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Chronic Obstructive Pulmonary Disease-Related Mortality in Brazil, 2000–2019: A Multiple-Cause-of-Death Study 2000-2019年巴西慢性阻塞性肺疾病相关死亡率:一项多死因研究
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-13 DOI: 10.1080/15412555.2022.2061934
A. H. Santo, F. L. Fernandes
Abstract Chronic obstructive pulmonary disease (COPD) remains a compelling cause of morbidity and mortality; however, it is underestimated and undertreated in Brazil. Using multiple causes of death data from the Information System on Mortality, we evaluated, from 2000 to 2019, national proportional mortality; trends in mortality rates stratified by age, sex, and macro-region; and causes of death and seasonal variation, considering COPD as an underlying and associated cause of death. COPD occurred in 1,132,968 deaths, corresponding to a proportional mortality of 5.0% (5.2% and 4.7% among men and women), 67.6% as the underlying, and 32.4% as an associated cause of death. The standardized mortality rate decreased by 25.8% from 2000 to 2019, and the underlying, associated, male and female, Southeast, South, and Center-West region deaths revealed decreasing standardized mortality trends. The mean age at death increased from 73.2 (±12.5) to 76.0 (±12.0) years of age. Respiratory diseases were the leading underlying causes, totaling 69.8%, with COPD itself reported for 67.6% of deaths, followed by circulatory diseases (15.8%) and neoplasms (6.24%). Respiratory failure, pneumonia, septicemia, and hypertensive diseases were the major associated causes of death. Significant seasonal variations, with the highest proportional COPD mortality during winter, occurred in the southeast, south, and center-west regions. This study discloses the need and value to accurately document epidemiologic trends related to COPD in Brazil, provided its burden on mortality in older age as a significant cause of death, aiming at effective planning of mortality prevention and control.
慢性阻塞性肺疾病(COPD)仍然是一个令人信服的发病率和死亡率的原因;然而,它在巴西被低估和治疗不足。使用来自死亡率信息系统的多种死亡原因数据,我们评估了2000年至2019年的全国比例死亡率;按年龄、性别和宏观区域分层的死亡率趋势;以及死亡原因和季节变化,考虑到慢性阻塞性肺病是潜在和相关的死亡原因。在1,132,968例COPD死亡中,相应的比例死亡率为5.0%(男性和女性分别为5.2%和4.7%),67.6%为潜在死亡原因,32.4%为相关死亡原因。2000 - 2019年,标准化死亡率下降了25.8%,男性和女性、东南部、南部和中西部地区的潜在死亡率和相关死亡率呈下降趋势。平均死亡年龄由73.2(±12.5)岁增加到76.0(±12.0)岁。呼吸系统疾病是主要的潜在原因,占69.8%,COPD本身报告的死亡人数占67.6%,其次是循环系统疾病(15.8%)和肿瘤(6.24%)。呼吸衰竭、肺炎、败血症和高血压疾病是主要的相关死亡原因。显著的季节变化,冬季COPD死亡率比例最高,发生在东南部、南部和中西部地区。本研究揭示了准确记录巴西COPD相关流行病学趋势的必要性和价值,因为它对老年死亡率造成了负担,是一个重要的死亡原因,旨在有效规划死亡率的预防和控制。
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引用次数: 2
The Association between Fat-Free Mass and Exercise Test Outcomes in People with Chronic Obstructive Pulmonary Disease: A Systematic Review 慢性阻塞性肺疾病患者无脂量与运动试验结果之间的关系:一项系统综述
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-12 DOI: 10.1080/15412555.2022.2049737
Kaveh Gaynor-Sodeifi, H. Lewthwaite, A. Jenkins, Letícia Fernandes Belo, E. Koch, Ahzum Mujaddid, Dana Raffoul, Lauren Tracey, D. Jensen
Abstract People with chronic obstructive pulmonary disease (COPD) tend to have abnormally low levels of fat-free mass (FFM), which includes skeletal muscle mass as a central component. The purpose of this systematic review was to synthesise available evidence on the association between FFM and exercise test outcomes in COPD. MEDLINE, Cochrane Library, EMBASE, Web of Science, and Scopus were searched. Studies that evaluated exercise-related outcomes in relation to measures of FFM in COPD were included. Eighty-three studies, containing 18,770 (39% female) COPD participants, were included. Considerable heterogeneity was identified in the ways that FFM and exercise test outcomes were assessed; however, higher levels of FFM were generally associated with greater peak exercise capacity. This association was stronger for some exercise test outcomes (e.g. peak rate of oxygen consumption during incremental cycle exercise testing) than others (e.g. six-minute walking distance). This review identified heterogeneity in the methods used for measuring FFM and exercise capacity. There was, in general, a positive association between FFM and exercise capacity in COPD. There was also an identified lack of studies investigating associations between FFM and temporal physiological and perceptual responses to exercise. This review highlights the significance of FFM as a determinant of exercise capacity in COPD. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2049737 .
慢性阻塞性肺疾病(COPD)患者往往具有异常低水平的无脂质量(FFM),其中包括骨骼肌质量作为中心组成部分。本系统综述的目的是综合COPD患者FFM与运动试验结果之间关联的现有证据。检索了MEDLINE、Cochrane Library、EMBASE、Web of Science和Scopus。评估COPD患者运动相关结果与FFM测量的研究被纳入。83项研究纳入了18,770名COPD参与者(39%为女性)。在评估FFM和运动测试结果的方式中发现了相当大的异质性;然而,高水平的FFM通常与更高的峰值运动能力相关。这种关联在某些运动测试结果(如增量循环运动测试中的峰值耗氧量)比其他结果(如6分钟步行距离)更强。本综述确定了测量FFM和运动能力的方法存在异质性。总体而言,慢性阻塞性肺病患者FFM与运动能力呈正相关。此外,还缺乏调查FFM与运动时的生理和知觉反应之间关系的研究。这篇综述强调了FFM作为COPD患者运动能力决定因素的重要性。本文的补充数据可在https://doi.org/10.1080/15412555.2022.2049737上在线获得。
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引用次数: 3
Usefulness of Glucose to Lymphocyte Ratio to Predict in-Hospital Mortality in Patients with AECOPD Admitted to the Intensive Care Unit 葡萄糖与淋巴细胞比值预测重症监护病房AECOPD患者住院死亡率的有效性
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2052272
Tianyang Hu, Xiaoqiang Liu, Yanan Liu
Abstract The purpose of this study was to investigate the relationship between glucose to lymphocyte ratio (GLR) and the outcome of acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients admitted to the intensive care unit (ICU). This study included 3573 patients from the eICU Collaborative Research Database (eICU-CRD) and 926 AECOPD patients admitted to ICU from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The optimal cutoff value for GLR was 5.6. Kaplan-Meier analysis demonstrated that patients in lower GLR (< 5.6) group showed a better overall survival than patients in higher GLR (≥ 5.6) group in all sets. Multivariate Cox regression analysis demonstrated that age, Sequential Organ Failure Assessment (SOFA) score, SpO2, albumin and GLR are independent predictors of poor overall survival in the training cohort and were incorporated into the nomogram for in-hospital mortality as independent factors. The nomogram exhibited excellent discrimination with C-indexes in training cohort, internal validation and external validation cohort were (0.801, 95%CI: 0.769-0.863), (0.805, 95%CI: 0.759-0.851) and (0.811, 95%CI: 0.772-0.850), respectively. The calibration plot indicated an adequate fit of the nomogram for predicting the risk of in-hospital mortality in all sets. Moreover, the ROC analyses demonstrated that the discrimination abilities of GLR were better than other blood-based inflammatory biomarkers. As an easily available biomarker, GLR can independently predict the in-hospital mortality in AECOPD patients admitted to ICU. The nomogram combining GLR with other significant indicators exhibited excellence predictive performance for in-hospital mortality.
摘要本研究旨在探讨急性加重期慢性阻塞性肺疾病(AECOPD)重症监护病房(ICU)患者血糖与淋巴细胞比值(GLR)与预后的关系。本研究纳入了来自eICU合作研究数据库(eICU- crd)的3573例患者和来自重症监护医学信息市场- iv (MIMIC-IV)数据库的926例AECOPD患者。GLR的最佳临界值为5.6。Kaplan-Meier分析显示,各组低GLR组(< 5.6)患者的总生存期均优于高GLR组(≥5.6)患者。多因素Cox回归分析显示,年龄、顺序器官衰竭评估(SOFA)评分、SpO2、白蛋白和GLR是培训队列中总生存率差的独立预测因子,并作为独立因素纳入住院死亡率的nomogram。训练组、内部验证组和外部验证组的c -指数分别为(0.801,95%CI: 0.769 ~ 0.863)、(0.805,95%CI: 0.759 ~ 0.851)和(0.811,95%CI: 0.772 ~ 0.850)。校正图显示,所有组的nomogram (nomogram)在预测院内死亡风险方面具有足够的拟合性。此外,ROC分析表明,GLR的识别能力优于其他基于血液的炎症生物标志物。GLR作为一种容易获得的生物标志物,可以独立预测ICU AECOPD患者的住院死亡率。结合GLR与其他重要指标的nomogram对院内死亡率的预测表现优异。
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引用次数: 4
Physiological Impairments on Respiratory Oscillometry and Future Exacerbations in Chronic Obstructive Pulmonary Disease Patients without a History of Frequent Exacerbations 无频繁发作史的慢性阻塞性肺疾病患者呼吸振荡测量的生理损伤和未来的加重
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2051005
Yi Zhang, N. Tanabe, H. Shima, Yusuke Shiraisi, T. Oguma, A. Sato, S. Muro, S. Sato, T. Hirai
Abstract Respiratory oscillometry allows measuring respiratory resistance and reactance during tidal breathing and may predict exacerbations in patients with chronic obstructive pulmonary disease (COPD). While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) advocates the ABCD classification tool to determine therapeutic approach based on symptom and exacerbation history, we hypothesized that in addition to spirometry, respiratory oscillometry complemented the ABCD tool to identify patients with a high risk of exacerbations. This study enrolled male outpatients with stable COPD who were prospectively followed-up over 5 years after completing mMRC scale and COPD assessment test (CAT) questionnaires, post-bronchodilator spirometry and respiratory oscillometry to measure resistance, reactance, and resonant frequency (Fres), and emphysema quantitation on computed tomography. Total 134 patients were classified into the GOLD A, B, C, and D groups (n = 48, 71, 5, and 9) based on symptoms on mMRC and CAT and a history of exacerbations in the previous year. In univariable analysis, higher Fres was associated with an increased risk of exacerbation more strongly than other respiratory oscillometry indices. Fres was closely associated with forced expiratory volume in 1 sec (FEV1). In multivariable Cox-proportional hazard models of the GOLD A and B groups, either lower FEV1 group or higher Fres group was associated with a shorter time to the first exacerbation independent of the GOLD group (A vs B) and emphysema severity. Adding respiratory oscillometry to the ABCD tool may be useful for risk estimation of future exacerbations in COPD patients without frequent exacerbation history.
呼吸振荡法可以测量潮汐呼吸期间的呼吸阻力和电抗,并可预测慢性阻塞性肺疾病(COPD)患者的恶化情况。虽然全球慢性阻塞性肺疾病倡议(GOLD)提倡使用ABCD分类工具来根据症状和加重史确定治疗方法,但我们假设除了肺活量测定法外,呼吸振荡测定法还可以补充ABCD工具来识别高风险的加重患者。本研究招募了稳定型COPD男性门诊患者,在完成mMRC量表和COPD评估测试(CAT)问卷、支气管扩张剂后肺活量测定法和呼吸振荡测定法测量阻力、电抗和共振频率(Fres)以及计算机断层扫描肺气肿定量后,对他们进行了5年以上的前瞻性随访。根据mMRC和CAT的症状以及前一年的恶化史,总共134例患者被分为GOLD A、B、C和D组(n = 48、71、5和9)。在单变量分析中,与其他呼吸振荡指标相比,较高的Fres与加重风险增加的相关性更强。Fres与1秒用力呼气量(FEV1)密切相关。在GOLD A组和B组的多变量cox -比例风险模型中,较低FEV1组或较高FEV1组与较短的首次加重时间相关,独立于GOLD组(A vs B)和肺气肿严重程度。在ABCD工具中加入呼吸振荡测量可能对无频繁加重史的COPD患者未来加重的风险评估有用。
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引用次数: 0
Clinical Characteristics of Non-Smoking Chronic Obstructive Pulmonary Disease Patients: Findings from the KOCOSS Cohort 非吸烟慢性阻塞性肺疾病患者的临床特征:来自KOCOSS队列的发现
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2053088
Joon Young Choi, Jin Woo Kim, Y. Kim, K. Yoo, K. Jung, J. H. Lee, S. Um, W. Lee, Dongil Park, H. Yoon
ABSTRACT Chronic obstructive pulmonary disease (COPD) has been regarded as a disease of smokers, but the prevalence of non-smoking COPD patients have been reported to be considerable. We investigated differences in clinical characteristics between smoking and non-smoking COPD patients. We used data from the Korea COPD Subgroup Study (KOCOSS) database, which is a multicenter cohort that recruits patients from 54 medical centres in Korea. Comprehensive comparisons of smoking and non-smoking COPD patients were performed based on general characteristics, exacerbations, symptom scores, radiological findings, and lung-function tests. Of the 2477 patients included in the study, 8.1% were non-smokers and 91.9% were smokers. Non-smoking COPD patients were more likely to be female and to have a higher body mass index and lower level of education. Non-smoking COPD patients had more comorbidities, including hypertension, osteoporosis, and gastroesophageal reflux disease, and experienced more respiratory and allergic diseases. No significant differences in exacerbation rates, symptom scores, or exercise capacity scores were observed between the two groups. Smoking COPD patients had more emphysematous lung according to the radiological findings, and non-smoking patients had more tuberculosis-destroyed lung and bronchiectasis. Lung-function testing revealed no significant difference in the forced expiratory capacity in 1 sec between the two groups, but smokers had more rapid lung-function decline in the 5 years of follow-up data. We found differences in general characteristics and radiological findings between smoking and non-smoking COPD patients. No significant differences in exacerbation or symptom scores were observed, but decline in lung function was less steep in non-smoking patients. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2053088 .
慢性阻塞性肺疾病(COPD)一直被认为是一种吸烟者的疾病,但据报道,非吸烟COPD患者的患病率相当高。我们调查了吸烟和非吸烟COPD患者临床特征的差异。我们使用了来自韩国COPD亚组研究(KOCOSS)数据库的数据,这是一个多中心队列,招募了来自韩国54个医疗中心的患者。基于一般特征、恶化、症状评分、影像学表现和肺功能检查,对吸烟和非吸烟COPD患者进行全面比较。在纳入研究的2477例患者中,8.1%为不吸烟者,91.9%为吸烟者。非吸烟的慢性阻塞性肺病患者更可能是女性,并且具有较高的身体质量指数和较低的教育水平。非吸烟COPD患者有更多的合并症,包括高血压、骨质疏松症和胃食管反流病,并有更多的呼吸道和过敏性疾病。两组在加重率、症状评分或运动能力评分方面均无显著差异。吸烟的慢性阻塞性肺病患者影像学表现为肺气肿较多,非吸烟的慢性阻塞性肺病患者肺毁损及支气管扩张较多。肺功能测试显示,两组1秒用力呼气量无显著差异,但在5年随访数据中,吸烟者肺功能下降更快。我们发现吸烟和非吸烟COPD患者的一般特征和影像学表现存在差异。在加重或症状评分方面没有观察到显著差异,但非吸烟患者的肺功能下降幅度较小。本文的补充数据可在https://doi.org/10.1080/15412555.2022.2053088上在线获得。
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引用次数: 1
Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls 有跌倒风险的慢性阻塞性肺疾病(COPD)患者平衡结局的年龄和性别差异
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2038120
S. Alsubheen, M. Beauchamp, C. Ellerton, R. Goldstein, J. Alison, G. Dechman, K. Haines, S. Harrison, A. Holland, A. Lee, A. Marques, L. Spencer, M. Stickland, E. Skinner, D. Brooks
Abstract No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50–65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = − 0.37), BEST test (r = − 0.33)] and weakly with the ABC scale (r = − 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.
先前没有研究调查了有跌倒风险的慢性阻塞性肺疾病(COPD)患者平衡结果的年龄和性别差异。对正在进行的COPD预防跌倒试验的基线数据进行了二次分析。分析Berg平衡量表(BBS)、平衡评价系统测试(BEST测试)和特定活动平衡置信度量表(ABC)的年龄和性别差异。总共包括223名COPD患者。女性的平衡障碍高于男性[BBS:平均(SD) = 47(8)比49(6)分;BEST测试:73(16)对80(16)分],执行功能活动的置信度较低[ABC = 66(21)对77(19)]。与较年轻(50-65岁)组相比,> - 65岁与平衡控制不良有中度相关性[BBS (r = - 0.37), BEST测试(r = - 0.33)],与ABC量表的相关性较弱(r = - 0.13)。在控制了平衡危险因素的影响后,年龄、基线呼吸困难指数(BDI)和6分钟步行测试(6-MWT)解释了38%的BBS变异性;年龄、性别、BDI和6-MWT解释了BEST测试中40%的变异;BDI和6-MWT解释了ABC量表中44%的变异性。这项研究强调了有跌倒风险的COPD患者在平衡结果上的年龄和性别差异。认识到这些差异对COPD患者的肺康复和预防跌倒具有重要意义,特别是在女性和老年人中。
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引用次数: 3
Discontinuation of Inhaled Corticosteroids from Triple Therapy in COPD: Effects on Major Outcomes in Real World Clinical Practice 慢性阻塞性肺病三联治疗中停止吸入皮质类固醇:对现实世界临床实践主要结果的影响
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-07 DOI: 10.1080/15412555.2022.2045265
S. Suissa, S. Dell'aniello, P. Ernst
Abstract Recent reports provide evidence-based guidelines for the withdrawal of inhaled corticosteroids (ICS) in COPD, but data on patients treated with ICS-based triple therapy are sparse and contradictory. We assessed the effect of ICS discontinuation on the incidence of severe exacerbation and pneumonia in a real-world population of patients with COPD who initiated triple therapy. We identified a cohort of patients with COPD treated with LAMA-LABA-ICS triple therapy during 2002–2018, age 50 or older, from the UK’s CPRD database. Subjects who discontinued ICS were matched 1:1 on time-conditional propensity scores to those continuing ICS and followed for one year. Hazard ratios (HR) of severe exacerbation and pneumonia were estimated using Cox regression. The cohort included 42,667 patients who discontinued ICS matched to 42,667 who continued ICS treatment. The hazard ratio of a severe exacerbation with ICS discontinuation relative to ICS continuation was 0.86 (95% CI: 0.78–0.95), while for severe pneumonia it was 0.96 (95% CI: 0.88–1.05). The incidence of severe exacerbation after ICS discontinuation was numerically higher than after continuation among patients with two or more exacerbations in the prior year (HR 1.09; 95% CI: 0.94–1.26) and among those with FEV1 <30% predicted (HR 1.29; 95% CI: 1.04–1.59). This large real-world study in the clinical setting of COPD treatment suggests that certain patients on triple therapy can be safely withdrawn from ICS and remain on bronchodilator therapy. As residual confounding cannot be ruled out, ICS discontinuation is not warranted for patients with multiple exacerbations and with very severe airway obstruction.
最近的报告为COPD患者停用吸入性皮质类固醇(ICS)提供了循证指南,但关于以ICS为基础的三联疗法治疗患者的数据很少且相互矛盾。我们评估了在现实世界中开始三联治疗的COPD患者中,ICS停药对严重恶化和肺炎发生率的影响。我们从英国CPRD数据库中确定了2002-2018年期间接受LAMA-LABA-ICS三联疗法治疗的COPD患者队列,年龄在50岁或以上。停止ICS的受试者在时间条件倾向得分上与继续ICS的受试者1:1匹配,并随访一年。使用Cox回归估计严重恶化和肺炎的风险比(HR)。该队列包括42,667名停止ICS治疗的患者和42,667名继续ICS治疗的患者。与继续使用ICS相比,停用ICS严重加重的风险比为0.86 (95% CI: 0.78-0.95),而严重肺炎的风险比为0.96 (95% CI: 0.88-1.05)。在前一年有两次或两次以上发作的患者中,ICS停药后严重发作的发生率在数字上高于继续服用后的发生率(HR 1.09;95% CI: 0.94-1.26),预测FEV1 <30%的患者(HR 1.29;95% ci: 1.04-1.59)。在COPD治疗的临床环境中进行的这项大型现实世界研究表明,某些接受三联治疗的患者可以安全地退出ICS并继续接受支气管扩张剂治疗。由于不能排除残留的混杂因素,对于多次发作和非常严重的气道阻塞的患者,不应停止使用ICS。
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引用次数: 3
Fluticasone-Based versus Budesonide-Based Triple Therapies in COPD: Real-World Comparative Effectiveness and Safety 基于氟替卡松与基于布地奈德的三联治疗COPD:真实世界的比较有效性和安全性
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-06 DOI: 10.1080/15412555.2022.2035705
S. Suissa, S. Dell'aniello, P. Ernst
Abstract Triple therapy for chronic obstructive pulmonary disease (COPD) is recommended for some patients, but the inhaled corticosteroids (ICS) may differ in effectiveness and safety. We compared budesonide-based and fluticasone-based triple therapy given in two inhalers on the incidence of exacerbation, mortality and severe pneumonia, using an observational study approach. We identified a cohort of patients with COPD, new users of triple therapy given in two inhalers during 2002–2018, age 50 or older, from the UK’s CPRD database, and followed for one year. The hazard ratio (HR) of exacerbation, all-cause death and pneumonia was estimated using the Cox regression model, weighted by fine stratification of the propensity score of treatment initiation. The cohort included 29,716 new users of fluticasone-based triple therapy and 9,646 of budesonide-based. The HR of a first moderate or severe exacerbation with budesonide-based triple therapy was 0.98 (95% CI: 0.94–1.03), relative to fluticasone-based, while for a severe exacerbation it was 0.97 (95% CI: 0.87–1.07). The incidence of all-cause death was lower with budesonide-based therapy among patients with no prior exacerbations (HR 0.80; 95% CI: 0.66–0.98). The HR of severe pneumonia with budesonide-based therapy was 0.84 (95% CI: 0.75–0.95). In a real-world clinical setting of COPD treatment, budesonide-based triple therapy given in two inhalers was generally as effective at reducing exacerbations as fluticasone-based triple therapy. However, the budesonide-based triple therapy was associated with a lower incidence of severe pneumonia and possibly also of all-cause death, especially among patients with no prior exacerbations for whom triple therapy is not recommended. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2035705 .
慢性阻塞性肺疾病(COPD)的三联疗法被推荐用于一些患者,但吸入皮质类固醇(ICS)的有效性和安全性可能存在差异。我们采用观察性研究方法,比较了布地奈德和氟替卡松三联治疗在两种吸入器中的加重发生率、死亡率和重症肺炎发生率。我们从英国CPRD数据库中确定了一组COPD患者,2002-2018年期间使用两个吸入器进行三联治疗的新使用者,年龄在50岁或以上,并随访了一年。使用Cox回归模型估计病情加重、全因死亡和肺炎的风险比(HR),并对开始治疗的倾向评分进行精细分层加权。该队列包括29,716名以氟替卡松为基础的三联疗法新使用者和9,646名以布地奈德为基础的三联疗法新使用者。与基于氟替卡松的三联疗法相比,布地奈德为基础的首次中度或重度加重的HR为0.98 (95% CI: 0.94-1.03),而严重加重的HR为0.97 (95% CI: 0.87-1.07)。布地奈德为基础的治疗在既往无加重的患者中全因死亡发生率较低(HR 0.80;95% ci: 0.66-0.98)。布地奈德治疗重症肺炎的HR为0.84 (95% CI: 0.75-0.95)。在现实世界的慢性阻塞性肺病治疗临床环境中,布地奈德三联治疗在减少急性加重方面通常与氟替卡松三联治疗一样有效。然而,以布地奈德为基础的三联治疗与较低的严重肺炎发生率相关,也可能与全因死亡相关,特别是在先前没有加重的患者中,不推荐三联治疗。本文的补充数据可在https://doi.org/10.1080/15412555.2022.2035705上在线获得。
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引用次数: 3
Development and Validation of a Screening Questionnaire of COPD from a Large Epidemiological Study in China 中国大型流行病学研究中COPD筛查问卷的开发和验证
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-06 DOI: 10.1080/15412555.2022.2042504
Dingyi Wang, Guohui Fan, Sinan Wu, Ting Yang, Jianying Xu, Lan Yang, Jianping Zhao, Xiangyan Zhang, Chunxue Bai, Jian Kang, P. Ran, Huahao Shen, Fuqiang Wen, Kewu Huang, Yahong Chen, Tie-ying Sun, G. Shan, Yingxiang Lin, Guodong Xu, Rui-ying Wang, Zhihong Shi, Yong-jian Xu, Xianwei Ye, Yuanlin Song, Qiuyue Wang, Yumin Zhou, Wen Li, Liren Ding, C. Wan, W. Yao, Yanfei Guo, F. Xiao, Yong Lu, Xiaoxia Peng, Biao Zhang, D. Xiao, Zuomin Wang, X. Bu, Hong Zhang, Xiaolei Zhang, Li An, Shu Zhang, Jianguo Zhu, Zhixin Cao, Q. Zhan, Yuanhua Yang, L. Liang, H. Dai, Bin Cao, Jiang He, Chen Wang
Abstract Objective We aimed to establish an easy-to-use screening questionnaire with risk factors and suspected symptoms of COPD for primary health care settings. Methods Based on a nationwide epidemiological study of pulmonary health among adults in mainland China (China Pulmonary Health, CPH study) between 2012 and 2015, participants ≥40 years who completed the questionnaire and spirometry tests were recruited and randomly divided into development set and validation set by the ratio of 2:1. Parameters including sex, age, BMI, residence, education, smoking status, smoking pack-years, biomass exposure, parental history of respiratory diseases and daily respiratory symptoms were initially selected for the development of scoring system. Receiver operating characteristic (ROC) curve, area under curve (AUC), positive and negative predictive values were calculated in development set and validation set. Results After random split by 2:1 ratio, 22443 individuals were assigned to development set and 11221 to validation set. Ten variables were significantly associated with COPD independently in development set after a stepwise selection by multivariable logistic model and used to develop scoring system. The scoring system yielded good discrimination, as measured by AUC of 0.7737, and in the validation set, the AUC was 0.7711. When applying a cutoff point of ≥16, the sensitivity in development set was 0.69 (0.67 − 0.71); specificity 0.72 (0.71 − 0.73), PPV 0.25 (0.24 − 0.26) and NPV 0.94 (0.94 − 0.95). Conclusion We developed and validated a comprehensive screening questionnaire, COPD-CPHS, with good discrimination. The score system still needs to be validated by large cohort in the future. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2022.2042504 .
摘要目的为初级卫生保健机构建立一份易于使用的COPD危险因素和疑似症状筛查问卷。方法基于2012 - 2015年中国大陆成年人肺健康的全国流行病学研究(China pulmonary health, CPH study),招募≥40岁且完成问卷调查和肺活量测定的参与者,按2:1的比例随机分为发展组和验证组。初步选取性别、年龄、BMI、居住地、受教育程度、吸烟状况、吸烟包年、生物量暴露、父母呼吸道疾病史、每日呼吸道症状等参数制定评分系统。计算受试者工作特征(ROC)曲线、曲线下面积(AUC)、阳性预测值和阴性预测值。结果按2:1的比例随机划分,开发组22443人,验证组11221人。采用多变量logistic模型逐步筛选后,10个变量在发展组独立与COPD显著相关,并建立评分系统。评分系统产生了良好的判别,AUC为0.7737,在验证集中,AUC为0.7711。当截断点≥16时,发育组的敏感性为0.69 (0.67 ~ 0.71);PPV特异性0.72(0.71−0.73),0.25(0.24−0.26)和净现值为0.94(0.94−0.95)。结论我们编制并验证了COPD-CPHS综合筛查问卷,具有良好的甄别性。分数系统仍需要在未来进行大规模的队列验证。本文的补充数据可在https://doi.org/10.1080/15412555.2022.2042504上在线获得。
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引用次数: 0
Association of Body Mass Index and Abdominal Obesity with the Risk of Airflow Obstruction: National Health and Nutrition Examination Survey (NHANES) 2007–2012 体重指数和腹部肥胖与气流阻塞风险的关系:2007-2012年全国健康与营养调查(NHANES)
IF 2.2 4区 医学 Q3 Medicine Pub Date : 2022-04-06 DOI: 10.1080/15412555.2022.2032627
Xiaofei Zhang, Hongru Chen, Kunfang Gu, Xiubo Jiang
Abstract This study aimed to explore the relationship between body mass index (BMI) and abdominal obesity and the risk of airflow obstruction, based on the data from the 2007–2012 National Health and Nutrition Survey (NHANES). Logistic regression was applied to assess the relationships between BMI or abdominal obesity and the risk of airflow obstruction by the fixed ratio method and the lower limit of normal (LLN) method. We further used the restricted cubic splines with 3 knots located at the 5th, 50th, and 95th percentiles of the distribution to evaluate the dose-response relationship. A total of 12,865 individuals aged 20–80 years old were included. In the fixed ratio method, underweight was positively correlated with the risk of airflow obstruction, and overweight and obesity were negatively correlated with the risk of airflow obstruction. In the LLN method, the results were consistent with the fixed ratio method. Abdominal obesity was positively associated with the risk of airflow obstruction only in the fixed ratio method (OR: 1.41, 95% CI: 1.04–1.90). There was an additive interaction between underweight and smoking on airflow obstruction in both methods. Abdominal obesity and smoking had additive interactions in the LLN method. Dose-response analysis indicated that there was a non-linear trend between BMI and the risk of airflow obstruction (P for nonlinearity < 0.01). Our study suggested that underweight and abdominal obesity were associated with the increased risk of airflow obstruction, and overweight and general obesity were associated with the decreased risk of airflow obstruction.
摘要本研究基于2007-2012年全国健康与营养调查(NHANES)的数据,旨在探讨体重指数(BMI)、腹部肥胖和气流阻塞风险之间的关系。采用Logistic回归方法,采用固定比值法和正常下限(LLN)法评估BMI或腹部肥胖与气流阻塞风险的关系。我们进一步使用3个结点位于分布的第5、第50和第95百分位的限制性三次样条来评估剂量-反应关系。共纳入年龄在20-80岁之间的12,865人。在固定比例法中,体重过轻与气流阻塞风险正相关,超重和肥胖与气流阻塞风险负相关。在LLN法中,结果与固定比率法一致。腹部肥胖仅在固定比例法中与气流阻塞风险呈正相关(OR: 1.41, 95% CI: 1.04-1.90)。在两种方法中,体重不足和吸烟对气流阻塞都有加性的相互作用。在LLN方法中,腹部肥胖和吸烟具有加性相互作用。剂量-反应分析显示BMI与气流阻塞风险呈非线性关系(P为非线性< 0.01)。我们的研究表明,体重过轻和腹部肥胖与气流阻塞风险增加有关,而超重和一般肥胖与气流阻塞风险降低有关。
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引用次数: 4
期刊
COPD: Journal of Chronic Obstructive Pulmonary Disease
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