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Kraemer R, Smith HJ, Reinstaedtler J, Gallati S, Matthys H. Predicting parameters of airway dynamics generated from inspiratory and expiratory plethysmographic airway loops, differentiating subtypes of chronic obstructive diseases. BMJ Open Respir Res 2024; 11:e002142. [PMID: 38460977 PMCID: PMC11148667 DOI: 10.1136/bmjresp-2023-002142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/09/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND The plethysmographic shift volume-flow loop (sRaw-loop) measured during tidal breathing allows the determination of several lung function parameters such as the effective specific airway resistance (sReff), calculated from the ratio of the integral of the resistive aerodynamic specific work of breathing (sWOB) and the integral of the corresponding flow-volume loop. However, computing the inspiratory and expiratory areas of the sRaw-loop separately permits the determination of further parameters of airway dynamics. Therefore, we aimed to define the discriminating diagnostic power of the inspiratory and expiratory sWOB (sWOBin, sWOBex), as well as of the inspiratory and expiratory sReff (sReff IN and sReff EX), for discriminating different functional phenotypes of chronic obstructive lung diseases. METHODS Reference equations were obtained from measurement of different databases, incorporating 194 healthy subjects (35 children and 159 adults), and applied to a collective of 294 patients with chronic lung diseases (16 children with asthma, aged 6-16 years, and 278 adults, aged 17-92 years). For all measurements, the same type of plethysmograph was used (Jaeger Würzburg, Germany). RESULTS By multilinear modelling, reference equations of sWOBin, sWOBex, sReff IN and sReff EX were derived. Apart from anthropometric indices, additional parameters such as tidal volume (VT), the respiratory drive (P0.1), measured by means of a mouth occlusion pressure measurement 100 ms after inspiration and the mean inspiratory flow (VT/TI) were found to be informative. The statistical approach to define reference equations for parameters of airway dynamics reveals the interrelationship between covariants of the actual breathing pattern and the control of breathing. CONCLUSIONS We discovered that sWOBin, sWOBex, sReff IN and sReff EX are new discriminating target parameters, that differentiate much better between chronic obstructive diseases and their subtypes, especially between chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO), thus strengthening the concept of precision medicine.
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Affiliation(s)
- Richard Kraemer
- Center of Pneumology, Hirslanden Salem-Spital, Bern, Switzerland
- School of Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Hans-Jürgen Smith
- Research in Respiratory Diagnostics, Medical Development, Berlin, Germany
| | | | - Sabina Gallati
- Hirslanden Precise, Genetic Medicine, Zollikon/Zürich, Switzerland
| | - Heinrich Matthys
- Department of Pneumology, University of Freiburg, Freiburg im Breisgau, Germany
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Kraemer R, Baty F, Smith HJ, Minder S, Gallati S, Brutsche MH, Matthys H. Assessment of functional diversities in patients with Asthma, COPD, Asthma-COPD overlap, and Cystic Fibrosis (CF). PLoS One 2024; 19:e0292270. [PMID: 38377145 PMCID: PMC10878531 DOI: 10.1371/journal.pone.0292270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/17/2023] [Indexed: 02/22/2024] Open
Abstract
The objectives of the present study were to evaluate the discriminating power of spirometric and plethysmographic lung function parameters to differenciate the diagnosis of asthma, ACO, COPD, and to define functional characteristics for more precise classification of obstructive lung diseases. From the databases of 4 centers, a total of 756 lung function tests (194 healthy subjects, 175 with asthma, 71 with ACO, 78 with COPD and 238 with CF) were collected, and gradients among combinations of target parameters from spirometry (forced expiratory volume one second: FEV1; FEV1/forced vital capacity: FEV1/FVC; forced expiratory flow between 25-75% FVC: FEF25-75), and plethysmography (effective, resistive airway resistance: sReff; aerodynamic work of breathing at rest: sWOB), separately for in- and expiration (sReffIN, sReffEX, sWOBin, sWOBex) as well as static lung volumes (total lung capacity: TLC; functional residual capacity: FRCpleth; residual volume: RV), the control of breathing (mouth occlusion pressure: P0.1; mean inspiratory flow: VT/TI; the inspiratory to total time ratio: TI/Ttot) and the inspiratory impedance (Zinpleth = P0.1/VT/TI) were explored. Linear discriminant analyses (LDA) were applied to identify discriminant functions and classification rules using recursive partitioning decision trees. LDA showed a high classification accuracy (sensitivity and specificity > 90%) for healthy subjects, COPD and CF. The accuracy dropped for asthma (~70%) and even more for ACO (~60%). The decision tree revealed that P0.1, sRtot, and VT/TI differentiate most between healthy and asthma (68.9%), COPD (82.1%), and CF (60.6%). Moreover, using sWOBex and Zinpleth ACO can be discriminated from asthma and COPD (60%). Thus, the functional complexity of obstructive lung diseases can be understood, if specific spirometric and plethysmographic parameters are used. Moreover, the newly described parameters of airway dynamics and the central control of breathing including Zinpleth may well serve as promising functional marker in the field of precision medicine.
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Affiliation(s)
- Richard Kraemer
- Centre of Pulmonary Medicine, Hirslanden Hospital Group, Salem-Hospital, Bern, Switzerland
- Department of Paediatrics, University of Bern, Bern, Switzerland
- School of Biomedical and Precision Engineering (SBPE), University of Bern, Bern, Switzerland
| | - Florent Baty
- Department of Pneumology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Hans-Jürgen Smith
- Medical Development, Research in Respiratory Diagnostics, Berlin, Germany
| | - Stefan Minder
- Centre of Pulmonary Medicine, Hirslanden Hospital Group, Salem-Hospital, Bern, Switzerland
| | - Sabina Gallati
- Department of Paediatrics, University of Bern, Bern, Switzerland
- Hirslanden Precise, Genomic Medicine, Hirslanden Hospital Group, Zollikon/Zürich, Switzerland
| | - Martin H. Brutsche
- Department of Pneumology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Heinrich Matthys
- Department of Pneumology, University Hospital of Freiburg, Freiburg, Germany
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Fiore M, Ricci M, Rosso A, Flacco ME, Manzoli L. Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis. J Clin Med 2023; 12:6978. [PMID: 38002593 PMCID: PMC10672453 DOI: 10.3390/jcm12226978] [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: 09/02/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This meta-analysis of observational studies aimed at estimating the overall prevalence of overdiagnosis and overtreatment in subjects with a clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD). MedLine, Scopus, Embase and Cochrane databases were searched, and random-effect meta-analyses of proportions were stratified by spirometry criteria (Global Initiative for COPD (GOLD) or Lower Limit of Normal (LLN)), and setting (hospital or primary care). Forty-two studies were included. Combining the data from 39 datasets, including a total of 23,765 subjects, the pooled prevalence of COPD overdiagnosis, according to the GOLD definition, was 42.0% (95% Confidence Interval (CI): 37.3-46.8%). The pooled prevalence according to the LLN definition was 48.2% (40.6-55.9%). The overdiagnosis rate was higher in primary care than in hospital settings. Fourteen studies, including a total of 8183 individuals, were included in the meta-analysis estimating the prevalence of COPD overtreatment. The pooled rates of overtreatment according to GOLD and LLN definitions were 57.1% (40.9-72.6%) and 36.3% (17.8-57.2%), respectively. When spirometry is not used, a large proportion of patients are erroneously diagnosed with COPD. Approximately half of them are also incorrectly treated, with potential adverse effects and a massive inefficiency of resources allocation. Strategies to increase the compliance to current guidelines on COPD diagnosis are urgently needed.
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Affiliation(s)
- Matteo Fiore
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Matteo Ricci
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
| | - Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy; (A.R.); (M.E.F.)
| | - Lamberto Manzoli
- Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy; (M.F.); (M.R.)
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Lang K, Wang X, Wei T, Gu Z, Song Y, Yang D, Wang H. Concomitant preoperative airflow obstruction confers worse prognosis after trans-thoracic surgery for esophageal cancer. Front Surg 2023; 9:966340. [PMID: 36726951 PMCID: PMC9885207 DOI: 10.3389/fsurg.2022.966340] [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: 06/10/2022] [Accepted: 10/28/2022] [Indexed: 01/17/2023] Open
Abstract
Background Airflow obstruction is a critical element of chronic airway diseases. This study aimed to evaluate the impact of preoperative airflow obstruction on the prognosis of patients following surgery for esophageal carcinoma. Methods A total of 821 esophageal cancer patients were included and classified into two groups based on whether or not they had preoperative airflow obstruction. Airflow obstruction was defined as a forced expiration volume in the first second (FEV1)/forced vital capacity (FVC) ratio below the lower limit of normal (LLN). A retrospective analysis of the impact of airflow obstruction on the survival of patients with esophageal carcinoma undergoing esophagectomy was performed. Results Patients with airflow obstruction (102/821, 12.4%) had lower three-year overall (42/102, 58.8%) and progression-free survival rate (47/102, 53.9%) than those without airflow obstruction (P < 0.001). Multivariate analyses showed that airflow obstruction was an independent risk factor for overall survival (Hazard Ratio = 1.66; 95% CI: 1.17-2.35, P = 0.004) and disease progression (Hazard Ratio = 1.51; 95% CI: 1.1-2.08; P = 0.01). A subgroup analysis revealed that the above results were more significant in male patients, BMI < 23 kg/m2 patients or late-stage cancer (stage III-IVA) (P = 0.001) patients and those undergoing open esophagectomy (P < 0.001). Conclusion Preoperative airflow obstruction defined by FEV1/FVC ratio below LLN was an independent risk factor for mortality in esophageal cancer patients after trans-thoracic esophagectomy. Comprehensive management of airflow obstruction and more personalized surgical decision-making are necessary to improve survival outcomes in esophageal cancer patients.
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Affiliation(s)
- Ke Lang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaocen Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tingting Wei
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaolin Gu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yansha Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dong Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China,Correspondence: Hao Wang Dong Yang
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China,Correspondence: Hao Wang Dong Yang
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Kraemer R, Gardin F, Smith HJ, Baty F, Barandun J, Piecyk A, Minder S, Salomon J, Frey M, Brutsche MH, Matthys H. Functional Predictors Discriminating Asthma-COPD Overlap (ACO) from Chronic Obstructive Pulmonary Disease (COPD). Int J Chron Obstruct Pulmon Dis 2022; 17:2723-2743. [PMID: 36304971 PMCID: PMC9595126 DOI: 10.2147/copd.s382761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Background A significant proportion of patients with obstructive lung disease have clinical and functional features of both asthma and chronic obstructive pulmonary disease (COPD), referred to as the asthma–COPD overlap (ACO). The distinction of these phenotypes, however, is not yet well-established due to the lack of defining clinical and/or functional criteria. The aim of our investigations was to assess the discriminating power of various lung function parameters on the assessment of ACO. Methods From databases of 4 pulmonary centers, a total of 540 patients (231 males, 309 females), including 372 patients with asthma, 77 patients with ACO and 91 patients with COPD, were retrospectively collected, and gradients among combinations of explanatory variables of spirometric (FEV1, FEV1/FVC, FEF25-75), plethysmographic (sReff, sGeff, the aerodynamic work of breathing at rest; sWOB), static lung volumes, including trapped gases and measurements of the carbon monoxide transfer (DLCO, KCO) were explored using multiple factor analysis (MFA). The discriminating power of lung function parameters with respect to ACO was assessed using linear discriminant analysis (LDA). Results LDA revealed that parameters of airway dynamics (sWOB, sReff, sGeff) combined with parameters of static lung volumes such as functional residual capacity (FRCpleth) and trapped gas at FRC (VTGFRC) are valuable and potentially important tools discriminating between asthma, ACO and COPD. Moreover, sWOB significantly contributes to the diagnosis of obstructive airway diseases, independent from the state of pulmonary hyperinflation, whilst the diffusion capacity for carbon monoxide (DLCO) significantly differentiates between the 3 diagnostic classes. Conclusion The complexity of COPD with its components of interaction and their heterogeneity, especially in discrimination from ACO, may well be differentiated if patients are explored by a whole set of target parameters evaluating, interactionally, flow limitation, airway dynamics, pulmonary hyperinflation, small airways dysfunction and gas exchange disturbances assessing specific functional deficits.
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Affiliation(s)
- Richard Kraemer
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Salem-Hospital, Bern, Switzerland,Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland,Correspondence: Richard Kraemer, Center of Pulmonary Medicine, Hirslanden Private Hospital Group, Schänzlistrasse 39, Berne, CH-3013, Switzerland, Tel +41 79 300 26 53, Email
| | - Fabian Gardin
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Hans-Jürgen Smith
- Medical Development, Research in Respiratory Diagnostics, Berlin, Germany
| | - Florent Baty
- Department of Pneumology, Cantonal Hospital St, Gallen, Switzerland
| | - Jürg Barandun
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Andreas Piecyk
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Stefan Minder
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Salem-Hospital, Bern, Switzerland
| | - Jörg Salomon
- Centre of Pulmonary Medicine, Hirslanden Private Hospital Group, Salem-Hospital, Bern, Switzerland
| | - Martin Frey
- Department of Pneumology, Barmelweid Hospital, Barmelweid, Switzerland
| | | | - Heinrich Matthys
- Department of Pneumology, University Hospital of Freiburg, Freiburg, Germany
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6
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Yang Y, Li W, Guo Y, Liu Y, Li Q, Yang K, Wang S, Zeng N, Duan W, Chen Z, Chen H, Li X, Zhao W, Chen R, Kang Y. Early COPD Risk Decision for Adults Aged From 40 to 79 Years Based on Lung Radiomics Features. Front Med (Lausanne) 2022; 9:845286. [PMID: 35530043 PMCID: PMC9069013 DOI: 10.3389/fmed.2022.845286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/04/2022] [Indexed: 12/14/2022] Open
Abstract
BackgroundChronic obstructive pulmonary disease (COPD), a preventable lung disease, has the highest prevalence in the elderly and deserves special consideration regarding earlier warnings in this fragile population. The impact of age on COPD is well known, but the COPD risk of the aging process in the lungs remains unclear. Therefore, it is necessary to understand the COPD risk of the aging process in the lungs, providing an early COPD risk decision for adults.MethodsCOPD risk is evaluated for adults to make an early COPD risk decision from the perspective of lung radiomics features. First, the subjects are divided into four groups according to the COPD stages. Their ages are divided into eight equal age intervals in each group. Second, four survival Cox models are established based on the lung radiomics features to evaluate the risk probability from COPD stage 0 to suffering COPD and COPD stages. Finally, four risk ranks are defined by equally dividing the COPD risk probability from 0 to 1. Subsequently, the COPD risk at different stages is evaluated with varying age intervals to provide an early COPD risk decision.ResultsThe evaluation metrics area under the curve (AUC)/C index of four survival Cox models are 0.87/0.94, 0.84/0.83, 0.94/0.89, and 0.97/0.86, respectively, showing the effectiveness of the models. The risk rank levels up every 5 years for the subjects who had suffered COPD after 60. For the subjects with COPD stage 0, the risk rank of suffering COPD stage I levels up every 5 years after the age of 65 years, and the risk rank of suffering COPD stages II and III & IV levels up every 5 years after the age of 70 years.ConclusionOnce the age is above 60 years, the patients with COPD need to take action to prevent the progress and deterioration of COPD. Once the age is above 65 years, the patients with COPD stage 0 need to take precautions against COPD.
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Affiliation(s)
- Yingjian Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Wei Li
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
- *Correspondence: Wei Li
| | - Yingwei Guo
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Yang Liu
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Qiang Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Kai Yang
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China
| | - Shicong Wang
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Nanrong Zeng
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Wenxin Duan
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Ziran Chen
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
| | - Huai Chen
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Huai Chen
| | - Xian Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Zhao
- Medical Engineering, Liaoning Provincial Crops Hospital of Chinese People's Armed Police Forces, Shenyang, China
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China
- The Second Clinical Medical College, Jinan University, Guangzhou, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Rongchang Chen
| | - Yan Kang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Medical Device Innovation Center, Shenzhen Technology University, Shenzhen, China
- Engineering Research Centre of Medical Imaging and Intelligent Analysis, Ministry of Education, Shenyang, China
- Yan Kang
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7
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Mussell GT, Marshall H, Smith LJ, Biancardi AM, Hughes PJC, Capener DJ, Bray J, Swift AJ, Rajaram S, Condliffe AM, Collier GJ, Johns CS, Weatherley ND, Wild JM, Sabroe I. Xenon ventilation MRI in difficult asthma: initial experience in a clinical setting. ERJ Open Res 2021; 7:00785-2020. [PMID: 34589542 PMCID: PMC8473920 DOI: 10.1183/23120541.00785-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hyperpolarised gas magnetic resonance imaging (MRI) can be used to assess ventilation patterns. Previous studies have shown the image-derived metric of ventilation defect per cent (VDP) to correlate with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and FEV1 in asthma. Objectives The aim of this study was to explore the utility of hyperpolarised xenon-129 (129Xe) ventilation MRI in clinical care and examine its relationship with spirometry and other clinical metrics in people seen in a severe asthma service. Methods 26 people referred from a severe asthma clinic for MRI scanning were assessed by contemporaneous 129Xe MRI and spirometry. A subgroup of 18 patients also underwent reversibility testing with spirometry and MRI. Quantitative MRI measures of ventilation were calculated, VDP and the ventilation heterogeneity index (VHI), and compared to spirometry, Asthma Control Questionnaire 7 (ACQ7) and blood eosinophil count. Images were reviewed by a multidisciplinary team. Results VDP and VHI correlated with FEV1, FEV1/FVC and forced expiratory flow between 25% and 75% of FVC but not with ACQ7 or blood eosinophil count. Discordance of MRI imaging and symptoms and/or pulmonary function tests also occurred, prompting diagnostic re-evaluation in some cases. Conclusion Hyperpolarised gas MRI provides a complementary method of assessment in people with difficult to manage asthma in a clinical setting. When used as a tool supporting clinical care in a severe asthma service, occurrences of discordance between symptoms, spirometry and MRI scanning indicate how MRI scanning may add to a management pathway. This article demonstrates the feasibility of using 129Xe MRI in clinical practice. Discordance between symptoms, spirometry and MRI can support the use of further treatment or suggest coexisting breathing control issues or laryngeal disorders.https://bit.ly/3ky4oXP
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Affiliation(s)
- Grace T Mussell
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Helen Marshall
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alberto M Biancardi
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David J Capener
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jody Bray
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Smitha Rajaram
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alison M Condliffe
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Chris S Johns
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Nick D Weatherley
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Jim M Wild
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ian Sabroe
- Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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8
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Kraemer R, Smith HJ, Gardin F, Barandun J, Minder S, Kern L, Brutsche MH. Bronchodilator Response in Patients with COPD, Asthma-COPD-Overlap (ACO) and Asthma, Evaluated by Plethysmographic and Spirometric z-Score Target Parameters. Int J Chron Obstruct Pulmon Dis 2021; 16:2487-2500. [PMID: 34511893 PMCID: PMC8420556 DOI: 10.2147/copd.s319220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Airflow reversibility criteria in COPD are still debated - especially in situations of co-existing COPD and asthma. Bronchodilator response (BDR) is usually assessed by spirometric parameters. Changes assessed by plethysmographic parameters such as the effective, specific airway conductance (sGeff), and changes in end-expiratory resting level at functional residual capacity (FRCpleth) are rarely appreciated. We aimed to assess BDR by spirometric and concomitantly measured plethysmographic parameters. Moreover, BDR on the specific aerodynamic work of breathing (sWOB) was evaluated. METHODS From databases of 3 pulmonary centers, BDR to 200 g salbutamol was retrospectively evaluated by spirometric (∆FEV1 and ∆FEF25-75), and plethysmographic (∆sGeff, ∆FRCpleth, and ∆sWOB) parameters in a total of 843 patients diagnosed as COPD (478 = 57%), asthma-COPD-overlap (ACO) (139 = 17%), or asthma (226 = 27%), encountering 1686 BDR-measurement-sets (COPD n = 958; ACO n = 276; asthma n = 452). RESULTS Evaluating z-score improvement taking into consideration the whole pre-test z-score range, highest BDR was achieved by combining ∆sGeff and ∆FRC detecting BDR in 62.2% (asthma: 71.4%; ACO: 56.7%; COPD: 59.8%), by ∆sGeff in 53.4% (asthma: 69.1%; ACO: 51.6%; COPD: 47.4%), whereas ∆FEV1 only distinguished in 10.6% (asthma: 21.8%; ACO: 18.6%; COPD: 4.2%). Remarkably, ∆sWOB detected BDR in 49.4% (asthma: 76.2%; ACO: 47.8%; COPD: 46.9%). CONCLUSION BDR largely depends on the pre-test functional severity and, therefore, should be evaluated in relation to the pre-test conditions expressed as ∆z-scores, considering changes in airway dynamics, changes in static lung volumes and changes in small airway function. Plethysmographic parameters demonstrated BDR at a significant higher rate than spirometric parameters.
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Affiliation(s)
- Richard Kraemer
- Center of Pulmonary Medicine, Hirslanden Private Hospital Group, Salem-Hospital, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Hans-Jürgen Smith
- Medical Development, Research in Respiratory Diagnostics, Berlin, Germany
| | - Fabian Gardin
- Center of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Jürg Barandun
- Center of Pulmonary Medicine, Hirslanden Private Hospital Group, Clinic Hirslanden, Zürich, Switzerland
| | - Stefan Minder
- Medical Development, Research in Respiratory Diagnostics, Berlin, Germany
| | - Lukas Kern
- Clinic of Pneumology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Martin H Brutsche
- Clinic of Pneumology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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9
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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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Okada Y, Hashimoto N, Iwano S, Kawaguchi K, Fukui T, Sakamoto K, Wakai K, Yokoi K, Hasegawa Y. <Editors' Choice> Renewed Japanese spirometric reference variables and risk stratification for postoperative outcomes in COPD patients with resected lung cancer. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 81:427-438. [PMID: 31579333 PMCID: PMC6728190 DOI: 10.18999/nagjms.81.3.427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although the lower limit of normal (LLN) of FEV1/FVC detects at-risk patients for
postoperative outcomes among Japanese chronic obstructive pulmonary disease (COPD)
patients with resected lung cancer, there was a lack of a Japanese reference equation to
calculate the LLN of FEV1/FVC. Renewed Japanese spirometric reference variables might
enable us to verify clinical impact of the LLN of FEV1/FVC among the Japanese population.
To evaluate the clinical impact of the LLN of FEV1/FVC by using this renewed reference,
data were retrospectively analyzed from 609 newly diagnosed lung cancer patients who had
undergone thoracic surgery between 2006 and 2011. The combined assessment of the 0.70
fixed ratio and the LLN of the FEV1/FVC ratio classified the 609 subjects into the COPD
(214 subjects), non-COPD (337 subjects), and in-between (58 subjects) groups,
respectively. All of the relative odds ratios (ORs) of postoperative outcomes for the
comparison between the in-between and non-COPD groups did not show significant confidence
intervals (CIs). On the other hand, the adjusted ORs of postoperative outcomes for the
COPD group versus the non-COPD group were 2.840 (95% CI: 1.824–4.421) for prolonged oxygen
therapy (POT), 1.836 (95% CI: 1.166–2.890) for prolonged postoperative stays, and 1.637
(95% CI: 1.007–2.663) for combined complications. Adjusted comparisons of POT between the
in-between and COPD groups also showed a significant relative OR of 2.984 (95% CI:
1.447–6.153). A standardized assessment of the LLN of FEV1/FVC by a renewed Japanese
spirometric reference provides risk stratification for postoperative outcomes in the
population.
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Affiliation(s)
- Yu Okada
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Topalovic M, Das N, Burgel PR, Daenen M, Derom E, Haenebalcke C, Janssen R, Kerstjens HAM, Liistro G, Louis R, Ninane V, Pison C, Schlesser M, Vercauter P, Vogelmeier CF, Wouters E, Wynants J, Janssens W. Artificial intelligence outperforms pulmonologists in the interpretation of pulmonary function tests. Eur Respir J 2019; 53:13993003.01660-2018. [PMID: 30765505 DOI: 10.1183/13993003.01660-2018] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022]
Abstract
The interpretation of pulmonary function tests (PFTs) to diagnose respiratory diseases is built on expert opinion that relies on the recognition of patterns and the clinical context for detection of specific diseases. In this study, we aimed to explore the accuracy and interrater variability of pulmonologists when interpreting PFTs compared with artificial intelligence (AI)-based software that was developed and validated in more than 1500 historical patient cases.120 pulmonologists from 16 European hospitals evaluated 50 cases with PFT and clinical information, resulting in 6000 independent interpretations. The AI software examined the same data. American Thoracic Society/European Respiratory Society guidelines were used as the gold standard for PFT pattern interpretation. The gold standard for diagnosis was derived from clinical history, PFT and all additional tests.The pattern recognition of PFTs by pulmonologists (senior 73%, junior 27%) matched the guidelines in 74.4±5.9% of the cases (range 56-88%). The interrater variability of κ=0.67 pointed to a common agreement. Pulmonologists made correct diagnoses in 44.6±8.7% of the cases (range 24-62%) with a large interrater variability (κ=0.35). The AI-based software perfectly matched the PFT pattern interpretations (100%) and assigned a correct diagnosis in 82% of all cases (p<0.0001 for both measures).The interpretation of PFTs by pulmonologists leads to marked variations and errors. AI-based software provides more accurate interpretations and may serve as a powerful decision support tool to improve clinical practice.
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Affiliation(s)
- Marko Topalovic
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Nilakash Das
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Pierre-Régis Burgel
- Cochin Hospital, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marc Daenen
- Dept of Respiratory Medicine, Hospital Oost-Limburg, Genk, Belgium
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Rob Janssen
- Dept of Pulmonary Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Huib A M Kerstjens
- Dept of Pulmonary Medicine and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giuseppe Liistro
- Dept of Pneumology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Renaud Louis
- Dept of Respiratory Medicine, University Hospital, Liege, Belgium
| | - Vincent Ninane
- Dept of Respiratory Medicine, Saint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christophe Pison
- Service Hospitalier Universitaire de Pneumologie et Physiologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Marc Schlesser
- Dept of Pulmonary Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Piet Vercauter
- Dept of Respiratory Medicine, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Claus F Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Emiel Wouters
- Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jokke Wynants
- Dept of Pneumology, Jessa Hospital, Hasselt, Belgium.,For a full list of Pulmonary Function Study Investigators, please refer to the Acknowledgements section
| | - Wim Janssens
- Respiratory Medicine, University Hospital Leuven, Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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12
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Huang TH, Hsiue TR, Lin SH, Liao XM, Su PL, Chen CZ. Comparison of different staging methods for COPD in predicting outcomes. Eur Respir J 2018; 51:13993003.00577-2017. [PMID: 29439022 DOI: 10.1183/13993003.00577-2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is commonly staged according to the percentage of predicted forced expiratory volume in 1 s (FEV1 % pred), but other methods have been proposed. In this study we compared the performance of seven staging methods in predicting outcomes.We retrospectively studied 296 COPD outpatients. For each patient the disease severity was staged by separately applying the following methods: the criteria proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), quartiles of FEV1 % pred and z-score of FEV1, quartiles and specified cut-off points of the ratio of FEV1 over height squared ((FEV1·Ht-2)A and (FEV1·Ht-2)B, respectively), and quartiles of the ratio of FEV1 over height cubed (FEV1·Ht-3) and of FEV1 quotient (FEV1Q). We evaluated the performance of these methods in predicting the risks of severe acute exacerbation and all-cause mortality.Overall, staging based on the reference-independent FEV1Q performed best in predicting the risks of severe acute exacerbation (including frequent exacerbation) and mortality, followed by (FEV1·Ht-2)B The performance of staging methods could also be influenced by the choice of cut-off values. Future work using large and ethnically diverse populations to refine and validate the cut-off values would enhance the prediction of outcomes.
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Affiliation(s)
- Tang-Hsiu Huang
- Division of Chest Medicine, Dept of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Tzuen-Ren Hsiue
- Division of Chest Medicine, Dept of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Dept of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Xin-Ming Liao
- Division of Chest Medicine, Dept of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Po-Lan Su
- Division of Chest Medicine, Dept of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
| | - Chiung-Zuei Chen
- Division of Chest Medicine, Dept of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
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13
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Ramos Hernández C, Núñez Fernández M, Pallares Sanmartín A, Mouronte Roibas C, Cerdeira Domínguez L, Botana Rial MI, Blanco Cid N, Fernández Villar A. Validation of the portable Air-Smart Spirometer. PLoS One 2018; 13:e0192789. [PMID: 29474502 PMCID: PMC5825056 DOI: 10.1371/journal.pone.0192789] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/30/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Air-Smart Spirometer is the first portable device accepted by the European Community (EC) that performs spirometric measurements by a turbine mechanism and displays the results on a smartphone or a tablet. METHODS In this multicenter, descriptive and cross-sectional prospective study carried out in 2 hospital centers, we compare FEV1, FVC, FEV1/FVC ratio measured with the Air Smart-Spirometer device and a conventional spirometer, and analyze the ability of this new portable device to detect obstructions. Patients were included for 2 consecutive months. We calculate sensitivity, specificity, positive and negative predictive value (PPV and NPV) and likelihood ratio (LR +, LR-) as well as the Kappa Index to evaluate the concordance between the two devices for the detection of obstruction. The agreement and relation between the values of FEV1 and FVC in absolute value and the FEV1/FVC ratio measured by both devices were analyzed by calculating the intraclass correlation coefficient (ICC) and the Pearson correlation coefficient (r) respectively. RESULTS 200 patients (100 from each center) were included with a mean age of 57 (± 14) years, 110 were men (55%). Obstruction was detected by conventional spirometry in 73 patients (40.1%). Using a FEV1/FVC ratio smaller than 0.7 to detect obstruction with the Air Smart-Spirometer, the kappa index was 0.88, sensitivity (90.4%), specificity (97.2%), PPV (95.7%), NPV (93.7%), positive likelihood ratio (32.29), and negative likelihood ratio (0.10). The ICC and r between FEV1, FVC, and FEV1 / FVC ratio measured by the Air Smart Spirometer and the conventional spirometer were all higher than 0.94. CONCLUSION The Air-Smart Spirometer is a simple and very precise instrument for detecting obstructive airway diseases. It is easy to use, which could make it especially useful non-specialized care and in other areas.
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Affiliation(s)
- Cristina Ramos Hernández
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
| | | | | | - Cecilia Mouronte Roibas
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
| | | | - Maria Isabel Botana Rial
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
| | - Nagore Blanco Cid
- Department of Pneumonology, Hospital Complex of Pontevedra, Vigo, Pontevedra, Spain
| | - Alberto Fernández Villar
- Department of Pneumonology, University Hospital Complex of Vigo, Pontevedra, Spain
- Neumo Vigo I + i. Institute of Health Research South Galicia (IISGS), Vigo, Pontevedra, Spain
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14
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Abstract
OBJECTIVE To explore whether airway obstruction is associated with HIV in a cohort of HIV-infected and uninfected smokers. METHODS People living with HIV (PLWHIV) participated in the ANRS EP48 HIV CHEST study, an early lung cancer diagnosis study with low-dose chest tomography. HIV-uninfected study participants were from the CONSTANCES cohort. Inclusion criteria were an age greater than 40 years, a smoking history of at least 20 pack-years, and for PLWHIV, a CD4 T-lymphocyte nadir less than 350/μl and last CD4 cell count more than 100 cells/μl. Two randomly selected HIV-uninfected study participants were matched by age and sex with one PLWHIV. Prebronchodilatator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio was the primary outcome, and association of FEV1/FVC ratio less than 0.70 and FEV1 less than 80% of the theoretical value, as a proxy of chronic obstructive pulmonary disease, the secondary outcome. RESULTS In total, 351 PLWHIV and 702 HIV-uninfected study participants were included. Median age was 50 years, and 17% of study participants were women. Plasma HIV RNA was less than 50 copies/ml in 89% of PLWHIV, with a median CD4 cell count of 573 cells/μl. HIV (β -2.19), age (per 10 years increase; β -2.81), tobacco use (per 5 pack-years increase; β -0.34), and hepatitis C virus serology (β-2.50) were negatively associated with FEV1/FVC. HIV [odds ratio (OR: 1.72)], age (per 10 years increase; OR 1.77), and tobacco use (per 5 pack-years increase; OR 1.11) were significantly associated with the secondary outcome. CONCLUSION Our study found a significant association of airway obstruction with HIV status in smokers aged more than 40 years with previous immunodeficiency.
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15
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Rogliani P, Brusasco V, Fabbri L, Ungar A, Muscianisi E, Barisone I, Corsini A, De Angelis G. Multidimensional approach for the proper management of a complex chronic patient with chronic obstructive pulmonary disease. Expert Rev Respir Med 2017; 12:103-112. [PMID: 29241393 DOI: 10.1080/17476348.2018.1417041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is frequently associated with comorbidities occurring either independently or as consequences of COPD. Areas covered: This review examines the interactions between the pathophysiology of COPD and the most frequent comorbidities, and highlights the need for multidimensional clinical strategies to manage COPD patients with comorbidities. Expert commentary: Most COPD patients need to be approached in a complex and multifactorial scenario. The diagnosis of COPD is necessarily based on the presence of chronic respiratory symptoms and poorly reversible airflow obstruction, but exacerbations and comorbidities need to be considered in the evaluation of disease severity and prognosis in individual patients. More importantly, defining the precise relationship between COPD and comorbidities for each patient is the basis for a correct therapeutic approach.
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Affiliation(s)
- Paola Rogliani
- a Department of Experimental Medicine and Surgery , University of Rome "Tor Vergata" , Rome , Italy
| | - Vito Brusasco
- b Department of Internal Medicine , University of Genoa , Genova , Italy
| | - Leonardo Fabbri
- c Department of Endocrinology, Metabolism and Geriatric , Sant'Agostino Hospital , Modena , Italy
| | - Andrea Ungar
- d Geriatric and Intensive Care Medicine , AO Careggi and University of Florence , Florence , Italy
| | - Elisa Muscianisi
- e Novartis Farma Spa, Respiratory Franchise , Origgio , VA , Italy
| | - Ilaria Barisone
- e Novartis Farma Spa, Respiratory Franchise , Origgio , VA , Italy
| | - Alberto Corsini
- f Department of Pharmacological and Biomolecular Sciences , University of Milan , Milan , Italy.,g Multimedica IRCCS , Milan Italy
| | - Giuseppe De Angelis
- h Department of Cardiovascular Medicine , University of Milan , Milan , Italy
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16
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Karrasch S, Brüske I, Smith MP, Thorand B, Huth C, Ladwig KH, Kronenberg F, Heinrich J, Holle R, Peters A, Schulz H. What is the impact of different spirometric criteria on the prevalence of spirometrically defined COPD and its comorbidities? Results from the population-based KORA study. Int J Chron Obstruct Pulmon Dis 2016; 11:1881-94. [PMID: 27574413 PMCID: PMC4993254 DOI: 10.2147/copd.s104529] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background There is an ongoing debate about the appropriate spirometric criterion for airway obstruction to detect COPD. Furthermore, the association of different criteria with comorbidity prevalence and inflammatory biomarkers in advanced age is unclear. Materials and methods Spirometry was performed in a population-based study (n=2,256) covering an age range of 41–90 years. COPD was spirometrically determined either by a fixed ratio (FR) of <0.7 for forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) or by FEV1/FVC below the lower limit of normal (LLN). Comorbidity prevalences and circulating biomarker levels (C-reactive protein [CRP], interleukin [IL]-6) were compared between subjects with or without COPD by the two criteria using logistic and multiple regression models, adjusting for sex and age. Results The prevalence of spirometrically defined COPD by FR increased with age from 10% in subjects aged <65 years to 26% in subjects aged ≥75 years. For LLN-defined COPD, it remained below 10% for all age groups. Overall, COPD diagnosis was not associated with specific comorbidities, except for a lower prevalence of obesity in both FR- and LLN-defined cases. Both CRP and IL-6 tended to be higher in cases by both criteria. Conclusion In a population-based cohort of adults up to the age of 90 years, the prevalence of spirometrically defined COPD was higher for the FR criterion than for the LLN criterion. This difference increased with age. Neither prevalences of common comorbidities nor levels of the biomarkers, CRP or IL-6, were conclusively associated with the selection of the COPD criterion. Results have to be considered in light of the predominantly mild cases of airway obstruction in the examined study population.
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Affiliation(s)
- Stefan Karrasch
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität; Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich
| | - Irene Brüske
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
| | - Maia P Smith
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
| | - Barbara Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
| | - Cornelia Huth
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg; German Center for Diabetes Research (DZD), Munich/Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg
| | - Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research
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17
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Matsuzaki A, Hashimoto N, Okachi S, Taniguchi T, Kawaguchi K, Fukui T, Wakai K, Yokoi K, Hasegawa Y. Clinical impact of the lower limit of normal of FEV1/FVC on survival in lung cancer patients undergoing thoracic surgery. Respir Investig 2015; 54:184-92. [PMID: 27108014 DOI: 10.1016/j.resinv.2015.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 09/16/2015] [Accepted: 11/17/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previously, it has been shown that using a fixed ratio of FEV1/FVC of 0.7 to classify airway obstruction could not predict survival outcomes in lung cancer patients undergoing thoracic surgery. We demonstrated that use of the lower limit of normal (LLN) of FEV1/FVC may allow better risk stratification for postoperative outcomes in patients with chronic obstructive pulmonary disease (COPD) patients. Nevertheless, it remained unclear whether survival outcomes in this population could be predicted by LLN-defined airway obstruction. OBJECTIVE To evaluate the clinical relevance of LLN-defined airway obstruction to survival outcomes. METHODS The clinical relevance of LLN-defined airway obstruction was analyzed and compared in 699 subjects, using Kaplan-Meier curves and the log-rank test. A Cox regression model was used to explore prognostic risk factors. RESULTS One hundred-and-seventy-eight subjects were assigned to the below-LLN group, in which airflow obstruction determined by the FEV1/FVC ratio was below the LLN. Five hundred-and-twenty-one subjects were assigned to the above-LLN group. The below-LLN group had a worse overall survival (OS) and disease-free survival (DFS) than the above-LLN group. The diffusing capacity of the lung for carbon monoxide and the ratio of the inspiratory capacity divided to the total lung capacity were independent risk factors for OS and DFS. CONCLUSIONS A standardized assessment of LLN-defined airway obstruction may allow risk stratification for survival likelihood in lung cancer patients who undergo thoracic surgery.
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Affiliation(s)
- Asuka Matsuzaki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shotaro Okachi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Tetsuo Taniguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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18
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Affiliation(s)
- Malcolm R Sears
- McMaster University, Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
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19
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Dominelli PB, Foster GE, Guenette JA, Haverkamp HC, Eves ND, Dominelli GS, Henderson WR, O’Donnell DE, Sheel AW. Quantifying the shape of the maximal expiratory flow–volume curve in mild COPD. Respir Physiol Neurobiol 2015; 219:30-5. [DOI: 10.1016/j.resp.2015.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022]
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20
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Affes Z, Rekik S, Ben Saad H. Defining obstructive ventilatory defect in 2015. Libyan J Med 2015; 10:28946. [PMID: 26452407 PMCID: PMC4600093 DOI: 10.3402/ljm.v10.28946] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION There is no clear consensus as to what constitutes an obstructive ventilatory defect (OVD): Is it FEV1/FVC AIM To determine, according to the two definitions, the percentage of subjects having an OVD among them explored in a lung function exploration laboratory. POPULATION AND METHODS This is a retrospective study including 4,730 subjects aged 17-85 years. Subjects were divided according to the presence [physio (+) or operat (+)] or absence [physio (-) or operat (-)] of an OVD, and into younger (<45 years, n=2,076), older (≥45 years, n=2,654), smokers (n=1,208), and non-smokers (n=3,522) groups. RESULTS For the total sample, the younger and older groups [mean±SD of age (years), respectively, 46.7±14.1; 33.9±7.4, and 56.8±9.1], the 'physiological definition' detected, respectively, 13.46, 43.22, and 5.09% more OVD than the 'operational one' (p<0.05). In addition, the operational definition, compared with the physiological one, overdiagnosed OVD in 2.33 and 0.44% of smokers and non-smokers, respectively, and underdiagnosed it in 4.46% and 29.72% of smokers and non-smokers, respectively (p<0.05). Compared with the group 'physio (-), operat (+)', the 'physio (+), operat (-)' one was younger (74.2±4.7 years vs. 40.9±10.3 years) and had significantly higher FEV1 (62±13% vs. 78±17%) and FVC (71±15% vs. 93±19%). CONCLUSION The frequency of OVD much depends on the criteria used for its definition.
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Affiliation(s)
- Zied Affes
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
| | - Salaheddine Rekik
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Research Laboratory N° LR14ES05: Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia;
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21
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Affiliation(s)
- Ian Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew Bush
- Paediatric Respiratory Medicine and Paediatrics, Royal Brompton Hospital and Imperial College, London, UK
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Topalovic M, Exadaktylos V, Decramer M, Berckmans D, Troosters T, Janssens W. Using dynamics of forced expiration to identify COPD where conventional criteria for the FEV1/FVC ratio do not match. Respirology 2015; 20:925-31. [DOI: 10.1111/resp.12540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/29/2015] [Accepted: 02/19/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Marko Topalovic
- Respiratory Medicine; University Hospital Leuven; Department of Clinical and Experimental Medicine; Catholic University of Leuven; Leuven Belgium
| | - Vasileios Exadaktylos
- Division Measure, Model and Manage Bioresponses (M3-BIORES), Department of Biosystems; Catholic University of Leuven; Leuven Belgium
| | - Marc Decramer
- Respiratory Medicine; University Hospital Leuven; Department of Clinical and Experimental Medicine; Catholic University of Leuven; Leuven Belgium
| | - Daniel Berckmans
- Division Measure, Model and Manage Bioresponses (M3-BIORES), Department of Biosystems; Catholic University of Leuven; Leuven Belgium
| | - Thierry Troosters
- Respiratory Medicine; University Hospital Leuven; Department of Clinical and Experimental Medicine; Catholic University of Leuven; Leuven Belgium
- Department of Rehabilitation Sciences; Faculty of Kinesiology and Rehabilitation Sciences; Catholic University of Leuven; Leuven Belgium
| | - Wim Janssens
- Respiratory Medicine; University Hospital Leuven; Department of Clinical and Experimental Medicine; Catholic University of Leuven; Leuven Belgium
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23
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Osuka S, Hashimoto N, Sakamoto K, Wakai K, Yokoi K, Hasegawa Y. Risk stratification by the lower limit of normal of FEV1/FVC for postoperative outcomes in patients with COPD undergoing thoracic surgery. Respir Investig 2015; 53:117-23. [PMID: 25951098 DOI: 10.1016/j.resinv.2015.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/09/2015] [Accepted: 01/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mounting evidence suggests that airway obstruction defined by the lower limit of normal (LLN) of forced expiration volume in 1s (FEV1)/forced vital capacity (FVC) might be an important predictor of mortality in patients with an FEV1/FVC ratio below 0.70. Although better risk stratification for postoperative outcomes in patients with chronic obstructive pulmonary disease (COPD) undergoing thoracic surgery is warranted, whether an FEV1/FVC ratio below 0.70 but above the LLN (i.e., in-between) could identify patients at risk for adverse postoperative outcomes has not been fully evaluated. METHODS To determine the clinical impact of this "in-between" group of patients with COPD, we evaluated whether classification of the in-between group and the COPD group with FEV1/FVC ratios below 0.70 and below the LLN could provide more accurate risk stratification for postoperative outcomes in COPD patients undergoing thoracic surgery. RESULTS The criterion of LLN classified 302 patients with an FEV1/FVC ratio below 0.70 into either the in-between group (124 cases) or the COPD group (178 cases). The COPD group showed a 3-fold increase in prolonged oxygen therapy (POT) and a 50% increase in prolonged postoperative stay (PPS), as compared with the in-between group, with an adjusted odds ratio of 3.068 (95% confidence interval: 1.806-5.213) for POT. CONCLUSIONS Based on the finding that the in-between group could independently identify patients at risk for adverse postoperative outcomes, LLN assessment of the FEV1/FVC ratio might provide more accurate risk stratification in COPD patients undergoing thoracic surgery.
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Affiliation(s)
- Satoko Osuka
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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van Dijk W, Tan W, Li P, Guo B, Li S, Benedetti A, Bourbeau J. Clinical relevance of fixed ratio vs lower limit of normal of FEV1/FVC in COPD: patient-reported outcomes from the CanCOLD cohort. Ann Fam Med 2015; 13:41-8. [PMID: 25583891 PMCID: PMC4291264 DOI: 10.1370/afm.1714] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The way in which spirometry is interpreted can lead to misdiagnosis of chronic obstructive pulmonary disease (COPD) resulting in inappropriate treatment. We compared the clinical relevance of 2 criteria for defining a low ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC): the fixed ratio and the lower limit of normal. METHODS We analyzed data from the cross-sectional phase of the population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study. We determined associations of the spirometric criteria for airflow limitation with patient-reported adverse outcomes, including respiratory symptoms, disability, health status, exacerbations, and cardiovascular disease. Sensitivity analyses were used to explore the impact of age and severity of airflow limitation on these associations. RESULTS We analyzed data from 4,882 patients aged 40 years and older. The prevalence of airflow limitation was 17% by fixed ratio and 11% by lower limit of normal. Patients classified as having airflow limitation by fixed ratio only had generally small, nonsignificant increases in the odds of adverse outcomes. Patients having airflow limitation based on both fixed ratio and lower limit of normal had larger, significant increases in odds. But strongest associations were seen for patients who had airflow limitation by both fixed ratio and lower limit of normal and also had a low FEV1, defined as one less than 80% of the predicted value. CONCLUSIONS Our results suggest that use of the fixed ratio alone may lead to misdiagnosis of COPD. A diagnosis established by both a low FEV1/FVC (according to fixed ratio and/or lower limit of normal) and a low FEV1 is strongly associated with clinical outcomes. Guidelines should be reconsidered to require both spirometry abnormalities so as to reduce overdiagnosis of COPD.
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Affiliation(s)
- Wouter van Dijk
- Department of Primary and Community Care, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Wan Tan
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pei Li
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Best Guo
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Summer Li
- UBC James Hogg Research Centre, Providence Heart and Lung Institute, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada
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Makinson A, Hayot M, Eymard-Duvernay S, Quesnoy M, Raffi F, Thirard L, Bonnet F, Tattevin P, Abgrall S, Quantin X, Léna H, Bommart S, Reynes J, Le Moing V. High prevalence of undiagnosed COPD in a cohort of HIV-infected smokers. Eur Respir J 2014; 45:828-31. [DOI: 10.1183/09031936.00154914] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Scholes S, Moody A, Mindell JS. Estimating population prevalence of potential airflow obstruction using different spirometric criteria: a pooled cross-sectional analysis of persons aged 40-95 years in England and Wales. BMJ Open 2014; 4:e005685. [PMID: 25056983 PMCID: PMC4120415 DOI: 10.1136/bmjopen-2014-005685] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Consistent estimation of the burden of chronic obstructive pulmonary disease (COPD) has been hindered by differences in methods, including different spirometric cut-offs for impaired lung function. The impact of different definitions on the prevalence of potential airflow obstruction, and its associations with key risk factors, is evaluated using cross-sectional data from two nationally representative population surveys. DESIGN Pooled cross-sectional analysis of Wave 2 of the UK Household Longitudinal Survey and the Health Survey for England 2010, including 7879 participants, aged 40-95 years, who lived in England and Wales, without diagnosed asthma and with good-quality spirometry data. Potential airflow obstruction was defined using self-reported physician-diagnosed COPD; a fixed threshold (FT) forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7 and an age-specific, sex-specific, height-specific and ethnic-specific lower limit of normal (LLN). Standardised questions elicited self-reported information on demography, smoking history, ethnicity, occupation, respiratory symptoms and cardiovascular disease. RESULTS Consistent across definitions, participants classed with obstructed airflow were more likely to be older, currently smoke, have higher pack-years of smoking and be engaged in routine occupations. The prevalence of airflow obstruction was 2.8% (95% CI 2.3% to 3.2%), 22.2% (21.2% to 23.2%) and 13.1% (12.2% to 13.9%) according to diagnosed COPD, FT and LLN, respectively. The gap in prevalence between FT and LLN increased in older age groups. Sex differences in the risk of obstruction, after adjustment for key risk factors, was sensitive to the choice of spirometric cut-off, being significantly higher in men when using FT, compared with no significant difference using LLN. CONCLUSIONS Applying FT or LLN spirometric cut-offs gives a different picture of the size and distribution of the disease burden. Longitudinal studies examining differences in unscheduled hospital admissions and risk of death between FT and LLN may inform the choice as to the best way to include spirometry in assessments of airflow obstruction.
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Affiliation(s)
- Shaun Scholes
- Health and Social Surveys Research Group, Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Alison Moody
- Health and Social Surveys Research Group, Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jennifer S Mindell
- Health and Social Surveys Research Group, Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Perret JL, Walters EH, Abramson MJ, McDonald CF, Dharmage SC. The independent and combined effects of lifetime smoke exposures and asthma as they relate to COPD. Expert Rev Respir Med 2014; 8:503-14. [PMID: 24834459 DOI: 10.1586/17476348.2014.905913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is part of a worldwide tobacco-related disease epidemic, and is associated with progressive airflow obstruction and varying degrees of emphysema and/or hyperinflation. Greater focus has been placed recently on the potential for early life factors to influence the development of COPD, based on the premise that delayed lung growth during childhood and adolescence might predispose to lung disease in later life. For most people, the adverse effects on lung function of adult and early childhood factors are additive, which provides no additional incentive for current smokers to quit. However, if there is a (synergistic) interaction between active smoking and asthma, smoking cessation is likely to have a greater lung function benefit for the smoker who is also asthmatic, especially if quitting occurs at an early age. This article critically evaluates the evidence for the independent associations of lifetime asthma, smoking and smoke exposures with airflow obstruction, plus their interaction when multiple factors are present.
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Affiliation(s)
- Jennifer L Perret
- Unit for Allergy and Lung Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne 3010, Victoria, Australia
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Kubota M, Kobayashi H, Quanjer PH, Omori H, Tatsumi K, Kanazawa M. Reference values for spirometry, including vital capacity, in Japanese adults calculated with the LMS method and compared with previous values. Respir Investig 2014; 52:242-50. [PMID: 24998371 DOI: 10.1016/j.resinv.2014.03.003] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 02/13/2014] [Accepted: 03/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reference values for lung function tests should be periodically updated because of birth cohort effects and improved technology. This study updates the spirometric reference values, including vital capacity (VC), for Japanese adults and compares the new reference values with previous Japanese reference values. METHODS Spirometric data from healthy non-smokers (20,341 individuals aged 17-95 years, 67% females) were collected from 12 centers across Japan, and reference equations were derived using the LMS method. This method incorporates modeling skewness (lambda: L), mean (mu: M), and coefficient of variation (sigma: S), which are functions of sex, age, and height. In addition, the age-specific lower limits of normal (LLN) were calculated. RESULTS Spirometric reference values for the 17-95-year age range and the age-dependent LLN for Japanese adults were derived. The new reference values for FEV(1) in males are smaller, while those for VC and FVC in middle age and elderly males and those for FEV(1), VC, and FVC in females are larger than the previous values. The LLN of the FEV(1)/FVC for females is larger than previous values. The FVC is significantly smaller than the VC in the elderly. CONCLUSIONS The new reference values faithfully reflect spirometric indices and provide an age-specific LLN for the 17-95-year age range, enabling improved diagnostic accuracy. Compared with previous prediction equations, they more accurately reflect the transition in pulmonary function during young adulthood. In elderly subjects, the FVC reference values are not interchangeable with the VC values.
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Affiliation(s)
- Masaru Kubota
- Respiratory Medicine, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
| | - Hirosuke Kobayashi
- Graduate School of Medical Sciences, Kitasato University, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan.
| | - Philip H Quanjer
- Department of Pulmonary Diseases and Department of Paediatrics-Pulmonary Diseases, Erasmus Medical Centre, Erasmus University, ׳s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1, Kuhonji, Chuo-ku, Kumamoto-shi, Kumamoto 862-0976, Japan.
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan.
| | - Minoru Kanazawa
- Department of Respiratory Medicine, Saitama Medical University, 38, Morohongo, Moroyama, Iruma-gun, Saitama 350-0495, Japan.
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McLean S, Wild SH, Simpson CR, Sheikh A. Models for estimating projections for the prevalence and disease burden of chronic obstructive pulmonary disease (COPD): systematic review protocol. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:PS8-21. [PMID: 23732639 PMCID: PMC6442795 DOI: 10.4104/pcrj.2013.00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Susannah McLean
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
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van Dijk WD, Gupta N, Tan WC, Bourbeau J. Clinical relevance of diagnosing COPD by fixed ratio or lower limit of normal: a systematic review. COPD 2013; 11:113-20. [PMID: 23862613 DOI: 10.3109/15412555.2013.781996] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Different spirometric criteria in diagnosing COPD have been advocated by different groups, debilitating adequate diagnosis and treatment of COPD. We reviewed the clinical relevance of fixed ratio and lower limit of normal (LLN) in diagnosing COPD and explored if modifying factors may affect their clinical relevance. METHODS Two reviewers independently searched PubMed and Embase for papers that compared both criteria on any clinically relevant outcome, published before June 1st, 2012, without any language restriction. Two reviewers independently extracted the study characteristics, including study design, population characteristics and diagnostic criteria used, and summarized the results of clinical relevance. Study quality was assessed by scoring forms for bias and level of evidence. RESULTS Of 394 studies retrieved, 11 studies were included, with a median of 1,258 participants. Although both criteria appeared related with various clinically relevant outcomes, we were unable to prefer one criterion over the other, with various performances of the criteria for different outcomes. Should the criteria disagree on diagnosis, an alternative diagnosis should be suspected, in particular in those (elderly) with less severe airflow limitation for whom the LLN appears a better criterion. The fixed ratio appears to perform better in subjects with more severe airflow limitation. CONCLUSION In diagnosing COPD, severity of airflow limitation appears an important factor for choosing whether the fixed ratio or LLN. Disagreement between the criteria is suggestive for an alternative diagnosis. Future studies on clinical relevance should further reveal the criterion of choice, in order to improve adequate diagnosis and consequent treatments.
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Affiliation(s)
- Wouter D van Dijk
- 1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre , Nijmegen , the Netherlands
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Arnedillo Muñoz A. El infradiagnóstico de la enfermedad pulmonar obstructiva crónica en mujeres. ¿Otra tarea pendiente? Arch Bronconeumol 2013; 49:221-2. [DOI: 10.1016/j.arbres.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 11/26/2022]
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Stocks J, Sonnappa S. Early life influences on the development of chronic obstructive pulmonary disease. Ther Adv Respir Dis 2013; 7:161-73. [PMID: 23439689 PMCID: PMC4107852 DOI: 10.1177/1753465813479428] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
There is increasing evidence that chronic obstructive pulmonary disease (COPD) is not simply a disease of old age that is largely restricted to heavy smokers, but may be associated with insults to the developing lung during foetal life and the first few years of postnatal life, when lung growth and development are rapid. A better understanding of the long-term effects of early life factors, such as intrauterine growth restriction, prenatal and postnatal exposure to tobacco smoke and other pollutants, preterm delivery and childhood respiratory illnesses, on the subsequent development of chronic respiratory disease is imperative if appropriate preventive and management strategies to reduce the burden of COPD are to be developed. The extent to which insults to the developing lung are associated with increased risk of COPD in later life depends on the underlying cause, timing and severity of such derangements. Suboptimal conditions in utero result in aberrations of lung development such that affected individuals are born with reduced lung function, which tends to remain diminished throughout life, thereby increasing the risk both of wheezing disorders during childhood and subsequent COPD in genetically susceptible individuals. If the current trend towards the ever-increasing incidence of COPD is to be reversed, it is essential to minimize risks to the developing lung by improvements in antenatal and neonatal care, and to reduce prenatal and postnatal exposures to environmental pollutants, including passive tobacco smoke. Furthermore, adult physicians need to recognize that lung disease is potentially associated with early life insults and provide better education regarding diet, exercise and avoidance of smoking to preserve precious reserves of lung function in susceptible adults. This review focuses on factors that adversely influence lung development in utero and during the first 5 years of life, thereby predisposing to subsequent COPD.
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Affiliation(s)
- Janet Stocks
- Portex Unit, University College London Institute of Child Health, 30, Guilford Street, London WC1N 1EH, UK.
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Di Marco F, Tantucci C, Pellegrino G, Centanni S. Chronic obstructive pulmonary disease diagnosis: the simpler the better? Not always. Eur J Intern Med 2013; 24:199-202. [PMID: 23466208 DOI: 10.1016/j.ejim.2013.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/19/2012] [Accepted: 01/05/2013] [Indexed: 11/16/2022]
Abstract
The acronym chronic obstructive pulmonary disease (COPD) has been introduced in the early 1960s to describe a disease characterized by largely irreversible airflow obstruction, due to a combination of airway disease and pulmonary emphysema, without defining their respective contribution to the pathology. COPD is a disorder that causes considerable morbidity and mortality. Currently, it represents the fourth leading cause of death in the world, and it is expected to increase both in prevalence and in mortality over the next decades. The most widely adopted definition of COPD is that of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), that recommends the use of the post-bronchodilator forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC)<0.7 to define irreversible airflow obstruction. This approach, called "fixed ratio", has been introduced to provide a simple tool for COPD diagnosis, as it is easy to remember. Even if modern medicine and research seem to prefer rigid cut-offs and classifications, this often contrasts with the complex nature of the disease. The aim of the present review is to explain that such a fixed cut-off failed to increase COPD diagnosis, and furthermore often leads to inescapable misclassification of patients, with the risk of an excessive simplification of a clinical approach necessarily complex.
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Affiliation(s)
- Fabiano Di Marco
- Respiratory Unit, San Paolo Hospital, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
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Jithoo A, Enright PL, Burney P, Buist AS, Bateman ED, Tan WC, Studnicka M, Mejza F, Gillespie S, Vollmer WM. Case-finding options for COPD: results from the Burden of Obstructive Lung Disease study. Eur Respir J 2013; 41:548-55. [PMID: 22743668 PMCID: PMC3529919 DOI: 10.1183/09031936.00132011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to compare strategies for chronic obstructive pulmonary disease (COPD) case finding using data from the Burden of Obstructive Lung Disease study. Population-based samples of adults aged ≥40 yrs (n = 9,390) from 14 countries completed a questionnaire and spirometry. We compared the screening efficiency of differently staged algorithms that used questionnaire data and/or peak expiratory flow (PEF) data to identify persons at risk for COPD and, hence, needing confirmatory spirometry. Separate algorithms were fitted for moderate/severe COPD and for severe COPD. We estimated the cost of each algorithm in 1,000 people. For moderate/severe COPD, use of questionnaire data alone permitted high sensitivity (97%) but required confirmatory spirometry in 80% of participants. Use of PEF necessitated confirmatory spirometry in only 19-22% of subjects, with 83-84% sensitivity. For severe COPD, use of PEF achieved 91-93% sensitivity, requiring confirmatory spirometry in <9% of participants. Cost analysis suggested that a staged screening algorithm using only PEF initially, followed by confirmatory spirometry as needed, was the most cost-effective case-finding strategy. Our results support the use of PEF as a simple, cost-effective initial screening tool for conducting COPD case-finding in adults aged ≥40 yrs. These findings should be validated in real-world settings such as the primary care environment.
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Affiliation(s)
- Anamika Jithoo
- National Heart and Lung Institute, Imperial College London, London, UK
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Vaz Fragoso CA, Gill TM, McAvay G, Quanjer PH, Van Ness PH, Concato J. Respiratory impairment in older persons: when less means more. Am J Med 2013; 126:49-57. [PMID: 23177541 PMCID: PMC3529831 DOI: 10.1016/j.amjmed.2012.07.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 07/11/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Among older persons, within the clinical context of respiratory symptoms and mobility, evidence suggests that improvements are warranted regarding the current approach for identifying respiratory impairment (ie, a reduction in pulmonary function). METHODS Among 3583 white participants aged 65 to 80 years (Cardiovascular Health Study), we calculated the prevalence of respiratory impairment using the current spirometric standard from the Global Initiative for Obstructive Lung Disease (GOLD) and an alternative spirometric approach termed "lambda-mu-sigma" (LMS). Results for GOLD- and LMS-defined respiratory impairment were evaluated for their (cross-sectional) association with respiratory symptoms and gait speed, and for the 5-year cumulative incidence probability of mobility disability. RESULTS The prevalence of respiratory impairment was 49.7% (1780/3583) when using the GOLD and 23.2% (831/3583) when using LMS. Differences in prevalence were most evident among participants who had no respiratory symptoms, with respiratory impairment classified more often by the GOLD (38.1% [326/855]) than LMS (12.3% [105/855]), as well as among participants who had normal gait speed, with respiratory impairment classified more often by the GOLD (46.4% [1003/2164]) than LMS (19.3% [417/2164]). Conversely, the 5-year cumulative incidence probability of mobility disability for respiratory impairment was higher for LMS than GOLD (0.313 and 0.249 for never-smokers, and 0.352 and 0.289 for ever-smokers, respectively), but was similar for normal spirometry by LMS or GOLD (0.193 and 0.185 for never-smokers, and 0.219 and 0.216 for ever-smokers, respectively). CONCLUSIONS Among older persons, the LMS approach (vs the GOLD approach) classifies respiratory impairment less frequently in those who are asymptomatic and is more strongly associated with mobility disability.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT 06250-8025, USA.
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Karrasch S, Flexeder C, Behr J, Holle R, Huber RM, Jörres RA, Nowak D, Peters A, Wichmann HE, Heinrich J, Schulz H. Spirometric Reference Values for Advanced Age from a South German Population. Respiration 2013; 85:210-9. [DOI: 10.1159/000338780] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 04/02/2012] [Indexed: 11/19/2022] Open
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Kirkby J, Bonner R, Lum S, Bates P, Morgan V, Strunk RC, Kirkham F, Sonnappa S, Stocks J. Interpretation of pediatric lung function: impact of ethnicity. Pediatr Pulmonol 2013; 48:20-6. [PMID: 22431502 PMCID: PMC3736844 DOI: 10.1002/ppul.22538] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 01/13/2012] [Indexed: 02/02/2023]
Abstract
RATIONALE To evaluate the appropriateness of spirometric and plethysmographic reference equations in healthy young children according to ethnic origin. METHODS Spirometry data were collated in 400 healthy children (214 Black and 186 White) aged 6-12 years. Of these children, 68 Black and 115 White children also undertook plethysmography. Results were expressed as percent predicted according to commonly used equations for spirometry and plethysmography. RESULTS Black children had lower lung function for a given height compared to White children. The magnitude and direction of these differences varied according to specific outcome. In the studied age range (6-12 years) the ethnic-specific Wang equations were adequate for spirometry (mean results approximating 100% predicted in both ethnic groups). By contrast, significant differences were found between observed and % predicted plethysmographic lung volumes according to published equations derived from White children: Among the Black children, function residual capacity (FRC) and total lung capacity (TLC) were on average, 14 and 6% lower than predicted, whereas mean residual volume (RV) and RV/TLC were 4 and 10% higher. Among White children, the Rosenthal equations gave the best fit, with the exception of FRC which was, on average, 9% lower than predicted. CONCLUSION Spirometry equations may suffice in Black children; however, interpretation of static lung volumes in Black children is limited due to inappropriate reference equations. More appropriate plethysmographic reference equations that are applicable to all ethnic groups across the entire age range are urgently needed.
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Affiliation(s)
- J Kirkby
- Portex Unit, Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK.
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Çolak Y, Løkke A, Marott JL, Lange P, Vestbo J. Impact of diagnostic criteria on the prevalence of COPD. CLINICAL RESPIRATORY JOURNAL 2012; 7:297-303. [DOI: 10.1111/crj.12007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 08/15/2012] [Accepted: 10/05/2012] [Indexed: 01/07/2023]
Affiliation(s)
- Yunus Çolak
- The Copenhagen City Heart Study; Bispebjerg Hospital; Copenhagen; Denmark
| | - Anders Løkke
- Department of Respiratory Medicine; Aarhus County Hospital; Aarhus; Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study; Bispebjerg Hospital; Copenhagen; Denmark
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Aarli BB, Eagan TML, Ellingsen I, Bakke PS, Hardie JA. Reference values for within-breath pulmonary impedance parameters in asymptomatic elderly. CLINICAL RESPIRATORY JOURNAL 2012; 7:245-52. [DOI: 10.1111/j.1752-699x.2012.00312.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/10/2012] [Accepted: 07/06/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Bernt Bøgvald Aarli
- Department of Thoracic Medicine; Haukeland University Hospital; Bergen; Norway
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Canadian prediction equations of spirometric lung function for Caucasian adults 20 to 90 years of age: results from the Canadian Obstructive Lung Disease (COLD) study and the Lung Health Canadian Environment (LHCE) study. Can Respir J 2012; 18:321-6. [PMID: 22187687 DOI: 10.1155/2011/540396] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Currently, no reference or normative values for spirometry based on a randomly selected Canadian population exist. OBJECTIVE The aim of the present analysis was to construct spirometric reference values for Canadian adults 20 to 90 years of age by combining data collected from healthy lifelong nonsmokers in two population-based studies. METHOD Both studies similarly used random population sampling, conducted using validated epidemiological protocols in the Canadian Obstructive Lung Disease study, and the Lung Health Canadian Environment study. Spirometric lung function data were available from 3042 subjects in the COLD study, which was completed in 2009, and from 2571 subjects in the LHCE study completed in 1995. A total of 844 subjects 40 to 90 years of age, and 812 subjects 20 to 44 years of age, were identified as healthy, asymptomatic, lifelong nonsmokers, and provided normative reference values for spirometry. Multiple regression models were constructed separately for Caucasian men and women for the following spirometric parameters: forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and FEV(1)⁄FVC ratio, with covariates of height, sex and age. Comparison with published regression equations showed that the best agreement was obtained from data derived from random populations. RESULTS The best-fitting regression models for healthy, never-smoking, asymptomatic European-Canadian men and women 20 to 90 years of age were constructed. When age- and height-corrected FEV(1), FVC and FEV(1)⁄FVC ratio were compared with other spirometry reference studies, mean values were similar, with the closest being derived from population-based studies. CONCLUSION These spirometry reference equations, derived from randomly selected population-based cohorts with stringently monitored lung function measurements, provide data currently lacking in Canada.
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Vaz Fragoso CA, Concato J, McAvay G, Van Ness PH, Gill TM. Respiratory impairment and COPD hospitalisation in older persons: a competing risk analysis. Eur Respir J 2012; 40:37-44. [PMID: 22267770 PMCID: PMC3773173 DOI: 10.1183/09031936.00128711] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The aim of the present study was to evaluate, among older persons, the association between respiratory impairment and hospitalisation for chronic obstructive pulmonary disease (COPD), based on spirometric Z-scores, i.e. the LMS (lambda, mu, sigma) method, and a competing risk approach. Using data on 3,563 white participants aged 65-80 yrs (from the Cardiovascular Health Study) we evaluated the association of LMS-defined respiratory impairment with the incident of COPD hospitalisation and the competing outcome of death without COPD hospitalisation, over a 5-yr period. Respiratory impairment included airflow limitation (mild, moderate or severe) and restrictive pattern. Over a 5-yr period, 276 (7.7%) participants had a COPD hospitalisation incident, whereas 296 (8.3%) died without COPD hospitalisation. The risk of COPD hospitalisation was elevated more than two-fold in LMS-defined mild and moderate airflow limitation and restrictive pattern (adjusted HR (95% CI): 2.25 (1.25-4.05), 2.54 (1.53- 4.22) and 2.65 (1.82-3.86), respectively), and more than eight-fold in LMS-defined severe airflow limitation (adjusted HR (95% CI) 8.33 (6.24-11.12)). Conversely, only LMS-defined restrictive-pattern was associated with the competing outcome of death without COPD hospitalisation (adjusted HR (95% CI) 1.68 (1.22-2.32)). In older white persons, LMS-defined respiratory impairment is strongly associated with an increased risk of COPD hospitalisation. These results support the LMS method as a basis for defining respiratory impairment in older persons.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave, Mailcode 151B, West Haven, CT, USA.
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Sorino C, Battaglia S, Scichilone N, Pedone C, Antonelli-Incalzi R, Sherrill D, Bellia V. Diagnosis of airway obstruction in the elderly: contribution of the SARA study. Int J Chron Obstruct Pulmon Dis 2012; 7:389-95. [PMID: 22848152 PMCID: PMC3402059 DOI: 10.2147/copd.s31630] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The choice between lower limit of normal or fixed value of forced expiratory volume in one second/forced vital capacity ratio (FEV(1)/FVC) < 0.70 as the criterion for confirming airway obstruction is an open issue. In this study, we compared the criteria of lower limit of normal and fixed FEV(1)/FVC for diagnosis of airway obstruction, with a focus on healthy elderly people. METHODS We selected 367 healthy nonsmoking subjects aged 65-93 years from 1971 participants in the population-based SARA (Salute Respiratoria nell'Anziano, Italian for "Respiratory Health in the Elderly") study, analyzed their spirometric data, and tested the relationship between spirometric indices and anthropometric variables. The lower limit of normal for FEV(1)/FVC was calculated as the fifth percentile of the normal distribution for selected subjects. RESULTS While FEV(1) and FVC decreased significantly with aging, the relationship between FEV(1)/FVC and age was not statistically significant in men or women. The lower limit of normal for FEV(1)/FVC was 0.65 in men and 0.67 in women. Fifty-five participants (15%) had FEV(1)/FVC < 0.70 and would have been inappropriately classified as obstructed according to the Global Initiative for Obstructive Lung Disease, American Thoracic Society/European Respiratory Society, and Canadian guidelines on chronic obstructive pulmonary disease. By applying different FEV(1)/FVC thresholds for the different age groups, as previously proposed in the literature, (0.70 for <70 years, 0.65 for 70-80 years, and 0.60 for >80 years) the percentage of patients classified as obstructed decreased to 6%. No subjects older than 80 years had an FEV(1)/FVC < 0.60. CONCLUSION The present results confirm the inadequacy of FEV(1)/FVC < 0.70 as a diagnostic criterion for airway obstruction after the age of 65 years. FEV(1)/FVC < 0.65 and <0.67 (for men and women, respectively) could identify subjects with airway obstruction in such a population. Further reduction of the threshold after 80 years is not justified.
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Affiliation(s)
- Claudio Sorino
- Biomedical Department of Internal and Specialist Medicine, Section of Pulmonology, University of Palermo, Italy.
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Rossi A, Zanardi E. E pluribus plurima: multidimensional indices and clinical phenotypes in COPD. Respir Res 2011; 12:152. [PMID: 22082092 PMCID: PMC3233517 DOI: 10.1186/1465-9921-12-152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 11/14/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- Andrea Rossi
- Pulmonary Unit, Cardiovascular and Thoracic Department, University and General Hospital, P.le Stefani 1, I-37126, Verona, Italy
| | - Erika Zanardi
- Pulmonary Unit, Cardiovascular and Thoracic Department, University and General Hospital, P.le Stefani 1, I-37126, Verona, Italy
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Agustí A, Vestbo J. Current controversies and future perspectives in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2011; 184:507-13. [PMID: 21680951 DOI: 10.1164/rccm.201103-0405pp] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Over the past decade there has been much research and interest in COPD. As a result, the understanding and management of the disease has improved significantly. Yet, there are many uncertainties and controversies that require further work. This review discusses these controversies and anticipates some of the changes that may occur in the near future in the field of COPD.
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Affiliation(s)
- Alvar Agustí
- Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona and Centro deInvestigación Biomèdica en Red de Enfermedades Respiratorias and Centro Internacional de Medicina Respiratoria Avanzada, Mallorca, Illes Balears, Spain.
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