COPD in Never-Smokers: BOLD Australia Study

Purpose

Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors.

Methods

We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN).

Results

The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio

Conclusion

COPD was prevalent in this population of never-smokers aged 40 years and over. This finding highlights the significance of risk factors other than smoking in the development of COPD.

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Key Words

• BOLD
• LLN
• burden of obstructive lung disease
• lower limit of normal
• non-smokers
• prevalence
• spirometry

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MESH Headings

• Female
• Male
• Humans
• Adult
• Middle Aged
• Child
• Smokers
• Pulmonary Disease, Chronic Obstructive/diagnosis
• Pulmonary Disease, Chronic Obstructive/epidemiology
• Asthma
• Odds Ratio
• Australia/epidemiology

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Grants

• National Health and Medical Research Council (NHMRC) of Australia
• Thoracic Society of Australia and New Zealand
• Robert Pierce Grant-in-Aid for Indigenous Lung Health
• Air Liquide, AstraZeneca; GlaxoSmithKline; and Boehringer Ingelheim

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Comparison of the lower limit of normal to the fixed ratio method for the diagnosis of airflow obstruction at high altitudes: a large cross-sectional survey of subjects living between 3000-4700 m above sea level

BACKGROUND

There is no general agreement on the preferential use of a fixed ratio (FR) of forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC) < 0.7 vs. the lower limit of normal (LLN) of FEV₁/FVC to define airflow obstruction. Determining the impact of these different cut-off levels in people living at high altitudes has not been studied. We assessed the prevalence of airflow obstruction and its clinical characteristics in residents living at high altitude using a fixed ratio and the LLN of FEV₁/FVC according to Global Lung Initiative 2012 (GLI) reference values.

METHODS

Using a multistage stratified sampling method, 3702 participants (aged ≥ 15 years) living at an altitude of 3000-4700 m in Tibet were included.

RESULTS

11.4% and 7.7% of participants had airflow obstruction according to GLI-LLN and a fixed FEV₁/FVC cut-off value, respectively. The participants in the FR-/LLN+ group were younger, predominantly female, more frequently exposed to household air pollution, and had a higher proportion of chronic obstructive pulmonary disease assessment test scores ≥ 10 than those in the FR-/LLN- group. They also had a significantly lower FEV₁ and a higher frequency of small airway dysfunction. Compared with the participants of the FR+/LLN+ group, those in the FR-/LLN+ group showed no significant difference in the risk factors for airflow obstruction and respiratory symptoms, but had a lower prevalence of small airway dysfunction.

CONCLUSIONS

Defining airflow obstruction according to LLN, instead of using an FR, identified younger individuals with more frequent clinical symptoms of airflow obstruction and small airway dysfunction.

Compression-Aware Aggregation and Energy-Aware Routing in IoT-Fog-Enabled Forest Environment

Forest fire monitoring is very much needed for protecting the forest from any kind of disaster or anomaly leading to the destruction of the forest. Now, with the advent of Internet of Things (IoT), a good amount of research has been done on energy consumption, coverage, and other issues. These works did not focus on forest fire management. The IoT-enabled environment is made up of low power lossy networks (LLNs). For improving the performance of routing protocol in forest fire management, energy-efficient routing protocol for low power lossy networks (E-RPL) was developed where residual power was used as an objective function towards calculating the rank of the parent node to form the destination-oriented directed acyclic graph (DODAG). The challenge in E-RPL is the scalability of the network resulting in a long end-to-end delay and less packet delivery. Additionally, the energy of sensor nodes increased with different transmission range. So, for obviating the above-mentioned drawbacks in E-RPL, compressed data aggregation and energy-based RPL routing (CAA-ERPL) is proposed. The CAA-ERPL is compared with E-RPL, and the performance is analyzed resulting in reduced packet transfer delay, less energy consumption, and increased packet delivery ratio for 10, 20, 30, 40, and 50 nodes. This has been evaluated using a Contiki Cooja simulator.

DYNASTI-Dynamic Multiple RPL Instances for Multiple IoT Applications in Smart City

Internet of Things (IoT) is evolving to multi-application scenarios in smart cities, which demand specific traffic patterns and requirements. Multi-applications share resources from a single multi-hop wireless networks, where smart devices collaborate to send collected data over a Low-Power and Lossy Networks (LLNs). Routing Protocol for LLNs (RPL) emerged as a routing protocol to be used in IoT scenarios where the devices have limited resources. Instances are RPL mechanisms that play a key role in order to support the IoT scenarios with multiple applications, but it is not standardized yet. Although there are related works proposing multiple instances in RPL on the same IoT network, those works still have limitations to support multiple applications. For instance, there is a lack of flexibility and dynamism in management of multiple instances and service differentiation for applications. In this context, the goal of this work is to develop a solution called DYNAmic multiple RPL instanceS for multiple ioT applicatIons (DYNASTI), which provides more dynamism and flexibility by managing multiple instances of RPL. As a result of this, the traffic performance of multiple applications is enhanced through the routing, taking into consideration the distinct requirements of the applications. In addition, DYNASTI enables the support of sporadic applications as well as the coexistence between regular and sporadic applications. DYNASTI achieved results that demonstrate a significant improvement in reducing the number of control messages, which resulted in increased packet received, decreased end-to-end delay, reduced energy consumption, and an improvement in service differentiation to multiple applications.

Impacts of Different Spirometry Reference Equations and Diagnostic Criteria on the Frequency of Airway Obstruction in Adult People of North China

Background and Objective

The reference equations and diagnostic criteria play a critical role in the interpretation of pulmonary function tests (PFTs). The aim was to investigate the impacts of different reference equations and diagnostic criteria on the frequency of airway obstruction in adult people of a large teaching hospital of North China.

Methods

The spirometry data of all adult people who underwent PFTs in Qilu hospital from April 2012 to November 2015 were collected. Two spirometry reference equations, namely, Zhongshan-2011 and Global Lung Function Initiative 2012 (GLI-2012) were compared. The frequency of airway obstruction using different spirometry prediction equations and diagnostic criteria including forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <92% of predicted value and FEV1/FVC <lower limits of normal (LLN) were investigated.

Results

A total of 57,888 subjects were recruited with a mean age of 55.5 ± 13.72. There were significant differences in LLN and predicted value between the GLI-2012 and Zhongshan-2011. The average age of those who had an LLN of FEV1/FVC below 0.7 was 66.59 ± 6.05 years using GLI-2012, which was significantly lower than that in Zhongshan-2011 (77.46±2.63, P<0.001). Using FEV1/FVC<LLN as diagnostic criteria, Zhongshan-2011 identifies more obstructive subjects than GLI-2012 in each age group. In 45–59 or 60–80 age group, more participants were defined as obstructive using FEV1/FVC<92%pred than FEV1/FVC<LLN (both P<0.001).

Conclusion

Zhongshan-2011 identifies more airway obstruction than GLI-2012 in adult people of North China. Compared to FEV1/FVC<LLN, FEV1/FVC<92%pred may lead to overdiagnosis of airway obstruction in elderly people.

Spirometric instability - another hurdle in achieving real-world COPD diagnostic criteria?

Globally, mortality, morbidity and the economic burden of chronic obstructive pulmonary disease (COPD) are on the rise. In addition, its diagnosis continues to pose challenges to the physicians, which is compounded further by its new feature "spirometric instability." Based on the findings from the two recent observational studies, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommended repeat spirometry for the individuals with a fixed ratio between 0.6 and 0.8. In this perspective, we discuss the uncertainties and consequences of this critical update in the 2018 GOLD report.

Global lung function initiative 2012 reference values for spirometry in Asian Americans

Background

Spirometry reference values specifically designed for Asian Americans are currently unavailable. The performance of Global Lung Function Initiative 2012 (GLI-2012) equations on assessing spirometry in Asian Americans has not been evaluated. This study aimed to assess the fitness of relevant GLI-2012 equations for spirometry in Asian Americans.

Methods

Asian subjects who never smoked and had qualified spirometry data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Z-scores of forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and FEV₁/FVC were separately constructed with GLI-2012 equations for North East (NE) Asians, South East (SE) Asians, and individuals of mixed ethnic origin (Mixed). In addition, Proportions of subjects with observed spirometry data below the lower limit of normal (LLN) were also evaluated on each GLI-2012 equation of interest.

Results

This study included 567 subjects (250 men and 317 women) aged 6–79 years. Spirometry z-scores (z-FEV₁, z-FVC, and z-FEV₁/FVC) based on GLI-2012 Mixed equations had mean values close to zero (− 0.278 to − 0.057) and standard deviations close to one (1.001 to 1.128); additionally, 6.0% (95% confidence interval (CI) 3.1–8.9%) and 6.4% (95% CI 3.7–9.1%) of subjects were with observed data below LLN for FEV₁/FVC in men and women, respectively. In contrast, for NE Asian equations, all mean values of z-FEV₁ and z-FVC were smaller than − 0.5; for SE Asian equations, mean values of z-FEV₁/FVC were significantly smaller than zero in men (− 0.333) and women (− 0.440).

Conclusions

GLI-2012 equations for individuals of mixed ethnic origin adequately fitted spirometry data in this sample of Asian Americans. Future studies with larger sample sizes are needed to confirm these findings.

Electronic supplementary material

The online version of this article (10.1186/s12890-018-0658-9) contains supplementary material, which is available to authorized users.

Sigma Routing Metric for RPL Protocol

This paper presents the adaptation of a specific metric for the RPL protocol in the objective function MRHOF. Among the functions standardized by IETF, we find OF0, which is based on the minimum hop count, as well as MRHOF, which is based on the Expected Transmission Count (ETX). However, when the network becomes denser or the number of nodes increases, both OF0 and MRHOF introduce long hops, which can generate a bottleneck that restricts the network. The adaptation is proposed to optimize both OFs through a new routing metric. To solve the above problem, the metrics of the minimum number of hops and the ETX are combined by designing a new routing metric called SIGMA-ETX, in which the best route is calculated using the standard deviation of ETX values between each node, as opposed to working with the ETX average along the route. This method ensures a better routing performance in dense sensor networks. The simulations are done through the Cooja simulator, based on the Contiki operating system. The simulations showed that the proposed optimization outperforms at a high margin in both OF0 and MRHOF, in terms of network latency, packet delivery ratio, lifetime, and power consumption.

Clinical impact of the lower limit of normal of FEV1/FVC on detecting chronic obstructive pulmonary disease: A follow-up study based on cross-sectional data

BACKGROUND

Criteria of obstruction that establish a diagnosis of COPD have been debated in recent years. We carried out a follow-up study to assess the impact of the new LLN reference equation for Chinese on detecting COPD compared with the traditional 0.7fixed criteria.

METHODS

We examined the prevalence and characteristics of airflow limitation for a non-child population using post-bronchodilator airflow with both age-dependent predicted lower limit of the normal value and fixed-ratio spirometric criterion. Questionnaires and spirometry were completed for all eligible subjects during the baseline examination. Participants with inconsistent diagnosis according to the two criteria, normal participants (controls) and COPD patients in stages I or II, were invited to take a cardiopulmonary exercise testing (CPET) examination and follow up for 2-4 years.

RESULTS

A total of 5448 (mean age 50.51 ± 13.2 yr) study subjects with acceptable spirometry and complete questionnaire data were included in our final analyses. COPD detection based on LLN was consistent with the GOLD 0.7 fixed-ratio in general, as 51 subjects (0.9%) were underdiagnosed, and 61 subjects (1.1%) were overdiagnosed when using LLN as the reference diagnostic criterion. The underdiagnosed subjects were younger, had more symptoms, more exposure to biofuels and worse FEV₁ than the normal group; they also demonstrated a damaged cardiopulmonary reserve capacity and significant FEV₁ decline. Except for being older, the overdiagnosed subjects differed little from the normal group.

CONCLUSIONS

Individual-dependent LLN appears to better reveal impacts on detecting airflow limitation. Participants underdiagnosed by GOLD criterion should be paid more attention.

CLINICAL TRIAL REGISTRATION

ChiCTR-ECS-13004110.

Secure Service Proxy: A CoAP(s) Intermediary for a Securer and Smarter Web of Things

As the IoT continues to grow over the coming years, resource-constrained devices and networks will see an increase in traffic as everything is connected in an open Web of Things. The performance- and function-enhancing features are difficult to provide in resource-constrained environments, but will gain importance if the WoT is to be scaled up successfully. For example, scalable open standards-based authentication and authorization will be important to manage access to the limited resources of constrained devices and networks. Additionally, features such as caching and virtualization may help further reduce the load on these constrained systems. This work presents the Secure Service Proxy (SSP): a constrained-network edge proxy with the goal of improving the performance and functionality of constrained RESTful environments. Our evaluations show that the proposed design reaches its goal by reducing the load on constrained devices while implementing a wide range of features as different adapters. Specifically, the results show that the SSP leads to significant savings in processing, network traffic, network delay and packet loss rates for constrained devices. As a result, the SSP helps to guarantee the proper operation of constrained networks as these networks form an ever-expanding Web of Things.

Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study

COPD is the third leading cause of death in the world and its global burden is predicted to increase further. Even though the prevalence of COPD is well studied, only few studies examined the incidence of COPD in a prospective and standardized manner. In a prospective population-based cohort study (Rotterdam Study) enrolling subjects aged ≥45, COPD was diagnosed based on a pre-bronchodilator obstructive spirometry (FEV1/FVC < 0.70). In absence of an interpretable spirometry within the Rotterdam Study, cases were defined as having COPD diagnosed by a physician on the basis of clinical presentation and obstructive lung function measured by the general practitioner or respiratory physician. Incidence rates were calculated by dividing the number of incident cases by the total number of person years of subjects at risk. In this cohort of 14,619 participants, 1993 subjects with COPD were identified of whom 689 as prevalent ones and 1304 cases as incident ones. The overall incidence rate (IR) of COPD was 8.9/1000 person-years (PY); 95 % Confidence Interval (CI) 8.4-9.4. The IR was higher in males and in smokers. The proportion of female COPD participants without a history of smoking was 27.2 %, while this proportion was 7.3 % in males. The prevalence of COPD in the Rotterdam Study is 4.7 % and the overall incidence is approximately 9/1000 PY, with a higher incidence in males and in smokers. The proportion of never-smokers among female COPD cases is substantial.

COPD prevalence in a north-eastern Italian general population

BACKGROUND

COPD prevalence estimates vary mostly depending on different study methodologies. We evaluated the prevalence and clinical features of COPD, as defined by GOLD and ERS/ATS recommendations in a representative sample of Northern Italy general population.

METHODS

A randomized cross-sectional study was performed. The study participants completed a questionnaire covering: key indicators for considering a diagnosis of COPD, self-reported physician diagnoses of respiratory disease, pharmacological treatment for respiratory disease, indirect costs, occupational and environmental exposures. They also underwent spirometry and physician assessment.

RESULTS

We evaluated 1236 subjects. Daily respiratory symptoms were experienced by 26.7%. Of this group, only 30.7% had previously performed a spirometry. The overall COPD prevalence was: 11.7% according to GOLD criterion; 9.1% according to LLN criterion; 6.8% according to self-reported physician diagnosis. Of note, 48,8% of subjects with a reported diagnosis of COPD had never undergone a spirometry before the study.

CONCLUSIONS

Our study provides an estimation of COPD prevalence in a representative sample of Northern Italy general population relying on both clinical symptoms and spirometry outcomes, and describes the different prevalence rates depending on the adopted diagnostic criterion. Spirometry underuse may account for under-diagnosis and misdiagnosis of COPD. It may result in a major impact on quality of life as well as in economic burden.

COPD in chronic heart failure: less common than previously thought?

BACKGROUND

Using a fixed ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) < 0.70 instead of the lower limit of normal (LLN) to define chronic obstructive pulmonary disease (COPD) may lead to overdiagnosis of COPD in elderly patients with heart failure (HF) and consequently unnecessary treatment with possible adverse health effects.

OBJECTIVE

The aim of this study was to determine COPD prevalence in patients with chronic HF according to two definitions of airflow obstruction.

METHODS

Spirometry was performed in 187 outpatients with stable chronic HF without pulmonary congestion who had a left ventricular ejection fraction <40% (mean age 69 ± 10 years, 78% men). COPD diagnosis was confirmed 3 months after standard treatment with tiotropium in newly diagnosed COPD patients.

RESULTS

COPD prevalence varied substantially between 19.8% (LLN-COPD) and 32.1% (GOLD-COPD). Twenty-three of 60 patients (38.3%) with GOLD-COPD were potentially misclassified as having COPD (FEV1/FVC < 0.7 but > LLN). In contrast to patients with LLN-COPD, potentially misclassified patients did not differ significantly from those without COPD regarding respiratory symptoms and risk factors for COPD.

CONCLUSIONS

One fifth, rather than one third, of the patients with chronic HF had concomitant COPD using the LLN instead of the fixed ratio. LLN may identify clinically more important COPD than a fixed ratio of 0.7.

Can an airway challenge test predict respiratory diseases? A population-based international study

BACKGROUND

Evidence on the longitudinal association of airway responsiveness with respiratory diseases is scarce. The best indicator of responsiveness is still undetermined.

OBJECTIVE

We investigated the association of airway responsiveness with the incidence of asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis.

METHODS

We studied 3851 subjects who underwent spirometry and methacholine challenge tests both at baseline (1991-1993), when they were 20 to 44 years old, and at follow-up (1999-2002) in the European Community Respiratory Health Survey. Airway responsiveness was defined based on the methacholine dose-response slope on both occasions. Incidence rate ratios for the association of airway responsiveness with disease occurrence were computed by using Poisson regression.

RESULTS

With respect to reference (slope of the fourth quintile or greater), subjects with the greatest degree of airway responsiveness (slope less than the first quintile) showed the greatest risk of developing asthma, COPD, and allergic rhinitis (incidence rate ratios of 10.82, 5.53, and 4.84, respectively; all P < .01). A low slope predicted disease occurrence, even in subjects who did not reach a 20% decrease in FEV1 at the cumulative dose of 1 mg of methacholine (PD20 >1 mg). A decrease in slope over time was an independent predictor of disease risk.

CONCLUSION

Airway responsiveness predicted new-onset asthma, COPD, and allergic rhinitis. Our study supports the use of a continuous noncensored indicator of airway responsiveness, such as the slope of the methacholine dose-response curve, in clinical practice and research because it showed clear advantages over PD20.