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Zhou T, Guan Y, Lin X, Zhou X, Mao L, Ma Y, Fan B, Li J, Tu W, Liu S, Fan L. A clinical-radiomics nomogram based on automated segmentation of chest CT to discriminate PRISm and COPD patients. Eur J Radiol Open 2024; 13:100580. [PMID: 38989052 PMCID: PMC11233899 DOI: 10.1016/j.ejro.2024.100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Purpose It is vital to develop noninvasive approaches with high accuracy to discriminate the preserved ratio impaired spirometry (PRISm) group from the chronic obstructive pulmonary disease (COPD) groups. Radiomics has emerged as an image analysis technique. This study aims to develop and confirm the new radiomics-based noninvasive approach to discriminate these two groups. Methods Totally 1066 subjects from 4 centers were included in this retrospective research, and classified into training, internal validation or external validation sets. The chest computed tomography (CT) images were segmented by the fully automated deep learning segmentation algorithm (Unet231) for radiomics feature extraction. We established the radiomics signature (Rad-score) using the least absolute shrinkage and selection operator algorithm, then conducted ten-fold cross-validation using the training set. Last, we constructed a radiomics signature by incorporating independent risk factors using the multivariate logistic regression model. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses (DCA). Results The Rad-score, including 15 radiomic features in whole-lung region, which was suitable for diffuse lung diseases, was demonstrated to be effective for discriminating between PRISm and COPD. Its diagnostic accuracy was improved through integrating Rad-score with a clinical model, and the area under the ROC (AUC) were 0.82(95 %CI 0.79-0.86), 0.77(95 %CI 0.72-0.83) and 0.841(95 %CI 0.78-0.91) for training, internal validation and external validation sets, respectively. As revealed by analysis, radiomics nomogram showed good fit and superior clinical utility. Conclusions The present work constructed the new radiomics-based nomogram and verified its reliability for discriminating between PRISm and COPD.
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Affiliation(s)
- TaoHu Zhou
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
- School of Medical Imaging, Shandong Second Medical University, Weifang, Shandong 261053, China
| | - Yu Guan
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
| | - XiaoQing Lin
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
- College of Health Sciences and Engineering, University of Shanghai for Science and Technology, No.516 Jungong Road, Shanghai 200093, China
| | - XiuXiu Zhou
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
| | - Liang Mao
- Department of Medical Imaging, Affiliated Hospital of Ji Ning Medical University, Ji Ning 272000, China
| | - YanQing Ma
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, ZJ, China
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Jie Li
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
- College of Health Sciences and Engineering, University of Shanghai for Science and Technology, No.516 Jungong Road, Shanghai 200093, China
| | - WenTing Tu
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
| | - ShiYuan Liu
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
| | - Li Fan
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, No. 415 Fengyang Road, Shanghai 200003, China
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Solidoro P, Dente F, Micheletto C, Pappagallo G, Pelaia G, Papi A. An Italian Delphi Consensus on the Triple inhalation Therapy in Chronic Obstructive Pulmonary Disease. Multidiscip Respir Med 2024; 19. [PMID: 39291458 DOI: 10.5826/mrm.2024.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/01/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment. METHODS The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds. RESULTS Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions. CONCLUSIONS The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.
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Affiliation(s)
- Paolo Solidoro
- University of Turin, Medical Sciences Department, Pneumology Unit U, Cardiovascular and Thoracic Department, AOU Città Della Salute e Della Scienza di Torino, Italy
| | - Federico Dente
- Respiratory Pathophysiology Unit, Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
| | - Claudio Micheletto
- Pneumology Unit, Cardio-Thoracic Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Pappagallo
- School of Clinical Methodology, IRCCS "Sacre Heart - Don Calabria", Negrar di Valpolicella, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Alberto Papi
- Respiratory Medicine Unit, University of Ferrara, Ferrara, Italy
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Huang J, Li W, Sun Y, Huang Z, Cong R, Yu C, Tao H. Preserved Ratio Impaired Spirometry (PRISm): A Global Epidemiological Overview, Radiographic Characteristics, Comorbid Associations, and Differentiation from Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:753-764. [PMID: 38505581 PMCID: PMC10949882 DOI: 10.2147/copd.s453086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
Preserved Ratio Impaired Spirometry (PRISm) manifests notable epidemiological disparities across the globe, with its prevalence and influential factors showcasing pronounced diversities among various geographical territories and demographics. The prevalence of PRISm fluctuates considerably among regions such as Latin America, the United States, and Asian nations, potentially correlating with a myriad of determinants, including socioeconomic status, environmental factors, and lifestyle modalities. Concurrently, the link between PRISm and health risks and other disorders, especially its distinction and interrelation with chronic obstructive pulmonary disease (COPD), has become a pivotal subject of scientific enquiry. Radiographic anomalies, such as perturbations in the pulmonary parenchyma and structural alterations, are posited as salient characteristics of PRISm. Furthermore, PRISm unveils intricate associations with multiple comorbidities, inclusive of hypertension and type 2 diabetes, thereby amplifying the intricacy in comprehending and managing this condition. In this review, we aim to holistically elucidate the epidemiological peculiarities of PRISm, its potential aetiological contributors, its nexus with COPD, and its association with radiographic aberrations and other comorbidities. An integrative understanding of these dimensions will provide pivotal insights for the formulation of more precise and personalised preventative and therapeutic strategies.
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Affiliation(s)
- Jia Huang
- The Second Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Wenjun Li
- Department of Respiratory, The Second Hospital of Lanzhou University, Lanzhou, Gansu, People’s Republic of China
| | - Yecheng Sun
- The Second Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Zhutang Huang
- The Second Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Rong Cong
- The Second Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Chen Yu
- The Second Clinical Medical School, Lanzhou University, Lanzhou, Gansu, 730000, People’s Republic of China
| | - Hongyan Tao
- Department of Respiratory, The Second Hospital of Lanzhou University, Lanzhou, Gansu, People’s Republic of China
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Wrench CL, Baker JR, Monkley S, Fenwick PS, Murray L, Donnelly LE, Barnes PJ. Small airway fibroblasts from patients with chronic obstructive pulmonary disease exhibit cellular senescence. Am J Physiol Lung Cell Mol Physiol 2024; 326:L266-L279. [PMID: 38150543 PMCID: PMC11281792 DOI: 10.1152/ajplung.00419.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
Small airway disease (SAD) is a key early-stage pathology of chronic obstructive pulmonary disease (COPD). COPD is associated with cellular senescence whereby cells undergo growth arrest and express the senescence-associated secretory phenotype (SASP) leading to chronic inflammation and tissue remodeling. Parenchymal-derived fibroblasts have been shown to display senescent properties in COPD, however small airway fibroblasts (SAFs) have not been investigated. Therefore, this study investigated the role of these cells in COPD and their potential contribution to SAD. To investigate the senescent and fibrotic phenotype of SAF in COPD, SAFs were isolated from nonsmoker, smoker, and COPD lung resection tissue (n = 9-17 donors). Senescence and fibrotic marker expressions were determined using iCELLigence (proliferation), qPCR, Seahorse assay, and ELISAs. COPD SAFs were further enriched for senescent cells using FACSAria Fusion based on cell size and autofluorescence (10% largest/autofluorescent vs. 10% smallest/nonautofluorescent). The phenotype of the senescence-enriched population was investigated using RNA sequencing and pathway analysis. Markers of senescence were observed in COPD SAFs, including senescence-associated β-galactosidase, SASP release, and reduced proliferation. Because the pathways driving this phenotype were unclear, we used cell sorting to enrich senescent COPD SAFs. This population displayed increased p21CIP1 and p16INK4a expression and mitochondrial dysfunction. RNA sequencing suggested these senescent cells express genes involved in oxidative stress response, fibrosis, and mitochondrial dysfunction pathways. These data suggest COPD SAFs are senescent and may be associated with fibrotic properties and mitochondrial dysfunction. Further understanding of cellular senescence in SAFs may lead to potential therapies to limit SAD progression.NEW & NOTEWORTHY Fibroblasts and senescence are thought to play key roles in the pathogenesis of small airway disease and COPD; however, the characteristics of small airway-derived fibroblasts are not well explored. In this study we isolate and enrich the senescent small airway-derived fibroblast (SAF) population from COPD lungs and explore the pathways driving this phenotype using bulk RNA-seq.
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Affiliation(s)
- Catherine L Wrench
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Bioscience COPD/IPF, Research and Early Development, Respiratory & Immunology (R&I), Biopharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Jonathan R Baker
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sue Monkley
- Translation Science and Experimental Medicine, Research and Early Development, Respiratory & Immunology (R&I), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Peter S Fenwick
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Lynne Murray
- Bioscience COPD/IPF, Research and Early Development, Respiratory & Immunology (R&I), Biopharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Louise E Donnelly
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Peter J Barnes
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom
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Yoon SM, Jin KN, Lee HJ, Lee HW, Park TY, Heo EY, Kim DK, Lee JK. Acute Exacerbation and Longitudinal Lung Function Change of Preserved Ratio Impaired Spirometry. Int J Chron Obstruct Pulmon Dis 2024; 19:519-529. [PMID: 38414720 PMCID: PMC10898477 DOI: 10.2147/copd.s445369] [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: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
Background Preserved ratio impaired spirometry (PRISm) is a heterogeneous disease entity. Limited data are available regarding its prevalence, clinical course, or prognosis. We aimed to evaluate the longitudinal clinical course of patients with PRISm compared with chronic obstructive pulmonary disease (COPD). Methods A retrospective study enrolled PRISm and COPD patients who underwent chest computed tomography and longitudinal pulmonary function tests between January 2013 and December 2020. We compared the incidence of acute exacerbations and lung function changes between PRISm and COPD patients. Results Of the 623 patients, 40 and 583 had PRISm and COPD, respectively. Compared to COPD patients, PRISm patients were younger, more likely to be female and have a history of tuberculosis, and less likely to be smokers. They also had less severe comorbidities, lower forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO). The clinical course was not significantly different between the PRISm and COPD patients in terms of the risk of moderate-to-severe acute exacerbations or proportion of frequent exacerbators. During follow-up, PRISm patients had a significantly slower annual decline of forced expiratory volume in 1 second, FVC, and DLCO than COPD patients. Conclusion PRISm patients had no significant difference in the risk of acute exacerbations, but a significantly slower decline of lung function during longitudinal follow-up, compared with COPD patients.
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Affiliation(s)
- Si Mong Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyo Jin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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Sciurba FC, Dransfield MT, Kim V, Marchetti N, Comellas A, Hogarth DK, Majid A. Bronchial rheoplasty for chronic bronchitis: 2-year results from a US feasibility study with RheOx. BMJ Open Respir Res 2023; 10:e001710. [PMID: 38151258 PMCID: PMC10753755 DOI: 10.1136/bmjresp-2023-001710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Chronic bronchitis (CB), a phenotype of chronic obstructive pulmonary disease (COPD) characterised by persistent cough and mucus hypersecretion, is associated with poor outcomes despite guideline-based treatment. Bronchial rheoplasty (BR) with the RheOx system delivers non-thermal pulsed electric fields to the lower airway epithelium and submucosa to reduce mucus producing cells. Early phase clinical trials including 1-year follow-up have demonstrated reduction in airway goblet cell hyperplasia and improvement in CB symptoms. METHODS The current multicentre observational BR study enrolled 21 patients with CB at six centres in the USA, with bilateral treatment and 2-year follow-up. Entry criteria included elevated cough and sputum scores from COPD Assessment Test (CAT) and forced expiratory volume in one second<80% predicted. Safety was assessed by serious adverse event (SAE) incidence through 24 months. Clinical utility was evaluated using changes in the CAT, the St. George's Respiratory Questionnaire (SGRQ) and by comparing exacerbation rates before and following intervention. RESULTS No procedure-related or device-related SAEs occurred. Mean (SD) changes from baseline in CAT at 12 and 24 months were -9.0 (6.7) (p<0.0001) and -5.6 (7.1) (p<0.0047) and in SGRQ were -16.6 (13.2) (p<0.0001) and -11.8 (19.2) (p<0.0227), respectively. There was a 34% reduction in moderate and a 64% reduction in severe COPD exacerbation events compared with the year prior to treatment. CONCLUSIONS This study extends the findings from previous feasibility studies, demonstrating that BR can be performed safely and may significantly improve symptoms and health-related quality of life for patients with CB through 24 months. TRAIL REGISTRATION NUMBER NCT03631472.
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Affiliation(s)
- Frank C Sciurba
- Emphysema Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark T Dransfield
- Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, Lung Health Center, University of Alabama, Birmingham, Alabama, USA
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Thoracic Medicine and Surgery, School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Nathaniel Marchetti
- Pulmonary and Critical Care Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Douglas Kyle Hogarth
- Pulmonary/Critical Care, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Regan EA, Lowe ME, Make BJ, Curtis JL, Chen QG, Cho MH, Crooks JL, Lowe KE, Wilson C, O'Brien JK, Oates GR, Baldomero AK, Kinney GL, Young KA, Diaz AA, Bhatt SP, McCormack MC, Hansel NN, Kim V, Richmond NE, Westney GE, Foreman MG, Conrad DJ, DeMeo DL, Hoth KF, Amaza H, Balasubramanian A, Kallet J, Watts S, Hanania NA, Hokanson J, Beaty TH, Crapo JD, Silverman EK, Casaburi R, Wise R. Use of the Spirometric "Fixed-Ratio" Underdiagnoses COPD in African-Americans in a Longitudinal Cohort Study. J Gen Intern Med 2023; 38:2988-2997. [PMID: 37072532 PMCID: PMC10593702 DOI: 10.1007/s11606-023-08185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND COPD diagnosis is tightly linked to the fixed-ratio spirometry criteria of FEV1/FVC < 0.7. African-Americans are less often diagnosed with COPD. OBJECTIVE Compare COPD diagnosis by fixed-ratio with findings and outcomes by race. DESIGN Genetic Epidemiology of COPD (COPDGene) (2007-present), cross-sectional comparing non-Hispanic white (NHW) and African-American (AA) participants for COPD diagnosis, manifestations, and outcomes. SETTING Multicenter, longitudinal US cohort study. PARTICIPANTS Current or former smokers with ≥ 10-pack-year smoking history enrolled at 21 clinical centers including over-sampling of participants with known COPD and AA. Exclusions were pre-existing non-COPD lung disease, except for a history of asthma. MEASUREMENTS Subject diagnosis by conventional criteria. Mortality, imaging, respiratory symptoms, function, and socioeconomic characteristics, including area deprivation index (ADI). Matched analysis (age, sex, and smoking status) of AA vs. NHW within participants without diagnosed COPD (GOLD 0; FEV1 ≥ 80% predicted and FEV1/FVC ≥ 0.7). RESULTS Using the fixed ratio, 70% of AA (n = 3366) were classified as non-COPD, versus 49% of NHW (n = 6766). AA smokers were younger (55 vs. 62 years), more often current smoking (80% vs. 39%), with fewer pack-years but similar 12-year mortality. Density distribution plots for FEV1 and FVC raw spirometry values showed disproportionate reductions in FVC relative to FEV1 in AA that systematically led to higher ratios. The matched analysis demonstrated GOLD 0 AA had greater symptoms, worse DLCO, spirometry, BODE scores (1.03 vs 0.54, p < 0.0001), and greater deprivation than NHW. LIMITATIONS Lack of an alternative diagnostic metric for comparison. CONCLUSIONS The fixed-ratio spirometric criteria for COPD underdiagnosed potential COPD in AA participants when compared to broader diagnostic criteria. Disproportionate reductions in FVC relative to FEV1 leading to higher FEV1/FVC were identified in these participants and associated with deprivation. Broader diagnostic criteria for COPD are needed to identify the disease across all populations.
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Affiliation(s)
| | - Melissa E Lowe
- Duke Cancer Center, Biostatistics, Duke University Medical Center, Durham, NC, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Jeffrey L Curtis
- Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Pulmonary & Critical Care Medicine Section, Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | | | - Michael H Cho
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James L Crooks
- Division of Biostatistics and Bioinformatics and Department of Immunology and Genomic Medicine, National Jewish Health, Denver, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Katherine E Lowe
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Carla Wilson
- Research Informatics Services, National Jewish Health, Denver, CO, USA
| | - James K O'Brien
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | | | - Arianne K Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith C McCormack
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Nicole E Richmond
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Gloria E Westney
- Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Marilyn G Foreman
- Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Douglas J Conrad
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dawn L DeMeo
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Hannatu Amaza
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Aparna Balasubramanian
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Kallet
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Shandi Watts
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Nicola A Hanania
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Terri H Beaty
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Edwin K Silverman
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Robert Wise
- Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Baraghoshi D, Strand M, Humphries SM, San José Estépar R, Vegas Sanchez-Ferrero G, Charbonnier JP, Latisenko R, Silverman EK, Crapo JD, Lynch DA. Quantitative CT Evaluation of Emphysema Progression over 10 Years in the COPDGene Study. Radiology 2023; 307:e222786. [PMID: 37039685 PMCID: PMC10286952 DOI: 10.1148/radiol.222786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 04/12/2023]
Abstract
Background Long-term studies of chronic obstructive pulmonary disease (COPD) can evaluate emphysema progression. Adjustment for differences in equipment and scanning protocols of individual CT examinations have not been studied extensively. Purpose To evaluate emphysema progression in current and former smokers in the COPDGene cohort over three imaging points obtained at 5-year intervals accounting for individual CT parameters. Materials and Methods Current and former cigarette smokers enrolled between 2008 and 2011 from the COPDGene study were prospectively followed for 10 years between 2008 and 2020. Extent of emphysema as adjusted lung density (ALD) from quantitative CT was measured at baseline and at 5- and 10-year follow-up. Linear mixed models adjusted for CT technical characteristics were constructed to evaluate emphysema progression. Mean annual changes in ALD over consecutive 5-year study periods were estimated by smoking status and baseline emphysema. Results Of 8431 participants at baseline (mean age, 60 years ± 9 [SD]; 3905 female participants), 4913 were at 5-year follow-up and 1544 participants were at 10-year follow-up. There were 4134 (49%) participants who were current smokers, and 4449 (53%) participants had more than trace emphysema at baseline. Current smokers with more than trace emphysema showed the largest decline in ALD, with mean annual decreases of 1.4 g/L (95% CI: 1.2, 1.5) in the first 5 years and 0.9 g/L (95% CI: 0.7, 1.2) in the second 5 years. Accounting for CT noise, field of view, and scanner model improved model fit for estimation of emphysema progression (P < .001 by likelihood ratio test). Conclusion Evaluation at CT of emphysema progression in the COPDGene study showed that, during the span of 10 years, participants with pre-existing emphysema who continued smoking had the largest decline in ALD. Adjusting for CT equipment and protocol factors improved these longitudinal estimates. Clinical trial registration no. NCT00608764 © RSNA, 2023 Supplemental material is available for this article. See the editorial by Parraga and Kirby in this issue.
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Affiliation(s)
- David Baraghoshi
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Matthew Strand
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Stephen M. Humphries
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Raúl San José Estépar
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Jean-Paul Charbonnier
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Rudolfs Latisenko
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - Edwin K. Silverman
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - James D. Crapo
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
| | - David A. Lynch
- From the Division of Biostatistics, Environment and Health (D.B.,
M.S.), Department of Radiology (S.M.H., D.A.L.), and Division of Pulmonary and
Critical Care Medicine, Department of Medicine (J.D.C.), National Jewish Health,
1400 Jackson St, Denver, CO 80206; Applied Chest Imaging Laboratory (R.S.J.E.,
G.V.S.F.), Department of Radiology (R.S.J.E., G.V.S.F.), Channing Division of
Network Medicine (E.K.S.), and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (E.K.S.), Brigham and Women’s Hospital, Boston,
Mass; and Thirona, Nijmegen, the Netherlands (J.P.C., R.L.)
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9
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Pu Y, Zhou X, Zhang D, Guan Y, Xia Y, Tu W, Lu Y, Zhang W, Fu CC, Fang Q, de Bock GH, Liu S, Fan L. Re-Defining High Risk COPD with Parameter Response Mapping Based on Machine Learning Models. Int J Chron Obstruct Pulmon Dis 2022; 17:2471-2483. [PMID: 36217330 PMCID: PMC9547550 DOI: 10.2147/copd.s369904] [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: 04/21/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To explore optimal threshold of FEV1% predicted value (FEV1%pre) for high-risk chronic obstructive pulmonary disease (COPD) using the parameter response mapping (PRM) based on machine learning classification model. Patients and Methods A total of 561 consecutive non-COPD subjects who were screened for chest diseases in our hospital between August and October 2018 and who had complete questionnaire surveys, pulmonary function tests (PFT), and paired respiratory chest CT scans were enrolled retrospectively. The CT quantitative parameter for small airway remodeling was PRM, and 72 parameters were obtained at the levels of whole lung, left and right lung, and five lobes. To identify a more reasonable thresholds of FEV1% predicted value for distinguishing high-risk COPD patients from the normal, 80 thresholds from 50% to 129% were taken with a partition of 1% to establish a random forest classification model under each threshold, such that novel PFT-parameter-based high-risk criteria would be more consistent with the PRM-based machine learning classification model. Results Machine learning-based PRM showed that consistency between PRM parameters and PFT was better able to distinguish high-risk COPD from the normal, with an AUC of 0.84 when the threshold was 72%. When the threshold was 80%, the AUC was 0.72 and when the threshold was 95%, the AUC was 0.64. Conclusion Machine learning-based PRM is feasible for redefining high-risk COPD, and setting the optimal FEV1% predicted value lays the foundation for redefining high-risk COPD diagnosis.
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Affiliation(s)
- Yu Pu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Xiuxiu Zhou
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Di Zhang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yu Guan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yi Xia
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Wenting Tu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Yang Lu
- Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Weidong Zhang
- Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Chi-Cheng Fu
- Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Qu Fang
- Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, People’s Republic of China
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China,Correspondence: Shiyuan Liu; Li Fan, Department of Radiology, ChangZheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People’s Republic of China, Tel +86 21 81886012; Tel +86 21 81886012, Fax +86 21 63587668, Email ;
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China
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10
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Bamodu OA, Wu SM, Feng PH, Sun WL, Lin CW, Chuang HC, Ho SC, Chen KY, Chen TT, Tseng CH, Liu WT, Lee KY. lnc-IL7R Expression Reflects Physiological Pulmonary Function and Its Aberration Is a Putative Indicator of COPD. Biomedicines 2022; 10:biomedicines10040786. [PMID: 35453536 PMCID: PMC9031132 DOI: 10.3390/biomedicines10040786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Despite rapidly evolving pathobiological mechanistic demystification, coupled with advances in diagnostic and therapeutic modalities, chronic obstructive pulmonary disease (COPD) remains a major healthcare and clinical challenge, globally. Further compounded by the dearth of available curative anti-COPD therapy, it is posited that this challenge may not be dissociated from the current lack of actionable COPD pathognomonic molecular biomarkers. There is accruing evidence of the involvement of protracted ‘smoldering’ inflammation, repeated lung injury, and accelerated lung aging in enhanced predisposition to or progression of COPD. The relatively novel uncharacterized human long noncoding RNA lnc-IL7R (otherwise called LOC100506406) is increasingly designated a negative modulator of inflammation and regulator of cellular stress responses; however, its role in pulmonary physiology and COPD pathogenesis remains largely unclear and underexplored. Our previous work suggested that upregulated lnc-IL7R expression attenuates inflammation following the activation of the toll-like receptor (TLR)-dependent innate immune system, and that the upregulated lnc-IL7R is anti-correlated with concomitant high PM2.5, PM10, and SO2 levels, which is pathognomonic for exacerbated/aggravated COPD in Taiwan. In the present study, our quantitative analysis of lnc-IL7R expression in our COPD cohort (n = 125) showed that the lnc-IL7R level was significantly correlated with physiological pulmonary function and exhibited COPD-based stratification implications (area under the curve, AUC = 0.86, p < 0.001). We found that the lnc-IL7R level correctly identified patients with COPD (sensitivity = 0.83, specificity = 0.83), precisely discriminated those without emphysematous phenotype (sensitivity = 0.48, specificity = 0.89), and its differential expression reflected disease course based on its correlation with the COPD GOLD stage (r = −0.59, p < 0.001), %LAA-950insp (r = −0.30, p = 0.002), total LAA (r = −0.35, p < 0.001), FEV1(%) (r = 0.52, p < 0.001), FVC (%) (r = 0.45, p < 0.001), and post-bronchodilator FEV1/FVC (r = 0.41, p < 0.001). Consistent with other data, our bioinformatics-aided dose−response plot showed that the probability of COPD decreased as lnc-IL7R expression increased, thus, corroborating our posited anti-COPD therapeutic potential of lnc-IL7R. In conclusion, reduced lnc-IL7R expression not only is associated with inflammation in the airway epithelial cells but is indicative of impaired pulmonary function, pathognomonic of COPD, and predictive of an exacerbated/ aggravated COPD phenotype. These data provide new mechanistic insights into the ailing lung and COPD progression, as well as suggest a novel actionable molecular factor that may be exploited as an efficacious therapeutic strategy in patients with COPD.
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Affiliation(s)
- Oluwaseun Adebayo Bamodu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Sheng-Ming Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Division of Clinical Care Medicine, Department of Emergency and Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Wei-Lun Sun
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Cheng-Wei Lin
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- International PhD Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Hsiao-Chi Chuang
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shu-Chuan Ho
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Tzu-Tao Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Division of Clinical Care Medicine, Department of Emergency and Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 106, Taiwan
| | - Wen-Te Liu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (W.-T.L.); (K.-Y.L.); Tel.: +886-02-2249-0088 (ext. 2714) (W.-T.L. & K.-Y.L.)
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan; (O.A.B.); (S.-M.W.); (P.-H.F.); (W.-L.S.); (H.-C.C.); (S.-C.H.); (K.-Y.C.); (T.-T.C.); (C.-H.T.)
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- TMU Research Center of Thoracic Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (W.-T.L.); (K.-Y.L.); Tel.: +886-02-2249-0088 (ext. 2714) (W.-T.L. & K.-Y.L.)
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11
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Detection and staging of chronic obstructive pulmonary disease using a computed tomography-based weakly supervised deep learning approach. Eur Radiol 2022; 32:5319-5329. [PMID: 35201409 DOI: 10.1007/s00330-022-08632-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is underdiagnosed globally. The present study aimed to develop weakly supervised deep learning (DL) models that utilize computed tomography (CT) image data for the automated detection and staging of spirometry-defined COPD. METHODS A large, highly heterogeneous dataset was established, consisting of 1393 participants retrospectively recruited from outpatient, inpatient, and physical examination center settings of four large public hospitals in China. All participants underwent both inspiratory chest CT scans and pulmonary function tests. CT images, spirometry data, demographic information, and clinical information of each participant were collected. An attention-based multi-instance learning (MIL) model for COPD detection was trained using CT scans from 837 participants. External validation of the COPD detection was performed with 620 low-dose CT (LDCT) scans acquired from the National Lung Screening Trial (NLST) cohort. A multi-channel 3D residual network was further developed to categorize GOLD stages among confirmed COPD patients. RESULTS The attention-based MIL model used for COPD detection achieved an area under the receiver operating characteristic curve (AUC) of 0.934 (95% CI: 0.903, 0.961) on the internal test set and 0.866 (95% CI: 0.805, 0.928) on the LDCT subset acquired from the NLST. The multi-channel 3D residual network was able to correctly grade 76.4% of COPD patients in the test set (423/553) using the GOLD scale. CONCLUSIONS The proposed chest CT-DL approach can automatically identify spirometry-defined COPD and categorize patients according to the GOLD scale. As such, this approach may be an effective case-finding tool for COPD diagnosis and staging. KEY POINTS • Chronic obstructive pulmonary disease is underdiagnosed globally, particularly in developing countries. • The proposed chest computed tomography (CT)-based deep learning (DL) approaches could accurately identify spirometry-defined COPD and categorize patients according to the GOLD scale. • The chest CT-DL approach may be an alternative case-finding tool for COPD identification and evaluation.
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12
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Mkorombindo T, Balkissoon R. Journal Club-Respiratory Impairment With A Preserved Spirometric Ratio. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:103-110. [PMID: 35090103 PMCID: PMC8893968 DOI: 10.15326/jcopdf.2022.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama, United States
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13
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Zhao N, Wu F, Peng J, Zheng Y, Tian H, Yang H, Deng Z, Wang Z, Li H, Wen X, Xiao S, Huang P, Dai C, Lu L, Zhou K, Chen S, Zhou Y, Ran P. Preserved ratio impaired spirometry is associated with small airway dysfunction and reduced total lung capacity. Respir Res 2022; 23:298. [PMID: 36316732 PMCID: PMC9620623 DOI: 10.1186/s12931-022-02216-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) refers to decreased forced expiratory volume in 1 s (FEV1) in the setting of preserved ratio. Little is known about the role of PRISm and its complex relation with small airway dysfunction (SAD) and lung volume. Therefore, we aimed to investigate the associations between PRISm and SAD and lung volume. METHODS We conducted a cross-sectional community-dwelling study in China. Demographic data, standard respiratory epidemiology questionnaire, spirometry, impulse oscillometry (IOS) and computed tomography (CT) data were collected. PRISm was defined as post-bronchodilator FEV1/FVC ≥ 0.70 and FEV1 < 80% predicted. Spirometry-defined SAD was defined as at least two of three of the post-bronchodilator maximal mid-expiratory flow (MMEF), forced expiratory flow 50% (FEF50), and forced expiratory flow 75% (FEF75) less than 65% of predicted. IOS-defined SAD and CT-defined gas trapping were defined by the fact that the cutoff value of peripheral airway resistance R5-R20 > 0.07 kPa/L/s and LAA- 856>20%, respectively. Analysis of covariance and logistic regression were used to determine associations between PRISm and SAD and lung volume. We then repeated the analysis with a lower limit of normal definition of spirometry criteria and FVC definition of PRISm. Moreover, we also performed subgroup analyses in ever smoker, never smoker, subjects without airway reversibility or self-reported diagnosed asthma, and subjects with CT-measured total lung capacity ≥70% of predicted. RESULTS The final analysis included 1439 subjects. PRISm had higher odds and more severity in spirometry-defined SAD (pre-bronchodilator: odds ratio [OR]: 5.99, 95% confidence interval [95%CI]: 3.87-9.27, P < 0.001; post-bronchodilator: OR: 14.05, 95%CI: 8.88-22.24, P < 0.001), IOS-defined SAD (OR: 2.89, 95%CI: 1.82-4.58, P < 0.001), and CT-air trapping (OR: 2.01, 95%CI: 1.08-3.72, P = 0.027) compared with healthy control after adjustment for confounding factors. CT-measured total lung capacity in PRISm was lower than that in healthy controls (4.15 ± 0.98 vs. 4.78 ± 1.05 L, P < 0.05), after adjustment. These results were robust in repeating analyses and subgroup analyses. CONCLUSION Our finding revealed that PRISm was associated with SAD and reduced total lung capacity. Future studies to identify the underlying mechanisms and longitudinal progression of PRISm are warranted.
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Affiliation(s)
- Ningning Zhao
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Fan Wu
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Jieqi Peng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Youlan Zheng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Heshen Tian
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Huajing Yang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Zhishan Deng
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Zihui Wang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Haiqing Li
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Xiang Wen
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Shan Xiao
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Peiyu Huang
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Cuiqiong Dai
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Lifei Lu
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Kunning Zhou
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Shengtang Chen
- Medical Imaging Center, Wengyuan County People’s Hospital, Shaoguan, China
| | - Yumin Zhou
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
| | - Pixin Ran
- grid.470124.4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang west Road, Guangzhou Laboratory, Guangzhou, China
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14
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Thomashow BM, Mannino DM, Tal-Singer R, Crapo JD. A rapidly changing understanding of COPD: World COPD Day from the COPD Foundation. Am J Physiol Lung Cell Mol Physiol 2021; 321:L983-L987. [PMID: 34612086 DOI: 10.1152/ajplung.00400.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
World COPD Day raises awareness about chronic obstructive pulmonary disease (COPD). COPD accounts for over 150,000 US deaths per year. A major challenge is that COPD receives only a fraction of the research funding provided to other major diseases. Control of COPD is dependent on developing new approaches to diagnose the disease earlier with a recognition of either pre-COPD or established COPD based on symptoms, lung structural change and/or loss of lung function that occurs before meeting long established criteria for a population-based definition of obstruction. Optimization of current therapies improves lung function, exercise capacity, quality of life, and survival. New pathways of disease progression are being identified creating new opportunities for development of therapies that could stop or cure this disease.
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Affiliation(s)
- Byron M Thomashow
- COPD Foundation, Miami, Florida.,Department of Medicine, Columbia University, New York, New York
| | - David M Mannino
- COPD Foundation, Miami, Florida.,Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | | | - James D Crapo
- COPD Foundation, Miami, Florida.,Department of Medicine, National Jewish Health, Denver, Colorado
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15
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Anami K, Murata S, Nakano H, Nonaka K, Iwase H, Shiraiwa K, Abiko T, Goda A, Horie J. Physical performance in relation to preserved ratio impaired spirometry: a cross-sectional study of community-dwelling older Japanese adults. Sci Rep 2021; 11:17411. [PMID: 34465800 PMCID: PMC8408254 DOI: 10.1038/s41598-021-96830-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022] Open
Abstract
Preserved ratio impaired spirometry (PRISm) is associated with an increased mortality rate; however, its characteristics have not been clearly identified in Japan. This cross-sectional study of community-dwelling older adults compared physical function between people with PRISm and those with no respiratory issues, from 2014 to 2019. We collected demographic data through interviews and measured respiratory and physical functions. We included 668 older adults (male, 23.5%; mean age, 72.8 ± 5.6 years); the prevalence of PRISm was 12%, while the prevalence of obstruction was 6.9%. Propensity score matching was used to identify control subjects with normal spirometry (n = 80) while minimizing the effects of confounders during comparisons with the PRISm population (n = 80). Compared with community-dwelling older adults with normal lung capacity, older adults with PRISm had a lower forced vital capacity (%FVC; 68.7 ± 9.1% vs. 92.5 ± 12.7%, p < 0.001), lower core muscle endurance (sit-up test: 6.7 ± 5.8 vs. 8.7 ± 6.0, p = 0.032), and a longer one-leg stance duration (52.4 ± 41.1 s vs. 36.4 ± 34.1 s, p = 0.008). In multivariable logistic regression, %FVC and increased one-leg stance were independent predictors of PRISm status. The prevalence of PRISm among community-dwelling elderly Japanese exceeds that of obstructive lung disease and is associated with reduced %FVC and better performance on balance testing.
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Affiliation(s)
- Kunihiko Anami
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, 3-15-1, Nakatomigaoka, Nara-shi, Nara, 631-8524, Japan.
| | - Shin Murata
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Hideki Nakano
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Koji Nonaka
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, 3-15-1, Nakatomigaoka, Nara-shi, Nara, 631-8524, Japan
| | - Hiroaki Iwase
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe, 658-0032, Japan
| | - Kayoko Shiraiwa
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Teppei Abiko
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Jun Horie
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
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16
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Alabi FO, Alkhateeb HA, DeBarros KM, Barletti Benel PS, Sanchez-Martez RL, Zeper ML, Ismail RA, Umeh F, Medina-Villanueva N. The Heterogeneity of COPD Patients in a Community-Based Practice and the Inadequacy of the Global Initiative for Chronic Obstructive Lung Disease Criteria: A Real-World Experience. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:396-407. [PMID: 34236778 PMCID: PMC8428596 DOI: 10.15326/jcopdf.2021.0229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with differing clinical presentations, which range from an asymptomatic obstructive defect on spirometry to symptomatic normal spirometry. The current standard for diagnosis requires exposure history and the presence of an obstructive ventilatory defect (forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ratio < 70%) on spirometry. In this real-world study, we analyzed patients with physician-diagnosed COPD, described their characteristics, and evaluated the diagnostic sensitivity of Global initiative for chronic Obstructive Lung Disease (GOLD) criteria in this population. METHODS We retrospectively analyzed the charts of 2115 patients for eligibility. A total of 1224 patients with physician-diagnosed COPD were selected for this study. The average age was 68.4±11.5 years, with 51% being female. Of the 1224 patients, 18% did not have a history of smoking, 73% had bronchodilator testing, and a significant response of ≥12% was noted in 23% of the COPD patients. Moreover, 43% of the patients met the GOLD criteria for the diagnosis of COPD, whereas the Global Lung Function Initiative (GLI) and lower limit of normal (LLN)criteria were only able to identify 26%. DISCUSSION COPD-related mortality is continuing to rise, and it is currently ranked as the third leading cause of death, globally, after cardiovascular diseases and strokes. Despite this alarming statistic, COPD diagnosis is delayed in most cases and can remain undiagnosed, even in smokers. This is partly due to the restrictive GOLD diagnostic criteria, which requires the presence of FEV1/FVC ratio<70. CONCLUSIONS The recently proposed COPD Genetic Epidemiology (COPDGene®) 2019 definition for COPD will improve and enhance our ability to diagnose COPD earlier and more accurately.
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Affiliation(s)
- Fortune O. Alabi
- Florida Lung Asthma and Sleep Specialists, Kissimmee, Florida, United States
| | - Hadaya A. Alkhateeb
- Florida Lung Asthma and Sleep Specialists, Kissimmee, Florida, United States
| | - Kayla M. DeBarros
- Florida Lung Asthma and Sleep Specialists, Kissimmee, Florida, United States
| | | | | | - Mia L. Zeper
- Florida Lung Asthma and Sleep Specialists, Kissimmee, Florida, United States
| | - Reema A. Ismail
- Florida Lung Asthma and Sleep Specialists, Kissimmee, Florida, United States
| | - Fred Umeh
- Florida Lung Asthma and Sleep Specialists, Kissimmee, Florida, United States
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17
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Gogou E, Kotsiou OS, Siachpazidou DS, Pinaka M, Varsamas C, Bardaka F, Gerogianni I, Hatzoglou C, Gourgoulianis KI. Underestimation of respiratory symptoms by smokers: a thorn in chronic obstructive pulmonary disease diagnosis. NPJ Prim Care Respir Med 2021; 31:14. [PMID: 33712602 PMCID: PMC7955112 DOI: 10.1038/s41533-021-00226-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/08/2021] [Indexed: 01/11/2023] Open
Abstract
Primary care centers are ideal positions to identify chronic obstructive pulmonary disease (COPD). We determined the COPD prevalence among ever-smokers aged 40-65 years attending a 2-year program conducted in 22 Greek primary healthcare centers and made comparisons between genders, patients less than or greater than 55 years, and newly or previously diagnosed COPD patients. A total of 117 persons, after studying 1100 people, were diagnosed with previously unknown or known COPD, providing a COPD prevalence of 10.6% among the study population. In all, 7.5% of the participants were newly diagnosed with COPD. Women with COPD reported smoking less but experienced worse respiratory and depressive symptoms than men. A total of 19% of the COPD population below 55 years experienced wheezing and exacerbations more frequently than older patients. Newly diagnosed COPD patients were significantly younger, reported a significant burden of symptoms without seeking medical help. Primary health care has a crucial role in the early detection of COPD among unsuspecting smokers.
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Affiliation(s)
- Evdoxia Gogou
- Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece.
| | - Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece.
| | - Dimitra S Siachpazidou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Maria Pinaka
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Charalampos Varsamas
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Fotini Bardaka
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Irini Gerogianni
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece
| | - Chrysi Hatzoglou
- Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece
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18
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Han MK, Agusti A, Celli BR, Criner GJ, Halpin DMG, Roche N, Papi A, Stockley RA, Wedzicha J, Vogelmeier CF. From GOLD 0 to Pre-COPD. Am J Respir Crit Care Med 2021; 203:414-423. [PMID: 33211970 PMCID: PMC7885837 DOI: 10.1164/rccm.202008-3328pp] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, August Pi i Sunyer Biomedical Research Institute, Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
| | - Bartolome R Celli
- Department of Medicine, Pulmonary, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - David M G Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP.Centre-University of Paris, Cochin Institute (UMR1016), Paris, France
| | - Alberto Papi
- Respiratory Division, Department of Translational Medicine, School of Medicine, University of Ferrara, Ferrera, Italy
| | - Robert A Stockley
- Lung Investigation Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Jadwiga Wedzicha
- Airway Disease Section, National Heart and Lung Institute, Imperial College, London, United Kingdom; and
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, member of the German Center for Lung Research (DZL), Philipps-University, Marburg, Germany
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19
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Li Y, Ragland M, Austin E, Young K, Pratte K, Hokanson JE, Beaty TH, Regan EA, Rennard SI, Wern C, Jacobs MR, Tal-Singer R, Make BJ, Kinney GL. Co-Morbidity Patterns Identified Using Latent Class Analysis of Medications Predict All-Cause Mortality Independent of Other Known Risk Factors: The COPDGene ® Study. Clin Epidemiol 2020; 12:1171-1181. [PMID: 33149694 PMCID: PMC7602898 DOI: 10.2147/clep.s279075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/06/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Medication patterns include all medications in an individual's clinical profile. We aimed to identify chronic co-morbidity treatment patterns through medication use among COPDGene participants and determine whether these patterns were associated with mortality, acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and quality of life. MATERIALS AND METHODS Participants analyzed here completed Phase 1 (P1) and/or Phase 2 (P2) of COPDGene. Latent class analysis (LCA) was used to identify medication patterns and assign individuals into unobserved LCA classes. Mortality, AECOPD, and the St. George's Respiratory Questionnaire (SGRQ) health status were compared in different LCA classes through survival analysis, logistic regression, and Kruskal-Wallis test, respectively. RESULTS LCA identified 8 medication patterns from 32 classes of chronic comorbid medications. A total of 8110 out of 10,127 participants with complete covariate information were included. Survival analysis adjusted for covariates showed, compared to a low medication use class, mortality was highest in participants with hypertension+diabetes+statin+antiplatelet medication group. Participants in hypertension+SSRI+statin medication group had the highest odds of AECOPD and the highest SGRQ score at both P1 and P2. CONCLUSION Medication pattern can serve as a good indicator of an individual's comorbidities profile and improves models predicting clinical outcomes.
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Affiliation(s)
- Yisha Li
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Margaret Ragland
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Erin Austin
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, USA
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Terri H Beaty
- Bloomberg School of Public Health, University of John Hopkins, Baltimore, MD, USA
| | | | - Stephen I Rennard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NB, USA
| | - Christina Wern
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - On Behalf of theCOPDGene investigators
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO, USA
- National Jewish Health, Denver, CO, USA
- Bloomberg School of Public Health, University of John Hopkins, Baltimore, MD, USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NB, USA
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- School of Pharmacy, Temple University, PA, Pennsylvania, USA
- COPD Foundation, Washington, D.C., USA
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20
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Dolliver WR, Diaz AA. Advances in Chronic Obstructive Pulmonary Disease Imaging. ACTA ACUST UNITED AC 2020; 6:128-143. [PMID: 33758787 DOI: 10.23866/brnrev:2019-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chest computed tomography (CT) imaging is a useful tool that provides in vivo information regarding lung structure. Imaging has contributed to a better understanding of COPD, allowing for the detection of early structural changes and the quantification of extra-pulmonary structures. Novel CT imaging techniques have provided insight into the progression of the main COPD subtypes, such as emphysema and small airway disease. This article serves as a review of new information relevant to COPD imaging. CT abnormalities, such as emphysema and loss of airways, are present even in smokers who do not meet the criteria for COPD and in those with mild-to-moderate disease. Subjects with mild-to-moderate COPD, with the highest loss of airways, also experience the highest decline in lung function. Extra-pulmonary manifestations of COPD, such as right ventricle enlargement and low muscle mass measured on CT, are associated with increased risk for all-cause mortality. CT longitudinal data has also given insight into the progression of COPD. Mechanically affected areas of lung parenchyma adjacent to emphysematous areas are associated with a greater decline in FEV1. Subjects with the greatest percentage of small airway disease, as measured on matched inspiratory-expiratory CT scan, also present with the greatest decline in lung function.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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21
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Michalovic E, Jensen D, Dandurand RJ, Saad N, Ezer N, Moullec G, Smith BM, Bourbeau J, Sweet SN. Description of Participation in Daily and Social Activities for Individuals with COPD. COPD 2020; 17:543-556. [PMID: 32811208 DOI: 10.1080/15412555.2020.1798373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study described the participation in daily and social activities and the perceived barriers and facilitators to participation of individuals with chronic obstructive pulmonary disease (COPD). Individuals, recruited from outpatient clinics, responded to a survey on their participation in, and barriers and facilitators towards, 26 daily and social activities, divided into 3 categories: (1) physical activity and movement (PAM); (2) self-care; and (3) social engagement. For each activity, chi-square analyses were used to examine participation differences by individuals': quartiles of airflow obstruction [percent predicted forced expiratory volume in 1 second (FEV1%predicted)] and breathlessness burden and exacerbation risk. Of the 200 participants (47% women; mean ± standard deviation age = 68 ± 9 years), most wanted to increase their participation in PAM activities (range 21-75%) and significant differences were found in 5/10 PAM activities for individuals' breathlessness burden and exacerbation risk (e.g., more individuals than expected in group A (modified Medical Research Council breathlessness score <2 and 0-1 exacerbations in past 12 months) participated in regular exercise as much as they wanted (χ(9)2=20.43, Cramer's V=.23)). Regardless of the degree of airflow obstruction or breathlessness burden and exacerbation risk, the most common barrier to participation was breathlessness (p<.001, η2p=.86) and the most common facilitator was engaging as part of their routine (p<.001, η2p=.75). Individuals with COPD want to increase their participation in daily and social activities but are limited by breathlessness. Strategies to alleviate breathlessness should be identified/prioritized and incorporated into individuals' daily routines to meet their self-reported participation objectives in daily and social activities.
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Affiliation(s)
- Emilie Michalovic
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,McGill Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Dennis Jensen
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,McGill Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montreal, Quebec, Canada
| | - Ronald J Dandurand
- CIUSSS de l'Ouest-de-l'île-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada
| | - Nathalie Saad
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada
| | - Nicole Ezer
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute McGill University, Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gregory Moullec
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.,Research Center of the Centre Intégré Universitaire de Santé Et De Services Sociaux du Nord-de-l'Île de Montréal, Montreal, Quebec, Canada
| | - Benjamin M Smith
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute McGill University, Health Centre, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jean Bourbeau
- Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute McGill University, Health Centre, McGill University, Montreal, Quebec, Canada
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada.,McGill Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
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22
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Stringer WW. Are We Treating Heart Failure in Patients with Chronic Obstructive Pulmonary Disease Appropriately? Ann Am Thorac Soc 2020; 17:932-934. [PMID: 32735167 PMCID: PMC7393790 DOI: 10.1513/annalsats.202004-395ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- William W Stringer
- David Geffen School of Medicine at UCLA, Los Angeles, California; and
- Division of Respiratory and Critical Care, Physiology and Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
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23
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Lowe KE, Hokanson JE, Make BJ, Pratte KA, Regan EA, Silverman EK, Young KA, Kinney GL, Crapo JD. Letter to the Editor: Response by Authors. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2020; 7:82-85. [PMID: 32324979 PMCID: PMC7454025 DOI: 10.15326/jcopdf.7.2.2020.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Katherine E. Lowe
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio
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24
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Balkissoon R. Journal Club-COPD2020 Update. Global Initiative for Chronic Obstructive Lung Disease 2020 Report and the Journal of the COPD Foundation Special Edition, Moving to a New Definition for COPD: "COPDGene ® 2019". CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2020; 6. [PMID: 31999904 DOI: 10.15326/jcopdf.7.1.2020.0133] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Barnes PJ, Vestbo J, Calverley PM. The Pressing Need to Redefine "COPD". CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:380-383. [PMID: 31710794 DOI: 10.15326/jcopdf.6.5.2019.0173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, United Kingdom
| | - Peter M Calverley
- Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, United Kingdom
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