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Knox-Brown B, Potts J, Santofimio VQ, Minelli C, Patel J, Abass NM, Agarwal D, Ahmed R, Mahesh PA, Bs J, Denguezli M, Franssen F, Gislason T, Janson C, Juvekar SK, Koul P, Malinovschi A, Nafees AA, Nielsen R, Paraguas SNM, Buist S, Burney PG, Amaral AFS. Isolated small airways obstruction predicts future chronic airflow obstruction: a multinational longitudinal study. BMJ Open Respir Res 2023; 10:e002056. [PMID: 37989490 PMCID: PMC10660204 DOI: 10.1136/bmjresp-2023-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated with chronic airflow obstruction later in life. METHODS We used longitudinal data from 3957 participants of the multinational Burden of Obstructive Lung Disease study. We defined isolated small airways obstruction using the prebronchodilator mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF25-75) if a result was less than the lower limit of normal ( RESULTS Median follow-up time was 8.3 years. Chronic airflow obstruction was more likely to develop in participants with isolated small airways obstruction at baseline (FEF25-75 less than the LLN, OR: 2.95, 95% CI 1.02 to 8.54; FEV3/FVC less than the LLN, OR: 1.94, 95% CI 1.05 to 3.62). FEF25-75 was better than the FEV3/FVC ratio to discriminate future chronic airflow obstruction (AUC: 0.764 vs 0.692). Results were similar among participants of the UK Biobank study. CONCLUSION Measurements of small airways obstruction can be used as early markers of future obstructive lung disease.
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Affiliation(s)
- Ben Knox-Brown
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Jaymini Patel
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Pune Research Centre, Pune, India
| | - Rana Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | | | - Jayaraj Bs
- Respiratory Medicine, JSS Medical College, Mysore, Karnataka, India
| | - Meriam Denguezli
- Faculte de Medecine de Sousse, Universite de Sousse, Sousse, Tunisia
| | - Frits Franssen
- Respiratory medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- Research and Education, CIRO, Horn, Netherlands
| | - Thorarinn Gislason
- Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christer Janson
- Department of Medical Sciences Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Sanjay K Juvekar
- Vadu Rural Health Program, KEM Hospital Pune Research Centre, Pune, India
| | - Parvaiz Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Andrei Malinovschi
- Department of Medical Sciences Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Asaad Ahmed Nafees
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rune Nielsen
- Department of Thoracic Medicine, University of Bergen, Bergen, Hordaland, Norway
| | - Stefanni Nonna M Paraguas
- Philippine College of Chest Physicians, Quezon City, Philippines
- Philippine Heart Center, Quezon City, Manila, Philippines
| | - Sonia Buist
- Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Gj Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
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Mahendra M, S SK, Desai N, Bs J, Pa M. Evaluation for airway obstruction in adult patients with stable ischemic heart disease. Indian Heart J 2017; 70:266-271. [PMID: 29716705 PMCID: PMC5993984 DOI: 10.1016/j.ihj.2017.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/03/2017] [Accepted: 08/10/2017] [Indexed: 12/05/2022] Open
Abstract
Background Ischemic heart disease (IHD) and chronic airway disease (COPD and Asthma) are major epidemics accounting for significant mortality and morbidity. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. There is a need for airway evaluation in these patients to plan appropriate management. Methods Consecutive stable IHD patients attending the cardiology OPD in a tertiary care centre were interviewed for collecting basic demographic information, brief medical, occupational, personal history and risk factors for coronary artery disease and airway disease, modified medical research centre (MMRC) grade for dyspnea, quality of life-St. George respiratory questionnaire (SGRQ), spirometry and six-min walk tests. Patients with chronic airway obstruction were treated as per guidelines and were followed up at 3rd month with spirometry, six-minute walk test and SGRQ. Results One hundred fourteen consecutive patients with stable cardiac disease were included (Males-88, Females-26). Mean age was 58.89 ± 12.24 years, 53.50% were smokers, 31.56% were alcoholics, 40.35% diabetics, 47.36% hypertensive. Twenty five patients had airway obstruction on spirometry (COPD-13 and Asthma-12) and none were on treatment. Thirty-one patients had cough and 48 patients had dyspnea. Patients with abnormal spirometry had higher symptoms, lower exercise tolerance and quality of life. Treatment with appropriate respiratory medications resulted in increase in lung function, quality of life and exercise tolerance at 3rd month. Conclusion Chronic respiratory disease in patients with stable IHD is frequent but often missed due to overlap of symptoms. Spirometry is a simple tool to recognize the underlying pulmonary condition and patients respond favorably with appropriate treatment
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Affiliation(s)
- M Mahendra
- JSS Medical College, JSS University, Mysore, India.
| | | | | | - Jayaraj Bs
- JSS Medical College, JSS University, Mysore, India.
| | - Mahesh Pa
- JSS Medical College, JSS University, Mysore, India.
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