prevalence of airway obstruction in absolute terms compared with post-bronchodilator measurements, we found an increase in airway obstruction prevalence. Even with adjustment for several well-known risk factors for obstruction to make the populations across the years more comparable, we still saw a statistically significant increase in prevalence over this time period.
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Lundbäck B, Backman H, Calverley PMA. Lung Function through the PRISm. Spreading Light or Creating Confusion? Am J Respir Crit Care Med 2019; 198:1358-1360. [PMID: 30016598 DOI: 10.1164/rccm.201806-1163ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bo Lundbäck
- 1 Institute of Medicine University of Gothenburg Gothenburg, Sweden.,2 Department of Public Health and Clinical Medicine Umeå University Umeå, Sweden and
| | - Helena Backman
- 2 Department of Public Health and Clinical Medicine Umeå University Umeå, Sweden and
| | - Peter M A Calverley
- 3 Academy of Medical Sciences University of Liverpool Liverpool, United Kingdom
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Sánchez E, Gutiérrez-Carrasquilla L, Barbé F, Betriu À, López-Cano C, Gaeta AM, Purroy F, Pamplona R, Ortega M, Fernández E, Hernández C, Lecube A, Simó R. Lung function measurements in the prediabetes stage: data from the ILERVAS Project. Acta Diabetol 2019; 56:1005-1012. [PMID: 30989377 DOI: 10.1007/s00592-019-01333-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/25/2019] [Indexed: 12/31/2022]
Abstract
AIMS Patients with type 2 diabetes have been considered a susceptible group for pulmonary dysfunction. Our aim was to assess pulmonary function on the prediabetes stage. METHODS Pulmonary function was assessed in 4,459 non-diabetic subjects, aged between 45 and 70 years, without cardiovascular disease or chronic pulmonary obstructive disease from the ongoing study ILERVAS. A "restrictive spirometric pattern", an "abnormal FEV1" and an "obstructive ventilatory defect" were assessed. Prediabetes was defined by glycosylated hemoglobin (HbA1c) between 5.7 and 6.4% according to the American Diabetes Association criteria. RESULTS Population was composed of 52.1% women, aged 57 [53;63] years, a BMI of 28.6 [25.8;31.8] kg/m2, and with a prevalence of prediabetes of 29.9% (n = 1392). Subjects with prediabetes had lower forced vital capacity (FVC: 93 [82;105] vs. 96 [84;106], p < 0.001) and lower forced expired volume in the first second (FEV1: 94 [82;107] vs. 96 [84;108], p = 0.011), as well as a higher percentage of the restrictive spirometric pattern (16.5% vs. 13.6%, p = 0.015) and FEV1 < 80% (20.3% vs. 17.2%, p = 0.017) compared to non-prediabetes group. In the prediabetes group, HbA1c was negatively correlated with both pulmonary parameters (FVC: r = - 0.113, p < 0.001; FEV1: r = - 0.079, p = 0.003). The multivariable logistic regression model in the whole population showed that there was a significant and independent association between HbA1c with both restrictive spirometric pattern [OR = 1.42 (1.10-1.83), p = 0.008] and FEV1 < 80% [OR = 1.50 (1.19-1.90), p = 0.001]. CONCLUSIONS The deleterious effect of type 2 diabetes on pulmonary function appears to be initiated in prediabetes, and it is related to metabolic control. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT03228459.
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Affiliation(s)
- Enric Sánchez
- Endocrinology and Nutrition Department, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Avda. Rovira Roure 80. 25198, Lleida, Catalonia, Spain
| | - Liliana Gutiérrez-Carrasquilla
- Endocrinology and Nutrition Department, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Avda. Rovira Roure 80. 25198, Lleida, Catalonia, Spain
| | - Ferrán Barbé
- Respiratory Department, Translational Research in Respiratory Medicine, IRBLleida, University Hospital Arnau de Vilanova-Santa María, University of Lleida, Lleida, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Àngels Betriu
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R), Vascular and Renal Translational Research Group. IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Lleida, Catalonia, Spain
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Avda. Rovira Roure 80. 25198, Lleida, Catalonia, Spain
| | - Anna Michela Gaeta
- Respiratory Department, Translational Research in Respiratory Medicine, IRBLleida, University Hospital Arnau de Vilanova-Santa María, University of Lleida, Lleida, Catalonia, Spain
| | - Francesc Purroy
- Stroke Unit, Clinical Neurosciences Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Lleida, Catalonia, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, IRBLleida, University of Lleida, Lleida, Catalonia, Spain
| | - Marta Ortega
- Primary Health Care Unit, Lleida, Catalonia, Spain
| | - Elvira Fernández
- Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R), Vascular and Renal Translational Research Group. IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Lleida, Catalonia, Spain
| | - Cristina Hernández
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Avda. Rovira Roure 80. 25198, Lleida, Catalonia, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Rafael Simó
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Spirometric Pulmonary Restriction in Herbicide-Exposed U.S. Vietnam War Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173131. [PMID: 31466319 PMCID: PMC6747381 DOI: 10.3390/ijerph16173131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/24/2022]
Abstract
Spirometric restriction in herbicide-exposed U.S. Army Chemical Corps Vietnam War veterans was examined because no published research on this topic in Vietnam War veterans exists. Spirometry was conducted on 468 veterans who served in chemical operations in a 2013 study assessing the association between chronic obstructive pulmonary disease (COPD) and herbicide exposure. Exposure was verified based on blood serum values of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Further, the association between herbicide exposure and spirometry restriction (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ≥ lower limit of normal (LLN) and FVC < LLN) was tested after adjustment for military characteristics, selected anthropometrics, and other predictors using multivariable regression. Spirometric restriction in herbicide sprayers (15.7%, 95% CI: 10.6, 20.9) was almost twice that of nonsprayers (9.91%, 95% CI: 5.9, 13.9) (p = 0.081). While spirometric restriction was not significantly associated with herbicide exposure (adjusted odds ratio (aOR) = 1.64, 95% CI: 0.82, 3.29) despite the greater prevalence of restriction in sprayers versus nonsprayers, spirometric restriction was significantly associated with race/ethnicity (aOR = 3.04, 95% CI: 1.36, 6.79) and waist circumference (aOR = 2.46, 95% CI: 1.25, 4.85). Because restrictive pulmonary disease may result from chemically-induced inflammation or sensitivity, research on chemical exposures and restriction in veterans should continue. Future study should include full pulmonary function testing, targeted research designs, and a wider set of explanatory variables in analysis, such as other determinants of health.
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Oudkerk SF, Mohamed Hoesein FAA, Öner FC, Verlaan JJ, de Jong PA, Kuperus JS, Cho M, McDonald ML, Lynch DA, Silverman EK, Crapo JD, Make BJ, Lowe KE, Regan EA. Diffuse Idiopathic Skeletal Hyperostosis in Smokers and Restrictive Spirometry Pattern: An Analysis of the COPDGene Cohort. J Rheumatol 2019; 47:531-538. [PMID: 31043539 DOI: 10.3899/jrheum.181357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by bony proliferation at sites of tendinous and ligamentous insertions in the spine. Spinal mobility is reduced in DISH and may affect movement in the thorax, potentially leading to restrictive pulmonary function. This study investigated whether DISH is associated with restrictive spirometric pattern (RSP) in former and current smokers. METHODS Participants (n = 1784) with complete postbronchodilator spirometry who did not meet spirometric criteria for chronic obstructive pulmonary disease (COPD) at time of enrollment in the COPDGene study were included in this study. Subjects were classified as RSP if they had forced expiratory volume in 1 s(FEV1) to forced vital capacity (FVC) ratio > 0.7 with an FVC < 80%. Computed tomography (CT) scans were scored for the presence of DISH in accordance with the Resnick criteria. Chest CT measures of interstitial and alveolar lung disease, clinical symptoms, health surveys, and 6-min walking distance were recorded. Uni- and multivariable analyses were performed to test the association of DISH with RSP. RESULTS DISH was present in 236 subjects (13.2%). RSP was twice as common in participants with DISH (n = 90/236, 38.1%) compared to those without DISH (n = 301/1548, 19.4%; p < 0.001). In multivariable analysis, DISH was significantly associated with RSP (OR 1.78; 95% CI 1.22-2.60; p = 0.003) after adjusting for potential confounders. The RSP group with and without DISH had significantly worse spirometry, dyspnea, St. George's Respiratory Questionnaire score, BODE index (Body mass index, airflow Obstruction, Dyspnea and Exercise capacity), and Medical Outcomes Study Short Form-36 questionnaire score. CONCLUSION In heavy smokers with an FEV1/FVC ratio > 0.70, DISH is associated with RSP after adjustment for intrinsic and extrinsic causes of restrictive lung function. (Clinical trial registration number: NCT00608764.).
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Affiliation(s)
- Sytse F Oudkerk
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Firdaus A A Mohamed Hoesein
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - F Cumhur Öner
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Jorrit-Jan Verlaan
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Pim A de Jong
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK. .,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology.
| | - Jonneke S Kuperus
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Michael Cho
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Merry-Lynn McDonald
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - David A Lynch
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Edwin K Silverman
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - James D Crapo
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Barry J Make
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Katherine E Lowe
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
| | - Elizabeth A Regan
- From the University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, and Department of Orthopedics, Utrecht, the Netherlands; National Jewish Health, Department of Radiology, and divisions of Oncology, Pulmonary, Critical Care, Sleep Medicine, and Rheumatology, Denver, Colorado; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Pulmonary, Allergy, and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA; London School of Hygiene and Tropical Medicine, London, UK.,S.F. Oudkerk, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.A. Mohamed Hoesein, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; F.C. Öner, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; J.J. Verlaan, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; P.A. de Jong, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine; J.S. Kuperus, MD, PhD, University Medical Center Utrecht and Utrecht University, Department of Orthopedics; M. Cho, MD, MPH, Channing Division of Network Medicine, Brigham and Women's Hospital; M.L. McDonald, MSc, PhD, Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Genetics, University of Alabama at Birmingham; D.A. Lynch, MB, National Jewish Health, Department of Radiology, Division of Oncology, Cancer Center; E.K. Silverman, MD, PhD, Channing Division of Network Medicine, Brigham and Women's Hospital; J.D. Crapo, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; B.J. Make, MD, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine; K.E. Lowe, MSc, National Jewish Health, divisions of Pulmonary, Critical Care, and Sleep Medicine, and London School of Hygiene and Tropical Medicine; E.A. Regan, MD, PhD, National Jewish Health, Division of Rheumatology
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Carsin AE, Fuertes E, Schaffner E, Jarvis D, Antó JM, Heinrich J, Bellisario V, Svanes C, Keidel D, Imboden M, Weyler J, Nowak D, Martinez-Moratalla J, Gullón JA, Sanchez Ramos JL, Caviezel S, Beckmeyer-Borowko A, Raherison C, Pin I, Demoly P, Cerveri I, Accordini S, Gislason T, Toren K, Forsberg B, Janson C, Jogi R, Emtner M, Gómez Real F, Raza W, Leynaert B, Pascual S, Guerra S, Dharmage SC, Probst-Hensch N, Garcia-Aymerich J. Restrictive spirometry pattern is associated with low physical activity levels. A population based international study. Respir Med 2018; 146:116-123. [PMID: 30665509 DOI: 10.1016/j.rmed.2018.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/09/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry. METHODS Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC ≥ Lower Limit of Normal and a FVC<80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (<1st study-specific tertile) was evaluated using adjusted logistic regression models. RESULTS Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07-1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding. CONCLUSION Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.
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Affiliation(s)
- Anne-Elie Carsin
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Spain
| | - Elaine Fuertes
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Debbie Jarvis
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom; Population Health and Occupational Diseases, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Josep M Antó
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Spain
| | - Joachim Heinrich
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany; Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, German Centre for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Valeria Bellisario
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Joost Weyler
- University of Antwerp, Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, Stat UA Statistics Centre, Belgium
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, German Centre for Lung Research (DZL), Munich, Germany
| | - Jesus Martinez-Moratalla
- Complejo Hospitalario Universitario de Albacete, Servicio de Neumología, Universidad de Castilla-La Mancha, Facultad de Medicina, Albacete, Spain
| | | | | | - Seraina Caviezel
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Anna Beckmeyer-Borowko
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Chantal Raherison
- Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux, France
| | - Isabelle Pin
- CHU de Grenoble Alpes, Department of Pédiatrie, Inserm, U1209, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France
| | - Pascal Demoly
- University Hospital of Montpellier, Sorbonne Universités, Montpellier, France
| | - Isa Cerveri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Kjell Toren
- Department of Public Health and Community Medicine, Institute of Medicine, Goteburg, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Margareta Emtner
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Francisco Gómez Real
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Wasif Raza
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bénédicte Leynaert
- Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Paris, France; University Paris Diderot Paris, UMR 1152, Paris, France
| | - Silvia Pascual
- Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain
| | - Stefano Guerra
- ISGlobal, Barcelona, Spain; Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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Wan ES, Fortis S, Regan EA, Hokanson J, Han MK, Casaburi R, Make BJ, Crapo JD, DeMeo DL. Longitudinal Phenotypes and Mortality in Preserved Ratio Impaired Spirometry in the COPDGene Study. Am J Respir Crit Care Med 2018; 198:1397-1405. [PMID: 29874098 PMCID: PMC6290948 DOI: 10.1164/rccm.201804-0663oc] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/04/2018] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Increasing awareness of the prevalence and significance of Preserved Ratio Impaired Spirometry (PRISm), alternatively known as restrictive or Global Initiative for Chronic Obstructive Lung Disease (GOLD)-unclassified spirometry, has expanded the body of knowledge on cross-sectional risk factors. However, longitudinal studies of PRISm remain limited. OBJECTIVES To examine longitudinal patterns of change in lung function, radiographic characteristics, and mortality of current and former smokers with PRISm. METHODS Current and former smokers, aged 45 to 80 years, were enrolled in COPDGene (phase 1, 2008-2011) and returned for a 5-year follow-up (phase 2, 2012-2016). Subjects completed questionnaires, spirometry, chest computed tomography scans, and 6-minute-walk tests at both study visits. Baseline characteristics, longitudinal change in lung function, and mortality were assessed by post-bronchodilator lung function categories: PRISm (FEV1/FVC < 0.7 and FEV1 < 80%), GOLD0 (FEV1/FVC > 0.7 and FEV1 > 80%), and GOLD1-4 (FEV1/FVC < 0.7). MEASUREMENTS AND MAIN RESULTS Although the prevalence of PRISm was consistent (12.4-12.5%) at phases 1 and 2, subjects with PRISm exhibited substantial rates of transition to and from other lung function categories. Among subjects with PRISm at phase 1, 22.2% transitioned to GOLD0 and 25.1% progressed to GOLD1-4 at phase 2. Subjects with PRISm at both phase 1 and phase 2 had reduced rates of FEV1 decline (-27.3 ± 42.1 vs. -33.0 ± 41.7 ml/yr) and comparable proportions of normal computed tomography scans (51% vs. 52.7%) relative to subjects with stable GOLD0 spirometry. In contrast, incident PRISm exhibited accelerated rates of lung function decline. Subjects with PRISm at phase 1 had higher mortality rates relative to GOLD0 and lower rates relative to the GOLD1-4 group. CONCLUSIONS PRISm is highly prevalent, is associated with increased mortality, and represents a transitional state for significant subgroups of subjects. Additional studies to characterize longitudinal progression in PRISm are warranted.
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Affiliation(s)
- Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Pulmonary and Critical Care Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Spyridon Fortis
- Department of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa
| | | | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Colorado
| | | | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Torrance, California
| | | | | | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - for the COPDGene Investigators
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Pulmonary and Critical Care Section, VA Boston Healthcare System, Boston, Massachusetts
- Department of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa
- National Jewish Health, Denver, Colorado
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Colorado
- University of Michigan, Ann Arbor, Michigan; and
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Torrance, California
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Mukai H, Ming P, Lindholm B, Heimbürger O, Barany P, Stenvinkel P, Qureshi AR. Lung Dysfunction and Mortality in Patients with Chronic Kidney Disease. Kidney Blood Press Res 2018; 43:522-535. [PMID: 29627840 DOI: 10.1159/000488699] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Lung dysfunction associates with increased mortality but the impact of chronic kidney disease (CKD) is less clear. We evaluated lung function and its association with mortality among individuals with normal to severely reduced glomerular filtration rate (GFR). METHODS 404 individuals representing GFR category G1 (n=31; GFR >90 mL/min/1.73 m2), G2 (n=46), G3 (n=33), G4 (n=49) and G5 (n=245; GFR< 15 mL/min/1.73 m2) underwent spirometry yielding lung function indices forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and peak expiratory flow (PEF). Associations of lung function indices expressed as percentages of predicted values (%FEV1, %FVC and %PEF) with 5-year mortality were analyzed by competing-risk regression models. RESULTS The prevalence of obstructive (6% in G1 and 11% in G5) and especially restrictive (9% in G1 to 36% in G5) lung dysfunction increased with declining GFR and with higher comorbidity burden. In patients (n=22) with protein-energy wasting, inflammation and cardiovascular disease, the prevalence of restrictive lung function was 64%. The highest tertiles of % FEV1 and %FVC associated with lower sub-hazard ratios (sHR) for all-cause mortality, 0.49 (95% CI, 0.27-0.88)) and 0.56 (95% CI, 0.32-0.98), and that of %FEV1 also with lower cardiovascular mortality risk (sHR 0.16; 95%CI 0.04-0.69) after adjusting for multiple confounders. Restrictive lung dysfunction (FEV1/FVC ≥ 0.70, and %FVC < 80) associated with increased mortality risk (sHR 1.80, 95%CI, 1.04-3.13) while the association with obstructive lung impairment was not statistically significant. CONCLUSION Lung dysfunction and in particular restrictive lung dysfunction associates with degree of renal function impairment and presence of comorbidities, and is an independent predictor of increased mortality in CKD patients.
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Affiliation(s)
- Hideyuki Mukai
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Pei Ming
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
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Spirometric impairments, cardiovascular outcomes, and noncardiovascular death in older persons. Respir Med 2018; 137:40-47. [PMID: 29605211 DOI: 10.1016/j.rmed.2018.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/06/2018] [Accepted: 02/24/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In prior work involving older persons, the reported associations of spirometric impairments with cardiovascular outcomes may have been confounded by age-related changes in lung function. Hence, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI), we have evaluated the associations of spirometric impairments, specifically restrictive-pattern and airflow-obstruction, with cardiovascular death (CV-death) and hospitalization (CV-hospitalization). In these analyses, we also evaluated the competing outcome of noncardiovascular death (nonCV-death) and calculated measures of relative and absolute risk. METHODS Our study sample was drawn from the Cardiovascular Health Study (CHS), including 4232 community-dwelling white persons aged ≥65 years. Multivariable regression models included the following baseline predictors: GLI-defined restrictive-pattern and airflow-obstruction, age, male gender, obesity, waist circumference, current smoker status, ≥10 pack-years of smoking, hypertension, dyslipidemia, diabetes, and cardiovascular and cerebrovascular disease. Outcomes included adjudicated CV-death, CV-hospitalization, and nonCV-death, ascertained over 10 years of follow-up. Measures of association included hazard ratios (HRs), rate ratios (RRs), and average attributable fraction (AAF), each with 95% confidence intervals. RESULTS Restrictive-pattern and airflow-obstruction were associated with CV-death (adjusted HRs: 1.57 [1.18, 2.09] and 1.29 [1.04, 1.60]) and with nonCV-death (adjusted HRs: 2.10 [1.63, 2.69] and 1.79 [1.51, 2.12]), respectively. Airflow-obstruction, but not restrictive-pattern, was also associated with CV-hospitalization (adjusted RRs: 1.18 [1.02, 1.36] and 1.20 [0.96, 1.50], respectively). The adjusted AAFs of restrictive-pattern and airflow-obstruction were 1.68% (0.46, 3.06) and 2.35% (0.22, 4.72) for CV-death, and 3.44% (1.97, 5.08) and 7.77% (5.15, 10.60) for nonCV-death, respectively. CONCLUSION Assessment of GLI-defined spirometric impairments contributes to broad geriatric risk stratifications for both cardiovascular and non-cardiovascular outcomes.
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Pan J, Xu L, Lam TH, Jiang CQ, Zhang WS, Jin YL, Zhu F, Zhu T, Thomas GN, Cheng KK, Adab P. Association of adiposity with pulmonary function in older Chinese: Guangzhou Biobank Cohort Study. Respir Med 2017; 132:102-108. [PMID: 29229080 DOI: 10.1016/j.rmed.2017.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/10/2017] [Accepted: 10/07/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We examined the association between different adiposity indices and pulmonary function in Chinese adults in the Guangzhou Biobank Cohort Study (GBCS). METHODS Participants with body mass index (BMI) < 18.5 (underweight) were excluded. Adiposity indices including BMI, waist circumference (WC), waist hip ratio, waist height ratio and body fat percentage were measured. Lung function was assessed by spirometry using a turbine flowmeter. We analyzed percent predicted for forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC %) and restrictive respiratory defect (FEV1/FVC ratio > low limits of normal and FVC % <0.80). RESULTS Of 16186 participants (mean age 61.4 ± 7.2 years; 74.0% women), 116 (0.7%) had only general obesity (BMI ≥28 kg/m2), 4079 (25.2%) had only central obesity (WC: ≥90 cm in men, ≥80 cm in women) and 1591 (9.8%) had both central obesity and general obesity. Comparing to those with neither central nor general obesity, those with only central adiposity and with both central and general obesity had lower pulmonary function (adjusted β range from -2.85 to -6.02 for FEV1% and FVC%, adjusted OR range from 1.14 to 1.70, all P < 0.05). But those with only general obesity had better but non-significant pulmonary function. (Crude β range from 1.46 to 2.92 for FEV1% and FVC%, crude OR range from 0.68 to 0.93, all P > 0.05). Both FEV1% and FVC% decreased per standard deviation increase in obesity indices (adjusted β from -0.46 to -3.17, all P < 0.002). A positive association of central or general obesity with restrictive respiratory defect was observed (adjusted odds ratio (AOR) from 1.50 to 2.04, all P < 0.002). Further adjustment for WC reversed the inverse association between BMI and pulmonary function (adjusted β from 1.93 to 6.22, all P < 0.001) and restrictive respiratory defect (adjusted AOR from 0.72 to 0.80, all P < 0.001). CONCLUSION Central adiposity and its indices, but not general adiposity and BMI, were independently associated with lower pulmonary function and higher risk of restrictive respiratory defect in older Chinese.
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Affiliation(s)
- Jing Pan
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China; School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China; School of Public Health, The University of Hong Kong, Hong Kong, China.
| | | | - Wei Sen Zhang
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Ya Li Jin
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Feng Zhu
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - Tong Zhu
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Nilsson U, Blomberg A, Johansson B, Backman H, Eriksson B, Lindberg A. Ischemic ECG abnormalities are associated with an increased risk for death among subjects with COPD, also among those without known heart disease. Int J Chron Obstruct Pulmon Dis 2017; 12:2507-2514. [PMID: 28860744 PMCID: PMC5573057 DOI: 10.2147/copd.s136404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract presentation An abstract, including parts of the results, has been presented at an oral session at the European Respiratory Society International Conference, London, UK, September 2016. Background Cardiovascular comorbidity contributes to increased mortality among subjects with COPD. However, the prognostic value of ECG abnormalities in COPD has rarely been studied in population-based surveys. Aim To assess the impact of ischemic ECG abnormalities (I-ECG) on mortality among individuals with COPD, compared to subjects with normal lung function (NLF), in a population-based study. Methods During 2002–2004, all subjects with FEV1/VC <0.70 (COPD, n=993) were identified from population-based cohorts, together with age- and sex-matched referents without COPD. Re-examination in 2005 included interview, spirometry, and 12-lead ECG in COPD (n=635) and referents [n=991, whereof 786 had NLF]. All ECGs were Minnesota-coded. Mortality data were collected until December 31, 2010. Results I-ECG was equally common in COPD and NLF. The 5-year cumulative mortality was higher among subjects with I-ECG in both groups (29.6% vs 10.6%, P<0.001 and 17.1% vs 6.6%, P<0.001). COPD, but not NLF, with I-ECG had increased risk for death assessed as the mortality risk ratio [95% confidence interval (CI)] when compared with NLF without I-ECG, 2.36 (1.45–3.85) and 1.65 (0.94–2.90) when adjusted for common confounders. When analyzed separately among the COPD cohort, the increased risk for death associated with I-ECG persisted after adjustment for FEV1 % predicted, 1.89 (1.20–2.99). A majority of those with I-ECG had no previously reported heart disease (74.2% in NLF and 67.3% in COPD) and the pattern was similar among them. Conclusion I-ECG was associated with an increased risk for death in COPD, independent of common confounders and disease severity. I-ECG was of prognostic value also among those without previously known heart disease.
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Affiliation(s)
- Ulf Nilsson
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå
| | - Berne Eriksson
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
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