Prevalence of chronic obstructive pulmonary disease in independent community-dwelling older adults: The Fujiwara-kyo study

Underdiagnosis of COPD: The Japan COPD Real-World Data Epidemiological (CORE) Study

Purpose

The prevalence of airflow obstruction in Japan is 3.8%-16.9%. This epidemiological study based on a large database aimed to reassess the prevalence of airflow obstruction in Japan and the diagnosis rate of chronic obstructive pulmonary disease (COPD).

Patients and Methods

We used data regarding claims from the health insurance union and health checkups provided by JMDC. The present study included a subgroup of individuals aged ≥40 years who underwent health checkups involving spirometry between January and December 2019. The study endpoints were the prevalence of airflow obstruction, COPD diagnosis rate, disease stage, and respiratory function test results.

Results

Among 102,190 participants, 4113 (4.0%) had airflow obstruction. The prevalence of airflow obstruction was 5.3% in men and 2.1% in women. Among the study population, 6.8% were current smokers, while 3.4% were never or former smokers. Additionally, the prevalence of COPD increased with age. Approximately 8.4% of participants with airflow obstruction were diagnosed with COPD. Regarding the COPD diagnosis status, participants with airflow obstruction who were diagnosed with COPD were at a more advanced stage than those not diagnosed. Finally, patients diagnosed with COPD had significantly lower FEV1/FVC and FEV1 (p < 0.0001; Wilcoxon rank sum test).

Conclusion

The epidemiological study based on a large database determined the COPD diagnosis rate related to airflow obstruction. The COPD diagnosis rate was extremely low among individuals who underwent health checkups, indicating the need for increased awareness about this medical condition. Moreover, primary care physicians should identify patients with suspected COPD and collaborate with pulmonologists to facilitate the early detection of COPD and enhance the COPD diagnosis rate.

Comparison of respiratory function, physical function, and activities of daily living among community-dwelling patients with respiratory and non-respiratory disease

[Purpose] The purpose of this study was to investigate the differences in respiratory function, physical function, and Activities of Daily Living (ADL) between respiratory and non-respiratory patients using community-based home rehabilitation. [Participations and Methods] Maximum Phonation Time (MPT), upper and lower limb muscle strength, and ADL were compared in two groups: a respiratory disease group including respiratory patients and those with respiratory comorbidities, and a non-respiratory disease group. Cutoff values were determined for items that showed significant differences between groups. [Results] There were no significant differences between the two groups in assessments other than MPT. MPT was significantly lower in the respiratory disease group, with an MPT cutoff value of 10.1 sec and an area under the curve of 0.74. [Conclusion] Use of the MPT cutoff value may help to determine whether respiratory function is impaired in patients with respiratory disease.

Impact of Age-related Diseases on Pulmonary Function Tests in Older Japanese Adults: A Cross-sectional Pilot Study

Introduction:

A widely used reference range for pulmonary function testing was derived from middle-aged, healthy, non-smoking adults in Japan. This study examined the effect of age-related diseases on pulmonary function tests for older Japanese adults.

Methods:

All patients aged ≥65 years who underwent spirometry before general and orthopedic surgeries in Itoigawa General Hospital (Niigata, Japan) from January 2014 to June 2019 were identified, and their charts were reviewed.

Results:

This study included 1050 Japanese patients (median age: 75 years). The median spirometric values of vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC in all patients were 2.66 L [interquartile range; 2.24, 3.25], 2.57 L [2.13, 3.13], 1.98 L [1.66, 2.37], and 77.5% [72.2, 81.9], respectively. Multiple regression analyses revealed that spirometric values were significantly affected by age, body height, sex, smoking status, social dependency, dyslipidemia, diabetes, history of heart failure, peripheral artery disease, end-stage renal disease, neuromuscular disease, and psychiatric disorders. Male sex and height were positively correlated with FVC and FEV1. Other factors, such as a history of heart failure, neuromuscular disease, and independent physical activity, were negatively correlated with FVC and FEV1 to almost the same extent as that of age.

Conclusions:

These data will provide clinically useful information to accurately interpret pulmonary function test results in older Japanese adults.

Age modifies the risk factor profiles for acute kidney injury among recently diagnosed type 2 diabetic patients: a population-based study

The incidence of acute kidney injury (AKI) rises with age and is associated with multiple risk factors. Here, we compared the risk factors for AKI between younger and older incident diabetic patients to examine the trends in risk alteration for individual factors across different age groups. Between 2007 and 2013, we selected all incident type 2 diabetic adults from the Taiwan National Health Insurance registry, stratified based on age: young (< 65 years), old (≥ 65 but < 75 years), and older-old (≥ 75 years). All factors with potential renal influence (e.g., comorbidities, medications, and diagnostics/procedures) were recorded during the study period, with a nested case-controlled approach utilized to identify independent risk factors for AKI in each age group. Totally, 930,709 type 2 diabetic patients were categorized as young (68.7%), old (17.7%), or older-old (13.6%). Older-old patients showed a significantly higher incidence of AKI than the old and the young groups. Cardiovascular morbidities (hypertension, atrial fibrillation, acute coronary syndrome, and cerebrovascular disease) were shown to increase the risk of AKI, although the risk declined with increasing age. Chronic obstructive pulmonary disease and receiving cardiac catheterization elevated the risk of AKI preferentially in the older-old/old and older-old group, respectively, while the administration of angiotensin-converting enzyme/α-blocker and angiotensin receptor blocker/calcium channel blocker reduced the risk of AKI preferentially in the older-old and older-old/old group, respectively. In conclusion, our findings highlight the importance of devising age-specific risk factor panels for AKI in patients with recently diagnosed type 2 diabetes.