scholarly journals Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

2021 ◽  
Vol 8 (1) ◽  
pp. e001135
Author(s):  
Subash Heraganahally ◽  
Timothy P Howarth ◽  
Elisha White ◽  
Helmi Ben Saad
Keyword(s):  
Indigenous Population ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Indigenous Australians ◽  
Obstructive Pulmonary Disease ◽  
Reference Equations ◽  
Global Initiative ◽  
Lower Limit Of Normal

BackgroundAssessment of airflow limitation (AFL) is crucial in the clinical evaluation of patients with chronic obstructive pulmonary disease (COPD). However, in the absence of normative reference values among adult Australian Indigenous population, the implications of utilising the Global Lung Function Initiative (GLI-2012), Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Australian concise COPD-X recommended severity classifications is not known. Moreover, spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) are observed to be 20%–30% lower in an apparently healthy Indigenous population in comparison to Caucasian counterparts.MethodsAdult Indigenous patients diagnosed to have COPD on spirometry (postbronchodilator (BD) FEV1/FVC <0.7 ((GOLD, (COPD-X)) and ≤lower limit of normal (others/mixed reference equations) for GLI-2012) were assessed for AFL severity classifications on Post-BD FEV1 values (mild, moderate, severe, very severe) as per the recommended classifications.ResultsFrom a total of 742 unique patient records of Indigenous Australians, 253 were identified to have COPD via GOLD/COPD-X criteria (n=238) or GLI-2012 criteria (n=238) with significant agreeance between criteria (96%, κ=0.901). Of these, the majority were classified as having moderate or severe/very-severe AFL with significant variability across classification criteria (COPD-X (40%–43%), GOLD (33%–65%), GLI-2012 (18%–75%)). The FVC and FEV1 values also varied significantly between classification criterion (COPD-X/GOLD/GLI-2012) within the same AFL category, with COPD-X ‘moderate’ AFL almost matching ‘severe’ AFL categorisation by GOLD or GLI-2012.ConclusionsHealth professionals caring for Indigenous patients with COPD should be aware of the clinical implications and consequences of utilising various recommended AFL classifications in the absence of validated spirometry reference norms among adult Indigenous patients.

scholarly journals Gait patterns in COPD: the Rotterdam Study

2015 ◽  
Vol 46 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Lies Lahousse ◽  
Vincentius J.A. Verlinden ◽  
Jos N. van der Geest ◽  
Guy F. Joos ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Chronic Obstructive Lung Disease ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Gait Velocity ◽  
Normal Lung ◽  
Chronic Obstructive ◽  
Rotterdam Study ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Gait disturbances in patients with chronic obstructive pulmonary disease (COPD) may lead to disability and falls. As studies assessing gait kinematics in COPD are sparse, we investigated associations of COPD with various gait domains and explored a potential link with falling.Gait was measured within the prospective, population-based Rotterdam Study (age ≥55 years) using an electronic walkway and summarised into seven gait domains: Rhythm, Variability, Phases, Pace, Tandem, Turning and Base of Support. Rhythm is a temporal gait aspect that includes cadence and reflects how quickly steps are taken.Persons with COPD (n=196) exhibited worse Rhythm (−0.21 sd, 95% CI −0.36– −0.06 sd) compared with persons with normal lung function (n=898), independent of age, sex, height, education, smoking or analgesic use, especially when dyspnoea and severe airflow limitation or frequent exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D: −0.83 sd, 95% CI −1.25– −0.41 sd) were present. A lower forced expiratory volume in 1 s was associated with worse Rhythm and Pace, including lower cadence and gait velocity, respectively. Importantly, fallers with COPD had significantly worse Rhythm than nonfallers with COPD.This study demonstrates that persons with COPD exhibit worse Rhythm, especially fallers with COPD. The degree of Rhythm deterioration was associated with the degree of airflow limitation, symptoms and frequency of exacerbations.

scholarly journals Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity

2015 ◽  
Vol 46 (6) ◽  
pp. 1589-1597 ◽  
Author(s):  
Ben-Gary Harvey ◽  
Yael Strulovici-Barel ◽  
Robert J. Kaner ◽  
Abraham Sanders ◽  
Thomas L. Vincent ◽  
...  
Keyword(s):  
New York ◽  
Complete Blood Count ◽  
Significant Risk ◽  
Chronic Obstructive Lung Disease ◽  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these “normal spirometry/low DLCO” smokers is unknown.From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers.In the normal spirometry/normal DLCO group assessed over 45±20 months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22% developed GOLD-defined COPD.Despite appearing “normal” according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

scholarly journals Underuse of spirometry by general practitioners for the diagnosis of COPD in Italy

2005 ◽  
Vol 63 (1) ◽  
Author(s):  
G. Caramori ◽  
G. Bettoncelli ◽  
R. Tosatto ◽  
F. Arpinelli ◽  
G. Visonà ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
General Practitioners ◽  
Gold Standard ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Further Education ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Background. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) underlines that spirometry is the gold standard as the most reproducible, standardised, and objective way of measuring airflow limitation in the diagnosis and assessment of Chronic Obstructive Pulmonary Disease (COPD). However, studies undertaken in different countries have suggested a widespread underuse of spirometry by general practitioners to establish the diagnosis of COPD. Precise estimates of the prevalence of physician-diagnosed COPD in Italy are not currently available. In collaboration with the Italian Academy of General practitioners (SIMG) we have investigated the degree of use of spirometry to establish the diagnosis of COPD in Italy. Methods. A standardised questionnaire has been selfadministered to a sample of 2425 Italian general practitioners (representing 5% of all the Italian doctors involved in general practice). They have been chosen to cover each of the Italian counties. Results. The prevalence of physician-diagnosed COPD was found to be approximately 4%. However, 30% of general practitioners do not use spirometry to establish the diagnosis of COPD. The main reasons given for the failure to use spirometry are (i) that spirometry is not necessary for the diagnosis of COPD or (ii) there are logistical limitations to the access of the patients to lung function laboratories. Conclusions. This data suggests that contrary to GOLD Guidelines, in Italy, as with other countries, spirometry is not always used in the diagnosis of COPD. There is a clear necessity for further education initiatives targeted to this group of physicians.

scholarly journals GOLD criteria overestimate airflow limitation in one-third of cases in the general Finnish population

2016 ◽  
Vol 2 (4) ◽  
pp. 00084-2015 ◽  
Author(s):  
Annette Kainu ◽  
Kirsi Timonen ◽  
Ari Lindqvist ◽  
Päivi Piirilä
Keyword(s):  
Reference Values ◽  
Population Sample ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
International Studies ◽  
Finnish Population ◽  
Obstructive Pulmonary Disease ◽  
Severity Grading

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria for chronic obstructive pulmonary disease (COPD) use a fixed threshold of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (<0.70) in post-bronchodilation spirometry to indicate disease, which has been shown to underestimate and overestimate disease prevalence in younger and older adults, respectively, whilst criteria based on reference values have better accuracy. Differences in reference values have limited their use in international studies. However, the new Global Lung Function Initiative reference values (GLI2012) showed FEV1/FVC to be the least dependent on ethnicity. The aim of this study was to assess the prevalence of airflow limitation with GLI2012 and the degree of underdetection or overestimation related to the use of GOLD in the general population.A Finnish population sample of 1323 subjects (45% male) with post-bronchodilation spirometry was studied.80 subjects (6.0%) and 55 subjects (4.2%) were identified with airflow limitation with GOLD and GLI2012 criteria, respectively. The proportion of overestimation with GOLD increased with age from 25% of cases in 50-year-olds to 54% in 70-year-olds. Using z-score-based grading resulted in more dispersion in severity grading.In conclusion, the GOLD criteria cause a marked overestimation already from 50-year-olds and should be replaced with the GLI2012 criteria to improve diagnostic accuracy.

scholarly journals Prevalence and impact of diabetes, hypertension, and cardiovascular diseases in chronic obstructive pulmonary diseases: A hospital-based cross-section study

2015 ◽  
Vol 3 (4) ◽  
pp. 155-160 ◽  
Author(s):  
Vinay Mahishale ◽  
Naveen Angadi ◽  
Vijayanand Metgudmath ◽  
Ajith Eti ◽  
Mitchelle Lolly ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Limited Data ◽  
Obstructive Pulmonary Disease ◽  
Chronic Obstructive Pulmonary Diseases ◽  
Common Risk Factors ◽  
Global Initiative ◽  
The Relationship

Abstract Background: Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including diabetes, hypertension and cardiovascular diseases. As very limited data is available in India, the aim of the present study was to determine the relationship between COPD and the common, chronic comorbid conditions of diabetes mellitus (DM), hypertension (HTN), and cardiovascular diseases (CVD) and also to determine how these affect the clinical course of COPD. Methods: All the COPD cohorts diagnosed as per Global Initiative for Chronic Obstructive Lung Disease-2013 (GOLD-2013) criteria were screened for DM, HTN, and CVD as per stipulated national and WHO guidelines. Results: The prevalence of DM, HTN, and CVD in the 2432 COPD subjects was 25.94%, 37.25%, and 13.93%, respectively. In multivariate analyses, very severe COPD was associated with a higher risk of DM (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2), HTN (OR 1.6, 95% CI 1.4–1.9), and CVD (OR 2.5, 95% CI 1.9–3.0). Conclusion: A significant relationship was found between COPD and the presence of comorbid DM, HTN, and CVD. It was also found that subjects with advanced COPD were more likely to have at least two of these conditions and hugely affect the outcome of the disease. These findings suggest that the presence of COPD could provide a rationale to look for other comorbid disease and, conversely, that the presence of DM, HTN, or CVD might be the basis for the assessment of patients for airflow limitation and COPD as the tobacco smoking and advancing age were common risk factors.

scholarly journals Comparison of different staging methods for COPD in predicting outcomes

2018 ◽  
Vol 51 (3) ◽  
pp. 1700577 ◽  
Author(s):  
Tang-Hsiu Huang ◽  
Tzuen-Ren Hsiue ◽  
Sheng-Hsiang Lin ◽  
Xin-Ming Liao ◽  
Po-Lan Su ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Chronic Obstructive Lung Disease ◽  
Ethnically Diverse ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Severe Acute Exacerbation ◽  
Frequent Exacerbation ◽  
Global Initiative ◽  
Future Work

Chronic obstructive pulmonary disease (COPD) is commonly staged according to the percentage of predicted forced expiratory volume in 1 s (FEV1 % pred), but other methods have been proposed. In this study we compared the performance of seven staging methods in predicting outcomes.We retrospectively studied 296 COPD outpatients. For each patient the disease severity was staged by separately applying the following methods: the criteria proposed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), quartiles of FEV1 % pred and z-score of FEV1, quartiles and specified cut-off points of the ratio of FEV1 over height squared ((FEV1·Ht−2)A and (FEV1·Ht−2)B, respectively), and quartiles of the ratio of FEV1 over height cubed (FEV1·Ht−3) and of FEV1 quotient (FEV1Q). We evaluated the performance of these methods in predicting the risks of severe acute exacerbation and all-cause mortality.Overall, staging based on the reference-independent FEV1Q performed best in predicting the risks of severe acute exacerbation (including frequent exacerbation) and mortality, followed by (FEV1·Ht−2)B. The performance of staging methods could also be influenced by the choice of cut-off values. Future work using large and ethnically diverse populations to refine and validate the cut-off values would enhance the prediction of outcomes.

scholarly journals Participation of the miR-22-HDAC4-DLCO Axis in Patients with COPD by Tobacco and Biomass

Biomolecules ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. 837 ◽  
Author(s):  
Yadira Velasco-Torres ◽  
Víctor Ruiz ◽  
Martha Montaño ◽  
Rogelio Pérez-Padilla ◽  
Ramcés Falfán-Valencia ◽  
...  
Keyword(s):  
Posttranscriptional Regulation ◽  
Chronic Obstructive Lung Disease ◽  
Serum Levels ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Single Breath ◽  
Global Initiative ◽  
Genetic And Environmental Factors ◽  
And Gender

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and systemic inflammation. The main causes of COPD include interaction between genetic and environmental factors associated with tobacco smoking (COPD-TS) and/or exposure to biomass smoke (COPD-BS). Several microRNAs (miRNAs) control posttranscriptional regulation of COPD-TS associated gene expression. The miR-22-HDAC4-IL-17 axis was recently characterized. It is still unknown, however, whether this axis, participates in COPD-BS. To investigate, 50 patients diagnosed with severe-to-very severe COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages III/IV, were recruited, 25 women had COPD-BS (never smokers, exposed heavily to BS) and 25 had COPD-TS. Serum levels of miRNA-22-3p were measured by RT (Reverse Transcription)-qPCR, while the concentration of HDAC4 (Histone deacetylase 4) was detected by ELISA. Additionally, we looked for association between serum HDAC4 and DLCOsb (Single-breath diffusing capacity of the lung for carbon monoxide), as % of predicted by age, height, and gender, one of the main differences described between COPD-BS and COPD-TS. Women with COPD-BS were older and shorter and had a higher DLCOsb %P (percent predicted) compared to COPD-TS. Serum miR-22-3p was downregulated in COPD-BS relative to COPD-TS. In contrast, the concentration of HDAC4 was higher in COPD-BS compared to COPD-TS. Furthermore, a positive correlation between serum HDAC4 levels and DLCOsb %P was observed. We concluded that the miR-22-HDAC4-DLCO axis behaves differently in patients with COPD-BS and COPD-TS.

scholarly journals Incidence of airflow limitation in subjects 65–100 years of age

2015 ◽  
Vol 47 (2) ◽  
pp. 461-472 ◽  
Author(s):  
Johannes A. Luoto ◽  
Sölve Elmståhl ◽  
Per Wollmer ◽  
Mats Pihlsgård
Keyword(s):  
Fixed Ratio ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
European Respiratory Society ◽  
Obstructive Pulmonary Disease ◽  
True Incidence ◽  
Lower Limit Of Normal

The true incidence of chronic obstructive pulmonary disease is largely unknown, because the few longitudinal studies performed have used diagnostic criteria no longer recommended by either the European Respiratory Society or the American Thoracic Society (ATS).We studied the incidence and significance of airflow limitation in a population-based geriatric sample using both an age-dependent predicted lower limit of normal (LLN) value and a fixed-ratio spirometric criterion.Out of 2025 subjects with acceptable spirometry at baseline, 984 subjects aged 65–100 years completed a 6-year follow-up visit. Smoking habits were registered at baseline. Exclusion criteria were non-acceptable spirometry performance according to ATS criteria and inability to communicate. Airflow limitation was defined both according to forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio <0.7 and <LLN.The incidence of airflow limitation per 1000 person-years was 28.2 using a fixed ratio and 11.7 with LLN, corresponding to a 1.41-fold higher incidence rate using a fixed ratio. The incidence increased dramatically with age when using a fixed ratio, but less so when using LLN. In addition, a sex effect was observed with the LLN criterion. LLN airflow limitation was associated with increased 5-year mortality. Presence of fixed-ratio airflow limitation in individuals classified by LLN as non-obstructive was not associated with increased mortality.

scholarly journals Spirometric Values of Greek People and Comparison with ECSC and GLI Values in COPD People

2018 ◽  
Vol 12 (1) ◽  
pp. 29-38
Author(s):  
Nikolaos Tatsis ◽  
Sotirios Kakavas ◽  
Evgenios Metaxas ◽  
Evangelos Balis ◽  
George Tatsis ◽  
...  
Keyword(s):  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Greek Population ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Significant Difference ◽  
Global Initiative ◽  
Predicted Values

Background: During the past few years, the use of criteria introduced by Global Initiative for Chronic Obstructive Lung Disease (GOLD) is recommended for the diagnosis and classification of Chronic Obstructive Pulmonary Disease(COPD),taking into account the values of a Forced Expiratory Volume In 1 second (FEV1) and a Forced Expiratory Volume In 1 second (FEV1) to Forced Vital Capacity (FVC) ratio. In Europe, the reference values of the European Coal and Steel Community (ECSC), that were originally developed in 1993 are still used. Aim of the Study: The study aimed to carry out measurement of spirometric values in a healthy, non smoking Greek population, development of local equations and comparison with ECSC and Global Lung Initiative(GLI) equations, in order to see if there is a need for separate ones in everyday use. Methods: Normal predicted values for FEV1 and FEV1/FVC% were obtained from a group of 500 healthy subjects, aged 18-89 years. In addition, a group of 124 COPD patients, with no other comorbidities was studied. Patients were classified according to GOLD criteria in four groups with ECSC, GLI predicted values or with our own predicted values. Results: The statistical analysis has revealed that there is no significant difference among the three sets of predicted values and no statistical difference was detected among the classification of COPD patients. Conclusion: It is shown that the 3 sets of predicted values are almost identical, despite the fact that they have been collected from different study populations.Αccording to the study, there is no need in recalculating values for Greek population.

scholarly journals The Importance of Appropriate Diagnosis in the Practical Management of Chronic Obstructive Pulmonary Disease

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 618
Author(s):  
Naozumi Hashimoto ◽  
Keiko Wakahara ◽  
Koji Sakamoto
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Clinical Aspects ◽  
Chronic Obstructive ◽  
European Respiratory Society ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative ◽  
The Impact

Chronic obstructive pulmonary disease (COPD) is projected to continue to contribute to an increase in the overall worldwide burden of disease until 2030. Therefore, an accurate assessment of the risk of airway obstruction in patients with COPD has become vitally important. Although the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the American Thoracic Society (ATS) and European Respiratory Society (ERS), and the Japanese Respiratory Society (JRS) provide the criteria by which to diagnose COPD, many studies suggest that it is in fact underdiagnosed. Its prevalence increases, while the impact of COPD-related systemic comorbidities is also increasingly recognized in clinical aspects of COPD. Although a recent report suggests that spirometry should not be used to screen for airflow limitation in individuals without respiratory symptoms, the early detection of COPD in patients with no, or few, symptoms is an opportunity to provide appropriate management based on COPD guidelines. Clinical advances have been made in pharmacotherapeutic approaches to COPD. This article provides a current understanding of the importance of an appropriate diagnosis in the real-world management of COPD.

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