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Harboe ZB, Hamm SR, Pérez-Alós L, Sivapalan P, Priemé H, Wilcke T, Kjeldgaard P, Shaker S, Svorre Jordan A, Møller DL, Heftdal LD, Madsen JR, Bayarri-Olmos R, Hansen CB, Pries-Heje MM, Hasselbalch RB, Fogh K, Armenteros JJA, Hilsted L, Sørensen E, Lindegaard B, Browatzki A, Biering-Sørensen T, Frikke-Schmidt R, Ostrowski SR, Iversen KK, Bundgaard H, Nielsen SD, Garred P, Jensen JUS. Antibody responses and risk factors associated with impaired immunological outcomes following two doses of BNT162b2 COVID-19 vaccination in patients with chronic pulmonary diseases. BMJ Open Respir Res 2022; 9:9/1/e001268. [PMID: 35793836 PMCID: PMC9260234 DOI: 10.1136/bmjresp-2022-001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/11/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Responses to COVID-19 vaccination in patients with chronic pulmonary diseases are poorly characterised. We aimed to describe humoral responses following two doses of BNT162b2 mRNA COVID-19 vaccine and identify risk factors for impaired responses. Methods Prospective cohort study including adults with chronic pulmonary diseases and healthcare personnel as controls (1:1). Blood was sampled at inclusion, 3 weeks, 2 and 6 months after first vaccination. We reported antibody concentrations as geometric means with 95% CI of receptor binding domain (RBD)-IgG and neutralising antibody index of inhibition of ACE-2/RBD interaction (%). A low responder was defined as neutralising index in the lowest quartile (primary outcome) or RBD-IgG <225 AU/mL plus neutralising index <25% (secondary outcome), measured at 2 months. We tested associations using Poisson regression. Results We included 593 patients and 593 controls, 75% of all had neutralising index ≥97% at 2 months. For the primary outcome, 34.7% of patients (n=157/453) and 12.9% of controls (n=46/359) were low responders (p<0.0001). For the secondary outcome, 8.6% of patients (n=39/453) and 1.4% of controls (n=5/359) were low responders (p<0.001). Risk factors associated with low responder included increasing age (per decade, adjusted risk ratio (aRR) 1.17, 95% CI 1.03 to 1.32), Charlson Comorbidity Index (per point) (aRR 1.15, 95% CI 1.05 to 1.26), use of prednisolone (aRR 2.08, 95% CI 1.55 to 2.77) and other immunosuppressives (aRR 2.21, 95% CI 1.65 to 2.97). Discussion Patients with chronic pulmonary diseases established functional humoral responses to vaccination, however lower than controls. Age, comorbidities and immunosuppression were associated with poor immunological responses.
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Affiliation(s)
- Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Rask Hamm
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Helene Priemé
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Torgny Wilcke
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Peter Kjeldgaard
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Saher Shaker
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Alexander Svorre Jordan
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Dina Leth Møller
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Line Dam Heftdal
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johannes Roth Madsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rafael Bayarri-Olmos
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mia Marie Pries-Heje
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Jose Juan Almagro Armenteros
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Linda Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Section 2034, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Lindegaard
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Section 2034, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Garred
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Section of Respiratory Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- PERSIMUNE & CHIP: Department of Infectious Diseases, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Echevarria C, Steer J, Bourke SC. Comparison of early warning scores in patients with COPD exacerbation: DECAF and NEWS score. Thorax 2019; 74:941-946. [PMID: 31387892 PMCID: PMC6817986 DOI: 10.1136/thoraxjnl-2019-213470] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/12/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
Background The National Early Warning Score 2 (NEWS2) includes two oxygen saturation scales; the second adjusts target saturations to 88%–92% for those with hypercapnic respiratory failure. Using this second scale in all patients with COPD exacerbation (‘NEWS2All COPD’) would simplify practice, but the impact on alert frequency and prognostic performance is unknown. Admission NEWS2 score has not been compared with DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) for inpatient mortality prediction. Methods NEWS, NEWS2 and NEWS2All COPD and DECAF were calculated at admission in 2645 patients with COPD exacerbation attending consecutively to one of six UK hospitals, all of whom met spirometry criteria for COPD. Alert frequency and appropriateness were assessed for all NEWS iterations. Prognostic performance was compared using the area under the receiver operating characteristic (AUROC) curve. Missing data were imputed using multiple imputation. Findings Compared with NEWS, NEWS2 reclassified 3.1% patients as not requiring review by a senior clinician (score≥5). NEWS2All COPD reduced alerts by 12.6%, or 16.1% if scoring for injudicious use of oxygen was exempted. Mortality was low in reclassified patients, with no patients dying the same day as being identified as low risk. NEWS2All COPD was a better prognostic score than NEWS (AUROC 0.72 vs 0.65, p<0.001), with similar performance to NEWS2 (AUROC 0.72 vs 0.70, p=0.090). DECAF was superior to all scores (validation cohort AUROC 0.82) and offered a more clinically useful range of risk stratification (DECAF=1.2%–25.5%; NEWS2=3.5%–15.4%). Conclusion NEWS2All COPD safely reduces the alert frequency compared with NEWS2. DECAF offers superior prognostic performance to guide clinical decision-making on admission, but does not replace repeated measures of NEWS2 during hospitalisation to detect the deteriorating patient.
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Affiliation(s)
- Carlos Echevarria
- Newcastle University, Newcastle upon Tyne, UK.,Respiratory Medicine, Royal Victoria Infimrary, Newcastle upon Tyne, UK
| | - John Steer
- Newcastle University, Newcastle upon Tyne, UK.,Respiratory Medicine, North Tyneside General Hospital, North Shields, UK
| | - Stephen C Bourke
- Newcastle University, Newcastle upon Tyne, UK .,Respiratory Medicine, North Tyneside General Hospital, North Shields, UK
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4
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Hansen GM, Marott JL, Holtermann A, Gyntelberg F, Lange P, Jensen MT. Midlife cardiorespiratory fitness and the long-term risk of chronic obstructive pulmonary disease. Thorax 2019; 74:843-848. [PMID: 31209150 DOI: 10.1136/thoraxjnl-2018-212821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Good midlife cardiorespiratory fitness (CRF) may reduce the risk of chronic obstructive pulmonary disease (COPD). Reverse causation may play a role if follow-up time is short. We examined the association between CRF and both incident COPD and COPD mortality in employed men with up to 46 years follow-up, which allowed us to account for reverse causality. METHODS Middle-aged men (n=4730) were recruited in 1970-1971. CRF was determined as VO2max by ergometer test. Categories of CRF (low, normal, high) were defined as ± 1 Z-score (± 1 SD) above or below the age-adjusted mean. Endpoints were identified through national registers and defined as incident COPD, and death from COPD. Multi-adjusted Cox models and restricted mean survival times (RMST) were performed. RESULTS Compared with low CRF, the estimated risk of incident COPD was 21% lower in participants with normal CRF (HR 0.79, 95% CI 0.63 to 0.99) and 31 % lower with high CRF (HR 0.69, 95% CI 0.52 to 0.91). Compared with low CRF, the risk of death from COPD was 35% lower in participants with normal CRF (HR 0.65, 95% CI 0.46 to 0.91) and 62% lower in participants with high CRF (HR 0.38, 95% CI 0.23 to 0.61). RMST showed a delay to incident COPD and death from COPD in the magnitude of 1.3-1.8 years in normal and high CRF vs low CRF. Test for reverse causation did not alter the results. CONCLUSION In a population of healthy, middle-aged men, higher levels of CRF were associated with a lower long-term risk of incident COPD and death from COPD.
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Affiliation(s)
- Gorm Mørk Hansen
- Herlev-Gentofte University Hospital, Medical Department O, Respiratory Section; Herlev-Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen Male Study Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital; The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Andreas Holtermann
- National Research Centre for the Working Environment; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Copenhagen, Denmark
| | - Finn Gyntelberg
- The Copenhagen Male Study Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital; Bispebjerg Hospital, National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Peter Lange
- Herlev Hospital, Medical Department O, Respiratory Section; University of Copenhagen, Section of Epidemiology, Department of Public Health, Copenhagen, Denmark
| | - Magnus T Jensen
- The Copenhagen Male Study Epidemiological Research Unit, Departments of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
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Chen J, Cho M, Silverman EK, Hokanson JE, Kinney GL, Crapo JD, Rennard S, Dy J, Castaldi P. Turning subtypes into disease axes to improve prediction of COPD progression. Thorax 2019; 74:906-909. [PMID: 31189730 DOI: 10.1136/thoraxjnl-2018-213005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/18/2018] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 11/04/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an umbrella definition encompassing multiple disease processes. COPD heterogeneity has been described as distinct subgroups of individuals (subtypes) or as continuous measures of COPD variability (disease axes). There is little consensus on whether subtypes or disease axes are preferred, and the relative value of disease axes and subtypes for predicting COPD progression is unknown. Using a propensity score approach to learn disease axes from pairs of subtypes, we demonstrate that these disease axes predict prospective forced expiratory volume in 1 s decline and emphysema progression more accurately than the subtype pairs from which they were derived.
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Affiliation(s)
- Junxiang Chen
- Department of Electrical and Computer Engineering, Northeastern University, Boston, United States
| | - Michael Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, United States.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, United States
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, United States.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, United States
| | - John E Hokanson
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
| | - Greg L Kinney
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Stephen Rennard
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, United States.,IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Jennifer Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, United States
| | - Peter Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, United States .,Division of Primary Care and Internal Medicone, Brigham and Women's Hospital, Boston, United States
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6
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Sivapalan P, Ingebrigtsen TS, Rasmussen DB, Sørensen R, Rasmussen CM, Jensen CB, Allin KH, Eklöf J, Seersholm N, Vestbo J, Jensen JUS. COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months. BMJ Open Respir Res 2019; 6:e000407. [PMID: 31179005 PMCID: PMC6530506 DOI: 10.1136/bmjresp-2019-000407] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 01/14/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction A large group of patients with chronic obstructive pulmonary disease (COPD) are exposed to an overload of oral corticosteroids (OCS) due to repeated exacerbations. This is associated with potential serious adverse effects. Therefore, we evaluated the impact of a recommended reduction of OCS duration in 2014 on the risk of pneumonia hospitalisation and all-cause mortality in patients with acute exacerbation of COPD (AECOPD). Methods This was a nationwide observational cohort study that was based on linked administrative registry data between 1 January 2010 and 31 October 2017. 10 152 outpatients with COPD (median age 70 years) treated with either a short (≤250 mg) or long course (>250 mg) of OCS for AECOPD were included in the study. Cox proportional hazards regression models were used to derive an estimation of multivariable adjusted HRs (aHRs) for pneumonia hospitalisation or all-cause mortality combined and pneumonia hospitalisation and all-cause mortality, separately. Results The long course of OCS treatment for AECOPD was associated with an increased 1-year risk of pneumonia hospitalisation or all-cause mortality (aHR 1.3, 95% CI 1.1 to 1.4; p<0.0001), pneumonia hospitalisation (aHR 1.2, 95% CI 1.0 to 1.3; p=0.0110) and all-cause mortality (aHR 1.8, 95% CI 1.5 to 2.2; p<0.0001) as compared with the short course of OCS treatment. These results were confirmed in several sensitivity analyses. Conclusion The change of recommendations from long courses to short courses of OCS for AECOPD in 2014 was strongly associated with a decrease in pneumonia admissions and all-cause mortality, in favour of short courses of OCS.
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Affiliation(s)
- Pradeesh Sivapalan
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Truls Sylvan Ingebrigtsen
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Bech Rasmussen
- Respiratory Research Unit Zealand, Department of Respiratory Medicine, Naestved Hospital, Copenhagen University Hospital, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Camilla Bjørn Jensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Kristine Højgaard Allin
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Josefin Eklöf
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Joergen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, North West Lung Centre, Manchester, UK
| | - Jens-Ulrik Stæhr Jensen
- Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.,Department of Infectious Diseases, Rigshospitalet, PERSIMUNE, Copenhagen, Denmark
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7
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Affiliation(s)
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College, London, UK
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8
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Gayle AV, Axson EL, Bloom CI, Navaratnam V, Quint JK. Changing causes of death for patients with chronic respiratory disease in England, 2005-2015. Thorax 2019; 74:483-491. [PMID: 30696745 DOI: 10.1136/thoraxjnl-2018-212514] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/19/2018] [Accepted: 12/24/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic respiratory diseases (CRD) are common, are increasing in prevalence, and cause significant morbidity and mortality worldwide. However, we have limited knowledge on causes of death of patients with CRD in the general population. OBJECTIVE We evaluated mortality rates and causes of death over time in patients with CRD. METHODS We used linked primary care and mortality data to determine mortality rates and the most common causes of death in people with CRD (including asthma, bronchiectasis, COPD and interstitial lung diseases (ILD)) during 2005-2015 in England. RESULTS We identified 558 888 patients with CRD (451 830 asthma, 137 709 COPD, 19 374 bronchiectasis, 10 745 ILD). The age-standardised mortality rate of patients with CRD was 1607 per 100 000 persons (asthma=856, COPD=1503, ILD=2609, bronchiectasis=1463). CRD mortality was overall 54% higher than the general population. A third of patients with CRD died from respiratory-related causes. Respiratory-related mortality was constant, while cardiovascular-related mortality decreased significantly over time. COPD accounted for the majority of respiratory-related deaths (66% overall) in all patient groups except ILD. CONCLUSIONS Patients with CRD continue to experience substantial morbidity and mortality due to respiratory diseases. Disease-modifying intervention strategies are needed to improve outcomes for patients with CRD.
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Affiliation(s)
- Alicia V Gayle
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.,Market Access, Boehringer Ingelheim Ltd, Bracknell, UK
| | - Eleanor L Axson
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Chloe I Bloom
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Vidya Navaratnam
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
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Fermont JM, Masconi KL, Jensen MT, Ferrari R, Di Lorenzo VAP, Marott JM, Schuetz P, Watz H, Waschki B, Müllerova H, Polkey MI, Wilkinson IB, Wood AM. Biomarkers and clinical outcomes in COPD: a systematic review and meta-analysis. Thorax 2019; 74:439-446. [PMID: 30617161 PMCID: PMC6484697 DOI: 10.1136/thoraxjnl-2018-211855] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [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: 03/26/2018] [Revised: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 01/06/2023]
Abstract
Background Conventional measures to evaluate COPD may fail to capture systemic problems, particularly musculoskeletal weakness and cardiovascular disease. Identifying these manifestations and assessing their association with clinical outcomes (ie, mortality, exacerbation and COPD hospital admission) is of increasing clinical importance. Objective To assess associations between 6 min walk distance (6MWD), heart rate, fibrinogen, C reactive protein (CRP), white cell count (WCC), interleukins 6 and 8 (IL-6 and IL-8), tumour necrosis factor-alpha, quadriceps maximum voluntary contraction, sniff nasal inspiratory pressure, short physical performance battery, pulse wave velocity, carotid intima-media thickness and augmentation index and clinical outcomes in patients with stable COPD. Methods We systematically searched electronic databases (August 2018) and identified 61 studies, which were synthesised, including meta-analyses to estimate pooled HRs, following Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Shorter 6MWD and elevated heart rate, fibrinogen, CRP and WCC were associated with higher risk of mortality. Pooled HRs were 0.80 (95% CI 0.73 to 0.89) per 50 m longer 6MWD, 1.10 (95% CI 1.02 to 1.18) per 10 bpm higher heart rate, 3.13 (95% CI 2.14 to 4.57) per twofold increase in fibrinogen, 1.17 (95% CI 1.06 to 1.28) per twofold increase in CRP and 2.07 (95% CI 1.29 to 3.31) per twofold increase in WCC. Shorter 6MWD and elevated fibrinogen and CRP were associated with exacerbation, and shorter 6MWD, higher heart rate, CRP and IL-6 were associated with hospitalisation. Few studies examined associations with musculoskeletal measures. Conclusion Findings suggest 6MWD, heart rate, CRP, fibrinogen and WCC are associated with clinical outcomes in patients with stable COPD. Use of musculoskeletal measures to assess outcomes in patients with COPD requires further investigation. Trial registration number CRD42016052075.
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Affiliation(s)
- Jilles M Fermont
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katya L Masconi
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Magnus T Jensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Renata Ferrari
- Division of Pulmonology, Department of Internal Medicine, Botucatu Medical School, Univ Estadual Paulista, UNESP, Botucatu, Brazil
| | - Valéria A P Di Lorenzo
- Department of Physiotherapy, Federal University of Sao Carlos (UFSCar), São Carlos/São Paulo, Brazil
| | - Jacob M Marott
- Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Philipp Schuetz
- Internal Medicine and Emergency Medicine, Kantonsspital Aarau, Univertsity of Basel, Aarau, Switzerland
| | - Henrik Watz
- LungenClinic Grosshansorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Benjamin Waschki
- LungenClinic Grosshansorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Hana Müllerova
- Worldwide Epidemiology, GlaxoSmithKline R&D, Uxbridge, UK
| | - Michael I Polkey
- Respiratory Muscle Laboratory, Royal Brompton Hospital, London, UK
| | - Ian B Wilkinson
- Department of Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Angela M Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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10
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Miele CH, Grigsby MR, Siddharthan T, Gilman RH, Miranda JJ, Bernabe-Ortiz A, Wise RA, Checkley W. Environmental exposures and systemic hypertension are risk factors for decline in lung function. Thorax 2018; 73:1120-1127. [PMID: 30061168 PMCID: PMC7289445 DOI: 10.1136/thoraxjnl-2017-210477] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/01/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic lung disease is a leading contributor to the global disease burden; however, beyond tobacco smoke, we do not fully understand what risk factors contribute to lung function decline in low-income and middle-income countries. METHODS We collected sociodemographic and clinical data in a randomly selected, age-stratified, sex-stratified and site-stratified population-based sample of 3048 adults aged ≥35 years from four resource-poor settings in Peru. We assessed baseline and annual pre-bronchodilator and post-bronchodilator lung function over 3 years. We used linear mixed-effects models to assess biological, socioeconomic and environmental risk factors associated with accelerated lung function decline. RESULTS Mean±SD enrolment age was 55.4±12.5 years, 49.2% were male and mean follow-up time was 2.36 (SD 0.61) years. Mean annual pre-bronchodilator FEV1 decline was 30.3 mL/year (95% CI 28.6 to 32.0) and pre-bronchodilator FVC decline was 32.2 mL/year (30.0 to 34.4). Using multivariable linear mixed-effects regression, we found that urban living, high-altitude dwelling and having hypertension accounted for 25.9% (95% CI 15.7% to 36.1%), 21.3% (11.1% to 31.5%) and 15.7% (3.7% to 26.9%) of the overall mean annual decline in pre-bronchodilator FEV1/height2, respectively. Corresponding estimates for pre-bronchodilator FVC/height2 were 42.1% (95% CI% 29.8% to 54.4%), 36.0% (23.7% to 48.2%) and 15.8% (2.6% to 28.9%) of the overall mean annual decline, respectively. CONCLUSION Urbanisation, living at high altitude and hypertension were associated with accelerated lung function decline in a population with low daily smoking prevalence.
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Affiliation(s)
- Catherine H Miele
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew R Grigsby
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Robert H Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Medicina, Escuela de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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11
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Fidler MM, Reulen RC, Bright CJ, Henson KE, Kelly JS, Jenney M, Ng A, Whelan J, Winter DL, Frobisher C, Hawkins MM. Respiratory mortality of childhood, adolescent and young adult cancer survivors. Thorax 2018; 73:959-968. [PMID: 29748251 PMCID: PMC6166601 DOI: 10.1136/thoraxjnl-2017-210683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 06/23/2017] [Revised: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exposure to radiation and/or chemotherapy during cancer treatment can compromise respiratory function. We investigated the risk of long-term respiratory mortality among 5-year cancer survivors diagnosed before age 40 years using the British Childhood Cancer Survivor Study (BCCSS) and Teenage and Young Adult Cancer Survivor Study (TYACSS). METHODS The BCCSS comprises 34 489 cancer survivors diagnosed before 15 years from 1940 to 2006 in Great Britain. The TYACSS includes 200 945 cancer survivors diagnosed between 15 years and 39 years from 1971 to 2006 in England and Wales. Standardised mortality ratios and absolute excess risks were used. FINDINGS Overall, 164 and 1079 respiratory deaths were observed in the BCCSS and TYACSS cohorts respectively, which was 6.8 (95% CI 5.8 to 7.9) and 1.7 (95% CI 1.6 to 1.8) times that expected, but the risks varied substantially by type of respiratory death. Greatest excess numbers of deaths were experienced after central nervous system (CNS) tumours in the BCCSS and after lung cancer, leukaemia, head and neck cancer and CNS tumours in the TYACSS. The excess number of respiratory deaths increased with increasing attained age, with seven (95% CI 2.4 to 11.3) excess deaths observed among those aged 50+ years in the BCCSS and three (95% CI 1.4 to 4.2) excess deaths observed among those aged 60+ years in the TYACSS. It was reassuring to see a decline in the excess number of respiratory deaths among those diagnosed more recently in both cohorts. CONCLUSIONS Prior to this study, there was almost nothing known about the risks of respiratory death after cancer diagnosed in young adulthood, and this study addresses this gap. These new findings will be useful for both survivors and those involved in their clinical management and follow-up.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine E Henson
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Clinical Trial Service Unite, University of Oxford, Oxford, UK
| | - Julie S Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - Antony Ng
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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12
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Zeng S, Tham A, Bos B, Jin J, Giang B, Arjomandi M. Lung volume indices predict morbidity in smokers with preserved spirometry. Thorax 2018; 74:114-124. [PMID: 30030304 DOI: 10.1136/thoraxjnl-2018-211881] [Citation(s) in RCA: 24] [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: 03/30/2018] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Abnormal lung volumes that reflect air trapping are common in COPD. However, their significance in smokers with preserved spirometry (normal FEV1 to FVC ratio) is unclear. METHODS Using the Veterans Administration Informatics and Computing Infrastructure database, we identified 7479 patients at risk for COPD (ever smokers >40 years of age without restrictive lung disease) who had preserved spirometry and concomitant lung volume measurements, and examined their subsequent health records for clinical diagnoses of COPD, healthcare utilisation, follow-up spirometry and mortality. RESULTS Air trapping was prevalent, with 31% of patients having residual volume to total lung capacity ratio (RV:TLC) greater than the upper limit of normal (ULN). RV:TLC varied widely from 14% to 77% (51% to 204% of predicted) across the normal ranges of FEV1:FVC and FEV1. Patients with RV:TLC greater than the ULN were more likely to receive subsequent clinical diagnoses of COPD (HR (95% CI)=1.55 (1.42 to 1.70), p<0.001) and had higher all-cause mortality (HR (95% CI)=1.41 (1.29 to 1.54), p<0.001). They had higher rates of respiratory medication prescriptions and hospital and intensive care unit admissions. Other air trapping and static hyperinflation indices showed similar associations with health outcomes. Additionally, high-normal RV:TLC was associated with intermediate adverse health outcomes compared with low-normal and abnormal RV:TLC. Abnormal RV:TLC predicted higher likelihood of progression to spirometric COPD (OR (95% CI)=1.30 (1.03 to 1.65), p=0.027). CONCLUSION In this study of the Veterans Affairs electronic health records, air trapping was common in smokers with preserved spirometry and predicted adverse respiratory outcomes and progression to overt COPD.
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Affiliation(s)
- Siyang Zeng
- Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
| | - Andrea Tham
- Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,School of Medicine, University of Southern California, Los Angeles, USA
| | - Bruce Bos
- Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,School of Medicine, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Joan Jin
- Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,School of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brian Giang
- Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
| | - Mehrdad Arjomandi
- Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
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13
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Affiliation(s)
- Dick Heederik
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, University of Utrecht, Utrecht, The Netherlands
| | - David M Mannino
- Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA.,Medical Affairs, GlaxoSmithKline, Philadelphia, Pennsylvania, USA
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14
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Dicker AJ, Crichton ML, Cassidy AJ, Brady G, Hapca A, Tavendale R, Einarsson GG, Furrie E, Elborn JS, Schembri S, Marshall SE, Palmer CNA, Chalmers JD. Genetic mannose binding lectin deficiency is associated with airway microbiota diversity and reduced exacerbation frequency in COPD. Thorax 2018; 73:510-518. [PMID: 29101284 PMCID: PMC5969339 DOI: 10.1136/thoraxjnl-2016-209931] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 12/26/2016] [Revised: 08/19/2017] [Accepted: 10/02/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In cystic fibrosis and bronchiectasis, genetic mannose binding lectin (MBL) deficiency is associated with increased exacerbations and earlier mortality; associations in COPD are less clear. Preclinical data suggest MBL interferes with phagocytosis of Haemophilus influenzae, a key COPD pathogen. We investigated whether MBL deficiency impacted on clinical outcomes or microbiota composition in COPD. METHODS Patients with COPD (n=1796) underwent MBL genotyping; linkage to health records identified exacerbations, lung function decline and mortality. A nested subcohort of 141 patients, followed for up to 6 months, was studied to test if MBL deficiency was associated with altered sputum microbiota, through 16S rRNA PCR and sequencing, or airway inflammation during stable and exacerbated COPD. FINDINGS Patients with MBL deficiency with COPD were significantly less likely to have severe exacerbations (incidence rate ratio (IRR) 0.66, 95% CI 0.48 to 0.90, p=0.009), or to have moderate or severe exacerbations (IRR 0.77, 95% CI 0.60 to 0.99, p=0.047). MBL deficiency did not affect rate of FEV1 decline or mortality. In the subcohort, patients with MBL deficiency had a more diverse lung microbiota (p=0.008), and were less likely to be colonised with Haemophilus spp. There were lower levels of airway inflammation in patients with MBL deficiency. INTERPRETATION Patients with MBL deficient genotype with COPD have a lower risk of exacerbations and a more diverse lung microbiota. This is the first study to identify a genetic association with the lung microbiota in COPD.
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Affiliation(s)
- Alison J Dicker
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Megan L Crichton
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew J Cassidy
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Gill Brady
- Tayside Respiratory Research Group, Clinical Research Centre, Dundee, UK
| | - Adrian Hapca
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Roger Tavendale
- Pat MacPherson Centre for Pharmacogenetics and Pharmacogenomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Gisli G Einarsson
- School of Medicine, Centre for Experimental Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Elizabeth Furrie
- Department of Immunology, NHS Tayside, Ninewells Hospital Department of Medicine, Dundee, Dundee, UK
| | - J Stuart Elborn
- School of Medicine, Centre for Experimental Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Stuart Schembri
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Sara E Marshall
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Colin N A Palmer
- Pat MacPherson Centre for Pharmacogenetics and Pharmacogenomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - James D Chalmers
- Scottish Centre for Respiratory Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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15
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Marcon A, Locatelli F, Keidel D, Beckmeyer-Borowko AB, Cerveri I, Dharmage SC, Fuertes E, Garcia-Aymerich J, Heinrich J, Imboden M, Janson C, Johannessen A, Leynaert B, Pascual Erquicia S, Pesce G, Schaffner E, Svanes C, Urrutia I, Jarvis D, Probst-Hensch NM, Accordini S. Airway responsiveness to methacholine and incidence of COPD: an international prospective cohort study. Thorax 2018; 73:825-832. [PMID: 29720562 PMCID: PMC6109244 DOI: 10.1136/thoraxjnl-2017-211289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 01/31/2023]
Abstract
Background It has been debated, but not yet established, whether increased airway responsiveness can predict COPD. Recognising this link may help in identifying subjects at risk. Objective We studied prospectively whether airway responsiveness is associated with the risk of developing COPD. Methods We pooled data from two multicentre cohort studies that collected data from three time points using similar methods (European Community Respiratory Health Survey and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). We classified subjects (median age 37 years, 1st–3rd quartiles: 29–44) by their level of airway responsiveness using quintiles of methacholine dose–response slope at the first examination (1991–1994). Then, we excluded subjects with airflow obstruction at the second examination (1999–2003) and analysed incidence of COPD (postbronchodilator FEV1/FVC below the lower limit of normal) at the third examination (2010–2014) as a function of responsiveness, adjusting for sex, age, education, body mass index, history of asthma, smoking, occupational exposures and indicators of airway calibre. Results We observed 108 new cases of COPD among 4205 subjects during a median time of 9 years. Compared with the least responsive group (incidence rate 0.6 per 1000/year), adjusted incidence rate ratios for COPD ranged from 1.79 (95% CI 0.52 to 6.13) to 8.91 (95% CI 3.67 to 21.66) for increasing airway responsiveness. Similar dose–response associations were observed between smokers and non-smokers, and stronger associations were found among subjects without a history of asthma or asthma-like symptoms. Conclusions Our study suggests that increased airway responsiveness is an independent risk factor for COPD. Further research should clarify whether early treatment in patients with high responsiveness can slow down disease progression.
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Affiliation(s)
- Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Dirk Keidel
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Anna B Beckmeyer-Borowko
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Isa Cerveri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Elaine Fuertes
- Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Judith Garcia-Aymerich
- Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Munich, Germany.,Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Muenchen, Germany
| | - Medea Imboden
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Bénédicte Leynaert
- Inserm UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, University Paris Diderot Paris 7, Paris, France
| | | | - Giancarlo Pesce
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Emmanuel Schaffner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Cecilie Svanes
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Isabel Urrutia
- Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain
| | - Deborah Jarvis
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Nicole M Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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16
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Affiliation(s)
- Fernando Sergio Leitao Filho
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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17
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18
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Lytras T, Kogevinas M, Kromhout H, Carsin AE, Antó JM, Bentouhami H, Weyler J, Heinrich J, Nowak D, Urrutia I, Martinez-Moratalla J, Gullón JA, Pereira-Vega A, Raherison-Semjen C, Pin I, Demoly P, Leynaert B, Villani S, Gislason T, Svanes C, Holm M, Forsberg B, Norbäck D, Mehta AJ, Probst-Hensch N, Benke G, Jogi R, Torén K, Sigsgaard T, Schlünssen V, Olivieri M, Blanc PD, Vermeulen R, Garcia-Aymerich J, Jarvis D, Zock JP. Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey. Thorax 2018; 73:1008-1015. [PMID: 29574416 DOI: 10.1136/thoraxjnl-2017-211158] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Occupational exposures have been associated with an increased risk of COPD. However, few studies have related objectively assessed occupational exposures to prospectively assessed incidence of COPD, using postbronchodilator lung function tests. Our objective was to examine the effect of occupational exposures on COPD incidence in the European Community Respiratory Health Survey. METHODS General population samples aged 20-44 were randomly selected in 1991-1993 and followed up 20 years later (2010-2012). Spirometry was performed at baseline and at follow-up, with incident COPD defined using a lower limit of normal criterion for postbronchodilator FEV1/FVC. Only participants without COPD and without current asthma at baseline were included. Coded job histories during follow-up were linked to a Job-Exposure Matrix, generating occupational exposure estimates to 12 categories of agents. Their association with COPD incidence was examined in log-binomial models fitted in a Bayesian framework. FINDINGS 3343 participants fulfilled the inclusion criteria; 89 of them had COPD at follow-up (1.4 cases/1000 person-years). Participants exposed to biological dust had a higher incidence of COPD compared with those unexposed (relative risk (RR) 1.6, 95% CI 1.1 to 2.3), as did those exposed to gases and fumes (RR 1.5, 95% CI 1.0 to 2.2) and pesticides (RR 2.2, 95% CI 1.1 to 3.8). The combined population attributable fraction for these exposures was 21.0%. INTERPRETATION These results substantially strengthen the evidence base for occupational exposures as an important risk factor for COPD.
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Affiliation(s)
- Theodore Lytras
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Manolis Kogevinas
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Hans Kromhout
- IRAS, University of Utrecht, Utrecht, The Netherlands
| | - Anne-Elie Carsin
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Josep M Antó
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Hayat Bentouhami
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joost Weyler
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Munich, Germany
| | - Isabel Urrutia
- Pulmonology Department, Galdakao Hospital, Bizkaia, Spain
| | - Jesús Martinez-Moratalla
- Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.,Facultad de Medicina Albacete, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | | | - Antonio Pereira-Vega
- Respiratory and Allergy Clinical Unit, Universitary Hospitalary Complex, Huelva, Spain
| | - Chantal Raherison-Semjen
- Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, France
| | - Isabelle Pin
- Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.,Inserm, U1209, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, Paris, France
| | - Bénédicte Leynaert
- Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France
| | - Simona Villani
- Department of Health Sciences, Experimental and Forensic Medicine - Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amar J Mehta
- Research and Evaluation Office, Boston Public Health Commission, Boston, Massachusetts, USA
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Geza Benke
- Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Torben Sigsgaard
- Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Section for Environment, Occupation and Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Paul D Blanc
- University of California San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | | | - Judith Garcia-Aymerich
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Deborah Jarvis
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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19
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Abstract
A matched cohort study was conducted to determine the incidence of falls in patients following a diagnosis of COPD using a UK primary care database. 44 400 patients with COPD and 175 545 non-COPD subjects were identified. The incidence rate of fall per 1000 person-years in patients with COPD was higher (44.9; 95% CI 44.1 to 45.8) compared with non-COPD subjects (24.1; 95% CI 23.8 to 24.5) (P<0.0001). Patients with COPD were 55% more likely to have an incident record of fall than non-COPD subjects (adjusted HR, 1.55; 95% CI 1.50 to 1.59). The greater falls risk in patients with COPD needs consideration and modifiable factors addressed.
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Affiliation(s)
- Ali Hakamy
- Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, University of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Charlotte E Bolton
- Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jack E Gibson
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
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20
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Affiliation(s)
- Guy B Marks
- Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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21
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Morgan AD, Rothnie KJ, Bhaskaran K, Smeeth L, Quint JK. Chronic obstructive pulmonary disease and the risk of 12 cardiovascular diseases: a population-based study using UK primary care data. Thorax 2018; 73:877-879. [PMID: 29438071 DOI: 10.1136/thoraxjnl-2017-210865] [Citation(s) in RCA: 16] [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: 08/05/2017] [Revised: 01/11/2018] [Accepted: 01/15/2018] [Indexed: 11/03/2022]
Abstract
Risks for cardiovascular diseases (CVDs) other than myocardial infarction and stroke in the general COPD population are not well quantified. We used a matched cohort study design and Cox regression to estimate relative risks for 12 separate CVDs in a large population-based cohort of patients with COPD over a 12-year period. Associations between COPD and individual CVDs were heterogeneous, with the highest relative risks observed for heart failure and diseases of the arterial circulation (in excess of 2.5 for those aged 64-75 years). Relative risks declined with increasing age but for most CVD outcomes remained unchanged over the study period.
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Affiliation(s)
- Ann D Morgan
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kieran J Rothnie
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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22
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Sana A, Somda SMA, Meda N, Bouland C. Chronic obstructive pulmonary disease associated with biomass fuel use in women: a systematic review and meta-analysis. BMJ Open Respir Res 2018; 5:e000246. [PMID: 29387422 PMCID: PMC5786909 DOI: 10.1136/bmjresp-2017-000246] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/18/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality worldwide. The global prevalence of COPD is growing faster in women than in men. Women are often exposed to indoor pollutants produced by biomass fuels burning during household activities. Methods We conducted a meta-analysis to establish the association between COPD and exposure to biomass smoke in women.Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE and Scopus databases in 31December 2016, with the terms: "wood", "charcoal", "biomass", "solid fuels", "organic fuel", "biofuel", "female", "women", "COPD", "chronic bronchitis", "emphysema", "chronic obstructive pulmonary disease". Studies were eligible if they were case-control or cross-sectional studies involving exposure to indoor biomass smoke, conducted at any time and in any geographic location. Fixed-effects or random-effects meta-analysis was used to generate pooled OR. Results 24 studies were included: 5 case-control studies and 19 cross-sectional studies. Biomass-exposed individuals were 1.38 times more likely to be diagnosed with COPD than non-exposed (OR 1.38, 95% CI 1.28 to 1.57).Spirometry-diagnosed COPD studies failed to show a significant association (OR 1.20, 95% CI 0.99 to 1.40). Nevertheless, the summary estimate of OR for chronic bronchitis (CB) was significant (OR 2.11, 95% CI 1.70 to 2.52). The pooled OR for cross-sectional studies and case-control studies were respectively 1.82 (95% CI 1.54 to 2.10) and 1.05 (95% CI 0.81 to 1.30). Significant association was found between COPD and biomass smoke exposure for women living as well in rural as in urban areas. Conclusions This study showed that biomass smoke exposure is associated with COPD in rural and urban women.In many developing countries, modern fuels are more and more used alongside traditional ones, mainly in urban area. Data are needed to further explore the benefit of the use of mixed fuels for cooking on respiratory health, particularly on COPD reduction.
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Affiliation(s)
- Adama Sana
- Département de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso.,Département de Santé Publique, Universite Ouaga 1 Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Environmental and Occupational Health Research Center, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge M A Somda
- Département de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Belgium.,Unité de Formation et de Recherche en Sciences et Technologies, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Nicolas Meda
- Département de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso.,Département de Santé Publique, Universite Ouaga 1 Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Catherine Bouland
- Environmental and Occupational Health Research Center, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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23
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Abston E, Comellas A, Reed RM, Kim V, Wise RA, Brower R, Fortis S, Beichel R, Bhatt S, Zabner J, Newell J, Hoffman EA, Eberlein M. Higher BMI is associated with higher expiratory airflow normalised for lung volume (FEF25-75/FVC) in COPD. BMJ Open Respir Res 2017; 4:e000231. [PMID: 29071083 PMCID: PMC5652498 DOI: 10.1136/bmjresp-2017-000231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/30/2017] [Revised: 09/04/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The obesity paradox in chronic obstructive pulmonary disease (COPD), whereby patients with higher body mass index (BMI) fare better, is poorly understood. Higher BMIs are associated with lower lung volumes and greater lung elastic recoil, a key determinant of expiratory airflow. The forced expiratory flow (25-75) (FEF25-75)/forced vital capacity (FVC) ratio reflects effort-independent expiratory airflow in the context of lung volume and could be modulated by BMI. METHODS We analysed data from the COPDGene study, an observational study of 10 192 subjects, with at least a 10 pack-year smoking history. Data were limited to subjects with BMI 20-40 kg/m2 (n=9222). Subjects were stratified according to forced expiratory volume in 1 s (FEV1) (%predicted)-quintiles. In regression analyses and Cox proportional hazard models, we analysed the association between BMI, the FEF25-75/FVC ratio, the imaging phenotype, COPD exacerbations, hospitalisations and death. RESULTS There was no correlation between BMI and FEV1(%predicted). However, a higher BMI is correlated with a higher FEF25-75/FVC ratio. In CT scans, a higher BMI was associated with less emphysema and less air trapping. In risk-adjusted models, the quintile with the highest FEF25-75/FVC ratio was associated with a 46% lower risk of COPD exacerbations (OR 0.54, p<0.001) and a 40% lower risk of death (HR 0.60, p=0.02), compared with the lowest quintile. BMI was not independently associated with these outcomes. CONCLUSIONS A higher BMI is associated with lower lung volumes and higher expiratory airflows when normalised for lung volume, as quantified by the FEF25-75/FVC ratio. A higher FEF25-75/FVC ratio is associated with a lower risk of COPD exacerbations and death and might quantify functional aspects of the paradoxical effect of higher BMIs on COPD.
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Affiliation(s)
- Eric Abston
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro Comellas
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA.,Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Robert Michael Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Temple University, School of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roy Brower
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Spyridon Fortis
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA.,Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Reinhard Beichel
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA.,The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA
| | - Surya Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Joseph Zabner
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA.,Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - John Newell
- The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa, Iowa, USA
| | - Eric A Hoffman
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA.,The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa, Iowa, USA
| | - Michael Eberlein
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA.,Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
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24
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Ringshausen FC, Apel RM, Bange FC, de Roux A, Pletz MW, Rademacher J, Suhling H, Wagner D, Welte T. Burden and trends of hospitalisations associated with pulmonary non-tuberculous mycobacterial infections in Germany, 2005-2011. BMC Infect Dis 2013; 13:231. [PMID: 23692867 PMCID: PMC3667050 DOI: 10.1186/1471-2334-13-231] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/14/2013] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Representative population-based data on the epidemiology of pulmonary non-tuberculous mycobacterial (PNTM) infections in Europe are limited. However, these data are needed in order to optimise patient care and to facilitate the allocation of healthcare resources. The aim of the present study was to investigate the current burden and the trends of PNTM infection-associated hospitalisations in Germany. METHODS International Classification of Diseases, 10th revision (ICD-10) discharge diagnosis codes were extracted from the official nationwide diagnosis-related groups (DRG) hospital statistics in order to identify PNTM infection-associated hospitalisations (ICD-10 code A31.0) between 2005 and 2011. Poisson log-linear regression analysis was used to assess the significance of trends. RESULTS Overall, 5,959 records with PNTM infection as any hospital discharge diagnosis were extracted from more than 125 million hospitalisations. The average annual age-adjusted rate was 0.91 hospitalisations per 100,000 population. Hospitalisation rates increased during the study period for both males and females, with the highest rate of 3.0 hospitalisations per 100,000 population among elderly men, but the most pronounced average increase of 6.4%/year among females, particularly those of young and middle age, and hospitalisations associated with cystic fibrosis. Overall, chronic obstructive pulmonary disease (COPD) was the most frequent PNTM infection-associated condition in 28.9% of hospitalisations and also showed a significant average annual increase of 4.8%. CONCLUSIONS The prevalence of PNTM infection-associated hospitalisations is steadily increasing in Germany. COPD is currently the most important associated condition. Our population-based study provides evidence of a changing epidemiology of PNTM infections and highlights emerging clinical implications.
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Affiliation(s)
- Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Rosa-Marie Apel
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Franz-Christoph Bange
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Andrés de Roux
- Centre for Respiratory Medicine at the Charlottenburg Castle, Berlin, Germany
| | - Mathias W Pletz
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hendrik Suhling
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Dirk Wagner
- Centre for Infectious Diseases and Travel Medicine and Centre for Chronic Immunodeficiency, University Hospital Freiburg, Freiburg, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
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