Pub Date : 2022-04-13DOI: 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.
{"title":"Chronic Obstructive Pulmonary Disease-Related Mortality in Brazil, 2000–2019: A Multiple-Cause-of-Death Study","authors":"A. H. Santo, F. L. Fernandes","doi":"10.1080/15412555.2022.2061934","DOIUrl":"https://doi.org/10.1080/15412555.2022.2061934","url":null,"abstract":"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.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"85 1","pages":"216 - 225"},"PeriodicalIF":2.2,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80937016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-12DOI: 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。
{"title":"The Association between Fat-Free Mass and Exercise Test Outcomes in People with Chronic Obstructive Pulmonary Disease: A Systematic Review","authors":"Kaveh Gaynor-Sodeifi, H. Lewthwaite, A. Jenkins, Letícia Fernandes Belo, E. Koch, Ahzum Mujaddid, Dana Raffoul, Lauren Tracey, D. Jensen","doi":"10.1080/15412555.2022.2049737","DOIUrl":"https://doi.org/10.1080/15412555.2022.2049737","url":null,"abstract":"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 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"55 1","pages":"182 - 205"},"PeriodicalIF":2.2,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74115618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 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.
{"title":"Usefulness of Glucose to Lymphocyte Ratio to Predict in-Hospital Mortality in Patients with AECOPD Admitted to the Intensive Care Unit","authors":"Tianyang Hu, Xiaoqiang Liu, Yanan Liu","doi":"10.1080/15412555.2022.2052272","DOIUrl":"https://doi.org/10.1080/15412555.2022.2052272","url":null,"abstract":"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.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"66 1","pages":"158 - 165"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86780784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 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。
{"title":"Physiological Impairments on Respiratory Oscillometry and Future Exacerbations in Chronic Obstructive Pulmonary Disease Patients without a History of Frequent Exacerbations","authors":"Yi Zhang, N. Tanabe, H. Shima, Yusuke Shiraisi, T. Oguma, A. Sato, S. Muro, S. Sato, T. Hirai","doi":"10.1080/15412555.2022.2051005","DOIUrl":"https://doi.org/10.1080/15412555.2022.2051005","url":null,"abstract":"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.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"26 1","pages":"149 - 157"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78251576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 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 .
{"title":"Clinical Characteristics of Non-Smoking Chronic Obstructive Pulmonary Disease Patients: Findings from the KOCOSS Cohort","authors":"Joon Young Choi, Jin Woo Kim, Y. Kim, K. Yoo, K. Jung, J. H. Lee, S. Um, W. Lee, Dongil Park, H. Yoon","doi":"10.1080/15412555.2022.2053088","DOIUrl":"https://doi.org/10.1080/15412555.2022.2053088","url":null,"abstract":"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 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"17 1","pages":"174 - 181"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78186779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 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.
{"title":"Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls","authors":"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","doi":"10.1080/15412555.2022.2038120","DOIUrl":"https://doi.org/10.1080/15412555.2022.2038120","url":null,"abstract":"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.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"9 1","pages":"166 - 173"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87248059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 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.
{"title":"Discontinuation of Inhaled Corticosteroids from Triple Therapy in COPD: Effects on Major Outcomes in Real World Clinical Practice","authors":"S. Suissa, S. Dell'aniello, P. Ernst","doi":"10.1080/15412555.2022.2045265","DOIUrl":"https://doi.org/10.1080/15412555.2022.2045265","url":null,"abstract":"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.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"12 1","pages":"133 - 141"},"PeriodicalIF":2.2,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83196644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-06DOI: 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 .
{"title":"Fluticasone-Based versus Budesonide-Based Triple Therapies in COPD: Real-World Comparative Effectiveness and Safety","authors":"S. Suissa, S. Dell'aniello, P. Ernst","doi":"10.1080/15412555.2022.2035705","DOIUrl":"https://doi.org/10.1080/15412555.2022.2035705","url":null,"abstract":"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 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"44 1","pages":"109 - 117"},"PeriodicalIF":2.2,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86986056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-06DOI: 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 .
{"title":"Development and Validation of a Screening Questionnaire of COPD from a Large Epidemiological Study in China","authors":"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","doi":"10.1080/15412555.2022.2042504","DOIUrl":"https://doi.org/10.1080/15412555.2022.2042504","url":null,"abstract":"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 .","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"20 1","pages":"118 - 124"},"PeriodicalIF":2.2,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75986543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Association of Body Mass Index and Abdominal Obesity with the Risk of Airflow Obstruction: National Health and Nutrition Examination Survey (NHANES) 2007–2012","authors":"Xiaofei Zhang, Hongru Chen, Kunfang Gu, Xiubo Jiang","doi":"10.1080/15412555.2022.2032627","DOIUrl":"https://doi.org/10.1080/15412555.2022.2032627","url":null,"abstract":"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.","PeriodicalId":10704,"journal":{"name":"COPD: Journal of Chronic Obstructive Pulmonary Disease","volume":"40 1","pages":"99 - 108"},"PeriodicalIF":2.2,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77980873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}