1
|
Morena D, Izquierdo JL, Rodríguez J, Cuesta J, Benavent M, Perralejo A, Rodríguez JM. The Clinical Profile of Patients with COPD Is Conditioned by Age. J Clin Med 2023; 12:7595. [PMID: 38137664 PMCID: PMC10743861 DOI: 10.3390/jcm12247595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
In recent years, many studies have analyzed the importance of integrating time, or aging, into the equation that relates genetics and the environment to the development and origin of COPD. Under conditions of daily clinical practice, our study attempts to identify the differences in the clinical profile of patients with COPD according to age and the impact on the global burden of the disease. This study is non-interventional and observational, using artificial intelligence and data captured from electronic medical records. The study population included patients who were diagnosed with COPD between 2011 and 2021. A total of 73,901 patients had a diagnosis of COPD. The mean age was 73 years (95% CI: 72.9-73.1), and 56,763 were men (76.8%). We observed a specific prevalence of obesity, heart failure, depression, and hiatal hernia in women (p < 0.001), and ischemic heart disease and obstructive sleep apnea (OSA) in men (p < 0.001). In the analysis by age ranges, a progressive increase in cardiovascular risk factors was observed with age. In conclusion, in a real-life setting, COPD is a disease that primarily affects older subjects and frequently presents with comorbidities that are decisive in the evolutionary course of the disease.
Collapse
Affiliation(s)
- Diego Morena
- Pulmonology Department, Respiratory Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
- Doctoral Program in Health Sciences, University of Alcalá, 28871 Alcalá de Henares, Spain
| | - José Luis Izquierdo
- Pulmonology Department, Respiratory Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
| | - Juan Rodríguez
- Geriatric Medicine, Hospital Universitario de Guadalajara, 19002 Guadalajara, Spain;
| | - Jesús Cuesta
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
| | | | | | - José Miguel Rodríguez
- Department of Medicine and Medical Specialties, University of Alcalá, 28871 Alcalá de Henares, Spain; (J.C.); (J.M.R.)
- Respiratory Medicine, Hospital Universitario Príncipe de Asturias, 28805 Alcalá de Henares, Spain
| |
Collapse
|
2
|
Graziani D, Soriano JB, Del Rio-Bermudez C, Morena D, Díaz T, Castillo M, Alonso M, Ancochea J, Lumbreras S, Izquierdo JL. Characteristics and Prognosis of COVID-19 in Patients with COPD. J Clin Med 2020; 9:E3259. [PMID: 33053774 PMCID: PMC7600734 DOI: 10.3390/jcm9103259] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023] Open
Abstract
Patients with Chronic Obstructive Pulmonary Disease (COPD) have a higher prevalence of coronary ischemia and other factors that put them at risk for COVID-19-related complications. We aimed to explore the impact of COVID-19 in a large population-based sample of patients with COPD in Castilla-La Mancha, Spain. We analyzed clinical data in electronic health records from 1 January to 10 May 2020 by using Natural Language Processing through the SAVANA Manager® clinical platform. Out of 31,633 COPD patients, 793 had a diagnosis of COVID-19. The proportion of patients with COVID-19 in the COPD population (2.51%; 95% CI 2.33-2.68) was significantly higher than in the general population aged >40 years (1.16%; 95% CI 1.14-1.18); p < 0.001. Compared with COPD-free individuals, COPD patients with COVID-19 showed significantly poorer disease prognosis, as evaluated by hospitalizations (31.1% vs. 39.8%: OR 1.57; 95% CI 1.14-1.18) and mortality (3.4% vs. 9.3%: OR 2.93; 95% CI 2.27-3.79). Patients with COPD and COVID-19 were significantly older (75 vs. 66 years), predominantly male (83% vs. 17%), smoked more frequently, and had more comorbidities than their non-COPD counterparts. Pneumonia was the most common diagnosis among COPD patients hospitalized due to COVID-19 (59%); 19% of patients showed pulmonary infiltrates suggestive of pneumonia and heart failure. Mortality in COPD patients with COVID-19 was associated with older age and prevalence of heart failure (p < 0.05). COPD patients with COVID-19 showed higher rates of hospitalization and mortality, mainly associated with pneumonia. This clinical profile is different from exacerbations caused by other respiratory viruses in the winter season.
Collapse
Affiliation(s)
- Desirée Graziani
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Joan B Soriano
- Respiratory Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (J.B.S.); (J.A.)
- Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), 28006 Madrid, Spain
| | | | - Diego Morena
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Teresa Díaz
- SAVANA Medica, 28013 Madrid, Spain; (C.D.R.-B.); (T.D.)
| | - María Castillo
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Miguel Alonso
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
| | - Julio Ancochea
- Respiratory Medicine, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (J.B.S.); (J.A.)
- Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre (CIBERES), Institute of Health Carlos III (ISCIII), 28006 Madrid, Spain
| | | | - José Luis Izquierdo
- Respiratory Medicine, University Hospital of Guadalajara, 19002 Guadalajara, Spain; (D.G.); (D.M.); (M.C.); (M.A.)
- Department of Medicine and Medical Specialties, University of Alcalá, 28801 Madrid, Spain
| |
Collapse
|
3
|
Ibrahimou B, Azim SI, Sun N. Interaction between blood lead level and chronic obstructive pulmonary disease (COPD) on risk of heart attack or stroke: USA NHANES, 2013-2014. Pulm Pharmacol Ther 2019; 58:101805. [PMID: 31108188 DOI: 10.1016/j.pupt.2019.101805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/03/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Among all risk factors of cardiovascular disease (CVD), lead is associated with cardiovascular mortality. Besides CVD, blood lead level is also related to the chronic obstructive pulmonary disease (COPD). The inter-relationship of CVD, blood lead level and COPD are not yet studied. OBJECTIVE The aim of this study is to examine the interaction of COPD and blood lead level on the occurrence of heart attack. METHODS This analyzed data is from the 2013-2014 NHANES. The final analysis included 5736 adults. Survey logistic regression models were built to control confounders. We computed adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS A significant interaction (OR = 0.26, CI = 0.12, 0.56) between COPD and blood lead level on the occurrence of heart attack was observed. Those who had COPD were 4.05 times more likely to have heart attack than those who did not have COPD for 1 μg/dL increase in blood lead level. Similarly, a significant interaction between COPD and lead was found for the occurrence of stroke (OR = 0.44, CI = 0.19,1.00), leading to 1.15 times likely to have stroke than those who did not have COPD for 1 μg/dL increase in blood lead level. For the combined outcome, OR = 0.28 with CI=(0.14, 0.57). CONCLUSIONS The low lead level today means more effect of COPD on the occurrence of heart attack and stroke. More studies required to understand the pathways of the association of COPD, CVD and lead due to their shared risk factors.
Collapse
Affiliation(s)
- Boubakari Ibrahimou
- Florida International University, Robert Stempel College of Public Health & Social Work, Department of Biostatistics, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA.
| | - Syeda Ishra Azim
- Singapore Institute of Clinical Science, 30 Medical Drive, 117609, Singapore
| | - Ning Sun
- Florida International University, Robert Stempel College of Public Health & Social Work, Department of Biostatistics, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| |
Collapse
|
4
|
Hong Y, Graham MM, Southern D, McMurtry MS. The Association between Chronic Obstructive Pulmonary Disease and Coronary Artery Disease in Patients Undergoing Coronary Angiography. COPD 2019; 16:66-71. [PMID: 30897970 DOI: 10.1080/15412555.2019.1566894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of morbidity and mortality. There are conflicting results regarding the association between COPD and CAD. We sought to measure the association between COPD and angiographically diagnosed CAD in a population-based cohort. We performed a retrospective analysis using data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), a prospectively collected registry capturing all patients undergoing coronary angiography in Alberta, Canada, since 1995. We included adult patients who had undergone coronary angiogram between April 1, 2007 and March 31, 2014. CAD was present if at least one coronary artery had a significant stenosis ≥50%. COPD was present if the patient had a documented COPD history and was prescribed bronchodilators or inhaled steroids. We evaluated the association between COPD and CAD using univariable and multivariable logistic regression. There were 26,137 patients included with a mean age of 63.3 ± 12.2 years, and 19,542 (74.8%) were male. The crude odds ratio (OR) of having CAD was 0.83 (95% CI 0.74-0.92) for patients with COPD compared to those without COPD. The adjusted OR was 0.75 (95% CI 0.67-0.84) after controlling for age, sex, smoking history, body mass index, hypertension, diabetes, hyperlipidemia, peripheral artery disease and cardiac family history. In patients undergoing coronary angiography, COPD was negatively associated with CAD with and without the adjustment for classic risk factors. COPD patients should be properly examined for heart disease to reduce premature mortality.
Collapse
Affiliation(s)
- Yongzhe Hong
- a Department of Medicine and Mazankowski Alberta Heart Institute , University of Alberta , Edmonton , Alberta , Canada
- b The Second Affiliated Hospital of Shantou University Medical College , Shantou , Guangdong , China
| | - Michelle M Graham
- a Department of Medicine and Mazankowski Alberta Heart Institute , University of Alberta , Edmonton , Alberta , Canada
| | - Danielle Southern
- c O'Brien Institute for Public Health and Department of Community Health Sciences , University of Calgary , Calgary , Alberta , Canada
| | - Michael Sean McMurtry
- a Department of Medicine and Mazankowski Alberta Heart Institute , University of Alberta , Edmonton , Alberta , Canada
| |
Collapse
|
5
|
Mota IL, Sousa ACS, Almeida MLD, de Melo EV, Ferreira EJP, Neto JB, Matos CJO, Telino CJCL, Souto MJS, Oliveira JLM. Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I-III) and suspected or confirmed coronary arterial disease. Int J Chron Obstruct Pulmon Dis 2018; 13:1999-2006. [PMID: 29983554 PMCID: PMC6027684 DOI: 10.2147/copd.s162713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21–10.34; P < 0.001). Conclusion In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present.
Collapse
Affiliation(s)
- Igor Larchert Mota
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil,
| | - Antônio Carlos Sobral Sousa
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Maria Luiza Doria Almeida
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Enaldo Vieira de Melo
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Eduardo José Pereira Ferreira
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - José Barreto Neto
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Carlos José Oliveira Matos
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Caio José Coutinho Leal Telino
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Maria Júlia Silveira Souto
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Joselina Luzia Menezes Oliveira
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| |
Collapse
|
6
|
Mattila T, Vasankari T, Rissanen H, Knekt P, Puukka P, Heliövaara M. Airway obstruction and the risk of myocardial infarction and death from coronary heart disease: a national health examination survey with a 33-year follow-up period. Eur J Epidemiol 2017; 33:89-98. [DOI: 10.1007/s10654-017-0278-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/21/2017] [Indexed: 01/13/2023]
|
7
|
Subclinical Carotid Atherosclerosis in COPD Cases and Control Smokers: Analysis in Relation with COPD Exacerbations and Exacerbation-like Episodes. Lung 2017; 195:185-191. [DOI: 10.1007/s00408-017-9986-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
|
8
|
Khan NA, Saini H, Mawari G, Kumar S, Hira HS, Daga MK. The Effect of Folic Acid Supplementation on Hyperhomocysteinemia and Pulmonary Function Parameters in Chronic Obstructive Pulmonary Disease: A Pilot Study. J Clin Diagn Res 2016; 10:OC17-OC21. [PMID: 28050421 DOI: 10.7860/jcdr/2016/21322.8927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/31/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Preliminary studies have established the elevated plasma total Homocysteine (tHcy) levels as a risk factor for Chronic Obstructive Pulmonary Disease (COPD). However, studies describing plasma tHcy levels and their relationship to folic acid supplementation and Forced Expiratory Volume in 1 Second (FEV1) status in COPD patients are still lacking. AIM We investigated the role of hyperhomocysteinemia in COPD and then prospectively examined the relationship between plasma tHcy concentration and effect of folic acid supplementation on FEV1 status in COPD patients. MATERIALS AND METHODS This was a prospective case-control study with 50 clinically stable patients of COPD attending the chest clinic of the hospital and 30 healthy controls. The study was done at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India, from August 2011 to February 2013. Plasma levels of Hcy were measured by Enzyme Linked Immuno-Sorbent Assay (ELISA) method. All the subjects were given folic acid therapy (5mg daily) for six weeks duration and were followed up. Repeat plasma Hcy and FEV1 were measured after six weeks. RESULTS COPD patients had higher baseline plasma tHcy concentration than controls (Mean: 27.42±23.89μmol/L, versus 15.21±15.71μmol/L, p<0.001) and COPD was associated with higher tHcy concentrations also after adjusting for smoking, and age. The mean BMI of the patients was 21.36±4.26kg/m2. The mean Hcy values decreased from 27.42±23.89μmol/L to 15.2±15.71μmol/L (p-value=0.001) after six weeks of folic acid supplementation. However, no significant change was observed in FEV1 upon folic acid supplementation (FEV1=1.14±0.60 and 1.08±0.56 respectively; p-value=0.654). A significant correlation was observed between BMI and Hcy and also between plasma Hcy levels at the baseline and after six weeks of folic acid supplementation (r=0.283, p=0.04 and r=0.340, p=0.02, respectively) and (r=0.840, p=0.001). CONCLUSION COPD patients seem to have a poor folic acid status and as a consequence high tHcy. Also, folic acid supplementation has shown decreased plasma tHcy concentrations, but not necessarily significant change in FEV1.
Collapse
Affiliation(s)
- Naushad Ahmad Khan
- Research Associate, Department of Medicine, Maulana Azad Medical College , New Delhi, India
| | - Harish Saini
- Senior Resident, Department of Medicine, Maulana Azad Medical College , New Delhi, India
| | - Govind Mawari
- Research Co-ordinator, Department of Medicine, Maulana Azad Medical College , New Delhi, India
| | - Suman Kumar
- Research Officer, Department of Microbiology, Maulana Azad Medical College , New Delhi, India
| | - Harmanjit Singh Hira
- Director Professor, Department of Pulmonary Medicine, Maulana Azad Medical College , New Delhi, India
| | - Mradul Kumar Daga
- Director Professor, Department of Medicine, Maulana Azad Medical College , New Delhi, India
| |
Collapse
|
9
|
Blood Pressure Profile and Hypertensive Organ Damage in COPD Patients and Matched Controls. The RETAPOC Study. PLoS One 2016; 11:e0157932. [PMID: 27362479 PMCID: PMC4928916 DOI: 10.1371/journal.pone.0157932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies suggest that there is a pathogenic link between chronic obstructive pulmonary disease (COPD) and cardiovascular diseases. On the other hand, increased sympathetic tone has been described in several respiratory diseases. Our objective was to determine whether hypertension mediated by sympathetic overactivity is a mechanism that explains the association between COPD and cardiovascular diseases. METHODS Prospective nested case-control observational study; 67 COPD patients were matched 1:1 by sex and age to controls with smoking history. 24 hour-blood pressure monitoring, urinary catecholamines and their metabolites measurement, echocardiography, carotid ultrasound examination, nocturnal oximetry and retinography were performed. FINDINGS classic cardiovascular risk factors and comorbidities were similarly distributed between cases and controls. No significant differences for blood pressure variables (difference for mean systolic blood pressure: -0·13 mmHg; 95% CI: -4·48,4·20; p = 0·94; similar results for all blood presssure variables) or catecholamines values were found between both groups. There was a tendency for lower left ventricle ejection fraction in the COPD cases, that approached statistical significance (64·8 ± 7·4 vs 67·1 ± 6·2, p = 0·05). There were no differences in the retinal arteriovenous ratio, the carotid intima-media thickness, or the number of carotid plaques, between cases and controls. Fibrinogen values were higher in the COPD group (378·4 ± 69·6 vs 352·2 ± 45·6 mg/dL, p = 0·01) and mean nocturnal oxygen saturation values were lower for COPD patients (89·0 ± 4·07 vs 92·3 ± 2·2%, p < 0·0001). INTERPRETATION Hypertension induced by sympathetic overactivity does not seem to be a mechanism that could explain the association between COPD and cardiovascular disease.
Collapse
|
10
|
Park HJ, Leem AY, Lee SH, Song JH, Park MS, Kim YS, Kim SK, Chang J, Chung KS. Comorbidities in obstructive lung disease in Korea: data from the fourth and fifth Korean National Health and Nutrition Examination Survey. Int J Chron Obstruct Pulmon Dis 2015; 10:1571-82. [PMID: 26300636 PMCID: PMC4535560 DOI: 10.2147/copd.s85767] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Comorbidities can occur frequently in patients with chronic obstructive pulmonary disease (COPD) and can influence mortality and morbidity independently. It is increasingly recognized that many patients with COPD have comorbidities that have a major impact on their quality of life and survival. Therefore, we investigated the prevalence of comorbidities in Korean COPD populations. METHODS We used data obtained in the 6 years of the fourth and fifth Korean National Health and Nutrition Examination Survey (KNHANES) IV and V. Among 50,405 subjects, 16,151 subjects aged ≥40 years who performed spirometry adequately were included in this study. Airway obstruction was defined as forced expiratory volume in 1 second/forced vital capacity <0.7, and the Global Initiative For Chronic Obstructive Lung Disease stage was used to evaluate the severity of airway obstruction. Statistical analyses were performed using SAS 9.2. RESULTS Among the 16,151 subjects (43.2% male, 56.8% female; mean age: 57.1 years for men and 57.2 years for women), 13.1% had obstructive lung function; 11.3%, restrictive lung function; and 75.6%, normal lung function. Among individuals with obstructive lung function, 45.3%, 49.4%, and 5.3% had mild, moderate, and severe and very severe airflow limitation. The prevalence of hypertension, diabetes mellitus (DM), underweight, and hypertriglyceridemia was higher in the obstructive lung function group than in the normal lung function group (49.6% vs 35.2%; 16.8% vs 10.5%; 3.3% vs 1.3%; 19.7% vs 17.0%). According to the severity of airway obstruction, hypertension and underweight were more common as severity increased, although the prevalence of DM and hypertriglyceridemia was lower in subjects with severe airway obstruction. The prevalence of hypercholesterolemia, overweight, and osteoarthritis was lower in the obstructive lung function group, especially in the severe airway obstruction groups. CONCLUSIONS Overall, our analysis is similar to research that was conducted earlier. Our study showed that hypertension and underweight are common comorbidities in COPD patients, and are higher as the severity of airflow obstruction increased in both men and women. DM, hypertriglyceridemia, and low high-density lipoprotein cholesterol are more common in subjects with airway obstruction, although their incidence is lower in the severe group.
Collapse
Affiliation(s)
- Hee Jin Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju Han Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Kyu Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Institute of Chest Disease, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
11
|
Aliyali M, Mehravaran H, Abedi S, Sharifpour A, Yazdani Cherati J. Impact of Comorbid Ischemic Heart Disease on Short-Term Outcomes of Patients Hospitalized for Acute Exacerbations of COPD. TANAFFOS 2015; 14:165-71. [PMID: 26858761 PMCID: PMC4745184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ischemic heart disease (IHD) is a leading cause of mortality and morbidity in patients with COPD. The contribution of IHD to acute outcomes in patients with acute exacerbation of COPD (AECOPD) is not known in detail. The present study assessed the effect of comorbid IHD on length of stay (LOS), risk of intensive care unit (ICU) admission and death as indicators of the short-term outcomes for patients hospitalized for AECOPD. MATERIALS AND METHODS Medical records of patients hospitalized for AECOPD from September 2008 to March 2014 were reviewed. Data extracted from patient records regarding the presence of comorbidities and the markers of disease severity were analyzed using logistic regression for ICU admission and mortality, the Kaplan-Meier method, log rank test and Cox regression for LOS. RESULTS Of 507 separate admissions, 146 episodes (28.8%) occurred in patients with IHD. The median LOS was 7 days [interquartile range (IQR) 6, 11] in patients with IHD versus 6 days (IQR 5, 8) for patients without IHD. After adjustment for confounders, LOS was found to be 26% longer (p=0.033) for patients with IHD. The adjusted odds ratio for the risk of ICU admission and death in patients with IHD was 2.97 and 3.86, respectively. CONCLUSION Patients hospitalized for AECOPD with comorbid IHD had longer LOS, greater risk for ICU admission and death. It seems that this group is a particular COPD subtype with a more severe degree of COPD and poorer acute outcomes that may influence optimal management.
Collapse
Affiliation(s)
- Masoud Aliyali
- Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mehravaran
- Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran,,Correspondence to: Mehravaran H, Address: Department of Internal Medicine, Imam Hospital, Mazandaran University of Medical Sciences, 48146-33131, Sari, Iran, Email address:
| | - Siavash Abedi
- Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jamshid Yazdani Cherati
- Departments of Biostatistics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
12
|
Khammarnia M, Kassani A, Amiresmaili M, Sadeghi A, Karimi Jaberi Z, Kavosi Z. Study of patients absconding behavior in a general hospital at southern region of Iran. Int J Health Policy Manag 2014; 4:137-41. [PMID: 25774367 DOI: 10.15171/ijhpm.2014.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/27/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients' escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. METHODS This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011-3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. RESULTS The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (ORadj= 0.13), gender (ORadj= 2.15), self-employment/unemployed (ORadj= 0.47), emergency/admission (ORadj= 2.14), internal/admission (ORadj= 3.16), insurance status (ORadj= 4.49) and residence expenditure (ORadj= 1.15). CONCLUSION Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital.
Collapse
Affiliation(s)
- Mohammad Khammarnia
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Aziz Kassani
- Prevention of Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammadreza Amiresmaili
- Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Sadeghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Karimi Jaberi
- Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. ; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Department of Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
13
|
Müllerova H, Agusti A, Erqou S, Mapel DW. Cardiovascular comorbidity in COPD: systematic literature review. Chest 2014; 144:1163-1178. [PMID: 23722528 DOI: 10.1378/chest.12-2847] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is common among patients with COPD. However, it is not clear whether this is due to shared risk factors or if COPD increases the risk for CVD independently. This study aimed to provide a systematic review of studies that investigated the association between COPD and CVD outcomes, assessing any effect of confounding by common risk factors. METHODS A search was conducted in MEDLINE (via PubMed) for observational studies published between January 1990 and March 2012 reporting cardiovascular comorbidity in patients with COPD (or vice versa). RESULTS Of the 7,322 citations identified, 25 studies were relevant for this systematic review. Twenty-two studies provided an estimate for CVD risk in COPD, whereas four studies provided estimates of COPD risk in CVD. The crude prevalence for the aggregate CVD category ranged from 28% to 70%, likely due to differences in populations studied and CVD definitions; unadjusted rate ratio (RR) estimates of unspecified CVD among patients with COPD compared with patients without COPD ranged from 2.1 to 5.0. The association between COPD and CVD persisted after adjustment for shared risk factors in the majority of the studies. Two studies found a relationship between the severity of airflow limitation and CVD risk. Increased RRs were observed for individual CVD types, but their estimates varied considerably for congestive heart failure, coronary heart disease, arrhythmias, stroke, arterial hypertension, and peripheral arterial disease. CONCLUSIONS Available observational data support the hypothesis that COPD is associated with an increased risk of CVD.
Collapse
Affiliation(s)
- Hana Müllerova
- Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, England.
| | - Alvar Agusti
- Thorax Institute, Hospital Clinic, IDIBAPS, Universitat de Barcelona and FISIB, CIBER Enfermedades Respiratorias (CIBERES), Mallorca, Spain
| | | | | |
Collapse
|
14
|
García-Olmos L, Alberquilla A, Ayala V, García-Sagredo P, Morales L, Carmona M, de Tena-Dávila MJ, Pascual M, Muñoz A, Salvador CH, Monteagudo JL. Comorbidity in patients with chronic obstructive pulmonary disease in family practice: a cross sectional study. BMC FAMILY PRACTICE 2013; 14:11. [PMID: 23324308 PMCID: PMC3556139 DOI: 10.1186/1471-2296-14-11] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 01/14/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is frequent and often coexists with other diseases. The aim of this study was to quantify the prevalence of COPD and related chronic comorbidity among patients aged over 40 years visiting family practices in an area of Madrid. METHODS An observational, descriptive, cross-sectional study was conducted in a health area of the Madrid Autonomous Region (Comunidad Autónoma de Madrid). The practice population totalled 198,670 persons attended by 129 Family Physicians (FPs), and the study population was made up of persons over the age of 40 years drawn from this practice population. Patients were deemed to have COPD if this diagnosis appeared on their clinical histories. Prevalence of COPD; prevalence of a further 25 chronic diseases in patients with COPD; and standardised prevalence ratios, were calculated. RESULTS Prevalence of COPD in family medicine was 3.2% (95% CI 3.0-3.3) overall, 5.3% among men and 1.4% among women; 90% of patients presented with comorbidity, with a mean of 4 ± 2.04 chronic diseases per patient, with the most prevalent related diseases being arterial hypertension (52%), disorders of lipid metabolism (34%), obesity (25%), diabetes (20%) and arrhythmia (15%). After controlling for age and sex, the observed prevalence of the following ten chronic diseases was higher than expected: heart failure; chronic liver disease; asthma; generalised artherosclerosis; osteoporosis; ischaemic heart disease; thyroid disease; anxiety/depression; arrhythmia; and obesity. CONCLUSIONS Patients with COPD, who are frequent in family practice, have a complex profile and pose a clinical and organisational challenge to FPs.
Collapse
Affiliation(s)
- Luis García-Olmos
- Multiprofessional Education Unit for Family and Community Care (South-east), Hacienda de Pavones, 271, Madrid, 28030, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
de Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-Gonzalez Moro JM, Frances JF, Lozano PV, Bellón-Cano JM. Chronic obstructive pulmonary disease as a cardiovascular risk factor. Results of a case-control study (CONSISTE study). Int J Chron Obstruct Pulmon Dis 2012; 7:679-86. [PMID: 23055717 PMCID: PMC3468057 DOI: 10.2147/copd.s36222] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) patients present a high prevalence of cardiovascular disease. This excess of comorbidity could be related to a common pathogenic mechanism, but it could also be explained by the existence of common risk factors. The objective of this study was to determine whether COPD patients present greater cardiovascular comorbidity than control subjects and whether COPD can be considered a risk factor per se. Methods 1200 COPD patients and 300 control subjects were recruited for this multicenter, cross-sectional, case–control study. Results Compared with the control group, the COPD group showed a significantly higher prevalence of ischemic heart disease (12.5% versus 4.7%; P < 0.0001), cerebrovascular disease (10% versus 2%; P < 0.0001), and peripheral vascular disease (16.4% versus 4.1%; P < 0.001). In the univariate risk analysis, COPD, hypertension, diabetes, obesity, and dyslipidemia were risk factors for ischemic heart disease. In the multivariate analysis adjusted for the remaining factors, COPD was still an independent risk factor (odds ratio: 2.23; 95% confidence interval: 1.18–4.24; P = 0.014). Conclusion COPD patients show a high prevalence of cardiovascular disease, higher than expected given their age and the coexistence of classic cardiovascular risk factors.
Collapse
Affiliation(s)
- Pilar de Lucas-Ramos
- Servicio de Neumologia, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
16
|
Joo H, Park J, Lee SD, Oh YM. Comorbidities of chronic obstructive pulmonary disease in Koreans: a population-based study. J Korean Med Sci 2012; 27:901-6. [PMID: 22876057 PMCID: PMC3410238 DOI: 10.3346/jkms.2012.27.8.901] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 05/17/2012] [Indexed: 11/30/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) includes pulmonary components with increased comorbidity rates, as well as being a systemic disease. Comorbidities may frequently occur in COPD patients over 40 yr old. We report the comorbidities of patients with COPD, diagnosed by spirometry, in a population-based epidemiologic survey in Korea. Data were derived from the fourth Korean Health and Nutrition Examination Survey in 2008, a stratified multistage clustered probability design survey of a sample representing the entire population of Korea. Results of spirometry and various health-related questionnaires were analyzed in 2,177 subjects aged ≥ 40 yr. The prevalence of COPD (FEV(1)/FVC < 0.7) in subjects ≥ 40 yr of age was 14.1%. Multivariate analysis showed that underweight (odds ratio [OR] 3.07, 95% confidence interval [CI] 1.05-8.98), coronary heart disease (OR, 0.43; 95% CI, 0.20-0.93) and dyslipidemia (OR, 0.61; 95% CI, 0.45-0.82) were significantly associated with COPD, whereas allergic rhinitis, anemia, arthritis, chronic renal failure, depression, diabetes mellitus, hypertension, gastrointestinal ulcer, and osteoporosis were not. Underweight might be more prevalent but coronary heart disease and dyslipidemia are less prevalent in Koreans with than without COPD in population setting.
Collapse
Affiliation(s)
- Hyejin Joo
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinkyeong Park
- Department of Pulmonary and Critical Care Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Sang Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Clinical Research Center for Chronic Obstructive Airway Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Clinical Research Center for Chronic Obstructive Airway Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Bérard E, Bongard V, Roche N, Perez T, Brouquières D, Taraszkiewicz D, Fievez S, Denis F, Escamilla R, Ferrières J. Undiagnosed airflow limitation in patients at cardiovascular risk. Arch Cardiovasc Dis 2011; 104:619-26. [PMID: 22152514 DOI: 10.1016/j.acvd.2011.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 09/27/2011] [Accepted: 10/05/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) share risk factors and impair each other's prognosis. AIMS To assess the prevalence of airflow limitation (AL) compatible with COPD in a population at cardiovascular risk and to identify determinants of AL. METHODS All consecutive patients referred to the cardiovascular prevention unit of a university hospital in 2009 were studied in a cross-sectional analysis. Patients answered questionnaires on socioeconomic status, medical history and lifestyle, and underwent extensive physical examinations, biological measures and spirometry testing. AL was defined as FEV1/FVC<0.70, without any history of asthma. Determinants of AL were assessed using logistic regression. RESULTS The sample comprised 493 participants (mean age 57.4±11.1 years); 60% were men, 18% were current smokers, 42% were ex-smokers and 10% of patients had a history of CVD. Ten-year risk of coronary heart disease (CHD) according to the Framingham equation was intermediate (10-20%) for 25% of patients and high (>20%) for 10%. Prevalence of AL was 5.9% (95% confidence interval [CI] 4.0-8.3%) in the whole population and 4.3% (2.6-6.6%) among subjects in primary cardiovascular prevention. AL was independently associated with CVD (adjusted odds ratio 4.18, 95% CI 1.72-10.15; P=0.002) but not with Framingham CHD risk. More than 80% of patients screened with AL had not been diagnosed previously and more than one in two patients was asymptomatic. CONCLUSION Patients with CVD are at increased risk of AL and thus should benefit from AL screening as they are frequently asymptomatic.
Collapse
Affiliation(s)
- Emilie Bérard
- UMR 1027 Inserm, Department of Epidemiology, Health Economics and Public Health, CHU de Toulouse, université de Toulouse, 31073 Toulouse cedex, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|