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Jang H, Choi KH, Cho YM, Han D, Hong YS. Environmental risk score of multiple pollutants for kidney damage among residents in vulnerable areas by occupational chemical exposure in Korea. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:35938-35951. [PMID: 38743333 PMCID: PMC11136836 DOI: 10.1007/s11356-024-33567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
This study aimed to develop an environmental risk score (ERS) of multiple pollutants (MP) causing kidney damage (KD) in Korean residents near abandoned metal mines or smelters and evaluate the association between ERS and KD by a history of occupational chemical exposure (OCE). Exposure to MP, consisting of nine metals, four polycyclic aromatic hydrocarbons, and four volatile organic compounds, was measured as urinary metabolites. The study participants were recruited from the Forensic Research via Omics Markers (FROM) study (n = 256). Beta-2-microglobulin (β2-MG), N-acetyl-β-D-glucosaminidase (NAG), and estimated glomerular filtration rate (eGFR) were used as biomarkers of KD. Bayesian kernel machine regression (BKMR) was selected as the optimal ERS model with the best performance and stability of the predicted effect size among the elastic net, adaptive elastic net, weighted quantile sum regression, BKMR, Bayesian additive regression tree, and super learner model. Variable importance was estimated to evaluate the effects of metabolites on KD. When stratified with the history of OCE after adjusting for several confounding factors, the risks for KD were higher in the OCE group than those in the non-OCE group; the odds ratio (OR; 95% CI) for ERS in non-OCE and OCE groups were 2.97 (2.19, 4.02) and 6.43 (2.85, 14.5) for β2-MG, 1.37 (1.01, 1.86) and 4.16 (1.85, 9.39) for NAG, and 4.57 (3.37, 6.19) and 6.44 (2.85, 14.5) for eGFR, respectively. We found that the ERS stratified history of OCE was the most suitable for evaluating the association between MP and KD, and the risks were higher in the OCE group than those in the non-OCE group.
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Affiliation(s)
- Hyuna Jang
- Department of Environmental Science, Baylor University, Waco, TX, USA
| | - Kyung-Hwa Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea.
| | - Yong Min Cho
- Institute of Environmental Health, Seokyeong University, Seoul, Republic of Korea
- Department of Environmental Chemical Engineering, Seokyeong University, Seoul, Republic of Korea
| | - Dahee Han
- Institute of Environmental Health, Seokyeong University, Seoul, Republic of Korea
- Department of Environmental Chemical Engineering, Seokyeong University, Seoul, Republic of Korea
| | - Young Seoub Hong
- Department of Preventive Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
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2
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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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3
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Chung C, Park SY, Huh JY, Kim NH, Shon C, Oh EY, Park YJ, Lee SJ, Kim HC, Lee SW. Fine particulate matter aggravates smoking induced lung injury via NLRP3/caspase-1 pathway in COPD. J Inflamm (Lond) 2024; 21:13. [PMID: 38654364 DOI: 10.1186/s12950-024-00384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Exposure to noxious particles, including cigarette smoke and fine particulate matter (PM2.5), is a risk factor for chronic obstructive pulmonary disease (COPD) and promotes inflammation and cell death in the lungs. We investigated the combined effects of cigarette smoking and PM2.5 exposure in patients with COPD, mice, and human bronchial epithelial cells. METHODS The relationship between PM2.5 exposure and clinical parameters was investigated in patients with COPD based on smoking status. Alveolar destruction, inflammatory cell infiltration, and pro-inflammatory cytokines were monitored in the smoking-exposed emphysema mouse model. To investigate the mechanisms, cell viability and death and pyroptosis-related changes in BEAS-2B cells were assessed following the exposure to cigarette smoke extract (CSE) and PM2.5. RESULTS High levels of ambient PM2.5 were more strongly associated with high Saint George's respiratory questionnaire specific for COPD (SGRQ-C) scores in currently smoking patients with COPD. Combined exposure to cigarette smoke and PM2.5 increased mean linear intercept and TUNEL-positive cells in lung tissue, which was associated with increased inflammatory cell infiltration and inflammatory cytokine release in mice. Exposure to a combination of CSE and PM2.5 reduced cell viability and upregulated NLRP3, caspase-1, IL-1β, and IL-18 transcription in BEAS-2B cells. NLRP3 silencing with siRNA reduced pyroptosis and restored cell viability. CONCLUSIONS PM2.5 aggravates smoking-induced airway inflammation and cell death via pyroptosis. Clinically, PM2.5 deteriorates quality of life and may worsen prognosis in currently smoking patients with COPD.
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Affiliation(s)
- Chiwook Chung
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Suk Young Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - Jin-Young Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung- Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Na Hyun Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
| | - ChangHo Shon
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
- Efficacy Evaluation Center, WOOJUNGBIO Inc, Hwaseong, Republic of Korea
| | - Eun Yi Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea
- Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Jun Park
- Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Seon-Jin Lee
- Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea.
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Jang JG, Lee H, Min KH, Kim SH, Yoon HJ, Moon JY. Both quality of life and exacerbation are important outcomes of work-related asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:803-804. [PMID: 38458710 DOI: 10.1016/j.jaip.2023.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 03/10/2024]
Affiliation(s)
- Jong Geol Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang Medical Center, Seoul, Republic of Korea
| | - Kyung Hoon Min
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University Medical School, Seoul, Republic of Korea
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang Medical Center, Seoul, Republic of Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang Medical Center, Seoul, Republic of Korea
| | - Ji-Yong Moon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang Medical Center, Seoul, Republic of Korea.
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Jalasto J, Luukkonen R, Lindqvist A, Langhammer A, Kankaanranta H, Backman H, Rönmark E, Sovijärvi A, Piirilä P, Kauppi P. Occupational exposure to vapors, gasses, dusts, and fumes in relation to causes of death during 24 years in Helsinki, Finland. Int Arch Occup Environ Health 2024; 97:145-154. [PMID: 38112780 PMCID: PMC10876715 DOI: 10.1007/s00420-023-02031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Environmental particulate matter (PM) exposure has been shown to cause excess all-cause and disease-specific mortality. Our aim was to compare disease-specific mortality by estimated occupational exposure to vapors, gasses, dusts, and fumes (VGDF). METHODS The data source is the Helsinki part of the population-based FinEsS study on chronic obstructive pulmonary diseases including information on age, education level, main occupation, sex, and tobacco smoking combined with death registry information. We compared estimated VGDF exposure to mortality using adjusted competing-risks regression for disease-specific survival analysis for a 24-year follow-up. RESULTS Compared to the no-exposure group, the high occupational VGDF exposure group had sub-hazard ratios (sHR) of 1.7 (95% CI 1.3-2.2) for all cardiovascular-related and sHR 2.1 (1.5-3.9) for just coronary artery-related mortality. It also had sHR 1.7 (1.0-2.8) for Alzheimer's or vascular dementia-related mortality and sHR 1.7(1.2-2.4) for all respiratory disease-related mortality. CONCLUSION Long-term occupational exposure to VGDF increased the hazard of mortality- to cardiovascular-, respiratory-, and dementia-related causes. This emphasizes the need for minimizing occupational long-term respiratory exposure to dust, gasses, and fumes.
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Affiliation(s)
- Juuso Jalasto
- Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, PL 281, 00029 HUS, Helsinki, Finland.
| | | | - Ari Lindqvist
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Arnulf Langhammer
- Department of Public Health and Nursing, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Hannu Kankaanranta
- Krefting Research Centre, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere University, Tampere, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Anssi Sovijärvi
- Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, PL 281, 00029 HUS, Helsinki, Finland
| | - Päivi Piirilä
- Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, PL 281, 00029 HUS, Helsinki, Finland
| | - Paula Kauppi
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
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Hansel NN, Woo H, Koehler K, Gassett A, Paulin LM, Alexis NE, Putcha N, Lorizio W, Fawzy A, Belz D, Sack C, Barr RG, Martinez FJ, Han MK, Woodruff P, Pirozzi C, Paine R, Barjaktarevic I, Cooper CB, Ortega V, Zusman M, Kaufman JD. Indoor Pollution and Lung Function Decline in Current and Former Smokers: SPIROMICS AIR. Am J Respir Crit Care Med 2023; 208:1042-1051. [PMID: 37523421 PMCID: PMC10867935 DOI: 10.1164/rccm.202302-0207oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
Rationale: Indoor pollutants have been associated with chronic obstructive pulmonary disease morbidity, but it is unclear whether they contribute to disease progression. Objectives: We aimed to determine whether indoor particulate matter (PM) and nitrogen dioxide (NO2) are associated with lung function decline among current and former smokers. Methods: Of the 2,382 subjects with a history of smoking in SPIROMICS AIR, 1,208 participants had complete information to estimate indoor PM and NO2, using individual-based prediction models, in relation to measured spirometry at two or more clinic visits. We used a three-way interaction model between time, pollutant, and smoking status and assessed the indoor pollutant-associated difference in FEV1 decline separately using a generalized linear mixed model. Measurements and Main Results: Participants had an average rate of FEV1 decline of 60.3 ml/yr for those currently smoking compared with 35.2 ml/yr for those who quit. The association of indoor PM with FEV1 decline differed by smoking status. Among former smokers, every 10 μg/m3 increase in estimated indoor PM was associated with an additional 10 ml/yr decline in FEV1 (P = 0.044). Among current smokers, FEV1 decline did not differ by indoor PM. The results of indoor NO2 suggest trends similar to those for PM ⩽2.5 μm in aerodynamic diameter. Conclusions: Former smokers with chronic obstructive pulmonary disease who live in homes with high estimated PM have accelerated lung function loss, and those in homes with low PM have lung function loss similar to normal aging. In-home PM exposure may contribute to variability in lung function decline in people who quit smoking and may be a modifiable exposure.
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Affiliation(s)
- Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine and
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine and
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Gassett
- Department of Environmental and Occupational Health Sciences and
| | - Laura M. Paulin
- Section of Pulmonary and Critical Care, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Hanover, New Hampshire
| | - Neil E. Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, Division of Allergy and Immunology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Wendy Lorizio
- Division of Pulmonary and Critical Care Medicine and
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine and
| | - Daniel Belz
- Division of Pulmonary and Critical Care Medicine and
| | - Coralynn Sack
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - R. Graham Barr
- Division of Pulmonary and Critical Care, Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Fernando J. Martinez
- Department of Internal Medicine, Weill Cornell Medical College, New York, New York
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Michigan
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California
| | - Cheryl Pirozzi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Robert Paine
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Christopher B. Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Victor Ortega
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Marina Zusman
- Department of Environmental and Occupational Health Sciences and
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences and
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Parums DV. Editorial: Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 Guidelines for COPD, Including COVID-19, Climate Change, and Air Pollution. Med Sci Monit 2023; 29:e942672. [PMID: 37777859 PMCID: PMC10552569 DOI: 10.12659/msm.942672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report includes relevant topics from the clinician's perspective and evidence published on chronic obstructive pulmonary disease (COPD) since GOLD 2017. The World Health Organization (WHO) and GOLD 2023 have developed an updated definition of COPD as, "a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, exacerbations) due to abnormalities of the airway (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction." GOLD 2023 includes recommendations for COPD patients diagnosed with COVID-19 and acknowledges the role of reduced air quality in the etiology and progression of COPD. In May 2023, the GOLD Scientific Committee on Air Pollution and COPD reported that air pollution increasingly contributes to the pathogenesis of COPD. This Editorial aims to introduce the updated GOLD 2023 report in the context of climate change and the aftermath of the COVID-19 pandemic.
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Affiliation(s)
- Dinah V Parums
- Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA
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8
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Gandhi SA, Heinzerling A, Flattery J, Cummings KJ. Occupational Contributions to Respiratory Health Disparities. Clin Chest Med 2023; 44:635-649. [PMID: 37517841 PMCID: PMC10861114 DOI: 10.1016/j.ccm.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.
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Affiliation(s)
- Sheiphali A Gandhi
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, 2330 Post St Ste 460, San Francisco, CA 94115, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Jennifer Flattery
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, 850 Marina Bay Parkway P-3, Richmond, CA 94804, USA.
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9
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de Broucker V, Andujar P, Wardyn PM, Lepage N, Le Rouzic O, Edmé JL, Hulo S. Assessment of lung hyperinflation in occupational chronic obstructive pulmonary disease: a multicentric cross-sectional study. BMJ Open Respir Res 2023; 10:e001846. [PMID: 37758668 PMCID: PMC10537836 DOI: 10.1136/bmjresp-2023-001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Occupational exposure is associated with elevated morbidity and lower quality of life in patients with chronic obstructive pulmonary disease (COPD). Static hyperinflation is an independent risk factor for all-cause mortality in COPD and for COPD exacerbation. In a multicentre, cross-sectional study (BPROFETIO), we sought to analyse the relationship between static hyperinflation and occupational exposure in patients with COPD with or without occupational exposure. MATERIAL AND METHODS An overall 'whole working life' cumulative exposure index was calculated for occupational patients with COPD. Spirometry indices and lung volumes were measured according to the 2005 American Thoracic Society/European Respiratory Society guidelines. RESULTS After adjustment for age, sex, height, body mass index, smoking and coexposure, the analysis for each occupational hazard showed a higher risk for hyperinflation and FEV1 decline or progression of COPD or GOLD stage for patients with COPD exposed to non-metallic inorganic dusts. CONCLUSION Occupational exposures should be more investigated in clinical practice and studies as they contribute to the COPD heterogeneity and are associated for some with the development of a static hyperinflation; a condition that is known to have a negative impact on quality of life and survival.
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Affiliation(s)
- Virginie de Broucker
- ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, Lille, France
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
| | - Pascal Andujar
- Faculté de médecine, Occupational Diseases; IMRB, GEIC2O, Université Paris-Est Créteil Val de Marne, Creteil, France
- Service de Pneumologie et Pathologie professionnelle, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Pierre-Marie Wardyn
- ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, Lille, France
- Médecine du Travail du Personnel Hospitalier, CHU Lille, Lille, France
| | - Nadège Lepage
- ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, Lille, France
- Service des Pathologies Professionnelles et Environnementales, CHU Lille, Lille, France
| | - Olivier Le Rouzic
- Inserm U1019, University of Lille, Lille, France
- Service de Pneumologie, CHU Lille, Lille, France
| | - Jean-Louis Edmé
- ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, Lille, France
| | - Sébastien Hulo
- ULR 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, Lille, France
- Service des Explorations Fonctionnelles Respiratoires, CHU Lille, Lille, France
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10
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Agustí A, Sisó-Almirall A, Roman M, Vogelmeier CF. Gold 2023: Highlights for primary care. NPJ Prim Care Respir Med 2023; 33:28. [PMID: 37524724 PMCID: PMC10390461 DOI: 10.1038/s41533-023-00349-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Cátedra Salud Respiratoria, Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Barcelona, Spain.
| | - Antoni Sisó-Almirall
- Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPSBE). Grup de Recerca Transversal en Atenció Primària (IDIBAPS). Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Roman
- Univ. Islas Baleares, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), centro de salud Son Pisa Palma de Mallorca, Palma de Mallorca, Spain
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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11
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Rous JS, Lees PSJ, Koehler K, Buckley JP, Quirós-Alcalá L, Han MK, Hoffman EA, Labaki W, Barr RG, Peters SP, Paine R, Pirozzi C, Cooper CB, Dransfield MT, Comellas AP, Kanner RE, Drummond MB, Putcha N, Hansel NN, Paulin LM. Association of Occupational Exposures and Chronic Obstructive Pulmonary Disease Morbidity. J Occup Environ Med 2023; 65:e443-e452. [PMID: 36977360 PMCID: PMC10330008 DOI: 10.1097/jom.0000000000002850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVE The aim of the study is to determine whether aggregate measures of occupational exposures are associated with chronic obstructive pulmonary disease (COPD) outcomes in the Subpopulations and Intermediate Outcome Measures in COPD study cohort. METHODS Individuals were assigned to six predetermined exposure hazard categories based on self-reported employment history. Multivariable regression, adjusted for age, sex, race, current smoking status, and smoking pack-years determined the association of such exposures to odds of COPD and morbidity measures. We compared these with the results of a single summary question regarding occupational exposure. RESULTS A total of 2772 individuals were included. Some exposure estimates, including "gases and vapors" and "dust and fumes" exposures resulted in associations with effect estimates over two times the estimated effect size when compared with a single summary question. CONCLUSIONS Use of occupational hazard categories can identify important associations with COPD morbidity while use of single-point measures may underestimate important differences in health risks.
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Affiliation(s)
- Jennifer S Rous
- From the Region VIII, Occupational Safety and Health Administration, Department of Labor, Denver, Colorado (J.S.R.); Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.S.R., P.S.J.L., K.K., J.P.B., L.Q.-A.); Department of Medicine, University of Michigan, Ann Arbor, Michigan (M.K.H., W.L.); Department of Radiology, University of Iowa, Iowa City, Iowa (E.A.H.); Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York (R.G.B.); Department of Medicine, Wake Forest University, Winston-Salem, North Carolina (S.P.P.); Department of Medicine, University of Utah, Salt Lake City, Utah (R.P., C.P., R.E.K.); Department of Medicine, University of California, Los Angeles, Los Angeles, California (C.B.C.); Department of Medicine, University of Alabama, Birmingham, Alabama (M.T.D..); Department of Medicine, University of Iowa, Iowa City, Iowa (A.P.C.); Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (M.B.D.); Department of Medicine, Johns Hopkins University, Baltimore, Maryland (N.P., N.N.H.); and Department of Medicine, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (L.M.P.)
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12
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Curtis JL. Understanding COPD Etiology, Pathophysiology, and Definition. Respir Care 2023; 68:859-870. [PMID: 37353333 PMCID: PMC10289621 DOI: 10.4187/respcare.10873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
COPD, one of the leading worldwide health problems, currently lacks truly disease-modifying medical therapies applicable to most patients. Developing such novel therapies has been hampered by the marked heterogeneity of phenotypes between individuals with COPD. Such heterogeneity suggests that, rather than a single cause (particularly just direct inhalation of tobacco products), development and progression of COPD likely involve both complex gene-by-environment interactions to multiple inhalational exposures and a variety of molecular pathways. However, there has been considerable recent progress toward understanding how specific pathological processes can lead to discrete COPD phenotypes, particularly that of small airways disease. Advances in imaging techniques that correlate to specific types of histological damage, and in the immunological mechanisms of lung damage in COPD, hold promise for development of personalized therapies. At the same time, there is growing recognition that the current diagnostic criteria for COPD, based solely on spirometry, exclude large numbers of individuals with very similar disease manifestations. This concise review summarizes current understanding of the etiology and pathophysiology of COPD and provides background explaining the increasing calls to expand the diagnostic criteria used to diagnose COPD and some challenges in doing so.
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Affiliation(s)
- Jeffrey L Curtis
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Division of Pulmonary and Critical Care Medicine, Michigan Medicine, Ann Arbor, Michigan; and Graduate Program in Immunology, University of Michigan, Ann Arbor, Michigan.
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13
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Huang R, Hammelef E, Sabitsky M, Ream C, Khalilieh S, Zohar N, Lavu H, Bowne WB, Yeo CJ, Nevler A. Chronic Obstructive Pulmonary Disease Is Associated with Worse Oncologic Outcomes in Early-Stage Resected Pancreatic and Periampullary Cancers. Biomedicines 2023; 11:1684. [PMID: 37371779 DOI: 10.3390/biomedicines11061684] [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: 05/15/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the 3rd leading cause of cancer mortality in the United States. Hypoxic and hypercapnic tumor microenvironments have been suggested to promote tumor aggressiveness. The objective of this study was to evaluate the association between chronic obstructive pulmonary disease (COPD) and oncologic survival outcomes in patients with early-stage PDAC and periampullary cancers. In this case-control study, patients who underwent a pancreaticoduodenectomy during 2014-2021 were assessed. Demographic, perioperative, histologic, and oncologic data were collected. A total of 503 PDAC and periampullary adenocarcinoma patients were identified, 257 males and 246 females, with a mean age of 68.1 (±9.8) years and a mean pre-operative BMI of 26.6 (±4.7) kg/m2. Fifty-two percent of patients (N = 262) reported a history of smoking. A total of 42 patients (8.3%) had COPD. The average resected tumor size was 2.9 ± 1.4 cm and 65% of the specimens (N = 329) were positive for lymph-node involvement. Kaplan-Meier analysis showed that COPD was associated with worse overall and disease-specific survival (p < 0.05). Cox regression analysis showed COPD to be an independent prognostic factor (HR = 1.5, 95% CI 1.0-2.3, p = 0.039) along with margin status, lymphovascular invasion, and perineural invasion (p < 0.05 each). A 1:3 nearest neighbor propensity score matching was also employed and revealed COPD to be an independent risk factor for overall and disease-specific survival (OR 1.8 and OR 1.6, respectively; p < 0.05 each). These findings may support the rationale posed by in vitro laboratory studies, suggesting an important impact of hypoxic and hypercapnic tumor respiratory microenvironments in promoting therapy resistance in cancer.
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Affiliation(s)
- Rachel Huang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Emma Hammelef
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Matthew Sabitsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Carolyn Ream
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Saed Khalilieh
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Nitzan Zohar
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Harish Lavu
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Wilbur B Bowne
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Charles J Yeo
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Avinoam Nevler
- Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
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14
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2023; 207:819-837. [PMID: 36856433 PMCID: PMC10111975 DOI: 10.1164/rccm.202301-0106pp] [Citation(s) in RCA: 173] [Impact Index Per Article: 173.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas Health, San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J. Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital, New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D. Sin
- St. Paul’s Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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15
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Arch Bronconeumol 2023; 59:232-248. [PMID: 36933949 DOI: 10.1016/j.arbres.2023.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain.
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J Martinez
- Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK; School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | - Jadwiga A Wedzicha
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, de Oca MM, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, Varela MVL, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Respirology 2023; 28:316-338. [PMID: 36856440 DOI: 10.1111/resp.14486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute Imperial College London, UK
| | - Jean Bourbeau
- McGill University Health Centre McGill University Montreal, Canada
| | - MeiLan K Han
- University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando J Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
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Chen Y, Peng C, Zhang H, Cai Y, Yuan R, Song P, Zhang C, Yan Y. Exposure to occupational risk factors is associated with the severity and progression of chronic obstructive pulmonary disease. Medicine (Baltimore) 2023; 102:e32908. [PMID: 36820577 PMCID: PMC9907959 DOI: 10.1097/md.0000000000032908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) results from a complex interaction between genes and the environment, and occupational exposures are an underappreciated risk factor. Until now, little research attention has been paid to the potential impact of occupational risk factor exposure on the COPD in China. The aim of this retrospective study was to analyze the role of occupational risk factor exposure on the severity and progression of COPD for exploring new prevention strategies for this disease. This study adopted a random cluster-sampling method. Five grade-A tertiary hospitals that met the inclusion criteria were selected as the survey sites, and patients with COPD hospitalized in these hospitals from January 1, 2019, to December 31, 2019, were selected as the research subjects. Data of the patients diagnosed with COPD met the Global Initiative for Chronic Obstructive Lung Disease (2019) criteria and were collected from the computerized medical record databases. Among 4082 investigated COPD patients, 1063 (26%) were found to have occupational risk factor exposure history. The top 3 industries with a large COPD case number and a history of occupational risk factor exposure ranked in the order of agriculture (including farming, forestry, animal husbandry, and fishery), manufacturing, and mining. Further multivariate logistic regression analysis indicated that when setting a low exposure level as a reference, medium and high exposure levels were correlated with the severity of COPD (odds ratio values were 2.837 and 6.201, respectively, P < .05). Linear regression analysis showed that cumulative exposure to occupational risk factors was negatively correlated with the forced expiratory volume in 1-second percentage of COPD patients, with a correlation coefficient of 0.68. Our results indicated that occupational risk factor exposure levels were related to the severity of COPD significantly. The incubation period of COPD in the exposure group was significantly shorter than that in the non-exposure group. To prevent worked-related COPD, special attention and control efforts should be taken to reduce the level of occupational risk factors such as organic dust, irritating chemicals, etc in the work environments, especially in the industries of agriculture, forestry, animal husbandry and fishery, manufacturing, and mining.
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Affiliation(s)
- Yao Chen
- School of Public Health, Qingdao University, Qingdao, Shandong Province, China
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Cong Peng
- Health Bureau of Daiyue District, Tai’an, Shandong Province, China
| | - Hua Zhang
- The Affiliated Qingdao Central Hospital of Qingdao University, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong Province, China
| | - Yu Cai
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Rui Yuan
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
| | - Pingping Song
- The Affiliated Qingdao Central Hospital of Qingdao University, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong Province, China
| | - Chunling Zhang
- The Affiliated Qingdao Central Hospital of Qingdao University, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong Province, China
| | - Yongjian Yan
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
- The Affiliated Qingdao Central Hospital of Qingdao University, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong Province, China
- Shandong First Medical University & Shandong Provincial Hospital, Jinan, Shandong Province, China
- * Correspondence: Yongjian Yan, Shandong Provincial Hospital, The Affiliated Qingdao Central Hospital of Qingdao University, Shandong Academy Occupational Health and Occupational Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, 18877 Jingshi Road, Jinan, Shandong Province 250000, China (e-mail: )
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18
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Choi KY, Lee HJ, Lee JK, Park TY, Heo EY, Kim DK, Lee HW. Rapid FEV 1/FVC Decline Is Related With Incidence of Obstructive Lung Disease and Mortality in General Population. J Korean Med Sci 2023; 38:e4. [PMID: 36593688 PMCID: PMC9807769 DOI: 10.3346/jkms.2023.38.e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) naturally decreases with age; however, an excessive decline may be related with increased morbidity and mortality. This study aimed to evaluate the FEV1/FVC decline rate in the Korean general population and to identify whether rapid FEV1/FVC decline is a risk factor for obstructive lung disease (OLD) and all-cause and respiratory mortality. METHODS We evaluated individuals aged 40-69 years who underwent baseline and biannual follow-up spirometric assessments for up to 18 years, excluding those with airflow limitations at baseline. Based on the quartiles of the annual FEV1/FVC decline rate, the most negative FEV1/FVC change (1st quartile of annual FEV1/FVC decline rate) was classified as rapid FEV1/FVC decline. We investigated the risk of progression to OLD and all-cause and respiratory mortality in individuals with rapid FEV1/FVC decline. RESULTS The annual FEV1/FVC decline rate in the eligible 7,768 patients was 0.32 percentage point/year. The incidence rate of OLD was significantly higher in patients with rapid FEV1/FVC decline than in those with non-rapid FEV1/FVC decline (adjusted incidence rate, 2.119; 95% confidence interval [CI], 1.932-2.324). Rapid FEV1/FVC decline was an independent risk factor for all-cause mortality (adjusted hazard [HR], 1.374; 95% CI, 1.105-1.709) and respiratory mortality (adjusted HR, 1.353; 95% CI, 1.089-1.680). CONCLUSION The annual FEV1/FVC decline rate was 0.32%p in the general population in Korea. The incidence rate of OLD and the hazards of all-cause and respiratory mortality were increased in rapid FEV1/FVC decliners.
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Affiliation(s)
- Kwang Yong Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyo Jin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
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Abstract
OBJECTIVES Our objective was to study mortality related to different obstructive lung diseases, occupational exposure, and their potential joint effect in a large, randomized population-based cohort. METHODS We divided the participants based on the answers to asthma and chronic obstructive pulmonary disease (COPD) diagnoses and occupational exposure and used a combined effects model and compared the results to no asthma or COPD with no occupational exposure. RESULTS High exposure had a hazards ratio (HR) of 1.34 (1.11-1.62) and asthma and COPD coexistence of 1.58 (1.10-2.27). The combined effects of intermediate exposure and coexistence had an HR of 2.20 (1.18-4.09), high exposure with coexistence of 1.94 (1.10-3.42) for overall mortality, and sub-HR for respiratory-related mortality of 3.21 (1.87-5.50). CONCLUSIONS High occupational exposure increased overall but not respiratory-related mortality hazards, while coexisting asthma and COPD overall and respiratory-related hazards of mortality.
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20
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Impact of Previous Occupational Exposure on Outcomes of Chronic Obstructive Pulmonary Disease. J Pers Med 2022; 12:jpm12101592. [PMID: 36294730 PMCID: PMC9604772 DOI: 10.3390/jpm12101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Occupational exposures have been regarded as a risk factor for the development of chronic obstructive pulmonary disease (COPD). However, there is little knowledge regarding the effect of occupational exposure on the treatment outcomes of COPD. Therefore, the aim of this study was to evaluate the question of whether occupational exposure can have a potential impact on COPD outcomes. Methods: Information regarding self-reported occupational exposure for 312 patients with COPD from the Korean Obstructive Lung Disease (KOLD) Cohort were included. A comparison of the rate of acute exacerbation, annual lung function change, and quality of life according to the presence or absence of occupational exposure was performed. Results: Seventy-six patients (24.4%) had experienced occupational exposure; chemical materials were most common. At enrollment, a higher COPD-specific version of the St. George Respiratory Questionnaire total score (39.7 ± 18.8 vs. 33.1 ± 17.6, p = 0.005) and a higher exacerbation history in the past year (30.3% vs. 17.5%, p = 0.017) were observed for patients with occupational exposure compared to those without occupational exposure. Furthermore, in the follow-up period, after adjusting for potential confounders, a higher frequency of acute exacerbation (odd ratio, 1.418; 95% confidence interval, 1.027–1.956; p = 0.033) and a more rapid decline in forced expiratory volume in 1 s (p = 0.009) was observed for COPD patients with occupational exposure compared to those without occupational exposure. Conclusions: In the KOLD cohort, worse outcomes in terms of exacerbation rate and change in lung function were observed for COPD patients with occupational exposure compared to those without occupational exposure. These findings suggest that occupational exposure not only is a risk factor for COPD but also might have a prognostic impact on COPD.
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21
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Belz DC, Woo H, Putcha N, Paulin LM, Koehler K, Fawzy A, Alexis NE, Barr RG, Comellas AP, Cooper CB, Couper D, Dransfield M, Gassett AJ, Han M, Hoffman EA, Kanner RE, Krishnan JA, Martinez FJ, Paine R, Peng RD, Peters S, Pirozzi CS, Woodruff PG, Kaufman JD, Hansel NN. Ambient ozone effects on respiratory outcomes among smokers modified by neighborhood poverty: An analysis of SPIROMICS AIR. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 829:154694. [PMID: 35318050 PMCID: PMC9117415 DOI: 10.1016/j.scitotenv.2022.154694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Neighborhood poverty has been associated with poor health outcomes. Previous studies have also identified adverse respiratory effects of long-term ambient ozone. Factors associated with neighborhood poverty may accentuate the adverse impact of ozone on respiratory health. OBJECTIVES To evaluate whether neighborhood poverty modifies the association between ambient ozone exposure and respiratory morbidity including symptoms, exacerbation risk, and radiologic parameters, among participants of the SPIROMICS AIR cohort study. METHODS Spatiotemporal models incorporating cohort-specific monitoring estimated 10-year average outdoor ozone concentrations at participants' homes. Adjusted regression models were used to determine the association of ozone exposure with respiratory outcomes, accounting for demographic factors, education, individual income, body mass index (BMI), and study site. Neighborhood poverty rate was defined by percentage of families living below federal poverty level per census tract. Interaction terms for neighborhood poverty rate with ozone were included in covariate-adjusted models to evaluate for effect modification. RESULTS 1874 participants were included in the analysis, with mean (± SD) age 64 (± 8.8) years and FEV1 (forced expiratory volume in one second) 74.7% (±25.8) predicted. Participants resided in neighborhoods with mean poverty rate of 9.9% (±10.3) of families below the federal poverty level and mean 10-year ambient ozone concentration of 24.7 (±5.2) ppb. There was an interaction between neighborhood poverty rate and ozone concentration for numerous respiratory outcomes, including COPD Assessment Test score, modified Medical Research Council Dyspnea Scale, six-minute walk test, and odds of COPD exacerbation in the year prior to enrollment, such that adverse effects of ozone were greater among participants in higher poverty neighborhoods. CONCLUSION Individuals with COPD in high poverty neighborhoods have higher susceptibility to adverse respiratory effects of ambient ozone exposure, after adjusting for individual factors. These findings highlight the interaction between exposures associated with poverty and their effect on respiratory health.
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Affiliation(s)
- Daniel C Belz
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Han Woo
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Laura M Paulin
- Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Pulmonary 5C Ste, Lebanon, NH 03756, USA.
| | - Kirsten Koehler
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Ashraf Fawzy
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
| | - Neil E Alexis
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - R Graham Barr
- Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, USA.
| | - Alejandro P Comellas
- University of Iowa Department of Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Christopher B Cooper
- University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - David Couper
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Mark Dransfield
- University of Alabama, Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Amanda J Gassett
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - MeiLan Han
- University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
| | - Eric A Hoffman
- University of Iowa Department of Internal Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Richard E Kanner
- University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
| | - Jerry A Krishnan
- University of Illinois at Chicago, 1853 West Polk Street, Chicago, IL 60612, USA.
| | | | - Robert Paine
- University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
| | - Roger D Peng
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Stephen Peters
- Wake Forest University, 475 Vine St, Winston-Salem, NC 27101, USA.
| | - Cheryl S Pirozzi
- University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
| | - Prescott G Woodruff
- University of California, San Francisco, 513 Parnassus Ave, HSE, San Francisco, CA 94143, USA.
| | - Joel D Kaufman
- University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, MD 21205, USA.
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22
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Baugh A, Buhr RG, Quibrera P, Barjaktarevic I, Barr RG, Bowler R, Han MK, Kaufman JD, Koch AL, Krishnan J, Labaki W, Martinez FJ, Mkorombindo T, Namen A, Ortega V, Paine R, Peters SP, Schotland H, Sundar K, Zeidler MR, Hansel NN, Woodruff PG, Thakur N. Risk of COPD exacerbation is increased by poor sleep quality and modified by social adversity. Sleep 2022; 45:6602021. [PMID: 35665826 PMCID: PMC9366643 DOI: 10.1093/sleep/zsac107] [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: 01/26/2022] [Revised: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES Sleep is an important dimension in the care of chronic obstructive pulmonary disease (COPD), but its relevance to exacerbations is unclear. We wanted to assess whether sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) is associated with an increased risk of COPD exacerbations and does this differ by socio-environmental exposures. METHODS We included 1647 current and former smokers with spirometrically confirmed COPD from the SPIROMICS cohort. We assessed incidence rate ratios for exacerbation using zero-inflated negative binomial regression adjusting for demographics, medical comorbidities, and multiple metrics of disease severity, including respiratory medications, airflow obstruction, and symptom burden. Our final model adjusted for socio-environmental exposures using the Area Deprivation Index, a composite measure of contemporary neighborhood quality, and Adversity-Opportunity Index, a composite measure of individual-level historic and current socioeconomic indicators. We used a pre-determined threshold of 20% missingness to undertake multiple imputation by chained equations. As sensitivity analyses, we repeated models in those with complete data and after controlling for prior exacerbations. As an exploratory analysis, we considered an interaction between socio-environmental condition and sleep quality. RESULTS After adjustment for all co-variates, increasing PSQI scores (range 0-21) were associated with a 5% increased risk for exacerbation per point (p = .001) in the imputed dataset. Sensitivity analyses using complete cases and after controlling for prior exacerbation history were similar. Exploratory analysis suggested less effect among those who lived in poor-quality neighborhoods (p-for-interaction = .035). CONCLUSIONS Poor sleep quality may contribute to future exacerbations among patients with COPD. This represents one target for improving disease control. CLINICAL TRIAL REGISTRATION Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). ClinicalTrials.gov Identifier# NCT01969344. Registry URL: https://clinicaltrials.gov/ct2/show/.
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Affiliation(s)
- Aaron Baugh
- Corresponding author. Aaron Baugh, University of California, San Francisco, Box 0111, 505 Parnassus Ave, San Francisco, CA 94143, USA. E-mail:
| | - Russell G Buhr
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Pedro Quibrera
- Collaborative Studies Coordination Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Igor Barjaktarevic
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, NY, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Meilan King Han
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joel D Kaufman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Abigail L Koch
- Department of Medicine, Veterans Administration Miami Healthcare, Miami, FL, USA
| | - Jerry Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Wassim Labaki
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Andrew Namen
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Victor Ortega
- Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Helena Schotland
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Krishna Sundar
- Department of Medicine, University of Utah, Salt Lake City, UA, USA
| | - Michelle R Zeidler
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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23
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Murgia N, Gambelunghe A. Occupational COPD-The most under-recognized occupational lung disease? Respirology 2022; 27:399-410. [PMID: 35513770 PMCID: PMC9321745 DOI: 10.1111/resp.14272] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/16/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is caused by exposure to noxious particles and gases. Smoking is the main risk factor, but other factors are also associated with COPD. Occupational exposure to vapours, gases, dusts and fumes contributes to the development and progression of COPD, accounting for a population attributable fraction of 14%. Workplace pollutants, in particular inorganic dust, can initiate airway damage and inflammation, which are the hallmarks of COPD pathogenesis. Occupational COPD is still underdiagnosed, mainly due to the challenges of assessing the occupational component of the disease in clinical settings, especially if other risk factors are present. There is a need for specific education and training for clinicians, and research with a focus on evaluating the role of occupational exposure in causing COPD. Early diagnosis and identification of occupational causes is very important to prevent further decline in lung function and to reduce the health and socio-economic burden of COPD. Establishing details of the occupational history by general practitioners or respiratory physicians could help to define the occupational burden of COPD for individual patients, providing the first useful interventions (smoking cessation, best therapeutic management, etc.). Once patients are diagnosed with occupational COPD, there is a wide international variation in access to specialist occupational medicine and public health services, along with limitations in workplace and income support. Therefore, a strong collaboration between primary care physicians, respiratory physicians and occupational medicine specialists is desirable to help manage COPD patients' health and social issues.
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Affiliation(s)
- Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Angela Gambelunghe
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
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24
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Putcha N, Woo H, McCormack MC, Fawzy A, Romero K, Davis MF, Wise RA, Diette GB, Koehler K, Matsui EC, Hansel NN. Home Dust Allergen Exposure Is Associated with Outcomes among Sensitized Individuals with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2022; 205:412-420. [PMID: 34752729 PMCID: PMC8886951 DOI: 10.1164/rccm.202103-0583oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Environmental exposures have been associated with adverse outcomes in chronic obstructive pulmonary disease (COPD). Approximately one-third of individuals with COPD have allergic sensitization, but it is unknown whether exposure to allergens in the home is associated with outcomes. Objectives: To determine the prevalence and associations of allergen sensitization with exposure to common indoor allergens with symptoms and exacerbation risk in COPD. Methods: Allergen sensitization to five common indoor allergens was assessed in former smokers with COPD. Home settled dust was assessed for presence of corresponding allergens. Sensitization and exposure status was determined and associations evaluated in adjusted models with longitudinal outcomes including symptoms, lung function, and exacerbations. Interactions were assessed between sensitization/exposure status and lung function. Measurements and Main Results: One hundred eighty-three individuals studied were on average 67.3 years of age (SD, 8.22) with average FEV1 of 53.2% (SD, 17.6%). Seventy-seven percent of participants were exposed to at least one tested allergen, and 17% had sensitization with corresponding allergen exposure. After adjustment, sensitization with exposure was associated with lower lung function (β, -8.29; 95% confidence interval [CI], -14.80 to -1.77), higher St. George's Respiratory Questionnaire Total Score (β, 6.71; 95% CI, 0.17 to 13.25), and higher exacerbation risk (odds ratio, 2.31; 95% CI, 1.11 to 4.79). Associations appeared to be more pronounced among individuals with lower lung function. Conclusions: Allergen exposures are common in COPD and associated with adverse outcomes among those with concomitant allergen sensitization. This study establishes allergens as an important home exposure that potentially could be addressed with comprehensive home environmental modification strategies to improve COPD outcomes.
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Affiliation(s)
- Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meredith C. McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karina Romero
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meghan F. Davis
- Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
| | - Robert A. Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory B. Diette
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kirsten Koehler
- Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
| | | | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Al-Moamary MS, Köktūrk N, Idrees MM, Şen E, Juvelekian G, Saleh WA, Zoumot Z, Behbehani N, Hatem A, Masoud HH, Snouber A, van Zyl-Smit RN. Unmet need in the management of chronic obstructive pulmonary disease in the Middle East and Africa region: An expert panel consensus. Respir Med 2021; 189:106641. [PMID: 34649155 DOI: 10.1016/j.rmed.2021.106641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has a significant impact on healthcare systems and health-related quality of life. Increased prevalence of smoking is an important factor contributing to high burden of COPD in the Middle East and Africa (MEA). Several other factors including sedentary lifestyle, urbanization, second-hand smoke, air pollution, and occupational exposure are also responsible for the upsurge of COPD in the MEA. Frequent COPD exacerbations accelerate disease progression, progressively deteriorate the lung function, and negatively affect quality of life. This consensus is based on review of the published evidence, international and regional guidelines, and insights provided by the expert committee members from the MEA region. Spirometry, though the gold standard for diagnosis, is often unavailable and/or underutilized leading to underdiagnosis of COPD in primary care settings. Low adherence to the treatment guidelines and delayed use of appropriate combination therapy including triple therapy are additional barriers in management of COPD in MEA. It is necessary to recognize COPD as a screenable condition and develop easy and simple screening tools to facilitate early diagnosis. Knowledge of the disease symptomatology at patient and physician level and adherence to the international or regional guidelines are important to create awareness about harmful effects of smoking and develop national guidelines to focus on prevention on COPD. Implementation of vaccination program and pulmonary rehabilitation are equally valuable to manage patients with COPD at local and regional level. We present recommendations made by the expert panel for improved screening, diagnosis, and management of COPD in MEA.
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Affiliation(s)
- Mohamed S Al-Moamary
- Department of Medicine, College of Medicine, King Saudi Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Nurdan Köktūrk
- Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Majdy M Idrees
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elif Şen
- Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - George Juvelekian
- Department of Pulmonary and Critical Care Medicine, Saint George Hospital University Medical Centre, Beirut, Lebanon
| | | | - Zaid Zoumot
- Department of Pulmonology, Respiratory Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ashraf Hatem
- Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hosam H Masoud
- Department of Chest Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Richard N van Zyl-Smit
- Division of Pulmonology and UCT Lung Institute, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
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26
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Leung C, Bourbeau J, Sin DD, Aaron SD, FitzGerald JM, Maltais F, Marciniuk DD, O'Donnell D, Hernandez P, Chapman KR, Walker B, Road JD, Zheng L, Zou C, Hogg JC, Tan WC. The Prevalence of Chronic Obstructive Pulmonary Disease (COPD) and the Heterogeneity of Risk Factors in the Canadian Population: Results from the Canadian Obstructive Lung Disease (COLD) Study. Int J Chron Obstruct Pulmon Dis 2021; 16:305-320. [PMID: 33603357 PMCID: PMC7886112 DOI: 10.2147/copd.s285338] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the spirometric-based prevalence of COPD across different regions in Canada and to evaluate the site heterogeneity of risk factors. Patients and Methods In this cross-sectional, population-based study, random samples of non-institutionalized adults aged ≥40 years were generated by random digit dialling. Participants answered an interviewer-administered questionnaire and performed spirometry before and after bronchodilator administration. COPD was defined as post-bronchodilator FEV1/FVC <0.70 (fixed ratio, FR) and as FEV1/FVC <5th percentile (lower limits of normal, LLN). Separate logistic regression models were used to compute the risk (adjusted odds ratio, aOR) for COPD. I2 and Tau2 analyses were used to evaluate heterogeneity. Results Out of 5176 (95%) participants, 4893 (47% male with mean age 56.6 years (95% confidence interval, 56.0-57.2)) had spirometry that satisfied ATS criteria. The population prevalence of COPD was 16.2% (95% CI, 14.5-17.8) by FR and 11.2% (95% CI, 9.7-12.6) by LLN. Male predominance in prevalence was shown by FR but not by LLN criteria. Patient characteristics associated with an increased risk of COPD included: age (OR 1.56; 95% CI 1.33-1.84); history of physician-diagnosed asthma (OR 3.30; 95% CI 2.42-4.49); and childhood hospitalization for respiratory illness (OR 1.81; 95% CI 1.17-2.80). In terms of smoking-related risk factors, current smoking status had the highest odds ratio (OR 3.49; 95% CI 2.55-4.80). Variance in prevalence among sites was significantly reduced by adjusting for risk factors in Tau2 analyses. Higher odds of exposure for each risk factor was found in more severe COPD, suggesting that a higher risk could be linked to the development of severe disease. Conclusion This study reports the population prevalence of COPD in nine urban cities which collectively represent the majority of the Canadian population and demonstrates that heterogeneity in prevalence among sites is substantially explained by variation in associated risk factors for COPD.
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Affiliation(s)
- Clarus Leung
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Research Institute McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - J Mark FitzGerald
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Canada
| | - Denis O'Donnell
- Department of Medicine, Queen's University, Kingston, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary (BW), Alberta, Canada
| | - Jeremy D Road
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Liyun Zheng
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Carl Zou
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
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27
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Kim J, Kim B, Bak SH, Oh YM, Kim WJ. A comparative study of chest CT findings regarding the effects of regional dust exposure on patients with COPD living in urban areas and rural areas near cement plants. Respir Res 2021; 22:43. [PMID: 33549113 PMCID: PMC7866433 DOI: 10.1186/s12931-021-01649-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background The clinical and radiological presentation of chronic obstructive pulmonary disease (COPD) is heterogenous depending on the characterized sources of inflammation. This study aimed to evaluate COPD phenotypes associated with specific dust exposure. Methods This study was designed to compare the characteristics, clinical outcomes and radiological findings between two prospective COPD cohorts representing two distinguishing regions in the Republic of Korea; COPD in Dusty Area (CODA) and the Korean Obstructive Lung Disease (KOLD) cohort. A total of 733 participants (n = 186 for CODA, and n = 547 for KOLD) were included finally. A multivariate analysis to compare lung function and computed tomography (CT) measurements of both cohort studies after adjusting for age, sex, education, body mass index, smoking status, and pack-year, Charlson comorbidity index, and frequency of exacerbation were performed by entering the level of FEV1(%), biomass exposure and COPD medication into the model in stepwise. Results The mean wall area (MWA, %) became significantly lower in COPD patients in KOLD from urban and metropolitan area than those in CODA cohort from cement dust area (mean ± standard deviation [SD]; 70.2 ± 1.21% in CODA vs. 66.8 ± 0.88% in KOLD, p = 0.028) after including FEV1 in the model. COPD subjects in KOLD cohort had higher CT-emphysema index (EI, 6.07 ± 3.06 in CODA vs. 20.0 ± 2.21 in KOLD, p < 0.001, respectively). The difference in the EI (%) was consistently significant even after further adjustment of FEV1 (6.12 ± 2.88% in CODA vs. 17.3 ± 2.10% in KOLD, p = 0.002, respectively). However, there was no difference in the ratio of mean lung density (MLD) between the two cohorts (p = 0.077). Additional adjustment for biomass parameters and medication for COPD did not alter the statistical significance after entering into the analysis with COPD medication. Conclusions Higher MWA and lower EI were observed in COPD patients from the region with dust exposure. These results suggest that the imaging phenotype of COPD is influenced by specific environmental exposure.
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Affiliation(s)
- Junghyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Bom Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Republic of Korea
| | - So Hyeon Bak
- Deparment of Radiology, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, Kangwon National University, Chuncheon, Republic of Korea.
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28
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Vinnikov D, Rybina T, Strizhakov L, Babanov S, Mukatova I. Occupational Burden of Chronic Obstructive Pulmonary Disease in the Commonwealth of Independent States: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 7:614827. [PMID: 33537332 PMCID: PMC7849650 DOI: 10.3389/fmed.2020.614827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/08/2020] [Indexed: 01/19/2023] Open
Abstract
Background: Population-based studies from the Russian Federation and neighboring countries on the occupational burden of chronic obstructive pulmonary disease (COPD) are seldom or not included in the systematic reviews. The aim of this review was to summarize published population-based studies from the Commonwealth of Independent States (CIS) in order to ascertain the occupational burden of COPD. Methods: We systematically searched www.elibrary.ru and PubMed for population-based studies on the epidemiology of COPD in nine countries using PRISMA. Quality of studies was assessed using the original tool. The odds of COPD in the included studies from vapors, gases, dusts, and fumes (VGDF) was pooled using meta-analysis (fixed effects model), whereas the population attributable fraction percent (PAF%) was pooled with meta-proportion using the random effects model in Stata 14.2. Results: Five studies, three from Russia, one from Kazakhstan, and one more from Azerbaijan and Kazakhstan (total N = 18,908) with moderate to high quality and published from 2014 to 2019 (none from Armenia, Belarus, Kyrgyzstan, Moldova, Tajikistan, and Uzbekistan), were included. Spirometry-defined COPD was the outcome in four of them. The pooled odds ratio (OR) of COPD from VGDF was 1.69 [95% confidence interval (CI) 1.34;2.13], greater in Kazakhstan [OR 1.96 (95% CI 1.35;2.85, N = 2 studies)] compared to Russia [OR 1.52 (95% CI 1.13;2.05, N = 2 studies)]. The pooled PAF% was 6% (95% CI 2; 14%) from three studies. Conclusions: Population-based studies in the CIS get little attention with very few studies published. Although the effect was greater in Kazakhstan compared to Russia, the overall effect did not differ from studies published in the rest of the world. Research capacity to study occupational risks of COPD should be strengthened to produce more evidence of higher quality.
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Affiliation(s)
- Denis Vinnikov
- Environmental and Occupational Health Lab, Al-Farabi Kazakh National University, Almaty, Kazakhstan.,Department of Biochemistry, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.,Biological Institute, National Research Tomsk State University, Tomsk, Russia
| | - Tatsyana Rybina
- Scientific and Practical Center MedEvery LLC, Minsk, Belarus
| | - Leonid Strizhakov
- Department of Internal Medicine, Occupational Diseases and Rheumatology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sergey Babanov
- Department of Occupational Diseases and Clinical Pharmacology, Samara State Medical University, Samara, Russia
| | - Irina Mukatova
- Department of Internal Medicine, Nephrology, Hematology, Immunology, and Allergy, Astana Medical University, Nur-Sultan, Kazakhstan
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Skaaby S, Flachs EM, Lange P, Schlünssen V, Marott JL, Brauer C, Nordestgaard BG, Sadhra S, Kurmi O, Bonde JPE. Occupational exposures and exacerbations of asthma and COPD-A general population study. PLoS One 2020; 15:e0243826. [PMID: 33370308 PMCID: PMC7769267 DOI: 10.1371/journal.pone.0243826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose Recent studies suggest that occupational inhalant exposures trigger exacerbations of asthma and chronic obstructive pulmonary disease, but findings are conflicting. Methods We included 7,768 individuals with self-reported asthma (n = 3,215) and/or spirometric airflow limitation (forced expiratory volume in 1 second (FEV1)/ forced expiratory volume (FVC) <0.70) (n = 5,275) who participated in The Copenhagen City Heart Study or The Copenhagen General Population Study from 2001–2016. Occupational exposure was assigned by linking job codes with job exposure matrices, and exacerbations were defined by register data on oral corticosteroid treatment, emergency care unit assessment or hospital admission. Associations between occupational inhalant exposure each year of follow-up and exacerbation were assessed by Cox regression with time varying exposure and age as the underlying time scale. Results Participants were followed for a median of 4.6 years (interquartile range, IQR 5.4), during which 870 exacerbations occurred. Exacerbations were not associated with any of the selected exposures (high molecular weight sensitizers, low molecular weight sensitizers, irritants or low and high levels of mineral dust, biological dust, gases & fumes or the composite variable vapours, gases, dusts or fumes). Hazards ratios ranged from 0.8 (95% confidence interval: 0.7;1.0) to 1.2 (95% confidence interval: 0.9;1.7). Conclusion Exacerbations of obstructive airway disease were not associated with occupational inhalant exposures assigned by a job exposure matrix. Further studies with alternative exposure assessment are warranted.
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Affiliation(s)
- Stinna Skaaby
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Lange
- Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Environmental, Work and Health, Danish Ramazzini Centre, University of Aarhus, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Jacob Louis Marott
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Børge G. Nordestgaard
- Copenhagen City Heart Study, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Copenhagen General Population Study, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Steven Sadhra
- Institute of Occupational and Environmental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Om Kurmi
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Vested A, Kolstad HA, Basinas I, Burdorf A, Elholm G, Heederik D, Jacobsen GH, Kromhout H, Omland Ø, Schaumburg I, Sigsgaard T, Vestergaard JM, Wouters IM, Schlünssen V. Dust exposure and the impact on hospital readmission of farming and wood industry workers for asthma and chronic obstructive pulmonary disease (COPD). Scand J Work Environ Health 2020; 47:163-168. [PMID: 33073852 PMCID: PMC8114568 DOI: 10.5271/sjweh.3926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: It is still not well established how occupational air pollutants affect the prognosis of asthma or chronic obstructive pulmonary disease (COPD). This study uses nationwide Danish registers and quantitative dust industry exposure matrices (IEM) for the farming and wood industries to estimate whether previous year dust exposure level impacts hospital readmissions for workers diagnosed with asthma or COPD. Methods: We identified all individuals with a first diagnosis of either asthma (769 individuals) or COPD (342 individuals) between 1997 and 2007 and followed them until the next hospital admission for asthma or COPD, emigration, death or 31 December 2007. We included only individuals who worked in either the wood or farming industries at least one year during follow-up. We used logistic regression analysis to investigate associations between dust exposure level in the previous year and hospital readmission, adjusting for sex, age, time since first diagnosis, socioeconomic status, and labor force participation. Results: Asthma readmissions for individuals with low and high dust exposure were increased [adjusted rate ratio (RRadj) 2.52, 95% confidence interval (CI) 1.45–4.40] and RRadj 2.64 (95% CI 1.52–4.60), respectively. For COPD readmission, the risk estimates were RRadj 1.36 (95% CI 0.57–3.23) for low and RRadj 1.20 (95% CI 0.49–2.95) for high exposure level in the previous year. For asthma readmission, stratified analyses by type of dust exposure during follow-up showed increased risks for both wood dust [RRadj 2.67 (95% CI 1.35–5.26) high exposure level] and farming dust [RRadj 3.59 (95% CI 1.11–11.59) high exposure level]. No clear associations were seen for COPD readmissions. Conclusions: This study indicates that exposure to wood or farm dust in the previous year increases the risk of hospital readmission for individuals with asthma but not for those with COPD.
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Affiliation(s)
- Anne Vested
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
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Blackley DJ, Halldin CN, Hayanga JWA, Laney AS. Transplantation for work-related lung disease in the USA. Occup Environ Med 2020; 77:790-794. [PMID: 32859693 DOI: 10.1136/oemed-2020-106578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Work-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival. METHODS Using US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers' pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis. RESULTS The frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers' pneumoconiosis and 78 were for silicosis. Patients with coal workers' pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers' pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers' pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis. CONCLUSIONS Lung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies.
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Affiliation(s)
- David J Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Cara N Halldin
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - J W Awori Hayanga
- Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - A Scott Laney
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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Abstract
BACKGROUND A meta-analysis was performed to evaluate the relationship between chronic obstructive pulmonary disease (COPD) and occupational dust exposure, and to provide a scientific basis for the prevention and treatment of COPD caused by occupational factors. METHODS PubMed and Embase databases were used to search for original epidemiological literature related to theme. Both random and fixed effects models were used to calculate pooled odds ratios and their corresponding 95% confidence intervals. Review Manager was used to perform data analysis. RESULTS Nine studies were included in the meta-analysis in accordance with the inclusion criteria. There was a significantly obvious correlation between occupational dust exposure and COPD of the population-based studies assessed in this article. The risk of developing COPD for workers exposed to dust was 1.51 times higher than for controls (I = 40%, 95% confidence interval: 1.27-1.79). The presence of publication bias was not found. CONCLUSION The study provided evidence supporting the association between occupational dust exposure and the risk of developing COPD.
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Affiliation(s)
- Cong Peng
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian
- Shandong Academy Occupational Health and Occupational Medicine
| | - Yongjian Yan
- Shandong Academy Occupational Health and Occupational Medicine
| | - Zhen Li
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
| | - Yuxin Jiang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
| | - Yu Cai
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
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Shpagina LA, Kamneva NV, Kudelya LM, Kotova OS, Shpagin IS, Kuznetsova GV, Anikina EV, Gerasimenko DA, Saraskina LE, Surovenko TN, Ponomareva AV. [Diagnostic and Prognostic Markers of Chronic Heart Failure in Patients with Occupational Chronic Obstructive Pulmonary Disease]. KARDIOLOGIIA 2020; 60:44-52. [PMID: 33155940 DOI: 10.18087/cardio.2020.7.n1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/21/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Aim Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are a common comorbidity. Professional chronic obstructive pulmonary disease (PCOPD) is a specific phenotype, which suggests peculiarities in the development of HF. Difficulties of HF diagnosis in such patients determine the relevance of searching for additional markers. The aim of the study was identifying HF markers in patients with PCOPD.Material and methods This single-site, cohort, prospective, observational study included 345 patients. The main group consisted of PCOPD patients; the comparison group consisted of patients with COPD induced by tobacco smoking; and the control group included conventionally healthy individuals. The groups were matched by the index of coincidence; pairs were matched at 1:1 by the "nearest neighbor index"; covariates for matching included COPD duration, sex, and age. Each group included 115 patients. The major professional adverse factors were silica-containing dust and organic solvents. COPD was diagnosed according to GOLD criteria; HF was diagnosed in accordance with Russian clinical guidelines. The markers were determined by multifactorial logistic regression. Likelihood of events with allowance for the time to the event was analyzed by the Kaplan-Meier method.Results HF in PCOPD patients was characterized by biventricular damage, preserved left ventricular ejection fraction, and frequent hospitalizations for decompensation (17.5 % vs. 9.5 % for COPD in smokers). HF markers in patients with PCOPD included the length of work of more than 20 years, pulmonary artery systolic pressure (PASP) higher than 35 mm Hg according to data of Doppler echocardiography, diffusing capacity of lungs for carbon monoxide (DLCO) less than 50 %, increased serum concentrations of CC-chemokine ligand 18 (CCL18), S-100‑beta protein, and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). Diagnostic sensitivity of the multifactorial model was 84 % and specificity was 81 %. Two models were proposed for purposes of screening, which included the following parameters: length of work, exposure to aromatic hydrocarbons, decreased distance in 6-min walk test by more than 60 m per year and length of work, exposure to inorganic dust, and decreased forced expiratory volume during the first second by more than 55 ml per year.Conclusion The markers for development of HF in PCOPD patients are length of work >20 years, PASP >35 mm Hg, DLCO <50 %, and increased serum concentrations of CCL18, S-100‑beta protein, and NT-pro-BNP.
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Affiliation(s)
- L A Shpagina
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - N V Kamneva
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - L M Kudelya
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - O S Kotova
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - I S Shpagin
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - G V Kuznetsova
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - E V Anikina
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - D A Gerasimenko
- Novosibirsk State Medical University MOH Russia, Novosibirsk
| | - L E Saraskina
- Department of foreign language of Siberian Federal University, Krasnoyarsk
| | | | - A V Ponomareva
- Novosibirsk State Medical University MOH Russia, Novosibirsk
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Sadhra SS, Mohammed N, Kurmi OP, Fishwick D, De Matteis S, Hutchings S, Jarvis D, Ayres JG, Rushton L. Occupational exposure to inhaled pollutants and risk of airflow obstruction: a large UK population-based UK Biobank cohort. Thorax 2020; 75:468-475. [DOI: 10.1136/thoraxjnl-2019-213407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 11/04/2022]
Abstract
BackgroundAlthough around 10% to 15% of COPD burden can be attributed to workplace exposures, little is known about the role of different airborne occupational pollutants (AOP). The main aim of the study was to assess the effect size of the relationship between various AOP, their level and duration of exposure with airflow obstruction (AFO).MethodsA cross-sectional analysis was conducted in 228 614 participants from the UK Biobank study who were assigned occupational exposure using a job exposure matrix blinded to health outcome. Adjusted prevalence ratios (PRs) and 95% CI for the risk of AFO for ever and years of exposure to AOPs were estimated using robust Poisson model. Sensitivity analyses were conducted for never-smokers, non-asthmatic and bi-pollutant model.ResultsOf 228 614 participants, 77 027 (33.7%) were exposed to at least one AOP form. 35.5% of the AFO cases were exposed to vapours, gases, dusts or fumes (VGDF) and 28.3% to dusts. High exposure to vapours increased the risk of occupational AFO by 26%. Exposure to dusts (adjusted PR=1.05; 95% CI 1.01 to 1.08), biological dusts (1.05; 1.01 to 1.10) and VGDF (1.04; 1.01 to 1.07) showed a significantly increased risk of AFO, however, statistically not significant following multiple testing. There was no significant increase in risk of AFO by duration (years) of exposure in current job. The results were null when restricted to never-smokers and when a bi-pollutant model was used. However, when data was analysed based on the level of exposure (low, medium and high) compared with no exposure, directionally there was increase in risk for those with high exposure to vapours, gases, fumes, mists and VGDF but statistically significant only for vapours.ConclusionHigh exposure (in current job) to airborne occupational pollutants was suggestive of higher risk of AFO. Future studies should investigate the relationship between lifetime occupational exposures and COPD.
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35
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Galiatsatos P, Woo H, Paulin LM, Kind A, Putcha N, Gassett AJ, Cooper CB, Dransfield MT, Parekh TM, Oates GR, Barr RG, Comellas AP, Han MK, Peters SP, Krishnan JA, Labaki WW, McCormack MC, Kaufman JD, Hansel NN. The Association Between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:981-993. [PMID: 32440110 PMCID: PMC7211318 DOI: 10.2147/copd.s238933] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/20/2020] [Indexed: 01/10/2023] Open
Abstract
Rationale Individual socioeconomic status has been shown to influence the outcomes of patients with chronic obstructive pulmonary disease (COPD). However, contextual factors may also play a role. The objective of this study is to evaluate the association between neighborhood socioeconomic disadvantage measured by the area deprivation index (ADI) and COPD-related outcomes. Methods Residential addresses of SubPopulations and InteRmediate Outcome Measures in COPD Study (SPIROMICS) subjects with COPD (FEV1/FVC <0.70) at baseline were geocoded and linked to their respective ADI national ranking score at the census block group level. The associations between the ADI and COPD-related outcomes were evaluated by examining the contrast between participants living in the most-disadvantaged (top quintile) to the least-disadvantaged (bottom quintile) neighborhood. Regression models included adjustment for individual-level demographics, socioeconomic variables (personal income, education), exposures (smoking status, packs per year, occupational exposures), clinical characteristics (FEV1% predicted, body mass index) and neighborhood rural status. Results A total of 1800 participants were included in the analysis. Participants residing in the most-disadvantaged neighborhoods had 56% higher rate of COPD exacerbation (P<0.001), 98% higher rate of severe COPD exacerbation (P=0.001), a 1.6 point higher CAT score (P<0.001), 3.1 points higher SGRQ (P<0.001), and 24.6 meters less six-minute walk distance (P=0.008) compared with participants who resided in the least disadvantaged neighborhoods. Conclusion Participants with COPD who reside in more-disadvantaged neighborhoods had worse COPD outcomes compared to those residing in less-disadvantaged neighborhoods. Neighborhood effects were independent of individual-level socioeconomic factors, suggesting that contextual factors could be used to inform intervention strategies targeting high-risk persons with COPD.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura M Paulin
- Pulmonary and Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Amy Kind
- University of Wisconsin School of Medicine and Public Health, Department of Medicine Health Services and Care Research Program and Division of Geriatrics, Madison, WI, USA.,Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christopher B Cooper
- Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Mark T Dransfield
- Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Trisha M Parekh
- Department of Medicine, University of Alabama Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Gabriela R Oates
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - R Graham Barr
- Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | - Meilan K Han
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P Peters
- Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Wassim W Labaki
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joel D Kaufman
- Office of the Dean, University of Washington School of Public Health, Seattle, WA, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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36
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Blanc PD, Annesi-Maesano I, Balmes JR, Cummings KJ, Fishwick D, Miedinger D, Murgia N, Naidoo RN, Reynolds CJ, Sigsgaard T, Torén K, Vinnikov D, Redlich CA. The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement. Am J Respir Crit Care Med 2020; 199:1312-1334. [PMID: 31149852 PMCID: PMC6543721 DOI: 10.1164/rccm.201904-0717st] [Citation(s) in RCA: 249] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.
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Paulin LM, Gassett AJ, Alexis NE, Kirwa K, Kanner RE, Peters S, Krishnan JA, Paine R, Dransfield M, Woodruff PG, Cooper CB, Barr RG, Comellas AP, Pirozzi CS, Han M, Hoffman EA, Martinez FJ, Woo H, Peng RD, Fawzy A, Putcha N, Breysse PN, Kaufman JD, Hansel NN. Association of Long-term Ambient Ozone Exposure With Respiratory Morbidity in Smokers. JAMA Intern Med 2020; 180:106-115. [PMID: 31816012 PMCID: PMC6902160 DOI: 10.1001/jamainternmed.2019.5498] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Few studies have investigated the association of long-term ambient ozone exposures with respiratory morbidity among individuals with a heavy smoking history. OBJECTIVE To investigate the association of historical ozone exposure with risk of chronic obstructive pulmonary disease (COPD), computed tomography (CT) scan measures of respiratory disease, patient-reported outcomes, disease severity, and exacerbations in smokers with or at risk for COPD. DESIGN, SETTING, AND PARTICIPANTS This multicenter cross-sectional study, conducted from November 1, 2010, to July 31, 2018, obtained data from the Air Pollution Study, an ancillary study of SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Data analyzed were from participants enrolled at 7 (New York City, New York; Baltimore, Maryland; Los Angeles, California; Ann Arbor, Michigan; San Francisco, California; Salt Lake City, Utah; and Winston-Salem, North Carolina) of the 12 SPIROMICS clinical sites. Included participants had historical ozone exposure data (n = 1874), were either current or former smokers (≥20 pack-years), were with or without COPD, and were aged 40 to 80 years at baseline. Healthy persons with a smoking history of 1 or more pack-years were excluded from the present analysis. EXPOSURES The 10-year mean historical ambient ozone concentration at participants' residences estimated by cohort-specific spatiotemporal modeling. MAIN OUTCOMES AND MEASURES Spirometry-confirmed COPD, chronic bronchitis diagnosis, CT scan measures (emphysema, air trapping, and airway wall thickness), 6-minute walk test, modified Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), postbronchodilator forced expiratory volume in the first second of expiration (FEV1) % predicted, and self-report of exacerbations in the 12 months before SPIROMICS enrollment, adjusted for demographics, smoking, and job exposure. RESULTS A total of 1874 SPIROMICS participants were analyzed (mean [SD] age, 64.5 [8.8] years; 1479 [78.9%] white; and 1013 [54.1%] male). In adjusted analysis, a 5-ppb (parts per billion) increase in ozone concentration was associated with a greater percentage of emphysema (β = 0.94; 95% CI, 0.25-1.64; P = .007) and percentage of air trapping (β = 1.60; 95% CI, 0.16-3.04; P = .03); worse scores for the mMRC Dyspnea Scale (β = 0.10; 95% CI, 0.03-0.17; P = .008), CAT (β = 0.65; 95% CI, 0.05-1.26; P = .04), and SGRQ (β = 1.47; 95% CI, 0.01-2.93; P = .048); lower FEV1% predicted value (β = -2.50; 95% CI, -4.42 to -0.59; P = .01); and higher odds of any exacerbation (odds ratio [OR], 1.37; 95% CI, 1.12-1.66; P = .002) and severe exacerbation (OR, 1.37; 95% CI, 1.07-1.76; P = .01). No association was found between historical ozone exposure and chronic bronchitis, COPD, airway wall thickness, or 6-minute walk test result. CONCLUSIONS AND RELEVANCE This study found that long-term historical ozone exposure was associated with reduced lung function, greater emphysema and air trapping on CT scan, worse patient-reported outcomes, and increased respiratory exacerbations for individuals with a history of heavy smoking. The association between ozone exposure and adverse respiratory outcomes suggests the need for continued reevaluation of ambient pollution standards that are designed to protect the most vulnerable members of the US population.
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Affiliation(s)
- Laura M Paulin
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Amanda J Gassett
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
| | - Neil E Alexis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kipruto Kirwa
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle
| | - Richard E Kanner
- Department of Internal Medicine, University of Utah, Salt Lake City
| | - Stephen Peters
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois at Chicago, Chicago
| | - Robert Paine
- Department of Internal Medicine, University of Utah, Salt Lake City
| | | | | | | | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York.,Department of Epidemiology, Columbia University Medical Center, New York, New York
| | | | - Cheryl S Pirozzi
- Department of Internal Medicine, University of Utah, Salt Lake City
| | - MeiLan Han
- Department of Medicine, University of Michigan, Ann Arbor
| | | | | | - Han Woo
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Roger D Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ashraf Fawzy
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Patrick N Breysse
- Department of Environmental Health Sciences and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle.,Department of Medicine, University of Washington, Seattle.,Department of Epidemiology, University of Washington, Seattle
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Parris BA, O'Farrell HE, Fong KM, Yang IA. Chronic obstructive pulmonary disease (COPD) and lung cancer: common pathways for pathogenesis. J Thorac Dis 2019; 11:S2155-S2172. [PMID: 31737343 DOI: 10.21037/jtd.2019.10.54] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer comprise the leading causes of lung disease-related mortality worldwide. Exposure to tobacco smoke is a mutual aetiology underlying the two diseases, accounting for almost 90% of cases. There is accumulating evidence supporting the role of immune dysfunction, the lung microbiome, extracellular vesicles and underlying genetic susceptibility in the development of COPD and lung cancer. Further, epigenetic factors, involving DNA methylation and microRNA expression, have been implicated in both diseases. Chronic inflammation is a key feature of COPD and could be a potential driver of lung cancer development. Using next generation technologies, further studies investigating the genomics, epigenetics and gene-environment interaction in key molecular pathways will continue to elucidate the pathogenic mechanisms underlying the development of COPD and lung cancer, and contribute to the development of novel diagnostic and prognostic tools for early intervention and personalised therapeutic strategies.
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Affiliation(s)
- Brielle A Parris
- UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Brisbane, Australia
| | - Hannah E O'Farrell
- UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Brisbane, Australia
| | - Kwun M Fong
- UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Ian A Yang
- UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia
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39
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Tanner L, Single AB. Animal Models Reflecting Chronic Obstructive Pulmonary Disease and Related Respiratory Disorders: Translating Pre-Clinical Data into Clinical Relevance. J Innate Immun 2019; 12:203-225. [PMID: 31527372 PMCID: PMC7265725 DOI: 10.1159/000502489] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/25/2019] [Accepted: 07/25/2019] [Indexed: 12/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) affects the lives of an ever-growing number of people worldwide. The lack of understanding surrounding the pathophysiology of the disease and its progression has led to COPD becoming the third leading cause of death worldwide. COPD is incurable, with current treatments only addressing associated symptoms and sometimes slowing its progression, thus highlighting the need to develop novel treatments. However, this has been limited by the lack of experimental standardization within the respiratory disease research area. A lack of coherent animal models that accurately represent all aspects of COPD clinical presentation makes the translation of promising in vitrodata to human clinical trials exceptionally challenging. Here, we review current knowledge within the COPD research field, with a focus on current COPD animal models. Moreover, we include a set of advantages and disadvantages for the selection of pre-clinical models for the identification of novel COPD treatments.
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Affiliation(s)
- Lloyd Tanner
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden,
| | - Andrew Bruce Single
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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40
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Ayora AF, Soler LM, Gasch AC. Analysis of two questionnaires on quality of life of Chronic Obstructive Pulmonary Disease patients. Rev Lat Am Enfermagem 2019; 27:e3148. [PMID: 31340341 PMCID: PMC6687364 DOI: 10.1590/1518-8345.2624.3148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 02/07/2019] [Indexed: 01/10/2023] Open
Abstract
Objective: to evaluate the efficacy of quality of life questionnaires St. George
Respiratory Questionnaire and Chronic Obstructive
Pulmonary Disease Assessment Test in patients with chronic
obstructive pulmonary disease based on correlation and agreement analyses,
and identify the most effective tool to assess their quality of life. Method: cross-sectional cohort study with patients hospitalized in a Spanish hospital
for exacerbation of chronic obstructive pulmonary disease. Health-related
quality of life was assessed with both questionnaires. The correlation and
the agreement between the questionnaires were analyzed, as well as the
internal consistency. Associations were established between the clinical
variables and the results of the questionnaire. Results: one hundred and fifty-six patients participated in the study. The scales had
a correlation and agreement between them and high internal consistency. A
higher sensitivity of the Chronic Obstructive Pulmonary Disease
Assessment Test was observed for the presence of cough and
expectoration. Conclusion: the questionnaires have similar reliability and validity to measure the
quality of life in patients with acute chronic obstructive pulmonary
disease, and the Chronic Obstructive Pulmonary Disease
Assessment Test is more sensitive to detect cough and
expectoration and requires a shorter time to be completed.
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Affiliation(s)
- Ana Folch Ayora
- Universitat Jaume I, Facultad de Ciencias de la Salud, Castellón de la Plana, Comunidad Valenciana, Espanha
| | - Loreto Macia Soler
- Universidad de Alicante, Facultad de Ciencias de la Salud, Alicante, Comunidad Valenciana, Espanha
| | - Agueda Cervera Gasch
- Universitat Jaume I, Facultad de Ciencias de la Salud, Castellón de la Plana, Comunidad Valenciana, Espanha
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41
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Khaltaev N, Axelrod S. Chronic respiratory diseases global mortality trends, treatment guidelines, life style modifications, and air pollution: preliminary analysis. J Thorac Dis 2019; 11:2643-2655. [PMID: 31372301 DOI: 10.21037/jtd.2019.06.08] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nikolai Khaltaev
- Global Alliance against Chronic Respiratory Diseases, Geneva, Switzerland
| | - Svetlana Axelrod
- Institute for Leadership and Healthcare Management, I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Abstract
: Chronic obstructive pulmonary disease (COPD) affects as many as 16 million Americans and is expected to be the third leading cause of death worldwide by 2020. To increase awareness of COPD, encourage related research, and improve care of patients with this chronic disease, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was launched in 1998 and published an evidence-based report on COPD prevention and management strategies in 2001 that has been revised regularly. The fourth major revision, which was published in 2017 and revised in 2018, includes significant changes related to COPD classification, as well as to pharmacologic, nonpharmacologic, and comorbidity management. The authors discuss the changes to the GOLD recommendations and, using a patient scenario, explain their application to clinical practice.
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43
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Rigo A, Paz-Lourido B. ¿Por qué la rehabilitación respiratoria no llega a todos los pacientes de enfermedad pulmonar obstructiva crónica que lo necesitan? Revisión de la literatura. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n2.67252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La rehabilitación respiratoria (RR) es un tratamiento clave en la enfermedad pulmonar obstructiva crónica, pero aun estando disponible, los pacientes no siempre acceden a ella.Objetivo. Identificar los factores que pueden limitar el acceso a la RR y que se relacionan con los pacientes, los médicos y los fisioterapeutas.Materiales y métodos. Se realizó una revisión de artículos publicados en inglés y español entre 2006 y 2018. Se usaron los términos “COPD”, “chronic obstructive pulmonary disease”, “COLD”, “chronic obstructive lung disease”, “physical therapy modalities”, “rehabilitation”, “health services accessibility” y “patient” en las bases de datos PubMed, PEDro, Scielo e IBECS.Resultados. Se seleccionaron 11 publicaciones. Entre las barreras que afectan a los pacientes destacan el transporte, la condición ambiental, las situaciones personales y algunos factores sociales y contextuales. El conocimiento de los profesionales, sus condiciones de trabajo y sus expectativas sobre beneficio de los protocolos de RR también son factores que condicionan el acceso de los pacientes.Conclusiones. La formación interprofesional de médicos y fisioterapeutas, la implantación de protocolos flexibles a las condiciones de los pacientes y las medidas organizativas e intersectoriales del sistema sanitario pueden facilitar la accesibilidad a la RR de los pacientes.
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44
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Li F, Yang J. Revefenacin for the treatment of chronic obstructive pulmonary disease. Expert Rev Clin Pharmacol 2019; 12:293-298. [PMID: 30803279 DOI: 10.1080/17512433.2019.1587292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Fuyuan Li
- Department of Endocrinology, Central Hospital of Linyi City, Yishui Shandong, China
| | - Junyi Yang
- Department of Pharmaceutical, Central Hospital of Linyi City, Yishui, Shandong, China
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45
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Paulin LM, Smith BM, Koch A, Han M, Hoffman EA, Martinez C, Ejike C, Blanc PD, Rous J, Barr RG, Peters SP, Paine R, Pirozzi C, Cooper CB, Dransfield MT, Comellas AP, Kanner RE, Drummond MB, Putcha N, Hansel NN. Occupational Exposures and Computed Tomographic Imaging Characteristics in the SPIROMICS Cohort. Ann Am Thorac Soc 2018; 15:1411-1419. [PMID: 30339479 PMCID: PMC6322018 DOI: 10.1513/annalsats.201802-150oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Quantitative computed tomographic (CT) imaging can aid in chronic obstructive pulmonary disease (COPD) phenotyping. Few studies have identified whether occupational exposures are associated with distinct CT imaging characteristics. OBJECTIVES To examine the association between occupational exposures and CT-measured patterns of disease in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). METHODS Participants underwent whole-lung multidetector helical CT at full inspiration and expiration. The association between occupational exposures (self-report of exposure to vapors, gas, dust, or fumes [VGDF] at the longest job) and CT metrics of emphysema (percentage of total voxels < -950 Hounsfield units at total lung capacity), large airways (wall area percent [WAP] and square-root wall area of a single hypothetical airway with an internal perimeter of 10 mm [Pi10]), and small airways (percent air trapping [percent total voxels < -856 Hounsfield units at residual volume] and parametric response mapping of functional small-airway abnormality [PRM fSAD]) were explored by multivariate linear regression, and for central airway measures by generalized estimating equations to account for multiple measurements per individual. Models were adjusted for age, sex, race, current smoking status, pack-years of smoking, body mass index, and site. Airway measurements were additionally adjusted for total lung volume. RESULTS A total of 2,736 participants with available occupational exposure data (n = 927 without airflow obstruction and 1,809 with COPD) were included. The mean age was 64 years, 78% were white, and 54% were male. Forty percent reported current smoking, and mean (SD) pack-years was 49.3 (26.9). Mean (SD) post-bronchodilator forced expiratory volume in 1 second (FEV1) was 73 (27) % predicted. Forty-nine percent reported VGDF exposure. VGDF exposure was associated with higher emphysema (β = 1.17; 95% confidence interval [CI], 0.44-1.89), greater large-airway disease as measured by WAP (segmental β = 0.487 [95% CI, 0.320-0.654]; subsegmental β = 0.400 [95% CI, 0.275-0.527]) and Pi10 (β = 0.008; 95% CI, 0.002-0.014), and greater small-airway disease was measured by air trapping (β = 2.60; 95% CI, 1.11-4.09) and was nominally associated with an increase in PRM fSAD (β = 1.45; 95% CI, 0.31-2.60). These findings correspond to higher odds of percent emphysema, WAP, and air trapping above the 95th percentile of measurements in nonsmoking control subjects in individuals reporting VGDF exposure. CONCLUSIONS In an analysis of SPIROMICS participants, we found that VGDF exposure in the longest job was associated with an increase in emphysema, and in large- and small-airway disease, as measured by quantitative CT imaging.
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Affiliation(s)
- Laura M. Paulin
- Department of Medicine, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Benjamin M. Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
- Translational Research in Respiratory Diseases Program, Department of Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Abby Koch
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - MeiLan Han
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Carlos Martinez
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Chinedu Ejike
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Paul D. Blanc
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Jennifer Rous
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Stephen P. Peters
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Cheryl Pirozzi
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | - Christopher B. Cooper
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | | | | | - M. Brad Drummond
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nadia N. Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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46
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Zaina F, Arshad S, Abubaker J, Ahmed A, Karim M. Prevalence of Obstructive Lung Disease in Asymptomatic Gas Field Workers. Cureus 2018; 10:e3580. [PMID: 30656084 PMCID: PMC6333259 DOI: 10.7759/cureus.3580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/12/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Obstructive lung disease, if not managed appropriately and in a timely manner, increases morbidity and mortality. The aim of this study was to see an obstruction on spirometry reports of clinically asymptomatic oil and gas field workers. Methods In this retrospective observational study, spirometry reports performed at the pulmonary function laboratory of Ziauddin Hospital and University, Karachi, were reviewed. All reports were of the clinically asymptomatic employees of an oil and gas company in Pakistan, who presented for their routine assessment. Obstructive impairment was defined as a forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7. Results Of the total of 199 spirometry reports, 197 (99%) were of male employees. The mean age of the employees was 30.52 ± 8.24 years and 46 (23.1%) employee were smokers. Obstruction was observed in 48 (24.1%) of the reports of the employees with 13 (27.1%) smokers and 35 (72.9%) non-smokers. No statistically significant association between obstruction and gender, age, and smoking was observed. Conclusion In this study, we observed obstructive impairment in around one-fourth of the otherwise clinically asymptomatic oil and gas field workers with no apparent impact of baseline smoking behavior.
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Affiliation(s)
- Fatima Zaina
- Pulmonology, Dr. Ziauddin University and Hospital, Karachi, PAK
| | - Salva Arshad
- Pulmonology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Jawed Abubaker
- Internal Medicine, Dr. Ziauddin University and Hospital, Karachi, PAK
| | - Arsalan Ahmed
- Internal Medicine, Dr. Ziauddin University and Hospital, Karachi, PAK
| | - Musa Karim
- Miscellaneous, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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47
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Akiki Z, Hallit S, Layoun N, Cherfane M, Sacre H, Waked M, Salameh P. Validation of the St George's respiratory questionnaire and risks factors affecting the quality of life of Lebanese COPD and asthma patients. J Asthma 2018; 56:1212-1221. [PMID: 30359153 DOI: 10.1080/02770903.2018.1531996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: We aimed to validate the Arabic version of the St George's Respiratory Questionnaire (SGRQ) for use in Lebanese Chronic obstructive pulmonary disease (COPD) and asthma patients and to identify risk factors that might affect the quality of life in these patients. Methods: COPD (n = 90) and asthma patients (n = 124) were recruited from the outpatient clinics of the Pulmonology department of a university hospital and a medical center in Beirut. They filled out a standardized questionnaire. The total SGRQ score and the component scores (symptoms, activity and impacts) were calculated. To confirm the SGRQ validity in the Lebanese population, factor analyses were applied for the whole sample, only asthma and only COPD patients, respectively. The associations between the total SGRQ score and FEV1% predicted, CCQ score and MRC scale were assessed. Multiple linear regression models were used to evaluate the association between the total SGRQ scores and the socio-demographics and the diseases risk factors. Results: COPD patients had a higher SGRQ total and subscales scores compared to asthma patients. A high Cronbach's alpha was found for the whole sample (0.802), only COPD patients (0.833) and only asthma patients (0.734). A significant negative correlation was found between FEV1% predicted and the total SGRQ scores. Occupational exposure, BMI and previous waterpipe smoking were among the factors that significantly and positively influenced a higher SGRQ score. Conclusions: The Lebanese version of the SGRQ emerges as a good health-related quality of life evaluative instrument that is reasonable to be used in COPD and asthma patients in Lebanon.
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Affiliation(s)
- Zeina Akiki
- Epidemiologie Clinique et Toxicologie, INSPECT-LB: Institut National de Sante Publique , Epidemiologie Clinique et Toxicologie, Beirut , Lebanon.,Faculty of Nursing and Health Sciences, Notre Dame Louaize University , Barsa , Lebanon.,Faculty of Public Health, Sainte Famille University , Batroun , Lebanon
| | - Souheil Hallit
- Epidemiologie Clinique et Toxicologie, INSPECT-LB: Institut National de Sante Publique , Epidemiologie Clinique et Toxicologie, Beirut , Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK) , Jounieh , Lebanon
| | - Nelly Layoun
- School of Pharmacy, Lebanese International University , Beirut , Lebanon
| | - Michelle Cherfane
- Drug Information Center, Order of Pharmacists in Lebanon , Beirut , Lebanon
| | - Hala Sacre
- Epidemiologie Clinique et Toxicologie, INSPECT-LB: Institut National de Sante Publique , Epidemiologie Clinique et Toxicologie, Beirut , Lebanon.,Faculty of Medicine, Balamand University, Balamand , Lebanon
| | - Mirna Waked
- Faculty of Pharmacy, Lebanese University , Beirut , Lebanon
| | - Pascale Salameh
- Epidemiologie Clinique et Toxicologie, INSPECT-LB: Institut National de Sante Publique , Epidemiologie Clinique et Toxicologie, Beirut , Lebanon.,School of Pharmacy, Lebanese International University , Beirut , Lebanon.,Faculty of Medicine, Lebanese University , Beirut , Lebanon
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48
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Robertsen Ø, Siebler F, Eisemann M, Hegseth MN, Føreland S, Vangberg HCB. Predictors of Respiratory Protective Equipment Use in the Norwegian Smelter Industry: The Role of the Theory of Planned Behavior, Safety Climate, and Work Experience in Understanding Protective Behavior. Front Psychol 2018; 9:1366. [PMID: 30135666 PMCID: PMC6092595 DOI: 10.3389/fpsyg.2018.01366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022] Open
Abstract
Previous research has revealed a higher prevalence of respiratory symptoms in Norwegian smelter workers compared to average population controls. Nevertheless, respiratory protective equipment (RPE) is not always used, even in situations with high exposure risk. A questionnaire was distributed to workers in the Norwegian smelting industry to investigate the relationship between psychological factors and self-reported use of RPEs. Response rate was 567/1,253. A scale measuring attitudes toward behavior (ATT), subjective norms (SN), perceived behavioral control (PBC), and behavioral intention (BI) was constructed based on the Theory of Planned Behavior (TPB). Reliability and Confirmatory Factor Analyses partially supported the theoretical structure of the TPB-based scale, the Work Experience Measurement Scale (WEMS) and the Short Scale for Safety Climate (SC). A model explaining the relationship between observed variables, latent constructs from TPB, WEMS and SC was developed by SEM-analysis. Significant influence on BI from ATT (β = 0.31 p < 0.01), SN (β = 0.36 p < 0.01), and SC (β = 0.19, p < 0.01) emerged. Among the observed variables included, relationship status (β = −0.12 p < 0.05), education level (β = 0.09, p < 0.05), previously completed respirator fit-testing (β = −0.09, p < 0.05) and average hours spent in exposed areas (β = −0.09) p < 0.05) had significant influence on behavioral intention. The model explained 48% of the variance in BI. BI and PBC significantly predicted PB, with β = 0.65 and β = −0.06, respectively. Results of this investigation can help facilitate further work and development of health & safety routines within industrial settings.
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Affiliation(s)
- Øystein Robertsen
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Frank Siebler
- Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Martin Eisemann
- Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Marit N Hegseth
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Solveig Føreland
- Department of Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Geoscience and Petroleum, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans-Christian B Vangberg
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
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49
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Smid DE, Franssen FME, Gonik M, Miravitlles M, Casanova C, Cosio BG, de Lucas-Ramos P, Marin JM, Martinez C, Mir I, Soriano JB, de Torres JP, Agusti A, Atalay NB, Billington J, Boutou AK, Brighenti-Zogg S, Chaplin E, Coster S, Dodd JW, Dürr S, Fernandez-Villar A, Groenen MTJ, Guimarães M, Hejduk K, Higgins V, Hopkinson NS, Horita N, Houben-Wilke S, Janssen DJA, Jehn M, Joerres R, Karch A, Kelly JL, Kim YI, Kimura H, Koblizek V, Kocks JH, Kon SSC, Kwon N, Ladeira I, Lee SD, Leuppi JD, Locantore N, Lopez-Campos JL, D-C Man W, Maricic L, Mendoza L, Miedinger D, Mihaltan F, Minami S, van der Molen T, Murrells TJ, Nakken N, Nishijima Y, Norman IJ, Novotna B, O'Donnell DE, Ogata Y, Pereira ED, Piercy J, Price D, Pothirat C, Raghavan N, Ringbaek T, Sajkov D, Sigari N, Singh S, Small M, da Silva GF, Tanner RJ, Tsiligianni IG, Tulek B, Tzanakis N, Vanfleteren LEGW, Watz H, Webb KA, Wouters EFM, Xie GG, Yoshikawa M, Spruit MA. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease. J Am Med Dir Assoc 2018; 18:1097.e11-1097.e24. [PMID: 29169740 DOI: 10.1016/j.jamda.2017.09.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. METHODS After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. MAIN OUTCOMES Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. FINDINGS A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. CONCLUSIONS The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed.
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Affiliation(s)
- Dionne E Smid
- Department of Research and Education, CIRO, Horn, The Netherlands.
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Ciro Casanova
- Pulmonary Department and Research Unit, Hospital Universitario NS La Candelaria, Santa Cruz de Tenerife, Spain
| | - Borja G Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISPa-CIBERES, Islas Baleares, Spain
| | - Pilar de Lucas-Ramos
- Hospital General Universitario Gregorio Marañon, Pulmonary Department, Madrid, Spain
| | - Jose M Marin
- Hospital Universitario Miguel Servet, IISAragon, CIBER Enfermedades Respiratorias, Zaragoza, Spain
| | - Cristina Martinez
- Pneumology Service Instituto Nacional de Silicosis-Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Isabel Mir
- Hospital General Universitario Gregorio Marañón, Madrid, Pulmonary Department, Madrid, Spain
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa, IISP, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan P de Torres
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona and CIBERES, Spain
| | - Nart B Atalay
- Department of Psychology, TOBB University of Economics and Technology, Ankara, Turkey
| | - Julia Billington
- Central Surgery, Surbiton Health Centre, Surbiton, Surrey, United Kingdom
| | - Afroditi K Boutou
- Intensive Care Unit, G Gennimats, General Hospital, Thessaloniki, Greece; Respiratory Failure Unit, Aristotle University of Thessaloniki, Greece
| | | | - Emma Chaplin
- Center for Exercise and Rehabilitation Science, NIHR Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Samantha Coster
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom
| | - James W Dodd
- Academic Respiratory Unit University of Bristol, North Bristol Lung Centre, Southmead Hospital Bristol, United Kingdom
| | - Selina Dürr
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Alberto Fernandez-Villar
- Servicio de Neumología, Instituto de Investigación Biomédica de Vigo, IBIV, Complexo Hospitalario de Vigo, Vigo, Pontevedra, España
| | | | - Miguel Guimarães
- Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | | | - Melissa Jehn
- Arbeitsbereich Ambulante Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Rudolf Joerres
- Institute and Output Clinic for Occupational and Environmental Medicine, Munich, Germany
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Julia L Kelly
- Academic Unit of Sleep and Ventilation, National Heart and Lung Institute, Imperial College London, NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton, United Kingdom; Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Yu-Il Kim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Donggu, Gwangju, South Korea
| | - Hiroshi Kimura
- Second Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - Vladimir Koblizek
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Janwillem H Kocks
- Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Samantha S C Kon
- The Hillingdon Hospital NHS Foundation Trust, United Kingdom; NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, United Kingdom
| | - Namhee Kwon
- Respiratory Franchise Medical, GlaxoSmithKline (GSK), London, United Kingdom
| | - Inês Ladeira
- Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Portugal
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - José L Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - William D-C Man
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, United Kingdom
| | - Lana Maricic
- University Hospital Osijek; Department of Internal Medicine; Faculty of Medicine, University J.J Strossmayer Osijek, Osijek, Croatia
| | - Laura Mendoza
- Hospital Clínico Universidad de Chile, Región Metropolitana, Chile
| | - David Miedinger
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Thys van der Molen
- Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Trevor J Murrells
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom
| | - Nienke Nakken
- Department of Research and Education, CIRO, Horn, The Netherlands
| | - Yu Nishijima
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan; Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ian J Norman
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom
| | - Barbora Novotna
- Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Denis E O'Donnell
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Yoshitaka Ogata
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | | | | | - David Price
- Observational and Pragmatic Research Institute, Singapore; University of Aberdeen, Aberdeen, United Kingdom
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Natya Raghavan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Ringbaek
- Department of Respiratory Medicine, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Dimitar Sajkov
- Australian Respiratory and Sleep Medicine Institute, Flinders Medical Center, Adelaide, Australia
| | - Naseh Sigari
- Internal Medicine Department, Medical Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sally Singh
- Center for Exercise and Rehabilitation Science, NIHR Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mark Small
- Adelphi Real World, Bollington, United Kingdom
| | | | - Rebecca J Tanner
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Ioanna G Tsiligianni
- Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Agia Barbara Health Care Center, Heraklion Crete, Greece
| | - Baykal Tulek
- Department of Chest Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece
| | - Lowie E G W Vanfleteren
- Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henrik Watz
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, German Center for Lung Research, Grosshansdorf, Germany
| | - Katherine A Webb
- Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada
| | - Emiel F M Wouters
- Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guogang G Xie
- Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Masanori Yoshikawa
- Second Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - Martijn A Spruit
- Department of Research and Education, CIRO, Horn, The Netherlands; REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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50
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Burkes RM, Gassett AJ, Ceppe AS, Anderson W, O'Neal WK, Woodruff PG, Krishnan JA, Barr RG, Han MK, Martinez FJ, Comellas AP, Lambert AA, Kaufman JD, Dransfield MT, Wells JM, Kanner RE, Paine R, Bleecker ER, Paulin LM, Hansel NN, Drummond MB. Rural Residence and Chronic Obstructive Pulmonary Disease Exacerbations. Analysis of the SPIROMICS Cohort. Ann Am Thorac Soc 2018; 15:808-816. [PMID: 29584453 PMCID: PMC6207115 DOI: 10.1513/annalsats.201710-837oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 12/13/2022] Open
Abstract
Rationale: Rural residence is associated with poor outcomes in several chronic diseases. The association between rural residence and chronic obstructive pulmonary disease (COPD) exacerbations remains unclear.Objectives: In this work, we sought to determine the independent association between rural residence and COPD-related outcomes, including COPD exacerbations, airflow obstruction, and symptom burden.Methods: A total of 1,684 SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) participants with forced expiratory volume in 1 second/forced vital capacity < 0.70 had geocoding-defined rural-urban residence status determined (N = 204 rural and N = 1,480 urban). Univariate and multivariate logistic and negative binomial regressions were performed to assess the independent association between rurality and COPD outcomes, including exacerbations, lung function, and symptom burden. The primary exposure of interest was rural residence, determined by geocoding of the home address to the block level at the time of study enrollment. Additional covariates of interest included demographic and clinical characteristics, occupation, and occupational exposures. The primary outcome measures were exacerbations determined over a 1-year course after enrollment by quarterly telephone calls and at an annual research clinic visit. The odds ratio (OR) and incidence rate ratio (IRR) of exacerbations that required treatment with medications, including steroids or antibiotics (total exacerbations), and exacerbations leading to hospitalization (severe exacerbations) were determined after adjusting for relevant covariates.Results: Rural residence was independently associated with a 70% increase in the odds of total exacerbations (OR, 1.70 [95% confidence interval (CI), 1.13-2.56]; P = 0.012) and a 46% higher incidence rate of total exacerbations (IRR 1.46 [95% CI, 1.02-2.10]; P = 0.039). There was no association between rural residence and severe exacerbations. Agricultural occupation was independently associated with increased odds and incidence of total and severe exacerbations. Inclusion of agricultural occupation in the analysis attenuated the association between rural residence and the odds and incidence rate of total exacerbations (OR, 1.52 [95% CI, 1.00-2.32]; P = 0.05 and IRR 1.39 [95% CI, 0.97-1.99]; P = 0.07). There was no difference in symptoms or airflow obstruction between rural and urban participants.Conclusions: Rural residence is independently associated with increased odds and incidence of total, but not severe, COPD exacerbations. These associations are not fully explained by agriculture-related exposures, highlighting the need for future research into potential mechanisms of the increased risk of COPD exacerbations in the rural population.
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Affiliation(s)
| | - Amanda J Gassett
- Department of Environmental and Occupational Health Sciences, School of Public Health, and
| | - Agathe S Ceppe
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wayne Anderson
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wanda K O'Neal
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, School of Medicine, San Francisco, California
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, Illinois
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Fernando J Martinez
- Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | | | - Allison A Lambert
- Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, and
| | - Mark T Dransfield
- Division of Pulmonary and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - J Michael Wells
- Division of Pulmonary and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard E Kanner
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Robert Paine
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Eugene R Bleecker
- Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina; and
| | - Laura M Paulin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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