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Patiño-García A, Guruceaga E, Andueza MP, Ocón M, Fodop Sokoudjou JJ, de Villalonga Zornoza N, Alkorta-Aranburu G, Uria IT, Gurpide A, Camps C, Jantus-Lewintre E, Navamuel-Andueza M, Sanmamed MF, Melero I, Elgendy M, Fusco JP, Zulueta JJ, de-Torres JP, Bastarrika G, Seijo L, Pio R, Montuenga LM, Hernáez M, Ochoa I, Perez-Gracia JL. Whole exome sequencing and machine learning germline analysis of individuals presenting with extreme phenotypes of high and low risk of developing tobacco-associated lung adenocarcinoma. EBioMedicine 2024; 102:105048. [PMID: 38484556 PMCID: PMC10955643 DOI: 10.1016/j.ebiom.2024.105048] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Tobacco is the main risk factor for developing lung cancer. Yet, while some heavy smokers develop lung cancer at a young age, other heavy smokers never develop it, even at an advanced age, suggesting a remarkable variability in the individual susceptibility to the carcinogenic effects of tobacco. We characterized the germline profile of subjects presenting these extreme phenotypes with Whole Exome Sequencing (WES) and Machine Learning (ML). METHODS We sequenced germline DNA from heavy smokers who either developed lung adenocarcinoma at an early age (extreme cases) or who did not develop lung cancer at an advanced age (extreme controls), selected from databases including over 6600 subjects. We selected individual coding genetic variants and variant-rich genes showing a significantly different distribution between extreme cases and controls. We validated the results from our discovery cohort, in which we analysed by WES extreme cases and controls presenting similar phenotypes. We developed ML models using both cohorts. FINDINGS Mean age for extreme cases and controls was 50.7 and 79.1 years respectively, and mean tobacco consumption was 34.6 and 62.3 pack-years. We validated 16 individual variants and 33 variant-rich genes. The gene harbouring the most validated variants was HLA-A in extreme controls (4 variants in the discovery cohort, p = 3.46E-07; and 4 in the validation cohort, p = 1.67E-06). We trained ML models using as input the 16 individual variants in the discovery cohort and tested them on the validation cohort, obtaining an accuracy of 76.5% and an AUC-ROC of 83.6%. Functions of validated genes included candidate oncogenes, tumour-suppressors, DNA repair, HLA-mediated antigen presentation and regulation of proliferation, apoptosis, inflammation and immune response. INTERPRETATION Individuals presenting extreme phenotypes of high and low risk of developing tobacco-associated lung adenocarcinoma show different germline profiles. Our strategy may allow the identification of high-risk subjects and the development of new therapeutic approaches. FUNDING See a detailed list of funding bodies in the Acknowledgements section at the end of the manuscript.
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Affiliation(s)
- Ana Patiño-García
- Department of Pediatrics and Clinical Genetics, Clínica Universidad de Navarra (CUN), Cancer Center Clínica Universidad de Navarra (CCUN), Program in Solid Tumors, Center for Applied Medical Research (Cima) and Navarra Institute for Health Research (IdisNA), University of Navarra, Pamplona, Spain
| | - Elizabeth Guruceaga
- Bioinformatics Platform, Cima and IdisNA, University of Navarra, Pamplona, Spain
| | - Maria Pilar Andueza
- Department of Oncology, CUN, CCUN and IdisNA, University of Navarra, Pamplona, Spain
| | - Marimar Ocón
- Pulmonary Department, CUN, CCUN and IdisNA, University of Navarra, Pamplona, Spain
| | | | | | | | - Ibon Tamayo Uria
- Bioinformatics Platform, Cima and IdisNA, University of Navarra, Pamplona, Spain
| | - Alfonso Gurpide
- Department of Oncology, CUN, CCUN and IdisNA, University of Navarra, Pamplona, Spain
| | - Carlos Camps
- Department of Medical Oncology, Hospital General Universitario de Valencia, Unidad Mixta TRIAL (Fundación para la Investigación del Hospital General Universitario de Valencia y Centro de Investigación Príncipe Felipe) and Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Valencia, Spain
| | - Eloísa Jantus-Lewintre
- Department of Biotechnology, Universitat Politècnica de València, Unidad Mixta TRIAL (Fundación para la Investigación del Hospital General Universitario de Valencia y Centro de Investigación Príncipe Felipe) and CIBERONC, Valencia, Spain
| | | | - Miguel F Sanmamed
- Department of Oncology, CUN, Division of Immunology, Cima, CCUN, IdisNA and CIBERONC, University of Navarra, Pamplona, Spain
| | - Ignacio Melero
- Division of Immunology, Cima and Immunotherapy, CUN, CCUN, IdisNA and CIBERONC, University of Navarra, Pamplona, Spain
| | - Mohamed Elgendy
- Institute for Clinical Chemistry and Laboratory Medicine, Mildred-Scheel Early Career Center, National Center for Tumor Diseases Dresden (NCT/UCC), University Hospital and Faculty of Medicine, Medical Clinic I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Laboratory of Cancer Cell Biology, Institute of Molecular Genetics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Juan Pablo Fusco
- Department of Medical Oncology Hospital La Luz, Quirón, Madrid, Spain
| | - Javier J Zulueta
- Pulmonary, Critical Care, and Sleep Division, Mount Sinai Morningside Hospital, New York, USA
| | - Juan P de-Torres
- Pulmonary Department, CUN, CCUN and IdisNA, University of Navarra, Pamplona, Spain
| | | | - Luis Seijo
- Pulmonary Department, CUN, CCUN and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), University of Navarra, Madrid, Spain
| | - Ruben Pio
- Program in Solid Tumors, Cima -CCUN, Department of Biochemistry and Genetics, School of Science, IdisNA and CIBERONC, University of Navarra, Pamplona, Spain
| | - Luis M Montuenga
- Program in Solid Tumors, Cima, Department of Pathology, Anatomy and Physiology, Schools of Medicine and Sciences, CCUN, IdisNA and CIBERONC, University of Navarra, Pamplona, Spain
| | - Mikel Hernáez
- Computational Biology Program, Cima, Data Science and Artificial Intelligence Institute (DATAI), CCUN, IdisNA and CIBERONC, University of Navarra, Pamplona, Spain
| | - Idoia Ochoa
- Electrical and Electronic Engineering Department, Tecnun, DATAI, University of Navarra, San Sebastian, Spain
| | - Jose Luis Perez-Gracia
- Department of Oncology, CUN, CCUN, IdisNA and CIBERONC, University of Navarra, Pamplona, Spain.
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de-Torres JP, Alcaide AB, Campo A, Zulueta JJ, Bastarrika G, Ezponda A, Mesa M, Murillo D, Rodriguez M, Del Mar Ocón M, Felgueroso C, Pueyo J, Lozano MD, Montuenga LM, Berto J, Perez-Warnisher MT, Di-Frisco IM, Seijo LM. Lung Cancer Screening in People With COPD: The Pamplona-IELCAP Experience. Arch Bronconeumol 2024; 60:95-100. [PMID: 38216404 DOI: 10.1016/j.arbres.2023.12.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION The Global Initiative for Obstructive Lung Disease (GOLD) recommends lung cancer screening for patients with Chronic Obstructive Pulmonary Disease (COPD), but data is lacking regarding results of screening in this high-risk population. The main goal of the present work is to explore if lung cancer screening with Low Dose Chest Tomography (LDCT) in people with COPD, allows lung cancer (LC) diagnosis in early stages with survival compatible with curative state. METHODS This is a post hoc exploratory analysis. Pamplona International Early Lung Cancer Action Program (P-IELCAP) participants with a GOLD defined obstructive pattern (post bronchodilator FEV1/FVC<0.70) were selected for analysis. The characteristics of those who developed LC and their survival are described. A Cox proportional analysis explored the factors associated with LC diagnosis. RESULTS Eight hundred and sixty-five patients (77% male, 93% in spirometric GOLD stage 1+2) were followed for 102±63 months. LC prevalence was 2.6% at baseline, with an annual LC diagnosis rate of 0.68%. Early-stage tumors predominated (74%) with a median survival (25-75th percentiles) of 139 (76-185) months. Cumulative tobacco exposure, FEV1%, and emphysema were the main predictors of an LC diagnosis. Eight (11%) patients with COPD had a second LC, most of them in early stage (92%), and 6 (8%) had recurrence. Median survival (25-75th percentiles) in these patients was 168 (108-191) months. CONCLUSIONS Lung cancer screening of selected high-risk participants with COPD allowed the LC diagnosis in early stages with survival compatible with curative state.
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Affiliation(s)
- Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Ana Belén Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Arancha Campo
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Javier J Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Division of Pulmonary, Critical Care and Sleep Medicine/Department of Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Miguel Mesa
- Thoracic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Diego Murillo
- Thoracic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Rodriguez
- Thoracic Surgery Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Del Mar Ocón
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Carmen Felgueroso
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Jesús Pueyo
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Dolores Lozano
- Pathology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Luis M Montuenga
- Solid Tumors Program, Center of Applied Medical Research (CIMA), Cancer Center Clinica Universidad de Navarra (CCUN), University of Navarra and IDISNA, Pamplona, Spain; CIBERONC, Madrid, Spain
| | - Juan Berto
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Teresa Perez-Warnisher
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Isberling Madeleine Di-Frisco
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Luis M Seijo
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain; CIBERES, Madrid, Spain
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de-Torres JP, Casanova C, Marín JM, Cabrera C, Marín M, Ezponda A, Cosio BG, Martínez C, Solanes I, Fuster A, Calle M, Peces-Barba G, Gotera C, Feu-Collado N, Marin A, Alcaide AB, Sangro M, Bastarrika G, Celli BR. Impact of Applying the Global Lung Initiative Criteria for Airway Obstruction in GOLD Defined COPD Cohorts: The BODE and CHAIN Experience. Arch Bronconeumol 2024; 60:10-15. [PMID: 37925245 DOI: 10.1016/j.arbres.2023.10.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts. METHODS COPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated. RESULTS In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE≥3: 9% and 20%; mMRC≥2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality - 33% and 22% respectively. CONCLUSIONS An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice.
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Affiliation(s)
- Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Ciro Casanova
- Pulmonary Department-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Tenerife, Spain
| | - José M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, IIS Aragon & CIBERES, University of Zaragoza, Zaragoza, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Marta Marín
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Borja G Cosio
- Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Mallorca, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Martínez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA-FINBA), Spain
| | - Ingrid Solanes
- Pulmonary Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonia Fuster
- Pulmonary Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | - Myriam Calle
- Department of Respiratory Medicine, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Germán Peces-Barba
- Department of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, CIBERES, Madrid, Spain
| | - Carolina Gotera
- Department of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, CIBERES, Madrid, Spain
| | - Nuria Feu-Collado
- Pulmonary Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Alicia Marin
- Pulmonary Department, Hospital Universitario German Trias y Pujol, Barcelona, Spain
| | - Ana Belén Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Matilde Sangro
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Bartolome R Celli
- Pulmonary Department, Brigham and Women's Hospital, Boston, MA, United States
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Smyth RM, James MD, Vincent SG, Milne KM, Marillier M, Domnik NJ, Parker CM, de-Torres JP, Moran-Mendoza O, Phillips DB, O'Donnell DE, Neder JA. Systemic Determinants of Exercise Intolerance in Patients With Fibrotic Interstitial Lung Disease and Severely Impaired D LCO. Respir Care 2023; 68:1662-1674. [PMID: 37643871 PMCID: PMC10676244 DOI: 10.4187/respcare.11147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND The precise mechanisms driving poor exercise tolerance in patients with fibrotic interstitial lung diseases (fibrotic ILDs) showing a severe impairment in single-breath lung diffusing capacity for carbon monoxide (DLCO < 40% predicted) are not fully understood. Rather than only reflecting impaired O2 transfer, a severely impaired DLCO may signal deranged integrative physiologic adjustments to exercise that jointly increase the burden of exertional symptoms in fibrotic ILD. METHODS Sixty-seven subjects (46 with idiopathic pulmonary fibrosis, 24 showing DLCO < 40%) and 22 controls underwent pulmonary function tests and an incremental cardiopulmonary exercise test with serial measurements of operating lung volumes and 0-10 Borg dyspnea and leg discomfort scores. RESULTS Subjects from the DLCO < 40% group showed lower spirometric values, more severe restriction, and lower alveolar volume and transfer coefficient compared to controls and participants with less impaired DLCO (P < .05). Peak work rate was ∼45% (vs controls) and ∼20% (vs DLCO > 40%) lower in the former group, being associated with lower (and flatter) O2 pulse, an earlier lactate (anaerobic) threshold, heightened submaximal ventilation, and lower SpO2 . Moreover, critically high inspiratory constrains were reached at lower exercise intensities in the DLCO < 40% group (P < .05). In association with the greatest leg discomfort scores, they reported the highest dyspnea scores at a given work rate. Between-group differences lessened or disappeared when dyspnea intensity was related to indexes of increased demand-capacity imbalance, that is, decreasing submaximal, dynamic ventilatory reserve, and inspiratory reserve volume/total lung capacity (P > .05). CONCLUSIONS A severely reduced DLCO in fibrotic ILD signals multiple interconnected derangements (cardiovascular impairment, an early shift to anaerobic metabolism, excess ventilation, inspiratory constraints, and hypoxemia) that ultimately lead to limiting respiratory (dyspnea) and peripheral (leg discomfort) symptoms. DLCO < 40%, therefore, might help in clinical decision-making to indicate the patient with fibrotic ILD who might derive particular benefit from pharmacologic and non-pharmacologic interventions aimed at lessening these systemic abnormalities.
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Affiliation(s)
- Reginald M Smyth
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Kathryn M Milne
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mathieu Marillier
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Nicolle J Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and Department of Biomedical and Molecular Sciences and Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Parker
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Juan P de-Torres
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and Pulmonary Department, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra, Navarra, Spain
| | - Onofre Moran-Mendoza
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada; and School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada.
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Berton DC, Plachi F, James MD, Vincent SG, Smyth RM, Domnik NJ, Phillips DB, de-Torres JP, Nery LE, O'Donnell DE, Neder JA. Dynamic Ventilatory Reserve During Incremental Exercise: Reference Values and Clinical Validation in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1425-1434. [PMID: 37413694 DOI: 10.1513/annalsats.202304-303oc] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/06/2023] [Indexed: 07/08/2023] Open
Abstract
Rationale: Ventilatory demand-capacity imbalance, as inferred based on a low ventilatory reserve, is currently assessed only at peak cardiopulmonary exercise testing (CPET). Peak ventilatory reserve, however, is poorly sensitive to the submaximal, dynamic mechanical ventilatory abnormalities that are key to dyspnea genesis and exercise intolerance. Objectives: After establishing sex- and age-corrected norms for dynamic ventilatory reserve at progressively higher work rates, we compared peak and dynamic ventilatory reserve for their ability to expose increased exertional dyspnea and poor exercise tolerance in mild to very severe chronic obstructive pulmonary disease (COPD). Methods: We analyzed resting functional and incremental CPET data from 275 controls (130 men, aged 19-85 yr) and 359 Global Initiative for Chronic Obstructive Lung Disease patients with stage 1-4 obstruction (203 men) who were prospectively recruited for previous ethically approved studies in three research centers. In addition to peak and dynamic ventilatory reserve (1 - [ventilation / estimated maximal voluntary ventilation] × 100), operating lung volumes and dyspnea scores (0-10 on the Borg scale) were obtained. Results: Dynamic ventilatory reserve was asymmetrically distributed in controls; thus, we calculated its centile distribution at every 20 W. The lower limit of normal (lower than the fifth centile) was consistently lower in women and older subjects. Peak and dynamic ventilatory reserve disagreed significantly in indicating an abnormally low test result in patients: whereas approximately 50% of those with a normal peak ventilatory reserve showed a reduced dynamic ventilatory reserve, the opposite was found in approximately 15% (P < 0.001). Irrespective of peak ventilatory reserve and COPD severity, patients who had a dynamic ventilatory reserve below the lower limit of normal at an isowork rate of 40 W had greater ventilatory requirements, prompting earlier attainment of critically low inspiratory reserve. Consequently, they reported higher dyspnea scores, showing poorer exercise tolerance compared with those with preserved dynamic ventilatory reserve. Conversely, patients with preserved dynamic ventilatory reserve but reduced peak ventilatory reserve reported the lowest dyspnea scores, showing the best exercise tolerance. Conclusions: Reduced submaximal dynamic ventilatory reserve, even in the setting of preserved peak ventilatory reserve, is a powerful predictor of exertional dyspnea and exercise intolerance in COPD. This new parameter of ventilatory demand-capacity mismatch may enhance the yield of clinical CPET in the investigation of activity-related breathlessness in individual patients with COPD and other prevalent cardiopulmonary diseases.
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Affiliation(s)
- Danilo C Berton
- Unidade de Fisiologia Pulmonar, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Franciele Plachi
- Unidade de Fisiologia Pulmonar, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Reginald M Smyth
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Nicolle J Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada; and
| | - Juan P de-Torres
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - Luiz E Nery
- Setor de Função Pulmonar e Fisiologia Clinica do Exercício, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Sciences Centre, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada
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Caballeros Lam M, Pujols P, Ezponda Casajús A, Guillén Valderrama F, García Velloso MJ, Wyss A, García Del Barrio L, Larrache Latasa J, Pueyo Villoslada J, Lozano Escario MD, de-Torres JP, Alcaide Ocaña AB, Campo Ezquibela A, Seijo Maceiras L, Montuenga Badía L, Zulueta J, Iñarrairaegui Bastarrica M, Herrero Santos I, Bastarrika Alemañ G. Lung cancer screening using low-dose CT and FDG-PET in liver transplant recipients. Liver Transpl 2023; 29:1100-1108. [PMID: 36929835 DOI: 10.1097/lvt.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
To address the feasibility of implementing a lung cancer screening program in liver transplant recipients (LTR) targeted to detect early-stage lung cancer one hundred twenty-four LTR (89% male, 59.8+/-8.8 y old), who entered the lung cancer screening program at our hospital were reviewed. The results of the diagnostic algorithm using low-dose CT and F-18-fluorodeoxyglycose positron emission tomography (FDG-PET) were analyzed. Lung cancer was detected in 12 LTR (9.7%), most of which corresponded to the non-small cell subtype. Two of the 12 lung cancers were detected in the baseline study (prevalence of 1.6%), whereas 10 patients were diagnosed with lung cancer in the follow-up (incidence of 8.1%). Considering all cancers, 10 of 12 (83.3%) were diagnosed at stage I, one cancer was diagnosed at stage IIIA, and another one at stage IV. The sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of F-18-fluorodeoxyglycose positron emission tomography to detect malignancy in our cohort were 81.8%,100%, 99.3%, 100%, and 99.3%, respectively. A carefully followed multidisciplinary lung cancer screening algorithm in LTR that includes F-18-fluorodeoxyglycose positron emission tomography and low-dose CT allows lung cancer to be diagnosed at an early stage while reducing unnecessary invasive procedures.
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Affiliation(s)
| | - Paula Pujols
- School of Medicine, University of Navarra, Pamplona, Spain
| | | | | | | | - Alejandra Wyss
- Department of Geological and Mining Engineering. Universidad Politécnica de Madrid
| | | | | | | | | | - Juan P de-Torres
- Department of Pulmonary, Clinica Universidad de Navarra, Pamplona, Spain
| | | | | | | | - Luis Montuenga Badía
- Solid tumors and biomarkers program, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Javier Zulueta
- Department of Pulmonary, Mount Sinai Morningside, New York, USA
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7
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Callejón-Leblic B, Sánchez Espirilla S, Gotera-Rivera C, Santana R, Díaz-Olivares I, Marín JM, Macario CC, Cosio BG, Fuster A, García IS, de-Torres JP, Feu Collado N, Cabrera Lopez C, Amado Diago C, Romero Plaza A, Fraysse LAP, Márquez Martín E, Marín Royo M, Balcells Vilarnau E, Llunell Casanovas A, Martínez González C, Galdíz Iturri JB, Lacárcel Bautista C, Gómez-Ariza JL, Pereira-Vega A, Seijo L, López-Campos JL, Peces-Barba G, García-Barrera T. Metallomic Signatures of Lung Cancer and Chronic Obstructive Pulmonary Disease. Int J Mol Sci 2023; 24:14250. [PMID: 37762552 PMCID: PMC10532173 DOI: 10.3390/ijms241814250] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Lung cancer (LC) is the leading cause of cancer deaths, and chronic obstructive pulmonary disease (COPD) can increase LC risk. Metallomics may provide insights into both of these tobacco-related diseases and their shared etiology. We conducted an observational study of 191 human serum samples, including those of healthy controls, LC patients, COPD patients, and patients with both COPD and LC. We found 18 elements (V, Al, As, Mn, Co, Cu, Zn, Cd, Se, W, Mo, Sb, Pb, Tl, Cr, Mg, Ni, and U) in these samples. In addition, we evaluated the elemental profiles of COPD cases of varying severity. The ratios and associations between the elements were also studied as possible signatures of the diseases. COPD severity and LC have a significant impact on the elemental composition of human serum. The severity of COPD was found to reduce the serum concentrations of As, Cd, and Tl and increased the serum concentrations of Mn and Sb compared with healthy control samples, while LC was found to increase Al, As, Mn, and Pb concentrations. This study provides new insights into the effects of LC and COPD on the human serum elemental profile that will pave the way for the potential use of elements as biomarkers for diagnosis and prognosis. It also sheds light on the potential link between the two diseases, i.e., the evolution of COPD to LC.
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Affiliation(s)
- Belén Callejón-Leblic
- Department of Chemistry, Research Center for Natural Resources, Health and the Environment (RENSMA), Faculty of Experimental Sciences, University of Huelva, Campus El Carmen, Fuerzas Armadas Ave., 21007 Huelva, Spain; (B.C.-L.); (S.S.E.); (J.L.G.-A.)
| | - Saida Sánchez Espirilla
- Department of Chemistry, Research Center for Natural Resources, Health and the Environment (RENSMA), Faculty of Experimental Sciences, University of Huelva, Campus El Carmen, Fuerzas Armadas Ave., 21007 Huelva, Spain; (B.C.-L.); (S.S.E.); (J.L.G.-A.)
- Department of Chemistry, Faculty of Sciences, National University of San Antonio Abad of Cusco, Av. de La Cultura, Cusco 773, Peru
| | - Carolina Gotera-Rivera
- IIS-Jiménez Díaz Foundation, ISCIII-CIBERES, Reyes Católicos Ave., 28040 Madrid, Spain; (C.G.-R.); (R.S.)
| | - Rafael Santana
- IIS-Jiménez Díaz Foundation, ISCIII-CIBERES, Reyes Católicos Ave., 28040 Madrid, Spain; (C.G.-R.); (R.S.)
| | - Isabel Díaz-Olivares
- Beturia Andalusian Foundation for Health Research (FABIS), Ronda Norte, s/n, 21005 Huelva, Spain;
| | - José M. Marín
- Miguel Servet Hospital-IIS Aragon, ISCIII-CIBERES, Paseo de Isabel la Católica, 1-3, 50009 Zaragoza, Spain;
| | - Ciro Casanova Macario
- Pulmonary Department—Research Unit, Hospital Universitario Nuestra Señora de Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Padre Herrera, s/n, 38200 Santa Cruz de Tenerife, Spain;
| | - Borja García Cosio
- Son Espases Hospital, IdISBa, ISCIII-CIBERES, Valldemossa Road, 79, 07120 Palma De Mallorca, Spain;
| | - Antonia Fuster
- Son Llàtzer Hospital, C. de Manacor, 07198 Palma, Spain;
| | - Ingrid Solanes García
- Santa Creu i Sant Pau Hospital, Carrer de St. Antoni Maria Claret, 167, 08025 Barcelona, Spain;
| | - Juan P. de-Torres
- University Clinic of Navarra, Pío XII Ave., 36, 31008 Pamplona, Spain;
| | - Nuria Feu Collado
- Reina Sofía Hospital, Maimonides Institute for Biomedical Research of Córdoba, Menéndez Pidal Ave., s/n, 14004 Córdoba, Spain;
| | - Carlos Cabrera Lopez
- University Hospital of Gran Canaria Dr. Negrín, Respiratory Service, C. Pl. Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canarias, Spain;
| | | | | | | | - Eduardo Márquez Martín
- Virgen del Rocío Hospital, Institute of Biomedicine of Seville (IBiS), ISCIII-CIBERES, Manuel Siurot Ave., s/n, 41013 Seville, Spain;
| | | | - Eva Balcells Vilarnau
- Hospital del Mar, ISCIII-CIBERES, Paseo Marítimo de la Barceloneta, 25, 29, 08003 Barcelona, Spain;
| | | | | | | | | | - José Luis Gómez-Ariza
- Department of Chemistry, Research Center for Natural Resources, Health and the Environment (RENSMA), Faculty of Experimental Sciences, University of Huelva, Campus El Carmen, Fuerzas Armadas Ave., 21007 Huelva, Spain; (B.C.-L.); (S.S.E.); (J.L.G.-A.)
| | - Antonio Pereira-Vega
- Pneumology Area of the Juan Ramón Jiménez Hospital, Ronda Norte, s/n, 21005 Huelva, Spain; (L.A.P.F.); (A.P.-V.)
| | - Luis Seijo
- University Clinic of Navarra, ISCIII-CIBERES, Monforte de Lemos Ave., 28029 Madrid, Spain;
| | - José Luis López-Campos
- Medical-Surgical Unit for Respiratory Diseases, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, Manuel Siurot Ave., s/n, 41013 Sevilla, Spain;
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Carlos III Health Institute, Av. de Monforte de Lemos, 3–5, 28029 Madrid, Spain
| | - Germán Peces-Barba
- IIS-Jiménez Díaz Foundation, ISCIII-CIBERES, Reyes Católicos Ave., 28040 Madrid, Spain; (C.G.-R.); (R.S.)
| | - Tamara García-Barrera
- Department of Chemistry, Research Center for Natural Resources, Health and the Environment (RENSMA), Faculty of Experimental Sciences, University of Huelva, Campus El Carmen, Fuerzas Armadas Ave., 21007 Huelva, Spain; (B.C.-L.); (S.S.E.); (J.L.G.-A.)
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de-Torres JP. "Another Hole in the Wall": The Importance of Centrilobular Emphysema in Patients With COPD. Chest 2023; 164:271-272. [PMID: 37558317 DOI: 10.1016/j.chest.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, and the Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
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9
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Milne KM, James MD, Smyth RM, Vincent SG, Singh N, D'Arsigny CL, de-Torres JP, de Wit K, Johri A, Neder JA, O'Donnell DE, Phillips DB. Neurophysiological mechanisms of exertional dyspnea in post-pulmonary embolism syndrome. J Appl Physiol (1985) 2023; 134:667-677. [PMID: 36701483 DOI: 10.1152/japplphysiol.00677.2022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Following pulmonary embolism (PE), a third of patients develop persistent dyspnea, which is commonly termed the post-PE syndrome. The neurophysiological underpinnings of exertional dyspnea in patients with post-PE syndrome without pulmonary hypertension (PH) are unclear. Thus, the current study determined if abnormally high inspiratory neural drive (IND) due, in part, to residual pulmonary gas-exchange abnormalities, was linked to heightened exertional dyspnea and exercise limitation, in such patients. Fourteen participants with post-PE syndrome (without resting PH) and 14 age-, sex-, and body mass index-matched healthy controls undertook pulmonary function testing and a symptom-limited cycle cardiopulmonary exercise test with measurements of IND (diaphragmatic electromyography), ventilatory requirements for CO2 (V̇e/V̇co2), and perceived dyspnea intensity (modified Borg 0-10 scale). Post-PE (vs. control) had a reduced resting transfer coefficient for carbon monoxide (KCO: 84 ± 15 vs. 104 ± 14%pred, P < 0.001) and peak oxygen uptake (V̇o2peak) (76 ± 14 vs. 124 ± 28%pred, P < 0.001). IND and V̇e/V̇co2 were higher in post-PE than controls at standardized submaximal work rates (P < 0.05). Dyspnea increased similarly in both groups as a function of increasing IND but was higher in post-PE at standardized submaximal work rates (P < 0.05). High IND was associated with low KCO (r = -0.484, P < 0.001), high V̇e/V̇co2 nadir (r = 0.453, P < 0.001), and low V̇o2peak (r = -0.523, P < 0.001). In patients with post-PE syndrome, exercise IND was higher than controls and was associated with greater dyspnea intensity. The heightened IND and dyspnea in post-PE, in turn, were strongly associated with low resting KCO and high exercise V̇e/V̇co2, which suggest important pulmonary gas-exchange abnormalities in this patient population.NEW & NOTEWORTHY This study is the first to show that increased exertional dyspnea in patients with post-pulmonary embolism (PE) syndrome, without overt pulmonary hypertension, was strongly associated with elevated inspiratory neural drive (IND) to the diaphragm during exercise, compared with healthy controls. The greater IND was associated with impairments in pulmonary gas exchange and significant deconditioning. Our results help to explain why many patients with post-PE syndrome report significant dyspnea at relatively low levels of physical activity.
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Affiliation(s)
- Kathryn M Milne
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada.,Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia St. Paul's Hospital, Vancouver, British Columbia, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Reginald M Smyth
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Namisha Singh
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Christine L D'Arsigny
- Department of Critical Care Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Juan P de-Torres
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Kerstin de Wit
- Department of Emergency Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Amer Johri
- Division of Cardiology, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Campus, Kingston, Ontario, Canada.,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
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10
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Smyth RM, Neder JA, James MD, Vincent SG, Milne KM, Marillier M, de-Torres JP, Moran-Mendoza O, O'Donnell DE, Phillips DB. Physiological underpinnings of exertional dyspnoea in mild fibrosing interstitial lung disease. Respir Physiol Neurobiol 2023; 312:104041. [PMID: 36858334 DOI: 10.1016/j.resp.2023.104041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/20/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
The functional disturbances driving "out-of-proportion" dyspnoea in patients with fibrosing interstitial lung disease (f-ILD) showing only mild restrictive abnormalities remain poorly understood. Eighteen patients (10 with idiopathic pulmonary fibrosis) showing preserved spirometry and mildly reduced total lung capacity (≥70% predicted) and 18 controls underwent an incremental cardiopulmonary exercise test with measurements of operating lung volumes and Borg dyspnoea scores. Patients' lower exercise tolerance was associated with higher ventilation (V̇E)/carbon dioxide (V̇CO2) compared with controls (V̇E/V̇CO2 nadir=35 ± 3 versus 29 ± 2; p < 0.001). Patients showed higher tidal volume/inspiratory capacity and lower inspiratory reserve volume at a given exercise intensity, reporting higher dyspnoea scores as a function of both work rate and V̇E. Steeper dyspnoea-work rate slopes were associated with lower lung diffusing capacity, higher V̇E/V̇CO2, and lower peak O2 uptake (p < 0.05). Heightened ventilatory demands in the setting of progressively lower capacity for tidal volume expansion on exertion largely explain higher-than-expected dyspnoea in f-ILD patients with largely preserved dynamic and "static" lung volumes at rest.
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Affiliation(s)
- Reginald M Smyth
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - J Alberto Neder
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Matthew D James
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Sandra G Vincent
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Kathryn M Milne
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada; Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
| | - Mathieu Marillier
- HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France.
| | - Juan P de-Torres
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Onofre Moran-Mendoza
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Denis E O'Donnell
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
| | - Devin B Phillips
- Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital, Kingston, ON, Canada.
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11
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Batista KS, Cézar ID, Benedetto IG, C da Silva RM, Wagner LE, Pereira da Silva D, Sanches PR, Gazzana MB, Knorst MM, de-Torres JP, Neder JA, Berton DC. Continuous Monitoring of Pulse Oximetry During the 6-Minute Walk Test Improves Clinical Outcomes Prediction in COPD. Respir Care 2023; 68:92-100. [PMID: 36167849 PMCID: PMC9993518 DOI: 10.4187/respcare.10091] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Continuous monitoring of SpO2 throughout the 6-min walk test (6MWT) unveiled that some patients with respiratory diseases may present values across the test lower than SpO2 measured at the end of the test. Nevertheless, it remains unclear whether this approach improves the yield of walk-induced desaturation detection in predicting mortality and hospitalizations in patients with COPD. METHODS Four hundred twenty-one subjects (51% males) with mild-very severe COPD underwent a 6MWT with continuous measurement of SpO2 . Exercise desaturation was defined as a fall in SpO2 ≥ 4%. All-cause mortality was assessed up to 6 y of follow-up and the rate of hospitalizations in the year succeeding the 6MWT. RESULTS One hundred forty-nine subjects (35.4%) died during a mean (interquartile) follow-up of 55.5 (30.2-64.1) months. Desaturation was observed in 299/421 (71.0%). SpO2 along the test was < end SpO2 (88 [82-92]% vs 90 [84-93]%, P < .001). Desaturation detected only during (but not at the end of) the test was found in 81/421 (19.2%) participants. Multivariate Cox regression model adjusted for sex, body composition, FEV1, residual volume/total lung capacity ratio, walk distance, O2 supplementation during the test, and comorbidities retained the presence of desaturation either at the end (1.85 [95% CI 1.02-3.36]) or only along the test (2.08 [95% CI 1.09-4.01]) as significant predictors of mortality. The rate of hospitalizations was higher in those presenting with any kind of desaturation compared to those without exercise desaturation. Logistic regression analysis revealed that walking interruption and diffusing capacity of the lung for carbon monoxide predicted desaturation observed only during the test. CONCLUSIONS O2 desaturation missed by end-exercise SpO2 but exposed by measurements during the test was independently associated with all-cause mortality and hospitalizations in subjects with COPD.
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Affiliation(s)
- Kellen S Batista
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Igor Dossin Cézar
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Igor G Benedetto
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Ravena M C da Silva
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Litiele Evelin Wagner
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Danton Pereira da Silva
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo R Sanches
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo B Gazzana
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Marli M Knorst
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
| | - Juan P de-Torres
- Division of Respirology and Sleep Medicine, Kingston Health Science Center and Queen's University, Kingston, Ontario, Canada
| | - J Alberto Neder
- Division of Respirology and Sleep Medicine, Kingston Health Science Center and Queen's University, Kingston, Ontario, Canada
| | - Danilo C Berton
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.
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12
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de-Torres JP, Celli BR. COPD detection in lung cancer screening programmes: "hitting two birds with one stone". Eur Respir J 2022; 60:2201294. [PMID: 37651376 DOI: 10.1183/13993003.01294-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Juan P de-Torres
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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McCartney A, Phillips D, James M, Chan O, Neder JA, de-Torres JP, Domnik NJ, Crinion SJ. Ventilatory neural drive in chronically hypercapnic patients with COPD: effects of sleep and nocturnal noninvasive ventilation. Eur Respir Rev 2022; 31:31/165/220069. [PMID: 36130786 DOI: 10.1183/16000617.0069-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
Sleep brings major challenges for the control of ventilation in humans, particularly the regulation of arterial carbon dioxide pressure (P aCO2 ). In patients with COPD, chronic hypercapnia is associated with increased mortality. Therefore, nocturnal high-level noninvasive positive-pressure ventilation (NIV) is recommended with the intention to reduce P aCO2 down to normocapnia. However, the long-term physiological consequences of P aCO2 "correction" on the mechanics of breathing, gas exchange efficiency and resulting symptoms (i.e. dyspnoea) remain poorly understood. Investigating the influence of sleep on the neural drive to breathe and its translation to the mechanical act of breathing is of foremost relevance to create a solid rationale for the use of nocturnal NIV. In this review, we critically discuss the mechanisms by which sleep influences ventilatory neural drive and mechanical consequences in healthy subjects and hypercapnic patients with advanced COPD. We then discuss the available literature on the effects of nocturnal NIV on ventilatory neural drive and respiratory mechanics, highlighting open avenues for further investigation.
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Affiliation(s)
| | - Devin Phillips
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Matthew James
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - Olivia Chan
- Dept of Medicine, Queen's University, Kingston, ON, Canada
| | - J Alberto Neder
- Dept of Medicine, Queen's University, Kingston, ON, Canada.,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Juan P de-Torres
- Dept of Medicine, Queen's University, Kingston, ON, Canada.,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Nicolle J Domnik
- Dept of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Sophie J Crinion
- Dept of Medicine, Queen's University, Kingston, ON, Canada .,Division of Respirology and Sleep Medicine, Kingston Health Sciences Centre, Kingston, ON, Canada
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14
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Divo MJ, Marin JM, Casanova C, Cabrera Lopez C, Pinto-Plata VM, Marin-Oto M, Polverino F, de-Torres JP, Billheimer D, Celli BR. Comorbidities and mortality risk in adults younger than 50 years of age with chronic obstructive pulmonary disease. Respir Res 2022; 23:267. [PMID: 36167533 PMCID: PMC9516817 DOI: 10.1186/s12931-022-02191-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
Rationale and objective Patients with chronic obstructive pulmonary disease (COPD), usually diagnosed after the 6th decade, frequently suffer from comorbidities. Whether COPD patients 50 years or younger (Young COPD) have similar comorbidities with the same frequency and mortality impact as aged-matched controls or older COPD patients is unknown. Methods We compared comorbidity number, prevalence and type in 3 groups of individuals with ≥ 10 pack-years of smoking: A Young (≤ 50 years) COPD group (n = 160), an age-balanced control group without airflow obstruction (n = 125), and Old (> 50 years) COPD group (n = 1860). We also compared survival between the young COPD and control subjects. Using Cox proportional model, we determined the comorbidities associated with mortality risk and generated Comorbidomes for the “Young” and “Old” COPD groups. Results The severity distribution by GOLD spirometric stages and BODE quartiles were similar between Young and Old COPD groups. After adjusting for age, sex, and pack-years, the prevalence of subjects with at least one comorbidity was 31% for controls, 77% for the Young, and 86% for older COPD patients. Compared to controls, “Young” COPDs’ had a nine-fold increased mortality risk (p < 0.0001). “Comorbidomes” differed between Young and Old COPD groups, with tuberculosis, substance use, and bipolar disorders being distinct comorbidities associated with increased mortality risk in the Young COPD group. Conclusions Young COPD patients carry a higher comorbidity prevalence and mortality risk compared to non-obstructed control subjects. Young COPD differed from older COPD patients by the behavioral-related comorbidities that increase their risk of premature death. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02191-7.
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Affiliation(s)
- Miguel J Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Spaulding Rehabilitation Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - José M Marin
- Respiratory Service, Hospital Universitario Miguel Servet-IISAragón & CIBER Enfermedades Respiratorias, Avda Isabel la Catolica 1-3, 50006, Saragossa, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Carretera del Rosario n 145, 38010, Santa Cruz de Tenerife, Spain
| | - Carlos Cabrera Lopez
- Respiratory Service, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas, Canary Islands, Spain
| | - Victor M Pinto-Plata
- Pulmonary and Critical Care Division Chair, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Marta Marin-Oto
- Pulmonary Department, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | | | - Juan P de-Torres
- Division of Respirology and Sleep Medicine, Queen's University, Kingston, Canada
| | - Dean Billheimer
- BIO5 Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Spaulding Rehabilitation Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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James MD, Phillips DB, Vincent SG, Abdallah SJ, Donovan AA, de-Torres JP, Neder JA, Smith BM, Jensen D, O'Donnell DE. Exertional dyspnoea in patients with mild-to-severe chronic obstructive pulmonary disease (COPD): Neuromechanical mechanisms. J Physiol 2022; 600:4227-4245. [PMID: 35861594 DOI: 10.1113/jp283252] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Dyspnoea during exercise is a common and troublesome symptom reported by patients with chronic obstructive pulmonary disease (COPD) and is linked to an elevated inspiratory neural drive (IND). The precise mechanisms of elevated IND and dyspnoea across the continuum of airflow obstruction severity in COPD remains unclear. The present study sought to determine the mechanisms of elevated IND [by diaphragm EMG, EMGdi (%max)] and dyspnoea during cardiopulmonary exercise testing (CPET) across the continuum of COPD severity. There was a strong association between increasing dyspnoea intensity and EMGdi (%max) during CPET across the COPD continuum despite significant heterogeneity in underlying pulmonary gas exchange and respiratory mechanical impairments. Critical inspiratory constraints occurred at progressively lower ventilation during exercise with worsening severity of COPD. This was associated with the progressively lower resting inspiratory capacity with worsening disease severity. Earlier critical inspiratory constraint was associated with earlier neuromechanical dissociation and greater likelihood of reporting the sensation of 'unsatisfied inspiration'. ABSTRACT In patients with COPD, exertional dyspnoea generally arises when there is imbalance between ventilatory demand and capacity, but the neurophysiological mechanisms are unclear. We therefore determined if disparity between elevated inspiratory neural drive (IND) and tidal volume (VT ) responses (neuromechanical dissociation) impacted dyspnoea intensity and quality during exercise, across the COPD severity spectrum. In this two-centre, cross-sectional observational study, 89 participants with COPD divided into tertiles of FEV1 %predicted (Tertile 1 = FEV1 = 87 ± 9%, Tertile 2 = 60 ± 9%, Tertile 3 = 32 ± 8%) and 18 non-smoking controls, completed a symptom-limited cardiopulmonary exercise tests (CPET) with measurement of IND by diaphragm electromyography [EMGdi (%max)]. The association between increasing dyspnoea intensity and EMGdi (%max) during CPET was strong (r = 0.730, P < 0.001) and not different between the four groups who showed marked heterogeneity in pulmonary gas exchange and mechanical abnormalities. Significant inspiratory constraints (tidal volume/inspiratory capacity (VT /IC) ≥ 70%) and onset of neuromechanical dissociation (EMGdi (%max):VT /IC > 0.75) occurred at progressively lower V̇E from Control to Tertile 3. Lower resting IC meant earlier onset of neuromechanical dissociation, heightened dyspnoea intensity and greater propensity (93% in Tertile 3) to select qualitative descriptors of 'unsatisfied inspiration'. We concluded that, regardless of marked variation in mechanical and pulmonary gas exchange abnormalities in our study sample, exertional dyspnoea intensity was linked to the magnitude of EMGdi (%max). Moreover, onset of critical inspiratory constraints and attendant neuromechanical dissociation amplified dyspnoea intensity at higher exercise intensities. Simple measurements of IC and breathing pattern during CPET provide useful insights into mechanisms of dyspnoea and exercise intolerance in individuals with COPD. Abstract figure legend As chronic obstructive pulmonary disease severity increases, worsening gas exchange and respiratory mechanical impairment causes increased afferent receptor stimulation, increasing inspiratory neural drive at a given ventilation. The widening disparity between progressively greater inspiratory neural drive and reduced ventilatory output causes, 'neuromechanical dissociation'. This is strongly associated with a rapid increase in the intensity of dyspnea during exercise, and the onset of the sensation of 'unsatisfied inspiration'. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Sara J Abdallah
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Quebec, Canada.,Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Adamo A Donovan
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Juan P de-Torres
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Benjamin M Smith
- Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Quebec, Canada.,Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | -
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
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16
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Phillips DB, Elbehairy AF, James MD, Vincent SG, Milne KM, de-Torres JP, Neder JA, Kirby M, Jensen D, Stickland MK, Guenette JA, Smith BM, Aaron SD, Tan WC, Bourbeau J, O'Donnell DE. Impaired Ventilatory Efficiency, Dyspnea and Exercise Intolerance in Chronic Obstructive Pulmonary Disease: Results from the CanCOLD Study. Am J Respir Crit Care Med 2022; 205:1391-1402. [PMID: 35333135 DOI: 10.1164/rccm.202109-2171oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Impaired exercise ventilatory efficiency (high ventilatory requirements for CO2 [V̇E/V̇CO2]) provides an indication of pulmonary gas exchange abnormalities in chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine: 1) the association between high V̇E/V̇CO2 and clinical outcomes (dyspnea and exercise capacity) and its relationship to lung function and structural radiographic abnormalities; and 2) its prevalence in a large population-based cohort. METHODS Participants were recruited randomly from the population and underwent clinical evaluation, pulmonary function, cardiopulmonary exercise testing and chest computed tomography (CT). Impaired exercise ventilatory efficiency was defined by a nadir V̇E/V̇CO2 above the upper limit of normal (V̇E/V̇CO2>ULN), using population-based normative values. MEASUREMENTS AND MAIN RESULTS Participants included 445 never-smokers, 381 ever-smokers without airflow obstruction, 224 with GOLD 1 COPD, and 200 with GOLD 2-4 COPD. Participants with V̇E/V̇CO2>ULN were more likely to have activity-related dyspnea (Medical Research Council dyspnea scale≥2, odds ratio=1.77[1.31-2.39]) and abnormally low peak oxygen uptake (V̇O2peak<LLN, odds ratio=4.58[3.06-6.86]). The carbon monoxide transfer coefficient (KCO) had a stronger correlation with nadir V̇E/V̇CO2 (r=-0.38, p<0.001) than other relevant lung function and CT metrics. The prevalence of V̇E/V̇CO2>ULN was 24% in COPD (similar in GOLD 1 and 2-4), which was greater than in never-smokers (13%) and ever-smokers (12%). CONCLUSIONS V̇E/V̇CO2>ULN was associated with greater dyspnea and low VO2peak and was present in 24% of all participants with COPD, regardless of GOLD stage. The results show the importance of recognizing impaired exercise ventilatory efficiency as a potential contributor to dyspnea and exercise limitation, even in mild COPD.
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Affiliation(s)
| | - Amany F Elbehairy
- Queen's University and Kingston General Hospital, Medicine, Kingston, Ontario, Canada.,Alexandria University, Department of Chest Diseases, Faculty of Medicine, Alexandria, Egypt
| | - Matthew D James
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | | | - Kathryn M Milne
- The University of British Columbia, 8166, Medicine, Vancouver, British Columbia, Canada
| | | | - J Alberto Neder
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | - Miranda Kirby
- Ryerson University, Physics, Toronto, Ontario, Canada
| | - Dennis Jensen
- McGill University, Kinesiology & Physical Education, Montreal, Quebec, Canada
| | | | | | - Benjamin M Smith
- McGill University, Respiratory Medicine, Montreal, Quebec, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Wan C Tan
- Providence Heart & Lung Institute, University of British Columbia, St Paul's Hospital, UBC James Hogg Research Centre, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Montreal Chest Institute, CORE, Montreal, Quebec, Canada.,McGill University Health Centre, 54473, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Queen's University, Division of Respiratory and Critical Care Medicine, Department of Medicine, Kingston, Ontario, Canada;
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17
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de-Torres JP, Wisnivesky JP. Lung Cancer Screening in Patients With Chronic Obstructive Pulmonary Disease: Do the Benefits Outweigh the Risks? Arch Bronconeumol 2021; 57:679-680. [PMID: 35699004 DOI: 10.1016/j.arbr.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Juan P de-Torres
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Ezponda A, Casanova C, Cabrera C, Martin-Palmero Á, Marin-Oto M, Marín JM, Pinto-Plata V, Divo M, Celli BR, Zulueta JJ, Bastarrika G, de-Torres JP. Psoas Muscle Density Evaluated by Chest CT and Long-Term Mortality in COPD Patients. Arch Bronconeumol 2021; 57:533-539. [PMID: 35699031 DOI: 10.1016/j.arbr.2021.04.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/08/2021] [Indexed: 06/15/2023]
Abstract
RATIONALE Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. METHODS At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65±8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. RESULTS PsD was lower in COPD patients than in controls (40.5 vs 42.5, p=0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p=0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p=0.023) were the variables independently associated with all-cause mortality. CONCLUSIONS In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.
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Affiliation(s)
- Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain; Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | | | - Marta Marin-Oto
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud & CIBERES, Zaragoza, Spain
| | | | - Miguel Divo
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bartolome R Celli
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier J Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P de-Torres
- Respirology and Sleep Division, Queen's University, Kingston, Canada; Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
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19
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Ezponda A, Casanova C, Cabrera C, Martin-Palmero Á, Marin-Oto M, Marín JM, Pinto-Plata V, Divo M, Celli BR, Zulueta JJ, Bastarrika G, de-Torres JP. Psoas Muscle Density Evaluated by Chest CT and Long-Term Mortality in COPD Patients. Arch Bronconeumol 2021; 57:S0300-2896(21)00133-2. [PMID: 33994243 DOI: 10.1016/j.arbres.2021.04.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
RATIONALE Poor muscle quality in COPD patients relates to exercise intolerance and mortality. Muscle quality can be estimated on computed tomography (CT) by estimating psoas density (PsD). We tested the hypothesis that PsD is lower in COPD patients than in controls and relates to all-cause mortality. METHODS At baseline, PsD was measured using axial low-dose chest CT images in 220 COPD patients, 80% men, who were 65±8 years old with mild to severe airflow limitation and in a control group of 58 subjects matched by age, sex, body mass index (BMI) and body surface area (BSA). COPD patients were prospectively followed for 76.5 (48-119) months. Anthropometrics, smoking history, BMI, dyspnoea, lung function, exercise capacity, BODE index and exacerbations history were recorded. Cox proportional risk analysis determined the factors more strongly associated with long-term mortality. RESULTS PsD was lower in COPD patients than in controls (40.5 vs 42.5, p=0.045). During the follow-up, 54 (24.5%) deaths occurred in the COPD group. PsD as well as age, sex, pack-year history, FEV1%, 6MWD, mMRC, BODE index, were independently associated with mortality. Multivariate analysis showed that age (HR 1.06; 95% CI 1.02-1.12, p=0.006) and CT-assessed PsD (HR 0.97; 95%CI 0.94-0.99, p=0.023) were the variables independently associated with all-cause mortality. CONCLUSIONS In COPD patients with mild to severe airflow limitation, chest CT-assessed psoas muscle density was lower than in matched controls and independently associated with long-term mortality. Muscle quality using the easy to evaluate psoas muscle density from chest CT may provide clinicians with important prognostic information in COPD.
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Affiliation(s)
- Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain; Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | | | - Marta Marin-Oto
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud & CIBERES, Zaragoza, Spain
| | | | - Miguel Divo
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bartolome R Celli
- Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier J Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P de-Torres
- Respirology and Sleep Division, Queen's University, Kingston, Canada; Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
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20
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de-Torres JP, Wisnivesky JP. Lung Cancer Screening in Patients With Chronic Obstructive Pulmonary Disease: Do the Benefits Outweigh the Risks? Arch Bronconeumol 2021; 57:S0300-2896(21)00141-1. [PMID: 34016466 DOI: 10.1016/j.arbres.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Juan P de-Torres
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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21
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de-Torres JP, O'Donnell DE, Marín JM, Cabrera C, Casanova C, Marín M, Ezponda A, Cosio BG, Martinez C, Solanes I, Fuster A, Neder JA, Gonzalez-Gutierrez J, Celli BR. Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD. Chest 2021; 160:872-878. [PMID: 33901498 DOI: 10.1016/j.chest.2021.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored. RESEARCH QUESTION Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients? STUDY DESIGN AND METHODS GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality. RESULTS A Dlco cutoff value of <60% predicted was associated with all-cause mortality (Dlco ≥ 60%: 9% vs Dlco < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with Dlco < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a Dlco < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined.
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Affiliation(s)
- Juan P de-Torres
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada.
| | - Denis E O'Donnell
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
| | - Jose M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud & CIBERES, Zaragoza, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain and Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain
| | - Marta Marín
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Borja G Cosio
- Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Mallorca, Spain, and Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Cristina Martinez
- Department of Respiratory Medicine, Hospital Central de Asturias, Oviedo, Spain
| | - Ingrid Solanes
- Pulmonary Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonia Fuster
- Pulmonary Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | - J Alberto Neder
- Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
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22
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Phillips DB, James MD, Elbehairy AF, Milne KM, Vincent SG, Domnik NJ, de-Torres JP, Neder JA, O'Donnell DE. Reduced exercise tolerance in mild chronic obstructive pulmonary disease: The contribution of combined abnormalities of diffusing capacity for carbon monoxide and ventilatory efficiency. Respirology 2021; 26:786-795. [PMID: 33829588 DOI: 10.1111/resp.14045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The combination of both reduced resting diffusing capacity of the lung for carbon monoxide (DLCO ) and ventilatory efficiency (increased ventilatory requirement for CO2 clearance [V˙E /V˙CO2 ]) has been linked to exertional dyspnoea and exercise intolerance in chronic obstructive pulmonary disease (COPD) but the underlying mechanisms are poorly understood. The current study examined if low resting DLCO and higher exercise ventilatory requirements were associated with earlier critical dynamic mechanical constraints, dyspnoea and exercise limitation in patients with mild COPD. METHODS In this retrospective analysis, we compared V˙E /V˙CO2 , dynamic inspiratory reserve volume (IRV), dyspnoea and exercise capacity in groups of patients with Global Initiative for Chronic Obstructive Lung Disease stage 1 COPD with (1) a resting DLCO at or greater than the lower limit of normal (≥LLN; Global Lung Function Initiative reference equations [n = 44]) or (2) below the <LLN (n = 33), and age- and sex-matched healthy controls (n = 81). RESULTS Spirometry and resting lung volumes were similar in the two COPD groups. During exercise, V˙E /V˙CO2 (nadir and slope) was consistently higher in the DLCO < LLN compared with the other groups (all p < 0.05). The DLCO < LLN group had lower IRV and greater dyspnoea intensity at standardized submaximal work rates and lower peak work rate and oxygen uptake than the other two groups (all p < 0.05). CONCLUSION Reduced exercise capacity in patients with DLCO < LLN was related to higher ventilatory requirements, a faster rate of decline in dynamic IRV and greater dyspnoea during exercise. These simple measurements should be considered for the clinical evaluation of unexplained exercise intolerance in individuals with ostensibly mild COPD.
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Affiliation(s)
- Devin B Phillips
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Amany F Elbehairy
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada.,Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kathryn M Milne
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada.,Department of Medicine Clinician Investigator Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Nicolle J Domnik
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Juan P de-Torres
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston General Hospital Campus, Kingston, Ontario, Canada
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Neder JA, Milne KM, Berton DC, de-Torres JP, Jensen D, Tan WC, Bourbeau J, O'Donnell DE. Exercise Tolerance according to the Definition of Airflow Obstruction in Smokers. Am J Respir Crit Care Med 2020; 202:760-762. [PMID: 32343595 DOI: 10.1164/rccm.202002-0298le] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Kathryn M Milne
- Queen's University Kingston, Ontario, Canada.,University of British Columbia Vancouver, British Columbia, Canada
| | - Danilo C Berton
- Queen's University Kingston, Ontario, Canada.,Federal University of Rio Grande do Sul Porto Alegre, Brazil and
| | | | | | - Wan C Tan
- University of British Columbia Vancouver, British Columbia, Canada
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García Castillo E, Alonso Pérez T, Ancochea J, Pastor Sanz MT, Almagro P, Martínez-Camblor P, Miravitlles M, Rodríguez-Carballeira M, Navarro A, Lamprecht B, Ramírez-García Luna AS, Kaiser B, Alfageme I, Casanova C, Esteban C, Soler-Cataluña JJ, de-Torres JP, Celli BR, Marín JM, Ter Riet G, Sobradillo P, Lange P, Garcia-Aymerich J, Anto JM, Turner AM, Han MK, Langhammer A, Vikjord SAA, Sternberg A, Leivseth L, Bakke P, Johannessen A, Oga T, Cosío BG, Echazarreta A, Roche N, Burgel PR, Sin DD, Puhan MA, López-Campos JL, Carrasco L, Soriano JB. Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2015 and GOLD 2019 staging: a pooled analysis of individual patient data. ERJ Open Res 2020; 6:00253-2020. [PMID: 33263033 PMCID: PMC7682666 DOI: 10.1183/23120541.00253-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/31/2020] [Indexed: 01/24/2023] Open
Abstract
In 2019, The Global Initiative for Chronic Obstructive Lung Disease (GOLD) modified the grading system for patients with COPD, creating 16 subgroups (1A–4D). As part of the COPD Cohorts Collaborative International Assessment (3CIA) initiative, we aim to compare the mortality prediction of the 2015 and 2019 COPD GOLD staging systems. We studied 17 139 COPD patients from the 3CIA study, selecting those with complete data. Patients were classified by the 2015 and 2019 GOLD ABCD systems, and we compared the predictive ability for 5-year mortality of both classifications. In total, 17 139 patients with COPD were enrolled in 22 cohorts from 11 countries between 2003 and 2017; 8823 of them had complete data and were analysed. Mean±sd age was 63.9±9.8 years and 62.9% were male. GOLD 2019 classified the patients in milder degrees of COPD. For both classifications, group D had higher mortality. 5-year mortality did not differ between groups B and C in GOLD 2015; in GOLD 2019, mortality was greater for group B than C. Patients classified as group A and B had better sensitivity and positive predictive value with the GOLD 2019 classification than GOLD 2015. GOLD 2015 had better sensitivity for group C and D than GOLD 2019. The area under the curve values for 5-year mortality were only 0.67 (95% CI 0.66–0.68) for GOLD 2015 and 0.65 (95% CI 0.63–0.66) for GOLD 2019. The new GOLD 2019 classification does not predict mortality better than the previous GOLD 2015 system. GOLD 2019 staging system created 16 subgroups. GOLD 2015 and GOLD 2019 are not strong predictors of mortality, and do not have sufficient discriminatory power to be used as a tool for risk classification of mortality in patients with COPD.https://bit.ly/3idBuaN
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Affiliation(s)
- Elena García Castillo
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,These authors contributed equally
| | - Tamara Alonso Pérez
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,These authors contributed equally
| | - Julio Ancochea
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Teresa Pastor Sanz
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Barcelona, Spain
| | | | - Marc Miravitlles
- Pneumology Dept, Hospital Universitary Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Annie Navarro
- Pneumology Service, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Bernd Lamprecht
- Dept of Pulmonary Medicine, Kepler-University-Hospital, Faculty of Medicine, Johannes-Kepler-University Linz, Linz, Austria
| | | | - Bernhard Kaiser
- Dept of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Inmaculada Alfageme
- Departamento de Medicina, Universidad de Sevilla, HU Virgen de Valme, Seville, Spain
| | - Ciro Casanova
- Pulmonary Department, Research Unit, Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna, Tenerife, Spain
| | - Cristóbal Esteban
- Pulmonary Department, Research Unit, Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna, Tenerife, Spain
| | | | - Juan P de-Torres
- Clinica Universidad de Navarra, Pamplona, Spain.,Respirology and Sleep Medicine Division, Queen's University, Kingston, Canada
| | - Bartolomé R Celli
- Pulmonary and Critical Care Medicine, Harvard University, Brigham and Women's Hospital, Boston, MA, USA
| | - Jose M Marín
- Hospital Universitario Miguel Servet, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Dept of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | | | - Peter Lange
- Section of Social Medicine, Dept of Public Health, Copenhagen University, Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Josep M Anto
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - MeiLan K Han
- Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Arnulf Langhammer
- Dept of Public Health and Nursing, NTNU (Norwegian University of Science and Technology), Trondheim, Norway.,Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Alice Sternberg
- Dept of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromso, Norway
| | - Per Bakke
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Ane Johannessen
- Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Toru Oga
- Dept of Respiratory Care and Sleep Control Medicine, Kyoto University, Kyoto, Japan
| | - Borja G Cosío
- Hospital Universitario Son Espases-IdISPa, Mallorca, Spain
| | - Andrés Echazarreta
- Servicio de Neumonología, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | - Nicolás Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
| | - Pierre-Régis Burgel
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, Vancouver, BC, Canada.,Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jose Luis López-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Unidad Médico Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Laura Carrasco
- Unidad Médico Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
| | - Joan B Soriano
- Pneumology Dept, Hospital Universitario de la Princesa, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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25
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López-Campos JL, Alcázar Navarrete B, Riesco Miranda JA, Cosío BG, de-Torres JP, Celli B, Jiménez-Ruiz CA, Casanova Macario C. A Delphi Consensus Document on the Use of Single-Inhaler Fixed-Dose Triple Therapies in COPD Patients. Int J Chron Obstruct Pulmon Dis 2020; 15:1801-1811. [PMID: 32884252 PMCID: PMC7435744 DOI: 10.2147/copd.s258818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Despite the evidence provided by clinical trials, there are some uncertainties and controversies regarding the use of triple inhaled therapy. With the aim of evaluating clinical practice in specialized respiratory units, a Delphi consensus document was implemented on the use of single-inhaler fixed-dose triple therapies after 1 year of use in Spain. Methods A scientific committee of COPD experts defined a thematic index, guided a systematic literature review and helped design the Delphi questionnaire. This was sent to the other 45 COPD experts between April and June 2019. Agreement/disagreement on 58 statements was tested in two rounds using a Likert scale. Replies were classified as a consensus when ≥80% of the panelists agreed; a majority when a degree of agreement of ≥66% was reached; and divergence if agreement was <66%. Results After two rounds, 44.44% of the statements reached consensus, 14.81% reached majority and 40.74% were divergent. Panelists agreed that escalating from double bronchodilation should be phenotype-based and aim to prevent exacerbations but not for improving symptoms. The addition of an antimuscarinic to inhaled corticosteroids combinations achieves improvement in lung function, symptoms and exacerbation prevention. Main safety concerns included the increased risk of pneumonia as compared to bronchodilator therapies, with similar cardiovascular effects. There was no consensus agreement on patient type response based on blood eosinophil counts or obstruction severity. Conclusion The low degree of consensus among panelists may reflect the complexity of severe COPD management. The information provided here may be useful to clinicians implementing personalized medicine for COPD patients.
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Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Juan Antonio Riesco Miranda
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario de Cáceres, Cáceres, Spain
| | - Borja G Cosío
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain
| | | | - Bartolomé Celli
- Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA
| | | | - Ciro Casanova Macario
- Servicio de Neumología-Unidad de Investigación, Hospital Universitario La Candelaria, Universidad de La Laguna, La Laguna, Spain
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26
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Gonzalez J, Rivera-Ortega P, Rodríguez-Fraile M, Restituto P, Colina I, Calleja MDLD, Alcaide AB, Campo A, Bertó J, Seijo L, Pérez-Warnisher MT, Zulueta JJ, Varo N, de-Torres JP. Exploring the Association Between Emphysema Phenotypes and Low Bone Mineral Density in Smokers with and without COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1823-1829. [PMID: 32801680 PMCID: PMC7401322 DOI: 10.2147/copd.s257918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
Rationale Emphysema and osteoporosis are tobacco-related diseases. Many studies have shown that emphysema is a strong and independent predictor of low bone mineral density (BMD) in smokers; however, none of them explored its association with different emphysema subtypes. Objective To explore the association between the different emphysema subtypes and the presence of low bone mineral density in a population of active or former smokers with and without chronic obstructive pulmonary disease (COPD). Methods One hundred and fifty-three active and former smokers from a pulmonary clinic completed clinical questionnaires, pulmonary function tests, a low-dose chest computed tomography (LDCT) and a dual-energy absorptiometry (DXA) scans. Subjects were classified as having normal BMD or low BMD (osteopenia or osteoporosis). Emphysema was classified visually for its subtype and severity. Logistic regression analysis explored the relationship between the different emphysema subtypes and the presence of low BMD adjusting for other important factors. Results Seventy-five percent of the patients had low BMD (78 had osteopenia and 37 had osteoporosis). Emphysema was more frequent (66.1 vs 26.3%, p=<0.001) and severe in those with low BMD. Multivariable analysis adjusting for other significant cofactors (age, sex, FEV1, and severity of emphysema) showed that BMI (OR=0.91, 95% CI: 0.76–0.92) and centrilobular emphysema (OR=26.19, 95% CI: 1.71 to 399.44) were associated with low BMD. Conclusion Low BMD is highly prevalent in current and former smokers. BMI and centrilobular emphysema are strong and independent predictors of its presence, which suggests that they should be considered when evaluating smokers at risk for low BMD.
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Affiliation(s)
- Jessica Gonzalez
- Pulmonary Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | - Patricia Restituto
- Biochemistry Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Inmaculada Colina
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Ana B Alcaide
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Aránzazu Campo
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Juan Bertó
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Luis Seijo
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain
| | | | - Javier J Zulueta
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Nerea Varo
- Biochemistry Department, Clínica Universitaria de Navarra, Pamplona, Spain
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27
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Divo MJ, Marin Oto M, Casanova Macario C, Cabrera Lopez C, de-Torres JP, Marin Trigo JM, Hersh CP, Ezponda Casajús A, Maguire C, Pinto-Plata VM, Polverino F, Ross JC, DeMeo D, Bastarrika G, Silverman EK, Celli BR. Somatotypes trajectories during adulthood and their association with COPD phenotypes. ERJ Open Res 2020; 6:00122-2020. [PMID: 32963991 PMCID: PMC7487345 DOI: 10.1183/23120541.00122-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) comprises distinct phenotypes, all characterised by airflow limitation. OBJECTIVES We hypothesised that somatotype changes - as a surrogate of adiposity - from early adulthood follow different trajectories to reach distinct phenotypes. METHODS Using the validated Stunkard's Pictogram, 356 COPD patients chose the somatotype that best reflects their current body build and those at ages 18, 30, 40 and 50 years. An unbiased group-based trajectory modelling was used to determine somatotype trajectories. We then compared the current COPD-related clinical and phenotypic characteristics of subjects belonging to each trajectory. MEASUREMENTS AND MAIN RESULTS At 18 years of age, 88% of the participants described having a lean or medium somatotype (estimated body mass index (BMI) between 19 and 23 kg·m-2) while the other 12% a heavier somatotype (estimated BMI between 25 and 27 kg·m-2). From age 18 onwards, five distinct trajectories were observed. Four of them demonstrating a continuous increase in adiposity throughout adulthood with the exception of one, where the initial increase was followed by loss of adiposity after age 40. Patients with this trajectory were primarily females with low BMI and D LCO (diffusing capacity of the lung for carbon monoxide). A persistently lean trajectory was seen in 14% of the cohort. This group had significantly lower forced expiratory volume in 1 s (FEV1), D LCO, more emphysema and a worse BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) score thus resembling the multiple organ loss of tissue (MOLT) phenotype. CONCLUSIONS COPD patients have distinct somatotype trajectories throughout adulthood. Those with the MOLT phenotype maintain a lean trajectory throughout life. Smoking subjects with this lean phenotype in early adulthood deserve particular attention as they seem to develop more severe COPD.
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Affiliation(s)
- Miguel J. Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marta Marin Oto
- Pulmonary Dept, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ciro Casanova Macario
- Pulmonary Dept and Research Unit, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Carlos Cabrera Lopez
- Respiratory Service, Hospital Universitario de Gran Canaria Dr. Negrin, Canary Islands, Spain
| | | | - Jose Maria Marin Trigo
- Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
- CIBER Enfermedades Respiratorias, Instituto Investigación Sanitaria, Madrid, Spain
| | - Craig P. Hersh
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Boston, MA, USA
| | | | | | | | - Francesca Polverino
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, NM, USA
| | - James C. Ross
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dawn DeMeo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Boston, MA, USA
| | - Gorka Bastarrika
- Dept of Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Edwin K. Silverman
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Boston, MA, USA
| | - Bartolome R. Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sanchez-Carpintero Abad M, Sanchez-Salcedo P, de-Torres JP, Alcaide AB, Seijo LM, Pueyo J, Bastarrika G, Zulueta JJ, Campo A. Prevalence and burden of bronchiectasis in a lung cancer screening program. PLoS One 2020; 15:e0231204. [PMID: 32282811 PMCID: PMC7153864 DOI: 10.1371/journal.pone.0231204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The prevalence of bronchiectasis in the general population and in individuals undergoing lung cancer screening with low dose computed tomography (LDCT) is unknown. The aim of this study is to estimate the prevalence and impact of bronchiectasis in a screening lung cancer program. METHODS 3028 individuals participating in an international multicenter lung cancer screening consortium (I-ELCAP) were selected from 2000 to 2012. Patients with bronchiectasis on baseline CT were identified and compared to selected controls. Detection of nodules, need for additional studies and incidence of cancer were analyzed over the follow-up period. RESULTS The prevalence of bronchiectasis was 11.6%(354/3028). On the baseline LDCT, the number of subjects with nodules identified was 189(53.4%) in patients with bronchiectasis compared to 63(17.8%) in controls (p<0.001). The occurrence of false positives was higher in subjects with bronchiectasis (26%vs17%;p = 0.003). During follow-up, new nodules were more common among subjects with bronchiectasis (17%vs.12%; p = 0.008). The total number of false positives during follow-up was 29(17.06%) for patients with bronchiectasis vs. 88(12.17%) for controls (p = 0.008).The incidence rate of lung cancer during follow-up was 6.8/1000 and 5.1/1000 person-years for each group respectively (p = 0.62). CONCLUSIONS Bronchiectasis are common among current and former smokers undergoing lung cancer screening with LDCT. The presence of bronchiectasis is associated with greater incidence of new nodules and false positives on baseline and follow-up screening rounds. This leads to an increase need of diagnostic tests, although the lung cancer occurrence is not different.
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Affiliation(s)
| | | | - Juan P. de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana B. Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luis M. Seijo
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Jesus Pueyo
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier J. Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Arantza Campo
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
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Sullivan JL, Bagevalu B, Glass C, Sholl L, Kraft M, Martinez FD, Bastarrika G, de-Torres JP, San Jose Estepar R, Guerra S, Polverino F. B Cell-Adaptive Immune Profile in Emphysema-Predominant Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 200:1434-1439. [PMID: 31348682 PMCID: PMC6884042 DOI: 10.1164/rccm.201903-0632le] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stefano Guerra
- University of ArizonaTucson, Arizona.,ISGlobal & Pompeu Fabra UniversityBarcelona, Spainand
| | - Francesca Polverino
- University of ArizonaTucson, Arizona.,Lovelace Respiratory Research InstituteAlbuquerque, New Mexico
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Whittaker Brown SA, Padilla M, Mhango G, Powell C, Salvatore M, Henschke C, Yankelevitz D, Sigel K, de-Torres JP, Wisnivesky J. Interstitial Lung Abnormalities and Lung Cancer Risk in the National Lung Screening Trial. Chest 2019; 156:1195-1203. [PMID: 31404527 DOI: 10.1016/j.chest.2019.06.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/11/2019] [Accepted: 06/25/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Some interstitial lung diseases are associated with lung cancer. However, it is unclear whether asymptomatic interstitial lung abnormalities convey an independent risk. OBJECTIVES The goal of this study was to assess whether interstitial lung abnormalities are associated with an increased risk of lung cancer. METHODS Data from all participants in the National Lung Cancer Trial were analyzed, except for subjects with preexisting interstitial lung disease or prevalent lung cancers. The primary analysis included those who underwent low-dose CT imaging; those undergoing chest radiography were included in a confirmatory analysis. Participants with evidence of reticular/reticulonodular opacities, honeycombing, fibrosis, or scarring were classified as having interstitial lung abnormalities. Lung cancer incidence and mortality in participants with and without interstitial lung abnormalities were compared by using Poisson and Cox regression, respectively. RESULTS Of the 25,041 participants undergoing low-dose CT imaging included in the primary analysis, 20.2% had interstitial lung abnormalities. Participants with interstitial lung abnormalities had a higher incidence of lung cancer (incidence rate ratio, 1.61; 95% CI, 1.30-1.99). Interstitial lung abnormalities were associated with higher lung cancer incidence on adjusted analyses (incidence rate ratio, 1.33; 95% CI, 1.07-1.65). Lung cancer-specific mortality was also greater in participants with interstitial lung abnormalities. Similar findings were obtained in the analysis of participants undergoing chest radiography. CONCLUSIONS Asymptomatic interstitial lung abnormalities are an independent risk factor for lung cancer that can be incorporated into risk score models.
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Affiliation(s)
- Stacey-Ann Whittaker Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Maria Padilla
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Grace Mhango
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Charles Powell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mary Salvatore
- Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claudia Henschke
- Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David Yankelevitz
- Division of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan P de-Torres
- Division of Respiratory Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan Wisnivesky
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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31
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Cabrera López C, Casanova Macario C, Marín Trigo JM, de-Torres JP, Torres RS, González JM, Polverino F, Divo M, Pinto Plata V, Zulueta J, Callejas FJ, Celli B. Validación pronóstica según los criterios de la GesEPOC 2017. Arch Bronconeumol 2019; 55:409-413. [DOI: 10.1016/j.arbres.2018.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/15/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022]
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González J, Henschke CI, Yankelevitz DF, Seijo LM, Reeves AP, Yip R, Xie Y, Chung M, Sánchez-Salcedo P, Alcaide AB, Campo A, Bertó J, del Mar Ocón M, Pueyo J, Bastarrika G, de-Torres JP, Zulueta JJ. Emphysema phenotypes and lung cancer risk. PLoS One 2019; 14:e0219187. [PMID: 31344121 PMCID: PMC6657833 DOI: 10.1371/journal.pone.0219187] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background To assess the relationship between lung cancer and emphysema subtypes. Objective Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment. Methods Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clínica Universidad de Navarra’s lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes. Results Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6). Conclusions Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk.
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Affiliation(s)
- Jessica González
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Claudia I. Henschke
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | - David F. Yankelevitz
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | - Luis M. Seijo
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Anthony P. Reeves
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States of America
- D4Vision, Inc, Ithaca, NY, United States of America
| | - Rowena Yip
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | - Yiting Xie
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States of America
| | - Michael Chung
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | | | - Ana B. Alcaide
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Aranzazu Campo
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan Bertó
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Jesus Pueyo
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P. de-Torres
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra’s Health Research Institute (IDISNA), Pamplona, Spain
| | - Javier J. Zulueta
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra’s Health Research Institute (IDISNA), Pamplona, Spain
- CIBERONC, ISCIII, Madrid, Spain
- VisionGate, Inc, Phoenix, Arizona, United States of America
- * E-mail:
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Almagro P, Martínez-Camblor P, Miravitlles M, Rodríguez-Carballeira M, Navarro A, Lamprecht B, Ramirez-Garcia Luna AS, Kaiser B, Alfageme I, Casanova C, Esteban C, Soler-Cataluña JJ, de-Torres JP, Celli BR, Marin JM, Ter Riet G, Sobradillo P, Lange P, Garcia-Aymerich J, Anto JM, Turner AM, Han MK, Langhammer A, Sternberg A, Leivseth L, Bakke P, Johannessen A, Oga T, Cosío B, Ancochea J, Echazarreta A, Roche N, Burgel PR, Sin DD, Puhan MA, Soriano JB. External Validation and Recalculation of the CODEX Index in COPD Patients. A 3CIAplus Cohort Study. COPD 2019; 16:8-17. [PMID: 30870059 DOI: 10.1080/15412555.2018.1484440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The CODEX index was developed and validated in patients hospitalized for COPD exacerbation to predict the risk of death and readmission within one year after discharge. Our study aimed to validate the CODEX index in a large external population of COPD patients with variable durations of follow-up. Additionally, we aimed to recalculate the thresholds of the CODEX index using the cutoffs of variables previously suggested in the 3CIA study (mCODEX). Individual data on 2,755 patients included in the COPD Cohorts Collaborative International Assessment Plus (3CIA+) were explored. A further two cohorts (ESMI AND EGARPOC-2) were added. To validate the CODEX index, the relationship between mortality and the CODEX index was assessed using cumulative/dynamic ROC curves at different follow-up periods, ranging from 3 months up to 10 years. Calibration was performed using univariate and multivariate Cox proportional hazard models and Hosmer-Lemeshow test. A total of 3,321 (87.8% males) patients were included with a mean ± SD age of 66.9 ± 10.5 years, and a median follow-up of 1,064 days (IQR 25-75% 426-1643), totaling 11,190 person-years. The CODEX index was statistically associated with mortality in the short- (≤3 months), medium- (≤1 year) and long-term (10 years), with an area under the curve of 0.72, 0.70 and 0.76, respectively. The mCODEX index performed better in the medium-term (<1 year) than the original CODEX, and similarly in the long-term. In conclusion, CODEX and mCODEX index are good predictors of mortality in patients with COPD, regardless of disease severity or duration of follow-up.
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Affiliation(s)
- Pere Almagro
- a Multimorbidity Patients Unit, Internal Medicine , Hospital Universitari Mutua de Terrassa, Universitat de Barcelona , Barcelona , Spain
| | | | - Marc Miravitlles
- c Pneumology Department , Hospital Universitary Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES) , Barcelona , Spain
| | - Mónica Rodríguez-Carballeira
- a Multimorbidity Patients Unit, Internal Medicine , Hospital Universitari Mutua de Terrassa, Universitat de Barcelona , Barcelona , Spain
| | - Annie Navarro
- d Pneumology Service , Hospital Universitari Mútua Terrassa , Barcelona , Spain
| | - Bernd Lamprecht
- e Department of Pulmonary Medicine , Kepler-University-Hospital , Linz , Austria.,f Faculty of Medicine , Johannes-Kepler-University , Linz , Austria
| | | | - Bernhard Kaiser
- h Department of Pulmonary Medicine , Paracelsus Medical University Hospital , Salzburg , Austria
| | - Inmaculada Alfageme
- i Universidad de Sevilla . Departamento de Medicina . HU Virgen de Valme. Sevilla . Spain
| | - Ciro Casanova
- j Hospital Universitario Nuestra Señora de La Candelaria, Universidad de La Laguna , Tenerife , Spain
| | | | | | | | - Bartolome R Celli
- n Pulmonary and Critical Care Medicine , Harvard University, Brigham and Women's Hospital , Boston , MA , USA
| | - Jose M Marin
- o Hospital Universitario Miguel Servet, Zaragoza, and CIBER de Enfermedades Respiratorias (CIBERES) , Spain
| | - Gerben Ter Riet
- p Department of General Practice , Academic Medical Center, University of Amsterdam (AMC) , Amsterdam , The Netherlands
| | - Patricia Sobradillo
- q Hospital Universitario Araba, Sede Txagorritxu, Vitoria, Spain for Universitary Hospital of Cruces in Barakaldo , Spain
| | - Peter Lange
- r Section of Social Medicine, Department of Public Health , Copenhagen University, Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg , Copenhagen , Denmark
| | - Judith Garcia-Aymerich
- s ISGlobal , Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain.,t Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain.,u CIBER Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
| | - Josep M Anto
- s ISGlobal , Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain.,t Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain.,u CIBER Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
| | - Alice M Turner
- v Institute of Applied Health Research, University of Birmingham , Edgbaston , UK
| | - MeiLan K Han
- w Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan , Ann Arbor , MI , USA
| | - Arnulf Langhammer
- x Department of Public Health and Nursing , NTNU, Norwegian University of Science and Technology , Trondheim , Norway
| | - Alice Sternberg
- y Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Linda Leivseth
- z Centre for Clinical Documentation and Evaluation , Northern Norway Regional Health Authority , Tromso , Norway
| | - Per Bakke
- aa Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Ane Johannessen
- ab Department of Global Public Health and Primary Care , University of Bergen , Bergen, Bergen , Norway
| | - Toru Oga
- ac Department of Respiratory Care and Sleep Control Medicine , Kyoto University , Kyoto , Japan
| | - Borja Cosío
- ad Department of Respiratory Medicine , Hospital Son Espases-IdISPa, Ciberes, Mallorca , Spain
| | - Julio Ancochea
- ae Servicio de Neumología , Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain
| | - Andres Echazarreta
- af Servicio de Neumonología , Hospital San Juan de Dios de La Plata , Buenos Aires , Argentina
| | - Nicolas Roche
- ag Respiratory Medicine, Cochin Hospital APHP, University Paris Descartes , Paris , France
| | - Pierre-Régis Burgel
- ah James Hogg Research Centre , University of British Columbia , Vancouver , BC , Canada
| | - Don D Sin
- ah James Hogg Research Centre , University of British Columbia , Vancouver , BC , Canada.,ai Division of Respiratory Medicine, Department of Medicine , St Paul's Hospital , Vancouver , BC , Canada
| | - Milo A Puhan
- aj Epidemiology , Biostatistics and Prevention Institute, University of Zurich , Zurich , Switzerland
| | - Joan B Soriano
- ak Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde , Madrid , Spain
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González J, Rodríguez-Fraile M, Rivera P, Restituto P, Colina I, Calleja MDLD, Alcaide AB, Campo A, Bertó J, Seijo LM, Pérez T, Zulueta J, Varo N, de-Torres JP. Trabecular bone score in active or former smokers with and without COPD. PLoS One 2019; 14:e0209777. [PMID: 30707701 PMCID: PMC6358061 DOI: 10.1371/journal.pone.0209777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smoking is a recognized risk factor for osteoporosis. Trabecular bone score (TBS) is a novel texture parameter to evaluate bone microarchitecture. TBS and their main determinants are unknown in active and former smokers. OBJECTIVE To assess TBS in a population of active or former smokers with and without Chronic Obstructive Pulmonary Disease (COPD) and to determine its predictive factors. METHODS Active and former smokers from a pulmonary clinic were invited to participate. Clinical features were recorded and bone turnover markers (BTMs) measured. Lung function, low dose chest Computed Tomography scans (LDCT), dual energy absorptiometry (DXA) scans were performed and TBS measured. Logistic regression analysis explored the relationship between measured parameters and TBS. RESULTS One hundred and forty five patients were included in the analysis, 97 (67.8%) with COPD. TBS was lower in COPD patients (median 1.323; IQR: 0.13 vs 1.48; IQR: 0.16, p = 0.003). Regression analysis showed that a higher body mass index (BMI), younger age, less number of exacerbations and a higher forced expiratory volume-one second (FEV1%) was associated with better TBS (β = 0.005, 95% CI:0.000-0.011, p = 0.032; β = -0.003, 95% CI:-0.007(-)-0.000, p = 0.008; β = -0.019, 95% CI:-0.034(-)-0.004, p = 0.015; β = 0.001, 95% CI:0.000-0.002, p = 0.012 respectively). The same factors with similar results were found in COPD patients. CONCLUSIONS A significant proportion of active and former smokers with and without COPD have an affected TBS. BMI, age, number of exacerbations and the degree of airway obstruction predicts TBS values in smokers with and without COPD. This important information should be considered when evaluating smokers at risk of osteoporosis.
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Affiliation(s)
- Jessica González
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- Nuclear Medicine Department and clinical densitometry certified, Clínica Universidad de Navarra, Pamplona, Spain
| | - Pilar Rivera
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Patricia Restituto
- Biochemical Analysis Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Inmaculada Colina
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Ana B. Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Aránzazu Campo
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan Bertó
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Luís M. Seijo
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Teresa Pérez
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain
| | - Javier Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Nerea Varo
- Biochemical Analysis Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P. de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
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35
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Martínez-Terroba E, Behrens C, Agorreta J, Monsó E, Millares L, Felip E, Rosell R, Ramirez JL, Remirez A, Torre W, Gil-Bazo I, Idoate MA, de-Torres JP, Pio R, Wistuba II, Pajares MJ, Montuenga LM. 5 protein-based signature for resectable lung squamous cell carcinoma improves the prognostic performance of the TNM staging. Thorax 2018; 74:371-379. [PMID: 30472670 DOI: 10.1136/thoraxjnl-2018-212194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Prognostic biomarkers have been very elusive in the lung squamous cell carcinoma (SCC) and none is currently being used in the clinical setting. We aimed to identify and validate the clinical utility of a protein-based prognostic signature to stratify patients with early lung SCC according to their risk of recurrence or death. METHODS Patients were staged following the new International Association for the Study of Lung Cancer (IASLC) staging criteria (eighth edition, 2018). Three independent retrospective cohorts of 117, 96 and 105 patients with lung SCC were analysed to develop and validate a prognostic signature based on immunohistochemistry for five proteins. RESULTS We identified a five protein-based signature whose prognostic index (PI) was an independent and significant predictor of disease-free survival (DFS) (p<0.001; HR=4.06, 95% CI 2.18 to 7.56) and overall survival (OS) (p=0.004; HR=2.38, 95% CI 1.32 to 4.31). The prognostic capability of PI was confirmed in an external multi-institutional cohort for DFS (p=0.042; HR=2.01, 95% CI 1.03 to 3.94) and for OS (p=0.031; HR=2.29, 95% CI 1.08 to 4.86). Moreover, PI added complementary information to the newly established IASLC TNM 8th edition staging system. A combined prognostic model including both molecular and anatomical (TNM) criteria improved the risk stratification in both cohorts (p<0.05). CONCLUSION We have identified and validated a clinically feasible protein-based prognostic model that complements the updated TNM system allowing more accurate risk stratification. This signature may be used as an advantageous tool to improve the clinical management of the patients, allowing the reduction of lung SCC mortality through a more accurate knowledge of the patient's potential outcome.
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Affiliation(s)
- Elena Martínez-Terroba
- Program in Solid Tumors, CIMA, Pamplona, Spain.,Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain
| | - Carmen Behrens
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jackeline Agorreta
- Program in Solid Tumors, CIMA, Pamplona, Spain.,Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Eduard Monsó
- Neumology Service, Parc Taulí Universitary Hospital, Sabadell, Spain.,CIBER de Enfermedades Respiratorias-CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Millares
- Neumology Service, Parc Taulí Universitary Hospital, Sabadell, Spain.,CIBER de Enfermedades Respiratorias-CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Enriqueta Felip
- Vall d'Hebron University Hospital, Institute of Oncology, Barcelona, Spain
| | - Rafael Rosell
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - José Luis Ramirez
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ana Remirez
- Program in Solid Tumors, CIMA, Pamplona, Spain
| | - Wenceslao Torre
- Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Department of Thoracic Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ignacio Gil-Bazo
- Program in Solid Tumors, CIMA, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Miguel A Idoate
- Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P de-Torres
- Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Neumology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ruben Pio
- Program in Solid Tumors, CIMA, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.,Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Ignacio I Wistuba
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - María J Pajares
- Program in Solid Tumors, CIMA, Pamplona, Spain.,Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Luis M Montuenga
- Program in Solid Tumors, CIMA, Pamplona, Spain.,Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain.,Navarra Health Research Institute (IDISNA), Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
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Soriano JB, Hahsler M, Soriano C, Martinez C, de-Torres JP, Marín JM, de Lucas P, Cosio BG, Fuster A, Casanova C. Temporal transitions in COPD severity stages within the GOLD 2017 classification system. Respir Med 2018; 142:81-85. [DOI: 10.1016/j.rmed.2018.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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Martínez-González C, Casanova C, de-Torres JP, Marín JM, de Lucas P, Fuster A, Cosío BG, Calle M, Peces-Barba G, Solanes I, Agüero R, Feu-Collado N, Alfageme I, Romero Plaza A, Balcells E, de Diego A, Marín Royo M, Moreno A, Llunell Casanovas A, Galdiz JB, Golpe R, Lacárcel Bautista C, Cabrera C, Marin A, Soriano JB, Lopez-Campos JL. Changes and Clinical Consequences of Smoking Cessation in Patients With COPD. Chest 2018; 154:274-285. [DOI: 10.1016/j.chest.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/27/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022] Open
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Fusco JP, Pita G, Pajares MJ, Andueza MP, Patiño-García A, de-Torres JP, Gurpide A, Zulueta J, Alonso R, Alvarez N, Pio R, Melero I, Sanmamed MF, Rodriguez Ruiz M, Gil-Bazo I, Lopez-Picazo JM, Casanova C, Baz Davila R, Agudo A, Lozano MD, Gonzalez A, Sala N, Ardanaz E, Benitez J, Montuenga L, Gonzalez-Neira A, Perez-Gracia JL. Genomic characterization of individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced lung cancer. Cancer Med 2018; 7:3474-3483. [PMID: 29766673 PMCID: PMC6051154 DOI: 10.1002/cam4.1500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/03/2018] [Accepted: 03/21/2018] [Indexed: 01/20/2023] Open
Abstract
Single nucleotide polymorphisms (SNPs) may modulate individual susceptibility to carcinogens. We designed a genome-wide association study to characterize individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced non-small cell lung cancer (NSCLC), and we validated our results. We hypothesized that this strategy would enrich the frequencies of the alleles that contribute to the observed traits. We genotyped 2.37 million SNPs in 95 extreme phenotype individuals, that is: heavy smokers that either developed NSCLC at an early age (extreme cases); or did not present NSCLC at an advanced age (extreme controls), selected from a discovery set (n = 3631). We validated significant SNPs in 133 additional subjects with extreme phenotypes selected from databases including >39,000 individuals. Two SNPs were validated: rs12660420 (pcombined = 5.66 × 10-5 ; ORcombined = 2.80), mapping to a noncoding transcript exon of PDE10A; and rs6835978 (pcombined = 1.02 × 10-4 ; ORcombined = 2.57), an intronic variant in ATP10D. We assessed the relevance of both proteins in early-stage NSCLC. PDE10A and ATP10DmRNA expressions correlated with survival in 821 stage I-II NSCLC patients (p = 0.01 and p < 0.0001). PDE10A protein expression correlated with survival in 149 patients with stage I-II NSCLC (p = 0.002). In conclusion, we validated two variants associated with extreme phenotypes of high and low risk of developing tobacco-induced NSCLC. Our findings may allow to identify individuals presenting high and low risk to develop tobacco-induced NSCLC and to characterize molecular mechanisms of carcinogenesis and resistance to develop NSCLC.
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Affiliation(s)
- Juan Pablo Fusco
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
| | - Guillermo Pita
- Human Genetics Group, Spanish National Cancer Centre (CNIO), Madrid, Spain
| | - María José Pajares
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Program in Solid Tumors and Biomarkers, Center for Applied Medical Research (CIMA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
| | - Maria Pilar Andueza
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
| | - Ana Patiño-García
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Department of Pediatrics and Clinical Genetics, Clinica Universidad de Navarra, Pamplona, Spain
| | - Juan P de-Torres
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Alfonso Gurpide
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
| | - Javier Zulueta
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Rosario Alonso
- Human Genetics Group, Spanish National Cancer Centre (CNIO), Madrid, Spain
| | - Nuria Alvarez
- Human Genetics Group, Spanish National Cancer Centre (CNIO), Madrid, Spain
| | - Ruben Pio
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Program in Solid Tumors and Biomarkers, Center for Applied Medical Research (CIMA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
| | - Ignacio Melero
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
- Departments of Immunology and Oncology, Clinica Universidad de Navarra and Center for Applied Medical Research (CIMA), Pamplona, Spain
| | - Miguel F Sanmamed
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
| | - Maria Rodriguez Ruiz
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
| | - Ignacio Gil-Bazo
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
| | - Jose María Lopez-Picazo
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
| | - Ciro Casanova
- Pulmonary Department and Research Department, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, Spain
| | - Rebeca Baz Davila
- Research Unit, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-ICO, IDIBELL, Barcelona, Spain
- Translational Research Laboratory, Catalan Institute of Oncology-ICO, IDIBELL, Barcelona, Spain
| | - Maria Dolores Lozano
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
- Pathology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Alvaro Gonzalez
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Department of Biochemistry, Clinica Universidad de Navarra, Pamplona, Spain
| | - Nuria Sala
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-ICO, IDIBELL, Barcelona, Spain
- Translational Research Laboratory, Catalan Institute of Oncology-ICO, IDIBELL, Barcelona, Spain
| | - Eva Ardanaz
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Navarra Public Health Institute, CIBER Epidemiology and Public Health (CIBERESP), Pamplona, Spain
| | - Javier Benitez
- Human Genetics Group, Spanish National Cancer Centre (CNIO), Madrid, Spain
| | - Luis Montuenga
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Program in Solid Tumors and Biomarkers, Center for Applied Medical Research (CIMA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
| | | | - Jose Luis Perez-Gracia
- Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain
- Health Research Institute of Navarra (IDISNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Spain
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de-Torres JP, Ezponda A, Alcaide AB, Campo A, Berto J, Gonzalez J, Zulueta JJ, Casanova C, Rodriguez-Delgado LE, Celli BR, Bastarrika G. Pulmonary arterial enlargement predicts long-term survival in COPD patients. PLoS One 2018; 13:e0195640. [PMID: 29694376 PMCID: PMC5918899 DOI: 10.1371/journal.pone.0195640] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/26/2018] [Indexed: 11/28/2022] Open
Abstract
Rationale Pulmonary artery enlargement (PAE) is associated with exacerbations in Chronic Obstructive Pulmonary Disease (COPD) and with survival in moderate to severe patients. The potential role of PAE in survival prediction has not been compared with other clinical and physiological prognostic markers. Methods In 188 patients with COPD, PA diameter was measured on a chest CT and the following clinical and physiological parameters registered: age, gender, smoking status, pack-years history, dyspnea, lung function, exercise capacity, Body Mass Index, BODE index and history of exacerbations in year prior to enrolment. Proportional Cox regression analysis determined the best predictor of all cause survival. Results During 83 months (±42), 43 patients died. Age, pack-years history, smoking status, BMI, FEV1%, six minute walking distance, Modified Medical Research Council dyspnea scale, BODE index, exacerbation rate prior to enrollment, PA diameter and PAE (diameter≥30mm) were associated with survival. In the multivariable analysis, age (HR: 1.08; 95%CI: 1.03–1.12, p<0.001) and PAE (HR: 2.78; 95%CI: 1.35–5.75, p = 0.006) were the most powerful parameters associated with all-cause mortality. Conclusions In this prospective observational study of COPD patients with mild to moderate airflow limitation, PAE was the best predictor of long-term survival along with age.
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Affiliation(s)
- Juan P. de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
- * E-mail:
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana B. Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Arantza Campo
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan Berto
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jessica Gonzalez
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier J. Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - Bartolome R. Celli
- Pulmonary Department, Brigham and Women Hospital, Boston, MA, United States of America
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
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40
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Guerra B, Haile SR, Lamprecht B, Ramírez AS, Martinez-Camblor P, Kaiser B, Alfageme I, Almagro P, Casanova C, Esteban-González C, Soler-Cataluña JJ, de-Torres JP, Miravitlles M, Celli BR, Marin JM, ter Riet G, Sobradillo P, Lange P, Garcia-Aymerich J, Antó JM, Turner AM, Han MK, Langhammer A, Leivseth L, Bakke P, Johannessen A, Oga T, Cosio B, Ancochea-Bermúdez J, Echazarreta A, Roche N, Burgel PR, Sin DD, Soriano JB, Puhan MA. Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease. BMC Med 2018; 16:33. [PMID: 29495970 PMCID: PMC5833113 DOI: 10.1186/s12916-018-1013-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/26/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores for 3-year all-cause mortality in mostly multimorbid patients with COPD. METHODS We relied on 24 cohort studies of the COPD Cohorts Collaborative International Assessment consortium, corresponding to primary, secondary, and tertiary care in Europe, the Americas, and Japan. These studies include globally 15,762 patients with COPD (1871 deaths and 42,203 person years of follow-up). We used network meta-analysis adapted to multiple score comparison (MSC), following a frequentist two-stage approach; thus, we were able to compare all scores in a single analytical framework accounting for correlations among scores within cohorts. We assessed transitivity, heterogeneity, and inconsistency and provided a performance ranking of the prognostic scores. RESULTS Depending on data availability, between two and nine prognostic scores could be calculated for each cohort. The BODE score (body mass index, airflow obstruction, dyspnea, and exercise capacity) had a median area under the curve (AUC) of 0.679 [1st quartile-3rd quartile = 0.655-0.733] across cohorts. The ADO score (age, dyspnea, and airflow obstruction) showed the best performance for predicting mortality (difference AUCADO - AUCBODE = 0.015 [95% confidence interval (CI) = -0.002 to 0.032]; p = 0.08) followed by the updated BODE (AUCBODE updated - AUCBODE = 0.008 [95% CI = -0.005 to +0.022]; p = 0.23). The assumption of transitivity was not violated. Heterogeneity across direct comparisons was small, and we did not identify any local or global inconsistency. CONCLUSIONS Our analyses showed best discriminatory performance for the ADO and updated BODE scores in patients with COPD. A limitation to be addressed in future studies is the extension of MSC network meta-analysis to measures of calibration. MSC network meta-analysis can be applied to prognostic scores in any medical field to identify the best scores, possibly paving the way for stratified medicine, public health, and research.
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Affiliation(s)
- Beniamino Guerra
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sarah R. Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
- Faculty of Medicine, Johannes Kepler Universitat Linz, Linz, Austria
| | - Ana S. Ramírez
- Facultad de Medicina UASLP, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | | | - Bernhard Kaiser
- Department of Pulmonary Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | | | - Pere Almagro
- Internal Medicine, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | - Ciro Casanova
- Pulmonary Department and Research Unit, Hospital Universitario NS La Candelaria, Tenerife, Spain
| | | | | | - Juan P. de-Torres
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Marc Miravitlles
- European Respiratory Society (ERS) Guidelines Director, Barcelona, Spain
| | - Bartolome R. Celli
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Jose M. Marin
- IISAragón and CIBERES, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Peter Lange
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Judith Garcia-Aymerich
- ISGlobal, CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Josep M. Antó
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Meilan K. Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI USA
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Norvegian University of Science and Technology, Trondheim, Norway
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Bodø, Norway
| | - Per Bakke
- University of Bergen, Haukeland University Hospital, Bergen, Norway
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Borja Cosio
- Department of Respiratory Medicine, Hospital Son Espases-IdISBa-CIBERES, Palma de Mallorca, Spain
| | - Julio Ancochea-Bermúdez
- Instituto de Investigación Sanitaria Princesa (IISP)-Servicio de Neumología- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Andres Echazarreta
- Universidad Nacional de la Plata, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | - Nicolas Roche
- Hopitaux Universitaires Paris Centre, Service de Pneumologie AP-HP, Paris, France
| | | | - Don D. Sin
- University of British Columbia, James Hogg Research Centre, Vancouver, Canada
| | - Joan B. Soriano
- Instituto de Investigación del Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Servicio de Neumología, Madrid, Spain
- Scientific and Methodological Consultant of SEPAR www.separ.es, Barcelona, Spain
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Room HRS G29, CH -8001 Zurich, Switzerland
- Epidemiology & Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - for the 3CIA collaboration
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
- Faculty of Medicine, Johannes Kepler Universitat Linz, Linz, Austria
- Facultad de Medicina UASLP, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
- Dartmouth College Geisel School of Medicine, Dartmouth, NH USA
- Department of Pulmonary Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
- Hospital Universitario de Valme, Sevilla, Spain
- Internal Medicine, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
- Pulmonary Department and Research Unit, Hospital Universitario NS La Candelaria, Tenerife, Spain
- Network and Health Services Research Chronic Diseases (REDISSEC), Hospital Galdakao, Bizkaia, Spain
- Servicio de Neumología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
- European Respiratory Society (ERS) Guidelines Director, Barcelona, Spain
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA USA
- IISAragón and CIBERES, Hospital Universitario Miguel Servet, Zaragoza, Spain
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Hospital Univarsitario de Cruces, Barakaldo, Vizcaya Spain
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- ISGlobal, CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), IMIM (Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI USA
- Department of Public Health and Nursing, Norvegian University of Science and Technology, Trondheim, Norway
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Bodø, Norway
- University of Bergen, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Medicine, Hospital Son Espases-IdISBa-CIBERES, Palma de Mallorca, Spain
- Instituto de Investigación Sanitaria Princesa (IISP)-Servicio de Neumología- Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Universidad Nacional de la Plata, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
- Hopitaux Universitaires Paris Centre, Service de Pneumologie AP-HP, Paris, France
- Hopital Cochin; Universite Paris Descartes, Paris, France
- University of British Columbia, James Hogg Research Centre, Vancouver, Canada
- Instituto de Investigación del Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Servicio de Neumología, Madrid, Spain
- Scientific and Methodological Consultant of SEPAR www.separ.es, Barcelona, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Room HRS G29, CH -8001 Zurich, Switzerland
- Epidemiology & Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Cabrera López C, Casanova Macario C, Marín Trigo JM, de-Torres JP, Sicilia Torres R, González JM, Polverino F, Divo M, Pinto Plata V, Zulueta JJ, Celli B. Comparison of the 2017 and 2015 Global Initiative for Chronic Obstructive Lung Disease Reports. Impact on Grouping and Outcomes. Am J Respir Crit Care Med 2018; 197:463-469. [DOI: 10.1164/rccm.201707-1363oc] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Carlos Cabrera López
- Respiratory Service, Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain
| | - Ciro Casanova Macario
- Respiratory Service, Hospital Universitario Nuestra Señora de la Candelaria, Canary Islands, Spain
| | | | - Juan P. de-Torres
- Respiratory Service, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Rebeca Sicilia Torres
- Respiratory Service, Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain
| | - Jesús María González
- Investigation Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain
| | - Francesca Polverino
- Pulmonary and Critical Care Service, Brigham and Women’s Hospital, Boston, Massachusetts and
| | - Miguel Divo
- Pulmonary and Critical Care Service, Brigham and Women’s Hospital, Boston, Massachusetts and
| | - Víctor Pinto Plata
- Pulmonary and Critical Care Division, Baystate Medical Center, Springfield, Massachusetts
| | - Javier J. Zulueta
- Respiratory Service, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Bartolomé Celli
- Pulmonary and Critical Care Service, Brigham and Women’s Hospital, Boston, Massachusetts and
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42
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Casanova C, Celli BR, de-Torres JP, Martínez-Gonzalez C, Cosio BG, Pinto-Plata V, de Lucas-Ramos P, Divo M, Fuster A, Peces-Barba G, Calle-Rubio M, Solanes I, Aguero R, Feu-Collado N, Alfageme I, De Diego A, Romero A, Balcells E, Llunell A, Galdiz J, Marin M, Moreno A, Cabrera C, Golpe R, Lacarcel C, Soriano JB, López-Campos JL, Soler-Cataluña JJ, Marin JM. Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD. Eur Respir J 2017; 50:50/5/1701162. [DOI: 10.1183/13993003.01162-2017] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 07/27/2017] [Indexed: 01/21/2023]
Abstract
The impact of blood eosinophilia in chronic obstructive pulmonary disease (COPD) remains controversial.To evaluate the prevalence and stability of a high level of blood eosinophils (≥300 cells·μL–1) and its relationship to outcomes, we determined blood eosinophils at baseline and over 2 years in 424 COPD patients (forced expiratory volume in 1 s (FEV1) 60% predicted) and 67 smokers without COPD from the CHAIN cohort, and in 308 COPD patients (FEV1 60% predicted) in the BODE cohort. We related eosinophil levels to exacerbations and survival using Cox hazard analysis.In COPD patients, 15.8% in the CHAIN cohort and 12.3% in the BODE cohort had persistently elevated blood eosinophils at all three visits. A significant proportion (43.8%) of patients had counts that oscillated above and below the cut-off points, while the rest had persistent eosinophil levels <300 cells·μL–1. A similar eosinophil blood pattern was observed in controls. Exacerbation rates did not differ in patients with and without eosinophilia. All-cause mortality was lower in patients with high eosinophils compared with those with values <300 cells·μL–1 (15.8% versus 33.7%; p=0.026).In patients with COPD, blood eosinophils ≥300 cells·μL–1 persisting over 2 years was not a risk factor for COPD exacerbations. High eosinophil count was associated with better survival.
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43
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Burgel PR, Paillasseur JL, Janssens W, Piquet J, Ter Riet G, Garcia-Aymerich J, Cosio B, Bakke P, Puhan MA, Langhammer A, Alfageme I, Almagro P, Ancochea J, Celli BR, Casanova C, de-Torres JP, Decramer M, Echazarreta A, Esteban C, Gomez Punter RM, Han MK, Johannessen A, Kaiser B, Lamprecht B, Lange P, Leivseth L, Marin JM, Martin F, Martinez-Camblor P, Miravitlles M, Oga T, Sofia Ramírez A, Sin DD, Sobradillo P, Soler-Cataluña JJ, Turner AM, Verdu Rivera FJ, Soriano JB, Roche N. A simple algorithm for the identification of clinical COPD phenotypes. Eur Respir J 2017; 50:50/5/1701034. [PMID: 29097431 DOI: 10.1183/13993003.01034-2017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/28/2017] [Indexed: 11/05/2022]
Abstract
This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses.Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed using cluster analysis resulting in the identification of subgroups, for which clinical relevance was determined by comparing 3-year all-cause mortality. Classification and regression trees (CARTs) were used to develop an algorithm for allocating patients to these subgroups. This algorithm was tested in 3651 patients from the COPD Cohorts Collaborative International Assessment (3CIA) initiative.Cluster analysis identified five subgroups of COPD patients with different clinical characteristics (especially regarding severity of respiratory disease and the presence of cardiovascular comorbidities and diabetes). The CART-based algorithm indicated that the variables relevant for patient grouping differed markedly between patients with isolated respiratory disease (FEV1, dyspnoea grade) and those with multi-morbidity (dyspnoea grade, age, FEV1 and body mass index). Application of this algorithm to the 3CIA cohorts confirmed that it identified subgroups of patients with different clinical characteristics, mortality rates (median, from 4% to 27%) and age at death (median, from 68 to 76 years).A simple algorithm, integrating respiratory characteristics and comorbidities, allowed the identification of clinically relevant COPD phenotypes.
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Affiliation(s)
- Pierre-Régis Burgel
- University Paris Descartes (EA2511), Sorbonne Paris Cité, Paris, France .,Dept of Respiratory Medicine, Cochin Hospital, AP-HP, Paris, France
| | | | - Wim Janssens
- Respiratory Division, University Hospital Gasthuisberg, K.U. Leuven, Leuven, Belgium
| | - Jacques Piquet
- Dept of Respiratory Medicine, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - Gerben Ter Riet
- Dept General Practice - Academic Medical Center, Amsterdam, The Netherlands
| | - Judith Garcia-Aymerich
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra (UPF), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Borja Cosio
- Unidad de Investigación, Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Per Bakke
- Dept of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Milo A Puhan
- Epidemiology, Biostatistics und Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Arnulf Langhammer
- Dept of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | | | - Pere Almagro
- Internal Medicine, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Julio Ancochea
- Pneumology Service, La Princesa Institute for Health Research (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Ciro Casanova
- Hospital Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | - Marc Decramer
- Respiratory Division, University Hospital Gasthuisberg, K.U. Leuven, Leuven, Belgium
| | - Andrés Echazarreta
- Servicio de Neumonología Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | | | | | | | - Ane Johannessen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Bernhard Kaiser
- Dept of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Bernd Lamprecht
- Dept of Pulmonary Medicine, General Hospital Linz (AKH), Linz, Austria
| | - Peter Lange
- Section of Social Medicine, Dept of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Linda Leivseth
- Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromso, Norway
| | - Jose M Marin
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Francis Martin
- Pneumologie, Centre Hospitalier de Compiègne, Compiègne, France
| | - Pablo Martinez-Camblor
- Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.,Universidad Autónoma de Chile, San Miguel, Chile
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitary Vall d'Hebron. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Toru Oga
- Dept of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Don D Sin
- James Hogg Research Centre, University of British Columbia; Division of Respiratory Medicine, Dept of Medicine, St Paul's Hospital, Vancouver, Canada
| | | | | | - Alice M Turner
- Queen Elizabeth Hospital Research Laboratories, Birmingham, UK
| | | | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Nicolas Roche
- University Paris Descartes (EA2511), Sorbonne Paris Cité, Paris, France.,Dept of Respiratory Medicine, Cochin Hospital, AP-HP, Paris, France
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Zagaceta J, Bastarrika G, Zulueta JJ, Colina I, Alcaide AB, Campo A, Divo M, Casanova C, Marin JM, Pinto-Plata VM, Celli BR, de-Torres JP. Prospective comparison of non-invasive risk markers of major cardiovascular events in COPD patients. Respir Res 2017; 18:175. [PMID: 28962654 PMCID: PMC5622585 DOI: 10.1186/s12931-017-0658-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients. Methods CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome. Results During a median follow up of 65 months (ICR: 36–100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19–1.46, p < 001). Conclusions In COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings.
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Affiliation(s)
- Jorge Zagaceta
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain.,Universidad de Piura, Piura, Peru.,Clínica Angloamericana, Lima, Peru
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier J Zulueta
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain
| | - Inmaculada Colina
- Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ana B Alcaide
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain
| | - Arantza Campo
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain
| | - Miguel Divo
- Pulmonary Division, Brigham and Women's Hospital, Boston, USA
| | - Ciro Casanova
- Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - José M Marin
- Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Juan P de-Torres
- Pulmonary Department, Clinica Universidad de Navarra, Av Pío XII, 36, 31008, Pamplona, Spain.
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Cordoba-Lanus E, Cazorla-Rivero S, Espinoza-Jimenez A, de-Torres JP, Pajares MJ, Aguirre-Jaime A, Celli B, Casanova C. Erratum to: Telomere shortening and accelerated aging in COPD: findings from the BODE cohort. Respir Res 2017; 18:113. [PMID: 28577567 PMCID: PMC5455076 DOI: 10.1186/s12931-017-0589-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Elizabeth Cordoba-Lanus
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain.
| | - Sara Cazorla-Rivero
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Adriana Espinoza-Jimenez
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Juan P de-Torres
- Pulmonary Division, Clínica Universitaria de Navarra, Pamplona, Spain
| | - María J Pajares
- Centro de Investigación Médica Aplicada (CIMA), UNAV, Pamplona, Spain
| | - Armando Aguirre-Jaime
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Bartolomé Celli
- Pulmonary and Critical Care Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Ciro Casanova
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain.,Pulmonary Division, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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de-Torres JP, Marin JM. Differences between GesEPOC and GOLD in 2017. Arch Bronconeumol 2017; 53:295-296. [PMID: 28506625 DOI: 10.1016/j.arbres.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Juan P de-Torres
- Servicio de Neumología, Clínica Universidad de Navarra, Pamplona, España.
| | - Jose M Marin
- Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, España
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Córdoba-Lanús E, Cazorla-Rivero S, Espinoza-Jiménez A, de-Torres JP, Pajares MJ, Aguirre-Jaime A, Celli B, Casanova C. Telomere shortening and accelerated aging in COPD: findings from the BODE cohort. Respir Res 2017; 18:59. [PMID: 28407775 PMCID: PMC5390353 DOI: 10.1186/s12931-017-0547-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) may be associated with accelerated aging. Telomere shortening is a biomarker of aging. Cross-sectional studies describe shorter telomeres in COPD compared with matched controls. No studies have described telomere length trajectory and its relationship with COPD progression. We investigated telomere shortening over time and its relationship to clinical and lung function parameters in a COPD cohort and smoker controls without COPD. METHODS At baseline leukocyte telomere length was measured by qPCR in 121 smokers with COPD and 121 without COPD matched by age (T/S0). The measurements were repeated in 70 of those patients with COPD and 73 non-COPD smokers after 3 years of follow up (T/S3). RESULTS At initial measurement, telomeres were shorter in COPD patients when compared to smoker controls (T/S = 0.68 ± 0.25 vs. 0.88 ± 0.52, p = 0.003) independent from age and sex. During the follow-up period, we observed an accelerated telomere shortening in individuals with COPD in contrast to smoker controls (T/S0 = 0.66 ± 0.21 vs. T/S3 = 0.46 ± 0.16, p < 0.001, for the patients with COPD and T/S0 = 0.83 ± 0.56 vs. T/S3 = 0.74 ± 0.52, p = 0.023 for controls; GLIM, p = 0.001). This shortening was inversely related to the baseline telomere length (r = -0.49, p < 0.001). No significant relationship was found between the rate of change in telomere length and change in lung function in the patients with COPD (p > 0.05). CONCLUSIONS Compared with smokers, patients with COPD have accelerated telomere shortening and this rate of attrition depends on baseline telomere length. Furthermore, the telomere length and its rate of shortening did not relate to clinical and lung function parameters changes over 3 years of follow-up.
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Affiliation(s)
- Elizabeth Córdoba-Lanús
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain.
| | - Sara Cazorla-Rivero
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Adriana Espinoza-Jiménez
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Juan P de-Torres
- Pulmonary Division, Clínica Universitaria de Navarra, Pamplona, Spain
| | - María J Pajares
- Centro de Investigación Médica Aplicada (CIMA), UNAV, Pamplona, Spain
| | - Armando Aguirre-Jaime
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
| | - Bartolomé Celli
- Pulmonary and Critical Care Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Ciro Casanova
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Ctra. del Rosario 145, 38010, Santa Cruz de Tenerife, Spain
- Pulmonary Division, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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de-Torres JP, Sanchez-Salcedo P, Bastarrika G, Alcaide AB, Pío R, Pajares MJ, Campo A, Berto J, Montuenga L, del Mar Ocon M, Monente C, Celli BR, Zulueta JJ. Telomere length, COPD and emphysema as risk factors for lung cancer. Eur Respir J 2016; 49:13993003.01521-2016. [DOI: 10.1183/13993003.01521-2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/28/2016] [Indexed: 11/05/2022]
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Affiliation(s)
- Jessica Gonzalez
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Juan P de-Torres
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
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