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Gong J, Xu L, Yu H, Qiu F, Zhang Z, Yin Y, Ma H, Cai Z, Zhong J, Ding W, Cao C. Increased postoperative complications after laparoscopic gastrectomy in patients with preserved ratio impaired spirometry. J Gastrointest Surg 2024; 28:889-895. [PMID: 38513947 DOI: 10.1016/j.gassur.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/03/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm), defined as decreased forced expiratory volume in the first second in the setting of normal ratio, is associated with an increased risk of respiratory disease and systemic comorbidities. Unlike severe obstructive pulmonary disease, little is known about the impact of PRISm on short-term outcomes in patients undergoing laparoscopic gastrectomy (LG) and its association with small airway dysfunction (SAD). METHODS This study enrolled 830 patients who underwent preoperative spirometry and LG between January 2021 and August 2023. Of these, 228 patients were excluded. Participants were categorized into 3 groups based on their baseline lung function, and postoperative outcomes were subsequently analyzed. Potential associations between postoperative outcomes and various clinical variables were examined using univariate and multivariate analyses. RESULTS PRISm was identified in 16.6% of the patients, whereas SAD was present in 20.4%. The incidence of postoperative pulmonary complications (PPCs) was notably higher in the SAD group (20.3% vs 9.8%, P = .002) and the PRISm group (28.0% vs 9.8%, P < .001) than the normal group. Among the 3 groups, pneumonia was the most frequently observed PPC. Multivariate analysis revealed that both SAD (odds ratio [OR], 2.34; 95% CI, 1.30-4.22; P = .005) and PRISm (OR, 3.26; 95% CI, 1.80-5.90; P < .001) independently constituted significant risk factors associated with the occurrence of PPCs. Univariate analysis showed that female was a possible risk factor for PPCs in PRISm group. CONCLUSION Our study showed that PRISm and SAD were associated with the increased PPCs in patients undergoing LG for gastric cancer.
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Affiliation(s)
- Jun Gong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China; School of Medicine, Ningbo University, Ningbo, China
| | - Linbin Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China; School of Medicine, Ningbo University, Ningbo, China
| | - Hang Yu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Feng Qiu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Zhiping Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yongfang Yin
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Hongying Ma
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Zejun Cai
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jingjing Zhong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Weiping Ding
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, First Affiliated Hospital of Ningbo University, Ningbo, China.
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Zhou L, Yang H, Zhang Y, Wang Y, Zhou X, Liu T, Yang Q, Wang Y. Predictive value of lung function measures for cardiovascular risk: a large prospective cohort study. Thorax 2024; 79:250-258. [PMID: 38050152 DOI: 10.1136/thorax-2023-220703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Although lung function measures are associated with cardiovascular disease (CVD), the added predictive values of these measures remain unclear. METHODS From the UK Biobank, 308 415 participants free of CVD with spirometry parameters were included. The CVD outcomes included were defined by QRISK3, the American College of Cardiology/American Heart Association (ACC/AHA) and the European Systematic Coronary Risk Evaluation (SCORE) prediction models, respectively. Cox proportional hazard models were used to estimate the associations of lung function measures with CVD outcomes. The predictive capability was determined by the decision curve analyses. RESULTS Over a median follow-up of 12.5 years, 21 885 QRISK3 events, 12 843 ACC/AHA events and 2987 SCORE events were recorded. The associations of spirometry parameters with CVD outcomes were L-shaped. Restrictive and obstructive impairments were associated with adjusted HRs of 1.84 (95% CI: 1.65 to 2.06) and 1.72 (95% CI: 1.55 to 1.90) for SCORE CVD, respectively, compared with normal spirometry. Similar associations were seen for QRISK3 CVD (restrictive vs normal, adjusted HR: 1.30, 95% CI: 1.25 to 1.36; obstructive vs normal, adjusted HR: 1.20, 95% CI: 1.15 to 1.25) and ACC/AHA CVD (restrictive vs normal, adjusted HR: 1.39, 95% CI: 1.31 to 1.47; obstructive vs normal, adjusted HR: 1.26, 95% CI: 1.19 to 1.33). Using models that integrated non-linear forced expiratory volume in 1 s led to additional 10-year net benefits per 100 000 persons of 25, 43 and 5 for QRISK3 CVD at the threshold of 10%, ACC/AHA CVD at 7.5% and SCORE CVD at 5.0%, respectively. CONCLUSION Clinicians could consider spirometry indicators in CVD risk assessment. Cost-effectiveness studies and clinical trials are needed to put new CVD risk assessment into practice.
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Affiliation(s)
- Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yuan Zhang
- Raymond G. Perelman Centre for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yuan Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xin Zhou
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- School of Integrative Medicine, Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Shin YY, Park S, Kim KJ, Rhee CK, Yoo KH, Jung KS, Lee JH. Clinical Characteristics and Medical Utilization of Smokers with Preserved Ratio Impaired Spirometry. Int J Chron Obstruct Pulmon Dis 2023; 18:2187-2194. [PMID: 37822330 PMCID: PMC10563768 DOI: 10.2147/copd.s425934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose To investigate the clinical characteristics and medical utilization of smokers with preserved ratio impaired spirometry (PRISm). Patients and Methods We used data from the Korean National Health and Nutrition Examination Survey between 2007 and 2012, linked to the Health Insurance Review and Assessment Service. Clinical characteristics and medical utilization, including inpatient admission, emergency department visit, prescribed medication, and medical cost, were retrospectively compared among three groups: normal spirometry, PRISm, and chronic obstructive pulmonary disease (COPD). Results A total of 7115 smokers were included (4743 normal spirometry, 689 PRISm, and 1683 COPD subjects). The mean age was the highest in the COPD group, followed by the PRISm and normal groups, and the proportion of women was the highest in the PRISm group. The tobacco exposure, socioeconomic status (SES), and schooling level of the PRISm group were at levels between those of the normal and COPD groups. However, the PRISm group had the highest proportion of current smokers, highest body mass index (BMI), and lowest mean FEV1 and FVC % predicted. During the study period, the medical utilization of 92 smokers (13.4%) in the PRISm group and 436 smokers (25.9%) in the COPD group was related to respiratory diseases. Emergency department visit or hospitalization and overall medical cost of the PRISm group were comparable to those of the COPD group, except for outpatient clinic visit. Old age, women, low BMI, low SES, low schooling level, high amount of tobacco exposure, wheezing, and decreased FEV1 and FVC % predicted were factors associated with medical utilization in PRISm. Conclusion Medical utilization was comparable between the PRISm and COPD groups. Smokers with PRISm who were older, women, or heavy smokers with low BMI, low SES and schooling level, wheezing, or low FEV1 and FVC might need close observation and early treatment.
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Affiliation(s)
- Yune-Young Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sojung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kyung Joo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ki-Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Gyeonggi-do, Republic of Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Haynes JM, Kaminsky DA, Ruppel GL. The Role of Pulmonary Function Testing in the Diagnosis and Management of COPD. Respir Care 2023; 68:889-913. [PMID: 37353330 PMCID: PMC10289615 DOI: 10.4187/respcare.10757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Pulmonary function testing (PFT) has a long and rich history in the definition, diagnosis, and management of COPD. For decades, spirometry has been regarded as the standard for diagnosing COPD; however, numerous studies have shown that COPD symptoms, pathology, and associated poor outcomes can occur, despite normal spirometry. Diffusing capacity and imaging studies have called into question the need for spirometry to put the "O" (obstruction) in COPD. The role of exercise testing and the ability of PFTs to phenotype COPD are reviewed. Although PFTs play an important role in diagnosis, treatment decisions are primarily determined by symptom intensity and exacerbation history. Although a seminal study positioned FEV1 as the primary predictor of survival, numerous studies have shown that tests other than spirometry are superior predictors of mortality. In years past, using spirometry to screen for COPD was promulgated; however, this only seems appropriate for individuals who are symptomatic and at risk for developing COPD.
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Affiliation(s)
- Jeffrey M Haynes
- Pulmonary Function Laboratory, Elliot Health System, Manchester, New Hampshire.
| | - David A Kaminsky
- Division of Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Gregg L Ruppel
- Division of Pulmonary, Critical Care and Sleep Medicine, St. Louis University, St. Louis, Missouri
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Preserved ratio impaired spirometry with or without restrictive spirometric abnormality. Sci Rep 2023; 13:2988. [PMID: 36806707 PMCID: PMC9941093 DOI: 10.1038/s41598-023-29922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
Preserved ratio impaired spirometry (PRISm) is defined by reduced FEV1 with a preserved FEV1/FVC ratio; some individuals with PRISm can also have restrictive ventilatory abnormality. The aim of this study was to clarify clinical features of restrictive and non-restrictive PRISm. In total, 11,246 participants (mean, 49.1 years; range, 35-65 years) from five healthcare centres were included in this study. We evaluated baseline characteristics of participants with restrictive PRISm (FEV1/FVC ≥ 0.7, FEV1 < 80% and FVC < 80%) and non-restrictive PRISm (FEV1/FVC ≥ 0.7, FEV1 < 80% and FVC ≥ 80%), and airflow obstruction (FEV1/FVC < 0.7). We examined the longitudinal risk of developing airflow obstruction by comparing spirometry results at baseline and 5 years post-baseline among 2141 participants. Multivariate analysis demonstrated that a history of asthma or smoking could constitute an independent risk factor for non-restrictive PRISm, and that non-restrictive PRISm was independently associated with the risk of developing airflow obstruction. In contrast, female sex, advanced age, and high BMI, but not history of asthma or smoking, were risk factors for restrictive PRISm. Restrictive PRISm was not associated with the development of airflow obstruction. In conclusion, our results indicate that PRISm can be categorized according to the presence or absence of restrictive abnormality. Non-restrictive PRISm, which does not meet the conventional criteria of obstructive and restrictive ventilatory abnormalities, may be a precursor of chronic obstructive pulmonary disease and merits increased monitoring.
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Sepúlveda-Loyola W, Carnicero JA, Álvarez-Bustos A, Probst VS, Garcia-Garcia FJ, Rodriguez-Mañas L. Pulmonary function is associated with frailty, hospitalization and mortality in older people: 5-year follow-up. Heart Lung 2023; 59:88-94. [PMID: 36796248 DOI: 10.1016/j.hrtlng.2023.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The relationship between pulmonary impairment and frailty has rarely been studied in community-dwelling older adults. OBJECTIVE This study aimed to analyze the association between pulmonary function and frailty (prevalent and incident), identifying the best cut-off points to detect frailty and its association with hospitalization and mortality. METHODS A longitudinal observational cohort study with 1188 community-dwelling older adults was taken from the Toledo Study for Healthy Aging. The forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) were measured with spirometry. Frailty was evaluated using the Frailty Phenotype and Frailty Trait Scale 5. Associations between pulmonary function and frailty, hospitalization and mortality in a 5-year follow-up and the best cut-off points for FEV1 and FVC were analyzed. RESULTS FEV1 and FVC were associated with frailty prevalence (OR from 0.25 to 0.60), incidence (OR from 0.26 to 0.53), and hospitalization and mortality (HR from 0.35 to 0.85). The cut-off points of pulmonary function identified in this study: FEV1 (≤1.805 L for male and ≤1.165 L for female) and FVC (≤2.385 L for male and ≤1.585 L for female) were associated with incident frailty (OR: 1.71-4.06), hospitalization (HR: 1.03-1.57) and mortality (HR: 2.64-5.17) in individuals with and without respiratory diseases (P < 0.05 for all). CONCLUSION Pulmonary function was inversely associated with the risk of frailty, hospitalization and mortality in community-dwelling older adults. The cut-off points for FEV1 and FVC to detect frailty were highly associated with hospitalization and mortality in the 5-year follow-up, regardless of the existence of pulmonary diseases.
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Affiliation(s)
- Walter Sepúlveda-Loyola
- Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago, Chile; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Masters and PhD Program in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Jose A Carnicero
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | - Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Suziane Probst
- Masters and PhD Program in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Francisco J Garcia-Garcia
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Geriatría, Hospital Virgen del Valle, Toledo, Spain
| | - Leocadio Rodriguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Geriatría, Hospital Universitario de Getafe, Carretera de Toledo, km 12,500, Getafe, Spain.
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An identifiable model of lung mechanics to diagnose and monitor COPD. Comput Biol Med 2023; 152:106430. [PMID: 36543001 DOI: 10.1016/j.compbiomed.2022.106430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current methods to diagnose and monitor COPD employ spirometry as the gold standard to identify lung function reduction with reduced forced expiratory volume (FEV1)/vital capacity (VC) ratio. Current methods utilise linear assumptions regarding airway resistance, where nonlinear resistance modelling may provide rapid insight into patient specific condition and disease progression. This study examines model-based expiratory resistance in healthy lungs and those with progressively more severe COPD. METHODS Healthy and COPD pressure (P)[cmH2O] and flow (Q)[L/s] data is obtained from the literature, and 5 intermediate levels of COPD and responses are created to simulate COPD progression and assess model-based metric resolution. Linear and nonlinear single compartment models are used to identify changes in inspiratory (R1,insp) and linear (R1,exp)/nonlinear (R2Φ) expiratory resistance with disease severity and over the course of expiration. RESULTS R1,insp increases from 2.1 to 7.3 cmH2O/L/s, R1,exp increases from 2.4 to 10.0 cmH2O/L/s with COPD severity. Nonlinear R2Φ increases (mean R2Φ: 2.5 cmH2O/L/s (healthy) to 24.4 cmH2O/L/s (COPD)), with increasing end-expiratory nonlinearity as COPD severity increases. CONCLUSION Expiratory resistance is increasingly highly nonlinear with COPD severity. These results show a simple, nonlinear model can capture fundamental COPD dynamics and progression from regular breathing data, and such an approach may be useful for patient-specific diagnosis and monitoring.
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Zhou L, Yang H, Zhang Y, Li H, Zhang S, Li D, Ma Y, Hou Y, Lu W, Wang Y. Association of impaired lung function with dementia, and brain magnetic resonance imaging indices: a large population-based longitudinal study. Age Ageing 2022; 51:6834143. [PMID: 36413587 DOI: 10.1093/ageing/afac269] [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: 05/22/2022] [Revised: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE to examine the association between different patterns of impaired lung function with the incident risk of dementia and magnetic resonance imaging (MRI)-based brain structural features. METHODS in UK Biobank, a total of 308,534 dementia-free participants with valid lung function measures (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]) were included. Association was assessed using Cox proportional hazards regression model. Furthermore, the association between impaired lung function and brain MRI biomarkers related to cognitive function was analysed among 30,159 participants. RESULTS during a median follow-up of 12.6 years, 3,607 incident all-cause dementia cases were recorded. Restrictive impairment (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.27-1.60) and obstructive impairment (HR, 1.28; 95% CI, 1.15-1.42) were associated with higher risk of all-cause dementia. The restricted cubic splines indicated FEV1% predicted and FVC % predicted had reversed J-shaped associations with dementia. Participants with impaired lung function have higher risks of all-cause dementia across all apolipoprotein E (APOE) risk categories, whereas associations were stronger among those of low APOE risk (P for interaction = 0.034). In addition, restrictive and obstructive impairment were linked to lower total (β: -0.075, SE: 0.021, Pfdr = 0.002; β: -0.033, SE: 0.017, Pfdr = 0.069) and frontoparietal grey matter volumes, higher white matter hyperintensity, poorer white matter integrity, lower hippocampus (β: -0.066, SE: 0.024, Pfdr = 0.017; β: -0.051, SE: 0.019, Pfdr = 0.019) and other subcortical volumes. CONCLUSIONS participants with restrictive and obstructive impairments had a higher risk of dementia. Brain MRI indices further supported adverse effects and provided insight into potential pathophysiology biomarkers.
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Affiliation(s)
- Lihui Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Huiping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Shunming Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Dun Li
- Department of Basic Integrated Medicine, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Department of Basic Integrated Medicine, School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Brusasco V, Pellegrino R. Pulmonary function interpretative strategies: from statistics to clinical practice. Eur Respir J 2022; 60:60/1/2200317. [PMID: 35835474 DOI: 10.1183/13993003.00317-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Vito Brusasco
- Dipartimento di Medicina Sperimentale, Università di Genova, Genova, Italy
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Wan ES, Hokanson JE, Regan EA, Young KA, Make BJ, DeMeo DL, Mason SE, San Jose Estepar R, Crapo JD, Silverman EK. Significant Spirometric Transitions and Preserved Ratio Impaired Spirometry Among Ever Smokers. Chest 2022; 161:651-661. [PMID: 34592319 PMCID: PMC8941606 DOI: 10.1016/j.chest.2021.09.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Emerging data from longitudinal studies suggest that preserved ratio impaired spirometry (PRISm), defined by proportionate reductions in FEV1 and FVC, is a heterogeneous population with frequent transitions to other lung function categories relative to individuals with normal and obstructive spirometry. Controversy regarding the clinical significance of these transitions exists (eg, whether transitions merely reflect measurement variability or noise). RESEARCH QUESTION Are individuals with PRISm enriched for transitions associated with substantial changes in lung function? STUDY DESIGN AND METHODS Current and former smokers enrolled in the Genetic Epidemiology of COPD (COPDGene) study with spirometry available in phases 1 through 3 (enrollment, 5-year follow-up, and 10-year follow-up) were analyzed. Postbronchodilator lung function categories were as follows: PRISm (FEV1 < 80% predicted with FEV1/FVC ratio ≥ 0.7), Global Initiative for Chronic Obstructive Lung Disease grade 0 (FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7), and obstruction (FEV1/FVC < 0.7). Significant transition status was affirmative if a subject belonged to two or more spirometric categories and had > 10% change in FEV1 % predicted and/or FVC % predicted between consecutive visits. Ever-PRISm was present if a subject had PRISm at any visit. Logistic regression examined the association between significant transitions and ever-PRISm status, adjusted for age, sex, race, FEV1 % predicted, current smoking, pack-years, BMI, and ever-positive bronchodilator response. RESULTS Among subjects with complete data (N = 1,775) over 10.1 ± 0.4 years of follow-up, the prevalence of PRISm remained consistent (10.4%-11.3%) between phases 1 through 3, but nearly one-half of subjects with PRISm transitioned into or out of PRISm at each visit. Among all subjects, 19.7% had a significant transition; ever-PRISm was a significant predictor of significant transitions (unadjusted OR, 10.3; 95% CI, 7.9-13.5; adjusted OR, 14.9; 95% CI, 10.9-20.7). Results were similar with additional adjustment for radiographic emphysema and gas trapping, when lower limit of normal criteria were used to define lung function categories, and when FEV1 alone (regardless of change in FVC % predicted) was used to define significant transitions. INTERPRETATION PRISm is an unstable group, with frequent significant transitions to both obstruction and normal spirometry over time. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT000608764; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA,Pulmonary & Critical Care Section, VA Boston Healthcare System, Boston, MA,CORRESPONDENCE TO: Emily S. Wan, MD, MPH
| | - John E. Hokanson
- University of Colorado, Denver, CO,Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - Elizabeth A. Regan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO,National Jewish Health, Denver, CO
| | - Kendra A. Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | | | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Stefanie E. Mason
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | | | | | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
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Wang G, Hallberg J, Charalampopoulos D, Sanahuja MC, Breyer-Kohansal R, Langhammer A, Granell R, Vonk JM, Mian A, Olvera N, Laustsen LM, Rönmark E, Abellan A, Agusti A, Arshad SH, Bergström A, Boezen HM, Breyer MK, Burghuber O, Bolund AC, Custovic A, Devereux G, Donaldson GC, Duijts L, Esplugues A, Faner R, Ballester F, Garcia-Aymerich J, Gehring U, Haider S, Hartl S, Backman H, Holloway JW, Koppelman GH, Lertxundi A, Holmen TL, Lowe L, Mensink-Bout SM, Murray CS, Roberts G, Hedman L, Schlünssen V, Sigsgaard T, Simpson A, Sunyer J, Torrent M, Turner S, Van den Berge M, Vermeulen RCH, Vikjord SAA, Wedzicha JA, Maitland van der Zee AH, Melén E. Spirometric phenotypes from early childhood to young adulthood: a Chronic Airway Disease Early Stratification study. ERJ Open Res 2021; 7:00457-2021. [PMID: 34881328 PMCID: PMC8646001 DOI: 10.1183/23120541.00457-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts. Methods We studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10–15, >15–20, >20–25 years, and overall, 5–25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV1/FVC z-score ≥LLN, and FVC z-score <LLN. Results The prevalence of obstructive and restrictive phenotypes varied from 3.2–10.9% and 1.8–7.7%, respectively, without clear age trends. A diagnosis of asthma (adjusted odds ratio (aOR=2.55, 95% CI 2.14–3.04), preterm birth (aOR=1.84, 1.27–2.66), maternal smoking during pregnancy (aOR=1.16, 95% CI 1.01–1.35) and family history of asthma (aOR=1.44, 95% CI 1.25–1.66) were associated with a higher prevalence of obstructive, but not restrictive, phenotype across ages (5–25 years). A higher current body mass index (BMI was more often observed in those with the obstructive phenotype but less in those with the restrictive phenotype (aOR=1.05, 95% CI 1.03–1.06 and aOR=0.81, 95% CI 0.78–0.85, per kg·m−2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24, 95% CI 1.05–1.46). Conclusion Obstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with the obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes. Obstructive and restrictive phenotypes are present from childhood to adulthood but without age trends. Established risk factors for airway disease are associated with the obstructive phenotype, whereas low BMI is associated with the restrictive.https://bit.ly/3BMoMtI
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Affiliation(s)
- Gang Wang
- Dept of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China.,Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Shared first authors
| | - Jenny Hallberg
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Shared first authors
| | - Dimitrios Charalampopoulos
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maribel Casas Sanahuja
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Dept of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
| | - Arnulf Langhammer
- Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | - Raquel Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judith M Vonk
- Dept of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Annemiek Mian
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Núria Olvera
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Institut d'investigacions biomediques August Pi I Sunyer, Barcelona, Spain
| | - Lisbeth Mølgaard Laustsen
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Eva Rönmark
- Dept of Public Health and Clinical Medicine, Section for Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Alicia Abellan
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Alvar Agusti
- Institut d'investigacions biomediques August Pi I Sunyer, Barcelona, Spain.,Respiratory Institute, Hospital Clinic, Univ. Barcelona, Barcelona, Spain.,CIBERESP (ISCiii), Barcelona, Spain
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - H Marike Boezen
- Dept of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Dept of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
| | - Otto Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Anneli Clea Bolund
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Liesbeth Duijts
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Respiratory Medicine and Allergology, and Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ana Esplugues
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Nursing Department, Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain.,Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Rosa Faner
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ferran Ballester
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Nursing Department, Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain.,Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sadia Haider
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Dept of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Helena Backman
- Dept of Public Health and Clinical Medicine, Section for Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - John W Holloway
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gerard H Koppelman
- University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands.,Dept of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands
| | - Aitana Lertxundi
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Dept of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, Spain.,BIODONOSTIA Health Research Institute, Donostia-San Sebastian, Spain
| | - Turid Lingaas Holmen
- Dept of Public Health and General Practice, HUNT Research Center, NTNU, Levanger, Norway
| | - Lesley Lowe
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, UK.,Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sara M Mensink-Bout
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, UK.,Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Roberts
- David Hide Asthma and Allergy Research Centre, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Linnea Hedman
- Dept of Public Health and Clinical Medicine, Section for Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Vivi Schlünssen
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, NIHR, Manchester, UK.,Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,IMIM-Parc Salut Mar, Barcelona, Spain
| | | | - Stephen Turner
- Royal Aberdeen Children's Hospital NHS Grampian, Aberdeen, UK
| | - Maarten Van den Berge
- University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands.,Dept of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sigrid Anna Aalberg Vikjord
- Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway.,Dept of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Anke H Maitland van der Zee
- Dept of Respiratory Medicine, Amsterdam University Medical Centers (UMC), University of Amsterdam.,Pediatric Respiratory Medicine, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.,Shared last authors
| | - Erik Melén
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Shared last authors
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12
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Hurst JR, Siddiqui MK, Singh B, Varghese P, Holmgren U, de Nigris E. A Systematic Literature Review of the Humanistic Burden of COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:1303-1314. [PMID: 34007170 PMCID: PMC8121160 DOI: 10.2147/copd.s296696] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, causing substantial economic and social burden. OBJECTIVE This review assessed the patient-reported humanistic burden associated with moderate to very severe COPD, specifically the impact on health-related quality of life (HRQoL), symptoms, limitations in daily life, and emotional implications, through the use of HRQoL instruments. METHODS A systematic review was conducted to retrieve relevant clinical data from published literature using a representative sample of countries where healthcare systems provide wide availability of COPD medications and/or universal coverage includes respiratory medicines (Australia, Canada, China, France, Germany, Italy, Spain, the UK, and the USA). The primary inclusion criteria were patients with moderate to very severe COPD. HRQoL was quantified with non-disease-specific and disease-specific questionnaires. RESULTS In total, 82 studies from 95 publications presented HRQoL data from patients with moderate to very severe COPD. Patient-reported HRQoL declined with worsening airflow limitation, advancing GOLD group, and increasing exacerbation frequency. Both increasing frequency of hospitalization for COPD exacerbations and recurrent hospitalization adversely impacted HRQoL. Comorbidity incidence was higher in patients with increased airflow limitation. It was associated with a further decline in HRQoL and increased depression and anxiety, particularly as disease-associated pain worsened. Physical activity improved HRQoL over time. CONCLUSION This review highlighted the impact of exacerbations and associated hospitalizations on the humanistic burden of COPD. These findings underline the importance of managing COPD actively, including prompt and appropriate use of pharmacological and non-pharmacological therapies that can improve symptoms and reduce the risk of exacerbations, thereby lessening the humanistic burden. Future reviews could consider a broader range of countries and publications to further assess the humanistic impact of COPD in low- and middle-income economies.
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Affiliation(s)
- John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Mohd Kashif Siddiqui
- HEOR and RWE Analytics, Regulatory Access, Parexel International Ltd, Mohali, India
| | - Barinder Singh
- HEOR Evidence Evaluation, Parexel International Ltd, Mohali, India
| | - Precil Varghese
- Biopharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Gothenburg, MD, USA
| | - Ulf Holmgren
- Real World Science and Digital, Biopharmaceutical Medical, AstraZeneca, Gothenburg, Sweden
| | - Enrico de Nigris
- Global Product and Portfolio Strategy, AstraZeneca, Cambridge, UK
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13
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Gaspar-Marques J, Palmeiro T, Caires I, Leiria Pinto P, Neuparth N, Carreiro-Martins P. Ventilatory defects and treatable traits in very elderly patients. Sci Prog 2021; 104:368504211013171. [PMID: 33929910 PMCID: PMC10305819 DOI: 10.1177/00368504211013171] [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: 11/17/2022]
Abstract
Though the approach used to classify chronic respiratory diseases is changing to a treatable-traits (TT) approach, data regarding very elderly patients is lacking. The objectives of this study were to assess TT frequency in very elderly patients and to study the link between extrapulmonary TT and ventilatory defects. Individuals (≥75 years) residing in elderly care centres answered a standardised questionnaire, underwent spirometry, atopy and fractional exhaled nitric oxide assessments and had their blood pressure and peripheral pulse oximetry measured. Pulmonary, extrapulmonary and behavioural TT were evaluated. Outcome variables were an airflow limitation (post-bronchodilator z-score FEV1/FVC<-1.64) and a restrictive spirometry pattern (z-score FEV1/FVC ≥ +1.64 and z-score FVC<-1.64). Seventy-two percent of the individuals who took part in the study (n = 234) were women, and the median age of participants was 86 (IQR: 7.4). At least one pulmonary TT was identified in 105 (44.9%) individuals. The most frequent extrapulmonary TTs were: persistent systemic inflammation (47.0%), anaemia (34.4%), depression (32.5%) and obesity (27.4). Airflow limitation was exclusively associated with smoking (OR 5.03; 95% CI 1.56-16.22). A restrictive spirometry pattern was associated with cognitive impairment (OR: 3.89; 95% CI: 1.55-9.79). A high frequency of various TTs was found. The novel association between a restrictive spirometry pattern and cognitive impairment highlights the urgency of clinical research on this vulnerable age group.
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Affiliation(s)
- João Gaspar-Marques
- NOVA Medical School/Comprehensive
Health Research Centre (CHRC), Lisbon, Portugal
- Immunoallergology Service, Dona
Estefânia Hospital, Central Lisbon Hospital Centre, EPE, Lisbon, Portugal
| | - Teresa Palmeiro
- NOVA Medical School/Comprehensive
Health Research Centre (CHRC), Lisbon, Portugal
| | - Iolanda Caires
- NOVA Medical School/Comprehensive
Health Research Centre (CHRC), Lisbon, Portugal
| | - Paula Leiria Pinto
- NOVA Medical School/Comprehensive
Health Research Centre (CHRC), Lisbon, Portugal
- Immunoallergology Service, Dona
Estefânia Hospital, Central Lisbon Hospital Centre, EPE, Lisbon, Portugal
| | - Nuno Neuparth
- NOVA Medical School/Comprehensive
Health Research Centre (CHRC), Lisbon, Portugal
- Immunoallergology Service, Dona
Estefânia Hospital, Central Lisbon Hospital Centre, EPE, Lisbon, Portugal
| | - Pedro Carreiro-Martins
- NOVA Medical School/Comprehensive
Health Research Centre (CHRC), Lisbon, Portugal
- Immunoallergology Service, Dona
Estefânia Hospital, Central Lisbon Hospital Centre, EPE, Lisbon, Portugal
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14
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Kolonics-Farkas AM, Kovats Z, Bohacs A, Odler B, Benke K, Agg B, Szabolcs Z, Müller V. Airway obstruction can be better predicted using Global Lung Function Initiative spirometry reference equations in Marfan syndrome. Physiol Int 2021. [PMID: 33769955 DOI: 10.1556/2060.2021.00002] [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: 05/07/2020] [Accepted: 08/29/2020] [Indexed: 11/19/2022]
Abstract
Marfan syndrome is a genetic disorder of the connective tissue, including involvement of the lungs.Pulmonary function test was performed in 32 asymptomatic adult Marfan patients using European Community for Coal and Steel (ECCS) and Global Lung Function Initiative (GLI) reference values.Using GLI equations for reference, significantly lower lung function values were noted for forced vital capacity (FVC) (87.0 ± 16.6% vs. 97.1 ± 16.9%; P < 0.01) and forced expiratory volume in the first second (FEV1) (79.6 ± 18.9% vs. 88.0 ± 19.1%; P < 0.01) predicted compared to ECCS. Obstructive ventilatory pattern was present in 25% of the cases when calculating with GLI lower limit of normal (LLN), and it was significantly more common in men as compared to women (n = 6, 50% vs. n = 2, 10%; P = 0.03).GLI is more suitable to detect early ventilatory changes including airway obstruction in young patients with special anatomic features, and should be used as a standard way of evaluation in asymptomatic Marfan population.
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Affiliation(s)
| | - Z Kovats
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - A Bohacs
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - B Odler
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
- 2Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - K Benke
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- 4Hungarian Marfan Foundation, Budapest, Hungary
| | - B Agg
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- 4Hungarian Marfan Foundation, Budapest, Hungary
- 5Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Z Szabolcs
- 3Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- 4Hungarian Marfan Foundation, Budapest, Hungary
| | - V Müller
- 1Department of Pulmonology, Semmelweis University, Budapest, Hungary
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15
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Lee S, Lasky-Su JA, Lange C, Kim W, Kumar PL, McDonald MLN, Vaz Fragoso CA, Laurie C, Raby BA, Celedón JC, Cho MH, Won S, Weiss ST, Hecker J. A novel locus for exertional dyspnoea in childhood asthma. Eur Respir J 2021; 57:2001224. [PMID: 32855217 PMCID: PMC8185954 DOI: 10.1183/13993003.01224-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022]
Abstract
Most children diagnosed with asthma have respiratory symptoms such as cough, dyspnoea and wheezing, which are also important markers of overall respiratory function. A decade of genome-wide association studies (GWAS) have investigated genetic susceptibility to asthma itself, but few have focused on important respiratory symptoms that characterise childhood asthma.Using whole-genome sequencing (WGS) data for 894 asthmatic trios from a Costa Rican cohort, we performed family-based association tests (FBATs) to assess the association between genetic variants and multiple asthma-relevant respiratory phenotypes: cough, phlegm, wheezing, exertional dyspnoea and exertional chest tightness. We tested whether genome-wide significant associations were replicated in two additional studies: 1) 286 asthmatic trios from the Childhood Asthma Management Program (CAMP), and 2) 2691 African American current or former smokers from the COPDGene study.In the 894 Costa Rican trios, we identified a genome-wide significant association (p=2.16×10-9) between exertional dyspnoea and the single nucleotide polymorphism (SNP) rs10165869, located on chromosome 2q37.3, that was replicated in the CAMP cohort (p=0.023) with the same direction of association (combined p=3.28×10-10). This association was not found in the African American participants from COPDGene. We also found suggestive evidence for an association between SNP rs10165869 and the atypical chemokine receptor 3 (ACKR3).Our finding encourages the secondary association analysis of a wider range of phenotypes that characterise respiratory symptoms in other airway diseases/studies.
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Affiliation(s)
- Sanghun Lee
- Dept of Medical Consilience, Division of Medicine, Graduate
School, Dankook University, Yongin, South Korea
- Dept of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Jessica Ann Lasky-Su
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Christoph Lange
- Dept of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Wonji Kim
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Preeti Lakshman Kumar
- Division of Pulmonary, Allergy and Critical Care Medicine,
University of Alabama at Birmingham, Birmingham, AL, USA
| | - Merry-Lynn N. McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine,
University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Cecelia Laurie
- Dept of Biostatistics, University of Washington, Seattle,
WA, USA
| | - Benjamin A. Raby
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, UPMC
Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Sungho Won
- Dept of Public Health Science, Seoul National University,
Seoul, South Korea
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Julian Hecker
- Channing Division of Network Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
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16
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Moon SM, Lim JH, Hong YS, Shin KC, Lee CY, Kim DJ, Lee SH, Jung KS, Lee CH, Yoo KH, Lee H, Park HY. Clinical impact of forced vital capacity on exercise performance in patients with chronic obstructive pulmonary disease. J Thorac Dis 2021; 13:837-846. [PMID: 33717557 PMCID: PMC7947547 DOI: 10.21037/jtd-20-1098a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Forced vital capacity (FVC) has been suggested to be a good biomarker for decreased exercise performance in patients with chronic obstructive pulmonary disease (COPD). However, as FVC is highly correlated with forced expiratory volume in 1 second (FEV1), the relationship between FVC and exercise capacity should be assessed within the category of FEV1, i.e., COPD severity. However, this was not considered in previous studies. Thus, limited data are available on the association between reduced FVC and exercise capacity measured by 6-min walk distance (6MWD) based on COPD severity. Methods We performed a cross-sectional study using data from the Korean COPD Subgroup Study (KOCOSS) cohort. We evaluated 1,386 patients with moderate (n=895) and severe-to-very severe (n=491) COPD. Reduced FVC was defined as FVC <80% predicted and short 6MWD as <350 m. Multivariable logistic regression was used to evaluate the association between reduced FVC and short 6MWD. Results There were no significant differences in respiratory symptoms and quality of life between the patients with reduced FVC and those with preserved FVC. However, patients with reduced FVC had shorter 6MWD (30.5 cm in moderate and 34.5 cm in severe-to-very severe COPD) and higher BODE index scores than those with preserved FVC. The cubic spline model revealed 6MWD peaked around 93% predicted of FVC in moderate COPD, whereas FVC showed a positive association with 6MWD in severe-to-very severe COPD. Multivariable analyses showed that reduced FVC was significantly associated with short 6MWD in both moderate [adjusted odds ratio (aOR) =1.44, 95% confidence interval (CI): 1.03-2.02] and severe-to-very severe (adjusted OR =1.55, 95% CI: 1.01-2.40) COPD. Conclusions Reduced FVC was significantly associated with shorter 6MWD in moderate-to-very severe COPD patients, suggesting that reduced FVC might be reflective of 6MWD-measured exercise capacity in moderate-to-very severe COPD.
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Affiliation(s)
- Seong Mi Moon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Jun Hyeok Lim
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Yun Soo Hong
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kyeong-Cheol Shin
- Division of Pulmonology and Allergy, Regional Center for Respiratory Disease, Yeungnam University Medical Center, Daegu, South Korea
| | - Chang Youl Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Gangwon-do, South Korea
| | - Do Jin Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, South Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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17
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Torén K, Schiöler L, Lindberg A, Andersson A, Behndig AF, Bergström G, Blomberg A, Caidahl K, Engvall JE, Eriksson MJ, Hamrefors V, Janson C, Kylhammar D, Lindberg E, Lindén A, Malinovschi A, Lennart Persson H, Sandelin M, Eriksson Ström J, Tanash H, Vikgren J, Johan Östgren C, Wollmer P, Sköld CM. The ratio FEV 1 /FVC and its association to respiratory symptoms-A Swedish general population study. Clin Physiol Funct Imaging 2020; 41:181-191. [PMID: 33284499 PMCID: PMC7898324 DOI: 10.1111/cpf.12684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
Abstract
Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.70 after bronchodilation. It is unclear which is the most optimal ratio in relation to respiratory morbidity. The aim was to investigate to what extent different ratios of FEV1/FVC were associated with any respiratory symptom. In a cross‐sectional general population study, 15,128 adults (50–64 years of age), 7,120 never‐smokers and 8,008 ever‐smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41–0.56). Among never‐smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41–0.70). Among ever‐smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16–1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38–0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80–0.85, with similar results among never‐smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Anders Andersson
- COPD Center, Department or Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,COPD Center, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie F Behndig
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan E Engvall
- CMIV, Centre of Medical Image Science and Visualization, Linkoping University, Linkoping, Sweden.,Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - David Kylhammar
- Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory-, Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anders Lindén
- Unit for Lung & Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hans Lennart Persson
- Department of Clinical Physiology, Linköping University, Linköping, Sweden.,Respiratory Medicine, Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Martin Sandelin
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Jonas Eriksson Ström
- Department of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden
| | - Hanan Tanash
- Department of Clinical Science in Malmö, Lund University, Lund, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital and the Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Carl Johan Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - C Magnus Sköld
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden.,Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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18
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Vaz Fragoso CA, Rochester CL, McAvay GJ, Iannone L, Leo-Summers LS. Diffusing capacity in normal-for-age spirometry and spirometric impairments, using reference equations from the global lung function initiative. Respir Med 2020; 170:106037. [PMID: 32843169 DOI: 10.1016/j.rmed.2020.106037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Reference equations from the Global Lung Function Initiative (GLI) are now available for both spirometry and diffusion. However, respiratory phenotypes defined by GLI-based measures of diffusion have not yet been evaluated in GLI-based normal-for-age spirometry or spirometric impairments. METHODS We evaluated cross-sectional data from 2100 Caucasians, aged 40-85 years. GLI-based spirometric categories included normal-for-age and the impairments of restrictive-pattern and three-level severity of airflow-obstruction (mild, moderate, severe). GLI-based diffusion included diffusing capacity of the lung for carbon monoxide (DLCO) and measured components of alveolar volume (VA) and transfer coefficient (KCO): DLCO = [VA]x[KCO]. Using multivariable regression models, adjusted odds ratios (adjORs) for DLCO, VA, and KCO < lower limit of normal (LLN) were calculated for spirometric impairments, relative to normal-for-age spirometry. RESULTS Relative to normal-for-age spirometry, the restrictive-pattern increased the adjORs (95% confidence intervals) for DLCO and VA < LLN-4.61 (3.62, 5.85) and 15.53 (11.8, 20.4), respectively, but not for KCO < LLN-1.02 (0.79, 1.33). Also relative to normal-for-age spirometry, airflow-obstruction from mild to severe increased the adjORs for DLCO < LLN-from 1.22 (0.80, 1.86) to 6.63 (4.91, 8.95), for VA < LLN-from 1.37 (0.85, 2.18) to 7.01 (5.20, 9.43), and for KCO < LLN-from 2.04 (1.33, 3.14) to 3.03 (2.29, 3.99). Notably, in normal-for-age spirometry, 34.5%, 19.7%, and 25.3% of participants had DLCO, VA, or KCO < LLN, respectively. CONCLUSION Abnormal diffusion is most prevalent in spirometric impairments but also occurs in normal-for-age spirometry. These results further inform the respiratory phenotypes of GLI-based spirometric categories and, in turn, the spirometric evaluation of respiratory disease.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Veterans Affairs (VA), Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA.
| | - Carolyn L Rochester
- Veterans Affairs (VA), Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Gail J McAvay
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Lynne Iannone
- Veterans Affairs (VA), Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | - Linda S Leo-Summers
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
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19
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Lim JH, Kang D, Hong YS, Kim H, Ryu S, Chang Y, Park HY, Cho J. Association between reproductive lifespan and lung function among postmenopausal women. J Thorac Dis 2020; 12:4243-4252. [PMID: 32944336 PMCID: PMC7475608 DOI: 10.21037/jtd-19-3726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Correspondence to: Hye Yun Park, MD, PhD. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. Email: hyeyunpark@skku.edu; Juhee Cho, PhD. Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. Email: Jcho@skku.edu.
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Affiliation(s)
- Jun Hyeok Lim
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Yun Soo Hong
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seungho Ryu
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoosoo Chang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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20
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GPs should not try to detect mild COPD. NPJ Prim Care Respir Med 2020; 30:20. [PMID: 32393734 PMCID: PMC7214409 DOI: 10.1038/s41533-020-0176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/07/2020] [Indexed: 11/08/2022] Open
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21
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Vaz Fragoso CA, Leo-Summers LS, Gill TM, McAvay GJ. Re-evaluation of the Uplift Clinical Trial Using Age-Appropriate Spirometric Criteria. Chest 2020; 158:539-549. [PMID: 32278783 DOI: 10.1016/j.chest.2020.02.070] [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: 09/18/2019] [Revised: 01/13/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The clinical trial of tiotropium in COPD, UPLIFT, enrolled adults with a mean age of 65 years and moderate-to-severe airflow obstruction, based on criteria from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). For the UPLIFT cohort, however, GOLD-based criteria are not age-appropriate. RESEARCH QUESTION Will the use of more age-appropriate criteria for airflow obstruction from the Global Lung Function Initiative (GLI) modify the spirometric classification of the UPLIFT cohort and, in turn, the mortality effect of tiotropium in COPD? STUDY DESIGN AND METHODS Baseline spirometric classifications were first cross-tabulated by GLI- and GOLD-based criteria. Next, in GLI- and GOLD-based airflow obstruction, modified intention-to-treat analyses evaluated differences in time to death over 4 years, comparing tiotropium vs placebo. Because treatment response may differ by COPD severity, the mortality effect also was evaluated within stratum defined by GLI- and GOLD-based moderate and severe airflow obstruction. RESULTS Of 5,898 participants with GOLD-based airflow-obstruction, staged as moderate in 2,739 (46.4%) and severe in 3,156 (53.5%), GLI-based criteria established airflow obstruction in 5,750 (97.5%), staged as moderate in 795 (13.5%) and severe in 4,947 (83.9%). Relative to placebo, tiotropium yielded statistically nonsignificant adjusted hazard ratios (adjHRs) (95% CI) for death of 0.91 (0.80-1.04) and 0.91 (0.79-1.03) in GLI- and GOLD-based airflow obstruction, respectively. However, statistically significant effect modification was observed, but only in GLI-based moderate and severe airflow-obstruction, with tiotropium yielding adjHRs for death of 0.53 (0.34-0.81) and 0.99 (0.86-1.13), respectively. The P value for interaction was .007. INTERPRETATION Mortality reduction by tiotropium was only statistically significant in GLI-based moderate airflow-obstruction, a group that was underrepresented in UPLIFT because of severity misclassification by the original GOLD-based enrollment criteria.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Veterans Affairs (VA) Connecticut Healthcare System, West Haven; Yale University School of Medicine, Department of Internal Medicine, New Haven, CT.
| | - Linda S Leo-Summers
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Thomas M Gill
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Gail J McAvay
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
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22
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Kim Y, Lee H, Son TO, Jang H, Cho SH, Kim SE, Kim SJ, Lee JS, Kim JP, Jung YH, Lockhart SN, Kim HJ, Na DL, Park HY, Seo SW. Reduced forced vital capacity is associated with cerebral small vessel disease burden in cognitively normal individuals. NEUROIMAGE-CLINICAL 2019; 25:102140. [PMID: 31896465 PMCID: PMC6940695 DOI: 10.1016/j.nicl.2019.102140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 12/13/2019] [Accepted: 12/21/2019] [Indexed: 01/18/2023]
Abstract
Decreased FVC (% pred) was associated with increased cerebral small vessel disease burden even in cognitively normal subjects. This reduced lung function was related to low Mini-Mental Status Examination (MMSE) scores in cognitively normal subjects. Path analyses showed that white matter hyperintensities partially mediated the positive relationship between FVC (% pred) and MMSE score. There was no significant association between low FVC (% pred) and cortical thickness in cognitively normal subjects.
Background Pulmonary dysfunction is associated with elevated risk of cognitive decline. However, the mechanism underlying this relationship has not been fully investigated. In this study, we investigate the relationships between pulmonary function, cerebral small vessel disease (CSVD) markers, cortical thickness, and the Mini-Mental Status Examination (MMSE) scores in cognitively normal individuals. Methods We used a cross-sectional study design. We identified 1924 patients who underwent pulmonary function testing, three-dimensional brain magnetic resonance imaging (MRI), and the MMSE. Pulmonary function was analyzed according to the quintiles of percentage predicted values (% pred) for forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1). Regarding CSVD markers, we visually rated white matter hyperintensities (WMH) and manually counted lacunes and microbleeds. Cortical thickness was measured by surface-based methods. Results Compared with the highest quintile of FVC, the lowest quintile of FVC (% pred) showed a higher risk of WMH (OR 1.98, 95% CI: 1.21–3.24) and lacunes (OR 1.86, 95% CI: 1.12–3.08). There were no associations between FVC or FEV1 and cortical thickness. Low FVC, but not FEV1, was associated with low MMSE scores. Path analyses showed that WMH partially mediated the positive relationship between FVC (% pred) and MMSE score. Conclusions Our findings suggested that decreased pulmonary function was associated with increased CSVD burdens, which in turn wass associated with decreased cognition, even in cognitively normal subjects.
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Affiliation(s)
- Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang Medical Center, Hanyang University College of Medicine, South Korea
| | - Tea Ok Son
- Cheongju Samsung Rehabilitation Hospital, Cheongju, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Si Eun Kim
- Departments of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Seung Joo Kim
- Department of Neurology, Gyeongsang National University School of Medicine and Gyeonsang National University Changwon Hospital, Changwon, South Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea
| | - Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University Medical Center, Republic of Korea
| | - Samuel N Lockhart
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea; Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Gangnam-gu, Republic of Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Kangnam-ku, Seoul 06351, South Korea.
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Samsung Alzheimer Research Center, Samsung Medical Center, Seoul, South Korea; Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea.
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23
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Vaz Fragoso CA, Van Ness PH, McAvay GJ. FEV 1 as a Standalone Spirometric Predictor and the Attributable Fraction for Death in Older Persons. Respir Care 2019; 65:217-226. [PMID: 31662447 DOI: 10.4187/respcare.07012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Commonly used thresholds for staging FEV1 have not been evaluated as standalone spirometric predictors of death in older persons. Specifically, the proportion of deaths attributed to a reduced FEV1, when staged by commonly used thresholds in L, percent of predicted (% pred), and Z scores, has not been previously reported. METHODS In 4,232 white persons ≥ 65 y old, sampled from the Cardiovascular Health Study, FEV1 was stratified as stage 1 (FEV1 ≥ 2.00 L, ≥80% pred, and Z score ≥-1.64), stage 2 (FEV1 1.50-1.99 L, 50-79%pred, and Z score -2.55 to -1.63), and stage 3 (FEV1 < 1.50 L, < 50% pred, and Z score < -2.55). Notably, a Z score threshold of -1.64 defines normal-for-age lung function as the lower limit of normal (ie, 5th percentile of distribution), and accounts for differences in age, sex, height, and ethnicity. Next, adjusted odds ratios and average attributable fractions for 10-y all-cause mortality were calculated, comparing FEV1 stages 2 and 3 against stage 1, expressed in L, % pred, and Z scores. The average attributable fraction estimates the proportion of deaths attributed to a predictor by combining the prevalence of the predictor with the relative risk of death conferred by that predictor. RESULTS FEV1 stage 2 and 3 in L, % pred, and Z scores yielded similar adjusted odds ratios of death: 1.40-1.51 for stage 2 and 2.35-2.66 for stage 3. Conversely, FEV1 stages 2 and 3 in L, % pred, and Z scores differed in prevalence: 12.8-28.6% for stage 2 and 6.4-17.5% for stage 3, and also differed in the adjusted average attributable fraction for death: 3.2-6.4% for stage 2 and 4.5-9.1% for stage 3. CONCLUSIONS In older persons, the proportion of deaths attributed to a reduced FEV1 is best stratified by Z score staging thresholds because these yield a similar relative risk of death but a more age- and sex-appropriate prevalence of FEV1 stage.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut. .,Veterans Affairs Connecticut Healthcare System, Clinical Epidemiology Research Center, West Haven, Connecticut
| | - Peter H Van Ness
- Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Gail J McAvay
- Yale University School of Medicine, Department of Internal Medicine, New Haven, Connecticut
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24
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Affiliation(s)
- Carlos A Vaz Fragoso
- Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven
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25
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Restrictive Spirometric Pattern and Postoperative Pulmonary Complications Following Non-cardiothoracic Surgery. Sci Rep 2019; 9:12750. [PMID: 31484946 PMCID: PMC6726761 DOI: 10.1038/s41598-019-49158-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023] Open
Abstract
Despite a substantial population of patients with a restrictive spirometric pattern, few studies have evaluated postoperative pulmonary complications (PPCs) after non-cardiothoracic surgery in these patients. We conducted a retrospective cohort study of 681 adults with a normal or restrictive spirometric pattern who were referred for preoperative evaluation of PPC risk before non-cardiothoracic surgery between March 2014 and January 2015. Overall, 8.7% (59/681) of study participants developed a PPC following non-cardiothoracic surgery. The occurrence of PPCs in patients with a restrictive spirometric pattern was higher than that in those with normal spirometry (12.4% [35/282] vs. 6.0% [24/399], P = 0.003). The occurrence of PPCs increased across the categories of restrictive spirometric pattern severity (6.0% with a normal spirometric pattern vs. 6.5% with a mild restrictive spirometric pattern [60 ≤ forced vital capacity (FVC) < 80% predicted] vs. 21.2% with a moderate-to-severe restrictive spirometric pattern [FVC < 60% predicted], P for trend test < 0.001). The length of hospital stay (P for trend = 0.002) was longer, and all-cause mortality at 30 days (P for trend = 0.008) and 90 days (P for trend = 0.001) was higher across the restrictive spirometric pattern severity. In multivariable-adjusted analyses, a moderate-to-severe restrictive spirometric pattern was associated with a higher risk of PPCs compared with a normal spirometric pattern (adjusted odds ratio 2.64, 95% confidence interval 1.22–5.67). The incidence of PPCs in patients with a restrictive spirometric pattern was higher than that in those with a normal spirometric pattern, especially in patients with a moderate-to-severe restrictive spirometric pattern. Patients with a moderate-to-severe restrictive spirometric pattern should be regarded as high risk for developing PPCs following non-cardiothoracic surgery.
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26
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Lundbäck B, Backman H, Calverley PMA. Lung Function through the PRISm. Spreading Light or Creating Confusion? Am J Respir Crit Care Med 2019; 198:1358-1360. [PMID: 30016598 DOI: 10.1164/rccm.201806-1163ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bo Lundbäck
- 1 Institute of Medicine University of Gothenburg Gothenburg, Sweden.,2 Department of Public Health and Clinical Medicine Umeå University Umeå, Sweden and
| | - Helena Backman
- 2 Department of Public Health and Clinical Medicine Umeå University Umeå, Sweden and
| | - Peter M A Calverley
- 3 Academy of Medical Sciences University of Liverpool Liverpool, United Kingdom
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27
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Vaz Fragoso CA, Magnussen H, Miller MR, Brusasco V. Spirometry-based Diagnostic Criteria That Are Not Age-Appropriate Lack Clinical Relevance. Am J Respir Crit Care Med 2019; 197:963-964. [PMID: 29096065 DOI: 10.1164/rccm.201709-1789le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Carlos A Vaz Fragoso
- 1 Yale University School of Medicine New Haven, Connecticut.,2 Connecticut Healthcare System and Clinical Epidemiology Research Center West Haven, Connecticut
| | - Helgo Magnussen
- 3 North German Center for Lung Research Grosshansdorf, Germany
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28
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Predicting Mortality with Percent Predicted and z-Scores of FEV 1: Not an EZ Task. Ann Am Thorac Soc 2019; 15:912-913. [PMID: 30067100 DOI: 10.1513/annalsats.201805-356ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Singh D, D'Urzo AD, Donohue JF, Kerwin EM. Weighing the evidence for pharmacological treatment interventions in mild COPD; a narrative perspective. Respir Res 2019; 20:141. [PMID: 31286970 PMCID: PMC6615221 DOI: 10.1186/s12931-019-1108-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
There is increasing focus on understanding the nature of chronic obstructive pulmonary disease (COPD) during the earlier stages. Mild COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1 or the now-withdrawn GOLD stage 0) represents an early stage of COPD that may progress to more severe disease. This review summarises the disease burden of patients with mild COPD and discusses the evidence for treatment intervention in this subgroup. Overall, patients with mild COPD suffer a substantial disease burden that includes persistent or potentially debilitating symptoms, increased risk of exacerbations, increased healthcare utilisation, reduced exercise tolerance and physical activity, and a higher rate of lung function decline versus controls. However, the evidence for treatment efficacy in these patients is limited due to their frequent exclusion from clinical trials. Careful assessment of disease burden and the rate of disease progression in individual patients, rather than a reliance on spirometry data, may identify patients who could benefit from earlier treatment intervention.
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Affiliation(s)
- Dave Singh
- University of Manchester, Medicines Evaluation Unit, Manchester University NHS Foundation Trust, Manchester, M23 9QZ, UK.
| | - Anthony D D'Urzo
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James F Donohue
- Division of Pulmonary Diseases & Critical Care Medicine, University of North Carolina Pulmonary Critical Medicine, Chapel Hill, North Carolina, USA
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Opina MTD, Nicklas BJ, Lovato JF, Files DC, Kritchevsky SB, Moore WC. Association of Symptoms of Obstructive Lung Disease and All-Cause Mortality in Older Adult Smokers. J Am Geriatr Soc 2019; 67:2116-2122. [PMID: 31250432 DOI: 10.1111/jgs.16052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study aims to investigate the impact of respiratory symptoms in current and former smokers with and without obstructive lung disease (OLD) on all-cause mortality. DESIGN Secondary analysis in a prospective cohort (the Health, Aging and Body Composition study). SETTING Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS Black and white men and women with a history of current and former smoking (N = 596; 63% male and 37% female) aged 70-79 years followed for 13 years. Participants were categorized into 4 mutually exclusive groups based on symptom profile and forced expiratory volume in the 1st second to forced vital capacity ratio. The groups were Less Dyspnea-No OLD (N = 196), More Dyspnea-No OLD (N = 104), Less Dyspnea-With OLD (N = 162), and More Dyspnea-With OLD (N = 134). MEASUREMENTS All-cause mortality. RESULTS Overall, 53% in Less Dyspnea-No OLD, 63% in More Dyspnea-No OLD, 67% in Less Dyspnea-With OLD, and 84% in More Dyspnea-With OLD died within the 13- year follow up period (log-rank χ2 = 44.4, P < .0001). The hazard ratio was highest for participants with OLD, both with (HR =1.91, 95% CI 1.44 - 2.54; P < .0001) and without dyspnea (HR = 1.52, 95% CI 1.15 - 2.02; p = .004). Participants without OLD but with dyspnea had a similar risk of death to subjects who had OLD but fewer symptoms. CONCLUSIONS OLD is associated with high risk of death with different risk profiles based on symptom group. Patients with symptoms of shortness of breath without OLD should be considered an at-risk group given their similar mortality to those with OLD with minimal symptoms. J Am Geriatr Soc 67:2116-2122, 2019.
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Affiliation(s)
- Maria Theresa D Opina
- Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center on Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara J Nicklas
- Sticht Center on Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James F Lovato
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel C Files
- Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center on Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen B Kritchevsky
- Sticht Center on Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wendy C Moore
- Section on Pulmonary, Critical Care, Allergy, and Immunologic Disease, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Sticht Center on Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Lutsey PL, Chen N, Mirabelli MC, Lakshminarayan K, Knopman DS, Vossel KA, Gottesman RF, Mosley TH, Alonso A. Impaired Lung Function, Lung Disease, and Risk of Incident Dementia. Am J Respir Crit Care Med 2019; 199:1385-1396. [PMID: 30433810 PMCID: PMC6543713 DOI: 10.1164/rccm.201807-1220oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022] Open
Abstract
Rationale: Growing evidence suggests that compromised lung health may be linked to dementia and worsening cognitive ability. Objectives: To test the hypothesis that impaired lung function or lung disease in midlife is associated with greater risk of incident dementia and mild cognitive impairment (MCI) later in life. Methods: A total of 14,184 Atherosclerosis Risk in Communities study participants who underwent spirometry and were asked about lung health (1987-1989) were followed. Dementia and MCI were defined by hospitalization diagnosis codes (1987-2013) in the whole cohort and with adjudication among 42% who attended a comprehensive neurocognitive examination (2011-2013). Measurements and Main Results: In analysis using adjudicated outcomes, odds of dementia or MCI were higher among participants with restrictive (multivariable-adjusted odds ratio, 1.58; 95% confidence interval, 1.14-2.19) and obstructive lung disease (multivariable-adjusted odds ratio, 1.33; 95% confidence interval, 1.07-1.64), compared with those without disease or respiratory symptoms. Associations were similar in analyses restricted to nonsmokers, and present for both Alzheimer's disease-related dementia and cerebrovascular etiologies. Low FEV1% predicted and FVC% predicted were also associated with increased dementia risk. Conclusions: Midlife lung disease and reduced lung function were associated with modestly increased odds of dementia and MCI later in life. Magnitudes of association were more pronounced for restrictive impairment than for obstructive lung disease. These associations were present in smokers and nonsmokers. If the observed associations are causal, policy and public health efforts to reduce smoking and improve air quality may have the added benefit of preventing the development of dementia and MCI.
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Affiliation(s)
- Pamela L. Lutsey
- Division of Epidemiology & Community Health, School of Public Health, and
| | | | - Maria C. Mirabelli
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, and
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | | | - Keith A. Vossel
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | | | - Thomas H. Mosley
- Department of Geriatrics/Gerontology and
- Department of Neurology, University of Mississippi Medical Center, Jackson, Mississippi
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32
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Re-evaluation of combination therapy in chronic obstructive pulmonary disease (COPD). Respir Med 2019; 151:27-34. [PMID: 31047114 DOI: 10.1016/j.rmed.2019.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/09/2019] [Accepted: 03/27/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical trials of COPD pharmacotherapy typically involve aging populations with moderate-to-severe COPD, but the latter is often diagnosed by spirometric criteria that are not age-appropriate across the continuum of lung function. We have therefore re-evaluated the clinical effect of combination therapy (salmeterol plus fluticasone) in moderate-to-severe COPD, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI) and trial data from Towards a Revolution in COPD Health (TORCH). METHODS Of the 6112 TORCH participants, 5688 (93.1%) had GLI-based moderate-to-severe COPD (mean age 64.8 years). The primary outcome was all-cause mortality and the primary comparison was combination therapy vs. placebo. Secondary outcomes included COPD and cardiovascular (CV) mortality and pneumonia. A modified intention-to-treat analysis evaluated differences in time-to-event over a three-year period, using Cox proportional hazards models with statistical significance at p < 0.010 (acknowledging repeated significance testing). RESULTS Relative to placebo, combination therapy yielded a statistically non-significant reduction in all-cause mortality-adjusted hazard ratio [adjHR] 0.78 (95% confidence interval [CI]: 0.64, 0.95), p = 0.012. Relative to placebo, combination therapy also yielded statistically non-significant reductions in COPD and CV mortality-adjHR 0.75 (95% CI: 0.55, 1.02), p = 0.068 and adjHR 0.76 (95% CI: 0.53, 1.09), p = 0.135, respectively. In contrast, combination therapy yielded a statistically significant increased risk of pneumonia, relative to placebo-adjHR 1.80 (95% CI: 1.46, 2.21), p < 0.001. CONCLUSION In GLI-based moderate-to-severe COPD, combination therapy yields a statistically significant increased risk of pneumonia but the reductions in mortality are not statistically significant, although could potentially be clinically meaningful.
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Kang N, Shin SH, Gu S, Kang D, Cho J, Jeong HJ, Suh GY, Lee H, Park HY. The impact of low forced vital capacity on behavior restrictions in a population with airflow obstruction. J Thorac Dis 2019; 11:1316-1324. [PMID: 31179073 DOI: 10.21037/jtd.2019.03.77] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Recent studies have suggested that low forced vital capacity (FVC) is related to respiratory symptoms with various comorbid conditions that eventually lead to physical inactivity and may be applied to subjects with airflow obstruction (AO). Therefore, this study aimed to evaluate the association between low FVC and behavior restrictions in subjects with AO. Methods A cross-sectional study was performed using data from the Korea National Health and Nutrition Survey conducted between 2007 and 2015. Participants aged 40 to 79 years with spirometry-defined AO (pre-bronchodilator forced expiratory volume in one second/FVC <70%) were analyzed to evaluate the association between low FVC (defined as FVC <80% predicted) and behavior restrictions. Results A total of 3,345 participants with AO were included. The proportion of subjects with low FVC varied widely according to severity of airflow limitation (0.9%, 35.5%, and 85.1% in the mild, moderate, and severe-to-very-severe AO groups, respectively). Compared to the moderate AO group with normal FVC, those with low FVC were more likely to be older, to be never- or ex-smokers, to have larger waist size with higher body mass index, and to have comorbidities such as diabetes, hypertension, dyslipidemia, and osteoporosis. Low FVC was independently associated with behavior restrictions [adjusted prevalence ratio (aPR), 1.72; 95% confidence interval (CI), 1.43-2.06] among all participants with AO, and this was most prominent in those with moderate AO (aPR, 1.65; 95% CI, 1.27-2.13). Conclusions In subjects with moderate AO, low FVC was independently associated with behavior restrictions even after adjusting for confounding factors.
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Affiliation(s)
- Noeul Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seonhye Gu
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Danbee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ho Jung Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Armed Forces Capital Hospital, Seongnam, South Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Stringer WW, Porszasz J, Bhatt SP, McCormack MC, Make BJ, Casaburi R. Physiologic Insights from the COPD Genetic Epidemiology Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:256-266. [PMID: 31342731 DOI: 10.15326/jcopdf.6.3.2019.0128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COPD Genetic Epidemiology Study (COPDGene®) manuscripts have provided important insights into chronic obstructive pulmonary disease (COPD) pathophysiology and outcomes, including a better understanding of COPD phenotypes relating computed tomography (CT) anatomic data to spirometric and patient-reported outcomes. Spirometry significantly underdiagnoses smoking-induced lung disease, and there is a marked improvement in sensitivity and specificity with CT scanning. This review also highlights the COPDGene® exploration of specific spirometry phenotypes (e.g.,PRISm), contributors to spirometric decline, composite physiologic measures, asthma-COPD overlap (ACO) syndrome, consequences of bronchodilator responsiveness, newer methods to assess small airway dysfunction, and spirometric correlates of comorbid diseases such as obesity and diabetes.
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Affiliation(s)
- William W Stringer
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Janos Porszasz
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center, University of Alabama, Birmingham
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
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35
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Carsin AE, Fuertes E, Schaffner E, Jarvis D, Antó JM, Heinrich J, Bellisario V, Svanes C, Keidel D, Imboden M, Weyler J, Nowak D, Martinez-Moratalla J, Gullón JA, Sanchez Ramos JL, Caviezel S, Beckmeyer-Borowko A, Raherison C, Pin I, Demoly P, Cerveri I, Accordini S, Gislason T, Toren K, Forsberg B, Janson C, Jogi R, Emtner M, Gómez Real F, Raza W, Leynaert B, Pascual S, Guerra S, Dharmage SC, Probst-Hensch N, Garcia-Aymerich J. Restrictive spirometry pattern is associated with low physical activity levels. A population based international study. Respir Med 2018; 146:116-123. [PMID: 30665509 DOI: 10.1016/j.rmed.2018.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/09/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry. METHODS Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC ≥ Lower Limit of Normal and a FVC<80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (<1st study-specific tertile) was evaluated using adjusted logistic regression models. RESULTS Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07-1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding. CONCLUSION Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.
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Affiliation(s)
- Anne-Elie Carsin
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Spain
| | - Elaine Fuertes
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Debbie Jarvis
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom; Population Health and Occupational Diseases, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Josep M Antó
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Spain
| | - Joachim Heinrich
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany; Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, German Centre for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Valeria Bellisario
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Joost Weyler
- University of Antwerp, Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, Stat UA Statistics Centre, Belgium
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, German Centre for Lung Research (DZL), Munich, Germany
| | - Jesus Martinez-Moratalla
- Complejo Hospitalario Universitario de Albacete, Servicio de Neumología, Universidad de Castilla-La Mancha, Facultad de Medicina, Albacete, Spain
| | | | | | - Seraina Caviezel
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Anna Beckmeyer-Borowko
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Chantal Raherison
- Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux, France
| | - Isabelle Pin
- CHU de Grenoble Alpes, Department of Pédiatrie, Inserm, U1209, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France
| | - Pascal Demoly
- University Hospital of Montpellier, Sorbonne Universités, Montpellier, France
| | - Isa Cerveri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Kjell Toren
- Department of Public Health and Community Medicine, Institute of Medicine, Goteburg, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Margareta Emtner
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Francisco Gómez Real
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Wasif Raza
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bénédicte Leynaert
- Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Paris, France; University Paris Diderot Paris, UMR 1152, Paris, France
| | - Silvia Pascual
- Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain
| | - Stefano Guerra
- ISGlobal, Barcelona, Spain; Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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Wan ES, Fortis S, Regan EA, Hokanson J, Han MK, Casaburi R, Make BJ, Crapo JD, DeMeo DL. Longitudinal Phenotypes and Mortality in Preserved Ratio Impaired Spirometry in the COPDGene Study. Am J Respir Crit Care Med 2018; 198:1397-1405. [PMID: 29874098 PMCID: PMC6290948 DOI: 10.1164/rccm.201804-0663oc] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/04/2018] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Increasing awareness of the prevalence and significance of Preserved Ratio Impaired Spirometry (PRISm), alternatively known as restrictive or Global Initiative for Chronic Obstructive Lung Disease (GOLD)-unclassified spirometry, has expanded the body of knowledge on cross-sectional risk factors. However, longitudinal studies of PRISm remain limited. OBJECTIVES To examine longitudinal patterns of change in lung function, radiographic characteristics, and mortality of current and former smokers with PRISm. METHODS Current and former smokers, aged 45 to 80 years, were enrolled in COPDGene (phase 1, 2008-2011) and returned for a 5-year follow-up (phase 2, 2012-2016). Subjects completed questionnaires, spirometry, chest computed tomography scans, and 6-minute-walk tests at both study visits. Baseline characteristics, longitudinal change in lung function, and mortality were assessed by post-bronchodilator lung function categories: PRISm (FEV1/FVC < 0.7 and FEV1 < 80%), GOLD0 (FEV1/FVC > 0.7 and FEV1 > 80%), and GOLD1-4 (FEV1/FVC < 0.7). MEASUREMENTS AND MAIN RESULTS Although the prevalence of PRISm was consistent (12.4-12.5%) at phases 1 and 2, subjects with PRISm exhibited substantial rates of transition to and from other lung function categories. Among subjects with PRISm at phase 1, 22.2% transitioned to GOLD0 and 25.1% progressed to GOLD1-4 at phase 2. Subjects with PRISm at both phase 1 and phase 2 had reduced rates of FEV1 decline (-27.3 ± 42.1 vs. -33.0 ± 41.7 ml/yr) and comparable proportions of normal computed tomography scans (51% vs. 52.7%) relative to subjects with stable GOLD0 spirometry. In contrast, incident PRISm exhibited accelerated rates of lung function decline. Subjects with PRISm at phase 1 had higher mortality rates relative to GOLD0 and lower rates relative to the GOLD1-4 group. CONCLUSIONS PRISm is highly prevalent, is associated with increased mortality, and represents a transitional state for significant subgroups of subjects. Additional studies to characterize longitudinal progression in PRISm are warranted.
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Affiliation(s)
- Emily S. Wan
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Pulmonary and Critical Care Section, VA Boston Healthcare System, Boston, Massachusetts
| | - Spyridon Fortis
- Department of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa
| | | | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Colorado
| | | | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Torrance, California
| | | | | | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - for the COPDGene Investigators
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Pulmonary and Critical Care Section, VA Boston Healthcare System, Boston, Massachusetts
- Department of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa
- National Jewish Health, Denver, Colorado
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, Colorado
- University of Michigan, Ann Arbor, Michigan; and
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles Medical Center, Torrance, California
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37
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Ovalı C, Şahin A. Chronic Obstructive Pulmonary Disease and Off-Pump Coronary Surgery. Ann Thorac Cardiovasc Surg 2018; 24:193-199. [PMID: 29780070 PMCID: PMC6102600 DOI: 10.5761/atcs.oa.17-00231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/29/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine to what extent chronic obstructive pulmonary disease (COPD) affects mortality and morbidity rates in patients treated with off-pump coronary artery bypass graft (CABG). METHODS A total of 321 patients treated with off-pump CABG were included in the present study. Of the 321 patients, 46 patients had COPD and they were designated as Group 1 and the remaining 275 patients did not have COPD and they were considered as Group 2. We compared the data obtained from the patients in both groups. RESULTS While preoperative spirometry values and arterial blood gas oxygen saturation levels were significantly lower, the partial values of carbon dioxide were higher in Group 1. Likewise, extubation time, the amount of drainage and blood transfusion, inotropic support, prolonged intubation, pulmonary complications, the use of bronchodilators, and steroids were statistically higher in Group 1 when compared with Group 2. Overall, there was no marked difference between the two groups in terms of mortality incidence. CONCLUSION We found similar morbidity and mortality rates among the patients with COPD and without COPD when they were treated with off-pump CABG. Therefore, the present results indicate that the presence of COPD is not associated with in-hospital mortality or severe morbidity post-CABG by off-pump approach.
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Affiliation(s)
- Cengiz Ovalı
- Department of Cardiovascular Surgery, Medical School of Eskisehir Osmangazi University (ESOGU), Eskisehir, Turkey
| | - Aykut Şahin
- Department of Cardiovascular Surgery, Medical School of Eskisehir Osmangazi University (ESOGU), Eskisehir, Turkey
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Bousquet J, Dinh-Xuan AT, Similowski T, Malva J, Ankri J, Barbagallo M, Fabbri L, Humbert M, Mercier J, Robalo-Cordeiro C, Rodriguez-Manas L, Vellas B. Should we use gait speed in COPD, FEV1 in frailty and dyspnoea in both? Eur Respir J 2018; 48:315-9. [PMID: 27478189 DOI: 10.1183/13993003.00633-2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Jean Bousquet
- MACVIA-LR, Contre les Maladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, Languedoc-Roussillon, France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France INSERM, VIMA: Ageing and chronic diseases, Epidemiological and public health approaches, U1168, Paris, France UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France
| | - Anh Tuan Dinh-Xuan
- Service de physiologie respiratoire, Hôpital Cochin, Université Paris-Descartes, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Thomas Similowski
- UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
| | - João Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joël Ankri
- Gerontology Center, Site Sainte Périne, Université de Versailles St Quentin, Paris, France
| | - Mario Barbagallo
- Dept of Internal Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Leonardo Fabbri
- Dept of Metabolic Medicine, University of Modena and Reggio Emilia, Sant'Agostino Estense Hospital, Modena, Italy
| | - Marc Humbert
- Université Paris-Sud, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Jacques Mercier
- Dept of Physiology, CHRU, University Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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The Effect of Defining Chronic Obstructive Pulmonary Disease by the Lower Limit of Normal of the FEV 1/FVC Ratio. Ann Am Thorac Soc 2018; 15:766-767. [PMID: 29557668 DOI: 10.1513/annalsats.201802-109le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Spirometric impairments, cardiovascular outcomes, and noncardiovascular death in older persons. Respir Med 2018; 137:40-47. [PMID: 29605211 DOI: 10.1016/j.rmed.2018.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/06/2018] [Accepted: 02/24/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In prior work involving older persons, the reported associations of spirometric impairments with cardiovascular outcomes may have been confounded by age-related changes in lung function. Hence, using more age-appropriate spirometric criteria from the Global Lung Function Initiative (GLI), we have evaluated the associations of spirometric impairments, specifically restrictive-pattern and airflow-obstruction, with cardiovascular death (CV-death) and hospitalization (CV-hospitalization). In these analyses, we also evaluated the competing outcome of noncardiovascular death (nonCV-death) and calculated measures of relative and absolute risk. METHODS Our study sample was drawn from the Cardiovascular Health Study (CHS), including 4232 community-dwelling white persons aged ≥65 years. Multivariable regression models included the following baseline predictors: GLI-defined restrictive-pattern and airflow-obstruction, age, male gender, obesity, waist circumference, current smoker status, ≥10 pack-years of smoking, hypertension, dyslipidemia, diabetes, and cardiovascular and cerebrovascular disease. Outcomes included adjudicated CV-death, CV-hospitalization, and nonCV-death, ascertained over 10 years of follow-up. Measures of association included hazard ratios (HRs), rate ratios (RRs), and average attributable fraction (AAF), each with 95% confidence intervals. RESULTS Restrictive-pattern and airflow-obstruction were associated with CV-death (adjusted HRs: 1.57 [1.18, 2.09] and 1.29 [1.04, 1.60]) and with nonCV-death (adjusted HRs: 2.10 [1.63, 2.69] and 1.79 [1.51, 2.12]), respectively. Airflow-obstruction, but not restrictive-pattern, was also associated with CV-hospitalization (adjusted RRs: 1.18 [1.02, 1.36] and 1.20 [0.96, 1.50], respectively). The adjusted AAFs of restrictive-pattern and airflow-obstruction were 1.68% (0.46, 3.06) and 2.35% (0.22, 4.72) for CV-death, and 3.44% (1.97, 5.08) and 7.77% (5.15, 10.60) for nonCV-death, respectively. CONCLUSION Assessment of GLI-defined spirometric impairments contributes to broad geriatric risk stratifications for both cardiovascular and non-cardiovascular outcomes.
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Fragoso CAV, Gill TM, Leo-Summers LS, Van Ness PH. Spirometric Criteria for Chronic Obstructive Pulmonary Disease in Clinical Trials of Pharmacotherapy. COPD 2018; 15:17-20. [PMID: 29469677 DOI: 10.1080/15412555.2018.1424815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Clinical trials of pharmacotherapy in chronic obstructive pulmonary disease (COPD) often include older persons with moderate-to-severe airflow-obstruction, as defined by the Global Initiative for chronic Obstructive Lung Disease (GOLD). In this context, spirometric airflow-obstruction establishes COPD. Because GOLD misidentifies COPD and its severity in older persons, we set out to apply more age-appropriate spirometric criteria from the Global Lung function Initiative (GLI) in a prior clinical trial of COPD pharmacotherapy, specifically the Towards a Revolution in COPD Health (TORCH) trial - N = 6,112, mean age 65 years. In the TORCH trial, which enrolled GOLD-defined moderate COPD (26.2%, n = 1,200) and GOLD-defined severe COPD (73.8%, n = 4,511), the GLI reclassification yielded a higher frequency of severe COPD (89.6%, n = 5,474), the inclusion of restrictive-pattern (6.9%, n = 420) and, in turn, a very low frequency of moderate COPD (3.5%, n = 212). These GLI reclassification results suggest that GOLD-based enrollment criteria for the TORCH trial may have assembled a cohort that was: 1) less likely to respond to COPD pharmacotherapy, given the greater representation of severe COPD, very minor representation of moderate COPD, and inclusion of a non-obstructive spirometric impairment (restrictive-pattern); and 2) more likely to have medication-related adverse events, given the inappropriate use of COPD pharmacotherapy in misidentified COPD (restrictive-pattern). We therefore propose that future clinical trials of COPD pharmacotherapy should consider GLI criteria for defining COPD, including a greater representation of GLI-defined moderate COPD.
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Affiliation(s)
- Carlos A Vaz Fragoso
- a Department of Internal Medicine , Veterans Affairs (VA) Connecticut Healthcare System , West Haven , Connecticut , USA.,b Department of Internal Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Thomas M Gill
- b Department of Internal Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Linda S Leo-Summers
- b Department of Internal Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
| | - Peter H Van Ness
- b Department of Internal Medicine , Yale University School of Medicine , New Haven , Connecticut , USA
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Koul PA, Hakim NA, Malik SA, Khan UH, Patel J, Gnatiuc L, Burney PGJ. Prevalence of chronic airflow limitation in Kashmir, North India: results from the BOLD study. Int J Tuberc Lung Dis 2018; 20:1399-1404. [PMID: 27725054 PMCID: PMC5019142 DOI: 10.5588/ijtld.15.0968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Data on spirometrically defined chronic airflow limitation (CAL) are scarce in developing countries. OBJECTIVE: To estimate the prevalence of spirometrically defined CAL in Kashmir, North India. METHODS: Using Burden of Obstructive Lung Disease survey methods, we administered questionnaires to randomly selected adults aged ⩾40 years. Post-bronchodilator spirometry was performed to estimate the prevalence of CAL and its relation to potential risk factors. RESULTS: Of 1100 participants initially recruited, 953 (86.9%) responded and 757 completed acceptable spirometry and questionnaires. The prevalence of a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio less than the lower limit of normal was 17.3% (4.5) in males and 14.8% (2.1) in females. Risk factors for CAL included higher age, cooking with wood and lower educational status. The prevalence of current smoking was 61% in males and 22% in females; most smoked hookahs. CAL was found equally in non-smoking males and females, and was independently associated with the use of the hookah, family history of respiratory disease and poor education. A self-reported doctor's diagnosis of chronic obstructive pulmonary disease was reported in 8.4/1000 (0.9% of females and 0.8% of males). CONCLUSION:Spirometrically confirmed CAL is highly prevalent in Indian Kashmir, and seems to be related to the high prevalence of smoking, predominantly in the form of hookah smoking.
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Affiliation(s)
- P A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - N A Hakim
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - S A Malik
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - U H Khan
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - J Patel
- National Heart & Lung Institute (NHLI), Imperial College, London, UK
| | - L Gnatiuc
- National Heart & Lung Institute (NHLI), Imperial College, London, UK
| | - P G J Burney
- Department of Respiratory Epidemiology and Public Health, NHLI, Imperial College London, London, UK
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Allinson JP, Wedzicha JA. Update in Chronic Obstructive Pulmonary Disease 2016. Am J Respir Crit Care Med 2017; 196:414-424. [PMID: 28570121 DOI: 10.1164/rccm.201703-0588up] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- James P Allinson
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jadwiga A Wedzicha
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N, Marin J, Miculinic N, Polese G, Samaržija M, Skrgat S, Vassilakopoulos T, Vukić-Dugac A, Zakynthinos S, Miravitlles M. Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies. Int J Chron Obstruct Pulmon Dis 2017; 12:2593-2610. [PMID: 28919728 PMCID: PMC5587130 DOI: 10.2147/copd.s132236] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 ≥80% predicted. In recent years, an elegant series of studies has shown that "exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment". In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient's physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of "mild COPD". To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with "mild" airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind "mild" COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both.
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Affiliation(s)
- Andrea Rossi
- Pulmonary Unit, University of Verona, Verona, Italy
| | | | | | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Son Espases-IdISPa and CIBERES, Palma, Spain
| | - Matjaz Flezar
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Nikolaos Koulouris
- First Department of Respiratory Medicine, Medical School of National and Kapodistrian University of Athens, Greece
| | - José Marin
- Respiratory Medicine, Hospital Universitario Miguel Servet, CIBERES & IISAragon, Zaragoza, Spain
| | - Neven Miculinic
- Respiratory Department, University Hospital Centre, Zagreb, Croatia
| | | | - Miroslav Samaržija
- Jordanovac Department for Respiratory Diseases, University of Zagreb School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Sabina Skrgat
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Theodoros Vassilakopoulos
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Greece
| | - Andrea Vukić-Dugac
- Jordanovac Department for Respiratory Diseases, University of Zagreb School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Spyridon Zakynthinos
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Greece
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitary Vall d'Hebron, Barcelona, Spain
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Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195:557-582. [PMID: 28128970 DOI: 10.1164/rccm.201701-0218pp] [Citation(s) in RCA: 2064] [Impact Index Per Article: 294.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.
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Affiliation(s)
- Claus F Vogelmeier
- 1 University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Gerard J Criner
- 2 Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Fernando J Martinez
- 3 New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Antonio Anzueto
- 4 University of Texas Health Science Center, San Antonio, Texas.,5 South Texas Veterans Health Care System, San Antonio, Texas
| | - Peter J Barnes
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jean Bourbeau
- 7 McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Rongchang Chen
- 9 State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- 12 Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Nicolas Roche
- 16 Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France
| | | | - Don D Sin
- 18 St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Singh
- 19 University of Manchester, Manchester, United Kingdom
| | | | - Jørgen Vestbo
- 19 University of Manchester, Manchester, United Kingdom
| | - Jadwiga A Wedzicha
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alvar Agustí
- 21 Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedade Respiratorias, Barcelona, Spain
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46
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Abstract
Older persons frequently report respiratory risk factors and symptoms and have a high prevalence of symptomatic lung disease, most commonly obstructive airway disease, interstitial lung disease, and lung cancer. Notably, coexisting nonrespiratory risk factors are also prevalent and may misidentify or modify respiratory diagnoses and their clinical course.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Department of Internal Medicine, Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
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47
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Vaz Fragoso CA, Cain HC, Casaburi R, Lee PJ, Iannone L, Leo-Summers LS, Van Ness PH. Spirometry, Static Lung Volumes, and Diffusing Capacity. Respir Care 2017; 62:1137-1147. [PMID: 28698266 DOI: 10.4187/respcare.05515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Spirometric Z-scores from the Global Lung Initiative (GLI) rigorously account for age-related changes in lung function and are thus age-appropriate when establishing spirometric impairments, including a restrictive pattern and air-flow obstruction. However, GLI-defined spirometric impairments have not yet been evaluated regarding associations with static lung volumes (total lung capacity [TLC], functional residual capacity [FRC], and residual volume [RV]) and gas exchange (diffusing capacity). METHODS We performed a retrospective review of pulmonary function tests in subjects ≥40 y old (mean age 64.6 y), including pre-bronchodilator measures for: spirometry (n = 2,586), static lung volumes by helium dilution with inspiratory capacity maneuver (n = 2,586), and hemoglobin-adjusted single-breath diffusing capacity (n = 2,508). Using multivariable linear regression, adjusted least-squares means (adjLSMeans) were calculated for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity. The adjLSMeans were expressed with and without height-cubed standardization and stratified by GLI-defined spirometry, including normal (n = 1,251), restrictive pattern (n = 663), and air-flow obstruction (mild, [n = 128]; moderate, [n = 150]; and severe, [n = 394]). RESULTS Relative to normal spirometry, restrictive-pattern had lower adjLSMeans for TLC, FRC, RV, and hemoglobin-adjusted single-breath diffusing capacity (P ≤ .001). Conversely, relative to normal spirometry, mild, moderate, and severe air-flow obstruction had higher adjLSMeans for FRC and RV (P < .001). However, only mild and moderate air-flow obstruction had higher adjLSMeans for TLC (P < .001), while only moderate and severe air-flow obstruction had higher adjLSMeans for RV/TLC (P < .001) and lower adjLSMeans for hemoglobin-adjusted single-breath diffusing capacity (P < .001). Notably, TLC (calculated as FRC + inspiratory capacity) was not increased in severe air-flow obstruction (P ≥ .11) because inspiratory capacity decreased with increasing air-flow obstruction (P < .001), thus opposing the increased FRC (P < .001). Finally, P values were similar whether adjLSMeans were height-cubed standardized. CONCLUSIONS A GLI-defined spirometric restrictive pattern is strongly associated with a restrictive ventilatory defect (decreased TLC, FRC, and RV), while GLI-defined spirometric air-flow obstruction is strongly associated with hyperinflation (increased FRC) and air trapping (increased RV and RV/TLC). Both spirometric impairments were strongly associated with impaired gas exchange (decreased hemoglobin-adjusted single-breath diffusing capacity).
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Affiliation(s)
- Carlos A Vaz Fragoso
- Veterans Affairs Connecticut Healthcare System and the Yale University School of Medicine, Department of Internal Medicine, New Haven, CT.
| | - Hilary C Cain
- Veterans Affairs Connecticut Healthcare System and the Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Patty J Lee
- Veterans Affairs Connecticut Healthcare System and the Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Lynne Iannone
- Veterans Affairs Connecticut Healthcare System and the Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Linda S Leo-Summers
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Peter H Van Ness
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
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Guerra S, Carsin AE, Keidel D, Sunyer J, Leynaert B, Janson C, Jarvis D, Stolz D, Rothe T, Pons M, Turk A, Anto JM, Probst-Hensch N. Health-related quality of life and risk factors associated with spirometric restriction. Eur Respir J 2017; 49:49/5/1602096. [PMID: 28546266 DOI: 10.1183/13993003.02096-2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/08/2017] [Indexed: 11/05/2022]
Abstract
The restrictive spirometric pattern is associated with a substantial morbidity and mortality burden. We sought to determine to what extent spirometric restriction is associated with impaired quality of life.We used data from two large population-based European cohorts: 6698 European Community Respiratory Health Survey (ECRHS) and 6069 Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) adult participants. The restrictive pattern was defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥lower limit of normal (LLN) and FVC <LLN; an obstructive pattern was defined as FEV1/FVC <LLN independent of FVC. The Physical Component Summary and Mental Component Summary of quality of life were computed using the Short Form-36 questionnaire.In both cohorts, the restrictive pattern was associated with heavy smoking, being underweight or obese and the coexistence of respiratory symptoms. In univariate analyses, compared with the normal group, both the restrictive and obstructive pattern had significant Physical Component Summary deficits (-2.77 and -2.08, respectively, in ECRHS; -3.25 and -2.14, respectively, in SAPALDIA; all p-values <0.001). However, in models adjusted for sex, age, education, body mass index, smoking, comorbidities and respiratory symptoms, only the restrictive pattern remained significantly associated with Physical Component Summary deficits (p=0.004 in ECRHS; p=0.001 in SAPALDIA).The restrictive spirometric pattern is associated with deficits in the physical component of quality of life that are partly independent of the presence of respiratory symptoms.
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Affiliation(s)
- Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA .,ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Anne-Elie Carsin
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jordi Sunyer
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Bénédicte Leynaert
- Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Epidemiology Team, Paris, France.,University Paris Diderot Paris 7, UMR 1152, Paris, France
| | - Christer Janson
- Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daiana Stolz
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | | | - Marco Pons
- Ospedale Regionale di Lugano - Sede Civico, Lugano, Switzerland
| | | | - Josep M Anto
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Köktürk N, Gürgün A, Şen E, Kocabaş A, Polatlı M, Naycı SA, Çöplü L, Tellioğlu E, Elmas F, Erdinç E. The View of the Turkish Thoracic Society on the Report of the GOLD 2017 Global Strategy for the Diagnosis, Management, and Prevention of COPD. Turk Thorac J 2017; 18:57-64. [PMID: 29404162 PMCID: PMC5783082 DOI: 10.5152/turkthoracj.2017.060417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/25/2017] [Indexed: 01/07/2023]
Abstract
Since the Global Initiative for Obstructive Lung Disease (GOLD) published its first guidelines on chronic obstructive pulmonary disease (COPD) in 2001, much has changed till 2017. Previous versions of GOLD guidelines mentioned the forced expiratory volume in one second (FEV1)-based approach for staging and treatment modalities. Since 2011, a composite multi-dimensional approach has been introduced to cover various aspects of the disease. Unfortunately, this approach was not found to be correlated with mortality as well as the FEV1-based approach, despite the fact that it was better for estimating exacerbation rates. Although this assessment tool has been considered as a big step in personalized medicine, the system was rather complex to use in daily practice. In 2017, GOLD introduced a major revision in many aspects of the disease. This mainly includes a revised assessment tool and treatment algorithm. This new ABCD algorithm has excluded spirometry for guiding pharmacological therapy. Treatment recommendations are mainly based on symptoms and exacerbation rates. Escalation and de-escalation strategies have been proposed for the first time. The spirometric measurement has only been retained to confirm the diagnosis and lead to nonpharmacological therapies. In this report, the Turkish Thoracic Society COPD assembly aimed to summarize and give an insight to the Turkish interpretation of GOLD 2017.
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Affiliation(s)
- Nurdan Köktürk
- Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Alev Gürgün
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Elif Şen
- Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Kocabaş
- Department of Pulmonary Medicine, Çukurova University School of Medicine, Adana, Turkey
| | - Mehmet Polatlı
- Department of Pulmonary Medicine, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sibel Atış Naycı
- Department of Pulmonary Medicine, Mersin University School of Medicine, Mersin, Turkey
| | - Lütfi Çöplü
- Department of Pulmonary Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emel Tellioğlu
- Department of Pulmonary Medicine, Health Sciences University, İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Funda Elmas
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Ertürk Erdinç
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
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Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Respirology 2017; 22:575-601. [PMID: 28150362 DOI: 10.1111/resp.13012] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.
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Affiliation(s)
- Claus F Vogelmeier
- University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Gerard J Criner
- Lewis Katz School of Medicine at, Temple University, Philadelphia, Pennsylvania
| | - Fernando J Martinez
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Antonio Anzueto
- University of Texas Health Science Center, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Rongchang Chen
- State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Nicolas Roche
- Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France
| | | | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Singh
- University of Manchester, Manchester, United Kingdom
| | | | - Jørgen Vestbo
- University of Manchester, Manchester, United Kingdom
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alvar Agusti
- Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomé dica en Red de Enfermedade Respiratorias, Barcelona, Spain
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