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Torén K, Schiöler L, Brisman J, Malinovschi A, Olin AC, Bergström G, Bake B. Restrictive spirometric pattern and true pulmonary restriction in a general population sample aged 50 - 64 years. BMC Pulm Med 2020; 20:55. [PMID: 32106839 PMCID: PMC7045734 DOI: 10.1186/s12890-020-1096-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is low diagnostic accuracy of the proxy restrictive spirometric pattern (RSP) to identify true pulmonary restriction. This knowledge is based on patients referred for spirometry and total lung volume determination by plethysmograpy, single breath nitrogen washout technique or gas dilution and selected controls. There is, however, a lack of data from general populations analyzing whether RSP is a valid proxy for true pulmonary restriction. We have validated RSP in relation to true pulmonary restriction in a general population where we have access to measurements of total lung capacity (TLC) and spirometry. METHODS The data was from the Swedish CArdioPulmonary bioImage Study (SCAPIS Pilot), a general population-based study, comprising 983 adults aged 50-64. All subjects answered a respiratory questionnaire. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were obtained before and after bronchodilation. TLC and residual volume (RV) was recorded using a body plethysmograph. All lung function values are generally expressed as percent predicted (% predicted) or in relation to lower limits of normal (LLN). True pulmonary restriction was defined as TLC < LLN5 defined as a Z score < - 1.645, i e the fifth percentile. RSP was defined as FEV1/FVC ≥ LLN and FVC < LLN after bronchodilation. Specificity, sensitivity, positive and negative likelihood ratios were calculated, and 95% confidence intervals (CIs) were calculated. RESULTS The prevalence of true pulmonary restriction was 5.4%, and the prevalence of RSP was 3.4%. The sensitivity of RSP to identify true pulmonary restriction was 0.34 (0.20-0.46), the corresponding specificity was 0.98 (0.97-0.99), and the positive likelihood ratio was 21.1 (11.3-39.4) and the negative likelihood ratio was 0.67 (0.55-0.81). CONCLUSIONS RSP has low accuracy for identifying true pulmonary restriction. The results support previous observations that RSP is useful for ruling out true pulmonary restriction.
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Affiliation(s)
- Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden.
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden
| | - Jonas Brisman
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, S-405 30, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Bake
- Department of Medicine/Lung Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Croghan A, Brunette A, Holm KE, Kozora E, Moser DJ, Wamboldt FS, Meschede K, Make BJ, Crapo JD, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Reduced Attention in Former Smokers with and without COPD. Int J Behav Med 2019; 26:600-607. [PMID: 31732904 PMCID: PMC7269072 DOI: 10.1007/s12529-019-09826-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. METHODS Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. RESULTS Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100 ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. CONCLUSION Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.
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Affiliation(s)
- Anna Croghan
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Amanda Brunette
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - David J Moser
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | | | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Aurora, Denver, CO, USA
| | - Russell P Bowler
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA.
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Pan J, Adab P, Jiang CQ, Zhang WS, Zhu F, Jin YL, Thomas GN, Lam TH. All-cause and cause-specific mortality from restrictive and obstructive spirometric patterns in Chinese adults with and without dyspnea: Guangzhou Biobank Cohort Study. Respir Med 2019; 151:66-80. [PMID: 31047120 DOI: 10.1016/j.rmed.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study whether abnormal spirometric patterns were associated with differential mortality in Chinese adults with and without dyspnea. METHODS Guangzhou Biobank Cohort Study (GBCS) participants were classified by spirometric patterns and presence of dyspnea into 6 groups: normal spirometry (NS), restriction on spirometry (ROS) and airflow obstruction (AO), each with and without dyspnea. Adjusted hazard ratios (aHRs) were calculated for mortality using Cox models. RESULTS Among 16777 subjects, 1595 (9.5%) had ROS, 1036 (6.2%) had AO and 1009 (6.0%) had dyspnea. A total of 1993 deaths (11.9%) occurred during 11-year follow-up. Using NS without dyspnea as reference, NS with dyspnea was significantly associated with increased cardiovascular mortality risk (aHRs 1.61 (95% confidence interval (CI) 1.18-2.19); ROS with and without dyspnea were associated with increased risks of all-cause (aHRs 1.46 (95% CI 1.28-1.66) and 1.81 (95% CI 1.33-2.47)) and cardiovascular mortality (aHRs 1.89 (95% CI 1.55-2.31) and 1.85 (95% CI 1.12-3.03)), but not of lung cancer mortality (aHRs 1.33 (95% CI 0.91-1.94) and 1.35 (95% CI 0.49-3.70)); AO with and without dyspnea were associated with increased risks of all-cause (aHRs 1.59 (95% CI 1.36-1.86) and 2.36 (95% CI 1.77-3.15)), cardiovascular (aHRs 1.43 (95% CI 1.08-1.90) and 1.61 (95% CI 0.91-2.82)) and lung cancer mortality (aHRs 1.91 (95% CI 1.29-2.84) and 3.01 (95% CI 1.46-6.23)). These associations did not vary by sex or smoking status (all P-values for interaction >0.05). CONCLUSION Both ROS and AO, with and without dyspnea, were associated with increased all-cause and cardiovascular disease mortality. The increased risk of all-cause was greater and that of cardiovascular mortality was lower for AO than ROS. AO showed significantly increased risk of lung cancer but ROS did not. (272 words).
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Affiliation(s)
- Jing Pan
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China.
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | | | - Wei Sen Zhang
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China.
| | - Feng Zhu
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China.
| | - Ya Li Jin
- Guangzhou No.12 Hospital, Guangzhou, Guangdong, China.
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China; Guangzhou No.12 Hospital, Guangzhou, Guangdong, China.
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Genetic and Environmental Basis in Phenotype Correlation Between Physical Function and Cognition in Aging Chinese Twins. Twin Res Hum Genet 2017; 20:60-65. [PMID: 28105965 DOI: 10.1017/thg.2016.98] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Although the correlation between cognition and physical function has been well studied in the general population, the genetic and environmental nature of the correlation has been rarely investigated. We conducted a classical twin analysis on cognitive and physical function, including forced expiratory volume in one second (FEV1), forced vital capacity (FVC), handgrip strength, five-times-sit-to-stand test (FTSST), near visual acuity, and number of teeth lost in 379 complete twin pairs. Bivariate twin models were fitted to estimate the genetic and environmental correlation between physical and cognitive function. Bivariate analysis showed mildly positively genetic correlations between cognition and FEV1, r G = 0.23 [95% CI: 0.03, 0.62], as well as FVC, r G = 0.35 [95% CI: 0.06, 1.00]. We found that FTSST and cognition presented very high common environmental correlation, r C = -1.00 [95% CI: -1.00, -0.57], and low but significant unique environmental correlation, r E = -0.11 [95% CI: -0.22, -0.01], all in the negative direction. Meanwhile, near visual acuity and cognition also showed unique environmental correlation, r E = 0.16 [95% CI: 0.03, 0.27]. We found no significantly genetic correlation for cognition with handgrip strength, FTSST, near visual acuity, and number of teeth lost. Cognitive function was genetically related to pulmonary function. The FTSST and cognition shared almost the same common environmental factors but only part of the unique environmental factors, both with negative correlation. In contrast, near visual acuity and cognition may positively share part of the unique environmental factors.
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Godfrey MS, Jankowich MD. The Vital Capacity Is Vital: Epidemiology and Clinical Significance of the Restrictive Spirometry Pattern. Chest 2016; 149:238-51. [PMID: 26356330 DOI: 10.1378/chest.15-1045] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 12/20/2022] Open
Abstract
Epidemiologic research has revealed a substantial portion of the general population with abnormal spirometry results that are characterized by decreased FEV1 and FVC but a preserved FEV1/FVC ratio. This restrictive spirometry pattern (RSP) is inconsistently defined in the literature and not well addressed by current guidelines; there is an accumulating body of evidence, however, that RSP is prevalent to a similar degree as airflow obstruction. Genetic and other risk factors for RSP, such as inhalational injuries and early life exposures, continue to be actively described. Although it seems that RSP is closely associated with the metabolic syndrome, diabetes, and systemic inflammation, it is not a simple marker of obesity. RSP is associated with adverse cardiovascular outcomes, as well as mortality, and it may be an underappreciated cause of functional impairments and respiratory symptoms. Improvement in outcomes in this population will require that clinicians have an appreciation for the significance of this spirometry pattern; additional research into the clinical and radiologic phenotype of these subjects is also needed. This article provides an overview of the recent developments in our understanding of this prevalent and highly morbid spirometry pattern.
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Affiliation(s)
- Mark S Godfrey
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Matthew D Jankowich
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI; Vascular Research Laboratory, Providence VA Medical Center, Providence, RI.
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Okura T, Saghazadeh M, Soma Y, Tsunoda K. Physical fitness, physical activity, exercise training and cognitive function in older adults. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2013. [DOI: 10.7600/jpfsm.2.275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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