β2-Adrenergic genotypes and risk of severe exacerbations in COPD: a prospective cohort study

BackgroundIndividual susceptibility to exacerbations in chronic obstructive pulmonary disease (COPD) is likely influenced by genetic factors; however, most such variance is unexplained. We hypothesised that β2-adrenergic receptor genotypes, Gly16Arg (rs1042713, c.46G>A) and Gln27Glu (rs1042714, c.79C>G) influence risk of severe exacerbations in COPD.MethodsAmong 96 762 individuals in the Copenhagen General Population Study, we identified 5262 with COPD (forced expiratory volume in one second divided by forced vital capacity, FEV1/FVC, below 0.7, FEV1 less than 80% of predicted value, age above 40 years and no asthma) who had genotyping performed. Severe exacerbations were defined as acute admissions due to COPD during 5 years of follow-up (mean 3.4 years). 923 individuals with COPD diagnosed similarly in the Copenhagen City Heart Study (CCHS) were used for replication analyses.ResultsWe recorded 461 severe exacerbations in 5262 subjects. The HRs for severe exacerbations were 1.62 (95% CI 1.30 to 2.03, p=0.00002) for 16Gly/Arg heterozygotes and 1.41 (1.04 to 1.91, p=0.03) for 16Arg homozygotes, compared with 16Gly homozygotes. HRs were 1.35 (1.03 to 1.76, p=0.03) for 27Gln/Glu heterozygotes and 1.49 (1.12 to 1.98, p=0.006) for 27Gln homozygotes, compared with 27Glu homozygotes. Similar trends were observed in the CCHS. Among 27Gln homozygotes only, HRs were 5.20 (1.81 to 14.9, p=0.002) for 16Gly/Arg heterozygotes and 4.03 (1.40 to 11.6, p=0.01) for 16Arg homozygotes, compared with 16Gly homozygotes.ConclusionCommon β2-adrenergic receptor genotypes influence risk of severe exacerbations in COPD, potentially mainly by genetic influence of the 16Arg allele in rs1042713.

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Microalbuminuria on admission for acute exacerbation of COPD as a predictor of all-cause mortality and future exacerbations

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-141206 ◽

2021 ◽

pp. postgradmedj-2021-141206

Author(s):

Konstantinos Bartziokas ◽

Christos Kyriakopoulos ◽

Evangelia Dounousi ◽

Konstantinos Kostikas

Keyword(s):

Acute Exacerbation ◽

Chronic Obstructive Lung Disease ◽

Multivariate Regression Analysis ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Acute Exacerbation Of Copd ◽

Tertiary Hospitals ◽

Exacerbation Of Copd

ObjectivesMicroalbuminuria (MAB) is a sensitive biomarker of cardiovascular risk that is directly associated with cardiovascular events and mortality. Recent studies have evaluated the presence of MAB in patients with stable chronic obstructive pulmonary disease (COPD) or hospitalised for acute exacerbation of COPD (AECOPD).MethodsWe evaluated 320 patients admitted for AECOPD in respiratory medicine departments of two tertiary hospitals. On admission, demographic, clinical and laboratory values and COPD severity were assessed. Patients were evaluated monthly for 1 year, recording new AECOPD and death from any cause.ResultsPatients with documented MAB (urinary albumin excretion of 30–300 mg/24 hours) on admission had worse lung function (forced expiratory volume in 1 s, %) (mean (SD) 34.2 (13.6)% vs 61.5 (16.7)%), higher modified Medical Research Council (3.6 (1.2) vs 2.1 (0.8)), lower 6 min walk test (171 (63) vs 366 (104)) and more hospitalisation days (9 (2.8) vs 4.7 (1.9)) (p<0.001 for all comparisons). MAB was also correlated with Global Initiative for Chronic Obstructive Lung Disease 2020 COPD stages (p<0.001). In multivariate regression analysis, MAB was a significant predictor of longer hospitalisation duration (OR 6.847, 95% CI 3.050 to 15.370, p<0.0001). Twelve-month follow-up revealed that patients with MAB experienced more AECOPDs (4.6 (3.6) vs 2.2 (3.5), p<0.0001) and deaths, n (%) (52 (36.6) vs 14 (7.8), p<0.001). Kaplan-Meier survival curves demonstrated that patients with MAB presented with increased mortality, AECOPD and hospitalisation for AECOPD risk at 1 year (p<0.001 for all comparisons).ConclusionsThe presence of MAB on admission for AECOPD was associated with more severe COPD and prolonged hospitalisation, as well as with higher rates of AECOPD and mortality risk at 1-year follow-up.

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Using Mobiles to Monitor Respiratory Diseases

Informatics ◽

10.3390/informatics7040056 ◽

2020 ◽

Vol 7 (4) ◽

pp. 56

Author(s):

Fatma Zubaydi ◽

Assim Sagahyroon ◽

Fadi Aloul ◽

Hasan Mir ◽

Bassam Mahboub

Keyword(s):

Mobile Application ◽

Respiratory Diseases ◽

Vital Capacity ◽

Cost Effective ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Air Flow Rate ◽

Obstructive Pulmonary Disease ◽

Effective Manner ◽

Using Data

In this work, a mobile application is developed to assist patients suffering from chronic obstructive pulmonary disease (COPD) or Asthma that will reduce the dependency on hospital and clinic based tests and enable users to better manage their disease through increased self-involvement. Due to the pervasiveness of smartphones, it is proposed to make use of their built-in sensors and ever increasing computational capabilities to provide patients with a mobile-based spirometer capable of diagnosing COPD or asthma in a reliable and cost effective manner. Data collected using an experimental setup consisting of an airflow source, an anemometer, and a smartphone is used to develop a mathematical model that relates exhalation frequency to air flow rate. This model allows for the computation of two key parameters known as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) that are used in the diagnosis of respiratory diseases. The developed platform has been validated using data collected from 25 subjects with various conditions. Results show that an excellent match is achieved between the FVC and FEV1 values computed using a clinical spirometer and those returned by the model embedded in the mobile application.

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Lung function, forced expiratory volume in 1 s decline and COPD hospitalisations over 44 years of follow-up

European Respiratory Journal ◽

10.1183/13993003.01575-2015 ◽

2015 ◽

Vol 47 (3) ◽

pp. 742-750 ◽

Cited By ~ 8

Author(s):

Suneela Zaigham ◽

Per Wollmer ◽

Gunnar Engström

Keyword(s):

Lung Function ◽

Airflow Obstruction ◽

Fixed Ratio ◽

Population Based ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Lung Function Decline ◽

Obstructive Pulmonary Disease ◽

Hazard Ratios

The use of baseline lung function in the prediction of chronic obstructive pulmonary disease (COPD) hospitalisations, all-cause mortality and lung function decline was assessed in the population-based “Men Born in 1914” cohort.Spirometry was assessed at age 55 years in 689 subjects, of whom 392 had spirometry reassessed at age 68 years. The cohort was divided into three groups using fixed ratio (FR) and lower limit of normal (LLN) criterion: forced expiratory volume in 1 s (FEV1)/vital capacity (VC) ≥70%, FEV1/VC <70% but ≥LLN (FR+LLN−), and FEV1/VC <70% and <LLN (FR+LLN+).Over 44 years of follow-up, 88 men were hospitalised due to COPD and 686 died. Hazard ratios (95% CI) for incident COPD hospitalisation were 4.15 (2.24–7.69) for FR+LLN− and 7.88 (4.82–12.87) for FR+LLN+ (reference FEV1/VC ≥70%). Hazard ratios for death were 1.30 (0.98–1.72) for FR+LLN− and 1.58 (1.25–2.00) for FR+LLN+. The adjusted FEV1 decline between 55 and 68 years of age was higher for FR+LLN− and FR+LLN+ relative to the reference. Of those with FR+LLN− at 55 years, 53% had progressed to the FR+LLN+ group at 68 years.Airflow obstruction at age 55 years is a powerful risk factor for future COPD hospitalisations. The FR+LLN− group should be carefully evaluated in clinical practice in relation to future risks and potential benefit from early intervention. This is reinforced by the increased FEV1 decline in this group.

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Never-smokers with occupational COPD have better exercise capacities and ventilatory efficiency than matched smokers with COPD

Journal of Applied Physiology ◽

10.1152/japplphysiol.00306.2020 ◽

2020 ◽

Vol 129 (6) ◽

pp. 1257-1266

Author(s):

Thibaud Soumagne ◽

Alicia Guillien ◽

Nicolas Roche ◽

Jean-Charles Dalphin ◽

Bruno Degano

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Exertional Dyspnea ◽

Obstructive Pulmonary Disease ◽

Ventilatory Efficiency ◽

Never Smokers ◽

Occupational Copd ◽

Lower Limit Of Normal

It is unknown whether or not never-smokers with chronic obstructive pulmonary disease (COPD) behave like their smoking counterparts during exercise. This is the first study showing that never-smokers with mild to moderate COPD [defined by a postbronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < lower limit of normal] have preserved exercise capacities. They also have lower exertional dyspnea than patients with smoking-related COPD. This suggests that the two COPD groups should not be managed in the same way.

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Do-not-resuscitate orders as part of advance care planning in patients with COPD

ERJ Open Research ◽

10.1183/23120541.00116-2017 ◽

2018 ◽

Vol 4 (1) ◽

pp. 00116-2017 ◽

Cited By ~ 4

Author(s):

Jo Raskin ◽

Kristina Vermeersch ◽

Stephanie Everaerts ◽

Pascal Van Bleyenbergh ◽

Wim Janssens

Keyword(s):

Advance Care Planning ◽

Prognostic Significance ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Care Planning ◽

Do Not Resuscitate ◽

Obstructive Pulmonary Disease ◽

Advance Care ◽

Dnr Orders

There is growing awareness of the need for advance care planning in patients with chronic obstructive pulmonary disease (COPD). However, do-not-resuscitate (DNR) order implementation remains a challenge in clinical practice.We retrospectively analysed an observational cohort of 569 COPD patients with 2.5–8 years of follow-up in secondary care, to evaluate potential determinants and the prognostic significance of DNR order implementation and specification.345 patients (61%) had no DNR order, of whom 27% died during a median (interquartile range (IQR)) follow-up of 1935 (1290–2448) days. 194 (39%) patients had a DNR order, of whom 17 had the order at baseline and 82% died (median (IQR) follow-up 528 (137–901) days), while 177 received an order during follow-up and 76% died (median (IQR) follow-up 1322 (721–2018) days). 88% of DNR orders were implemented during hospitalisation. 58% of the patients with a DNR order died within the first year after admission; of them, 66% died in the hospital. Age, forced expiratory volume in 1 s, chronic oxygen dependency and previous mechanical ventilation were significantly and independently associated with DNR order implementation. DNR order specification was significantly associated with increased mortality, even after adjustment for age and disease severity.These findings identify DNR orders as independent determinants of mortality, mainly implemented just before death.

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Benefits of physical activity on COPD hospitalisation depend on intensity

European Respiratory Journal ◽

10.1183/13993003.01699-2014 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1281-1289 ◽

Cited By ~ 27

Author(s):

David Donaire-Gonzalez ◽

Elena Gimeno-Santos ◽

Eva Balcells ◽

Jordi de Batlle ◽

Maria A. Ramon ◽

...

Keyword(s):

Physical Activity ◽

Risk Reduction ◽

Cox Regression ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Average Intensity ◽

Physically Active ◽

Obstructive Pulmonary Disease ◽

Intensity Physical Activity

The present study aims to disentangle the independent effects of the quantity and the intensity of physical activity on the risk reduction of chronic obstructive pulmonary disease (COPD) hospitalisations.177 patients from the Phenotype Characterization and Course of COPD (PAC-COPD) cohort (mean±sd age 71±8 years, forced expiratory volume in 1 s 52±16% predicted) wore the SenseWear Pro 2 Armband accelerometer (BodyMedia, Pittsburgh, PA, USA) for eight consecutive days, providing data on quantity (steps per day, physically active days and daily active time) and intensity (average metabolic equivalent tasks) of physical activity. Information on COPD hospitalisations during follow-up (2.5±0.8 years) was obtained from validated centralised datasets.During follow-up 67 (38%) patients were hospitalised. There was an interaction between quantity and intensity of physical activity in their effects on COPD hospitalisation risk. After adjusting for potential confounders in the Cox regression model, the risk of COPD hospitalisation was reduced by 20% (hazard ratio (HR) 0.79, 95% CI 0.67–0.93; p=0.005) for every additional 1000 daily steps at low average intensity. A greater quantity of daily steps at high average intensity did not influence the risk of COPD hospitalisations (HR 1.01, p=0.919). Similar results were found for the other measures of quantity of physical activity.Greater quantity of low-intensity physical activity reduces the risk of COPD hospitalisation, but high-intensity physical activity does not produce any risk reduction.

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Association Between Waist Circumference Change and Incident Chronic Obstructive Pulmonary Disease in Chinese Adults: An 18-year Cohort Study

10.21203/rs.3.rs-66864/v1 ◽

2020 ◽

Author(s):

Yun-Lei Ma ◽

Han-Jun Zhao ◽

Ying-Hao Su

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Waist Circumference ◽

Pulmonary Disease ◽

Abdominal Obesity ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Health Examination ◽

Chinese Adults ◽

Obstructive Pulmonary Disease

Abstract Background The aim of our study was to investigate waist circumference (WC) change and the risk of incident chronic obstructive pulmonary disease (COPD) among Chinese adults.Methods A total of 8,164 participants aged 20-35 years were recruited who attended health examination with the repeat measurements of WC and lung function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)) from 2001 to 2019. The data of same measurements were collected at their age of 38-53 years. Participants were categorized by WC change as ≤-2.5%, -2.5% to 2.5%, 2.5% to 5% and ＞5% according to gender. The modified Poisson regression models were used to assess the association of WC gain and the risk of COPD.Results During 18-year follow-up, a total of 917 COPD cases were identified. From baseline to follow-up, the mean of FEV1 decreased from 3.20 L to 2.79 L among male participants and 2.28 L to 1.95 L among female participants. Comparing with participants who were not abdominal obesity at both baseline and follow-up, participants with abdominal obesity among both genders after the follow-up were associated to the greater risk of COPD regardless of abdominal obesity at baseline. The risk of incident COPD increased 19% among male participants (RR=1.19, 95%CI=1.04-1.48) and 14% among female participants (RR=1.14, 95%CI=1.01-1.40) when WC gain increased ＞5% during the 18-year follow-up. The COPD risk decreased 28% among male participants with WC change ≤-2.5% (RR=0.82, 95%CI=0.67-0.99).Conclusions The risk of incident COPD was positively associated with increasing WC for both genders among Chinese adults.

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Prevalence of COPD among women and relation with cooking fuel choice in Ouagadougou, Burkina Faso

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0609 ◽

2020 ◽

Vol 24 (9) ◽

pp. 928-933

Author(s):

A. Sana ◽

N. Meda ◽

B. Kafando ◽

G. Badoum ◽

C. Bouland

Keyword(s):

Chronic Bronchitis ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Sub Saharan Africa ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Sub Saharan ◽

Test Result ◽

Urgent Action

BACKGROUND: According to the WHO, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death by 2030. In sub-Saharan Africa, the burden of the disease is unknown. We assessed the prevalence and the factors associated with COPD and chronic bronchitis among women in charge of household cooking.METHODS: A cross-sectional population survey was conducted. We randomly selected women aged ≥18 years in charge of cooking in their household. COPD was defined as post-bronchodilator FEV1/FVC (forced expiratory volume in 1 sec/forced vital capacity) ratio of <0.70; chronic bronchitis was defined as cough with sputum of at least 3 months in the year for at least 2 consecutive years.RESULTS: Of the 1705 women interviewed, 835 were selected to perform spirometry and 564 provided an acceptable test result. The prevalence of COPD was 1.1% and that of chronic bronchitis was 1.2%. COPD prevalence was higher among women using biomass, women aged >40 years, those had been cooking or had been exposed to toxic gases for more than 30 years. After adjustment, only biomass fuel use and exposure to toxic products were found to be associated with COPD.CONCLUSION: Urgent action is need to accelerate the transition to the other sources of energy.

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Tiotropium discontinuation in patients with early-stage COPD: a prospective observational cohort study

ERJ Open Research ◽

10.1183/23120541.00175-2018 ◽

2019 ◽

Vol 5 (1) ◽

pp. 00175-2018 ◽

Cited By ~ 1

Author(s):

Chenglong Li ◽

Yumin Zhou ◽

Sha Liu ◽

Mengning Zheng ◽

Jinzhen Zheng ◽

...

Keyword(s):

Placebo Group ◽

Early Stage ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Medication Withdrawal ◽

Observational Cohort ◽

Annual Decline

BackgroundTiotropium improves lung function and ameliorates the annual decline in forced expiratory volume in 1 s (FEV1) after bronchodilator use in patients with mild to moderate chronic obstructive pulmonary disease (COPD). However, whether these benefits persist in patients with early-stage COPD after tiotropium discontinuation is unknown.MethodsIn this prospective cohort observational follow-up study, patients who had completed the Tiotropium in Early-Stage COPD (Tie-COPD) trial were followed for a maximum of 3 years, continuing or discontinuing treatment according to their willingness. The outcomes measured were spirometry parameters, COPD exacerbations, COPD Assessment Test (CAT) scores, Clinical COPD Questionnaire (CCQ) scores, modified Medical Research Council (mMRC) scores and the use of respiratory medications.ResultsOut of 376 patients, 262 (126 in the post-placebo group and 136 in the post-tiotropium group) completed the maximum 3-year follow-up after the study medication was withdrawn. After discontinuation, the decrease in FEV1 and forced vital capacity (FVC) did not differ significantly between the two groups, and neither did their annual decline. In addition, the frequency of acute COPD exacerbations and the mMRC scores were similar between the two groups after medication withdrawal. Both the mean CAT and CCQ scores were significantly lower in the post-tiotropium group than in the post-placebo group (p<0.05 for all comparisons) at the 1-year follow-up after withdrawal, but they were not different at the next follow-up.ConclusionWithdrawal of tiotropium treatment in early-stage COPD resulted in difference reduction of both FEV1 and FVC, indicating that treatment should be continued.

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Exclusion Spirometry: A Good Idea

Canadian Respiratory Journal ◽

10.1155/2004/897324 ◽

2004 ◽

Vol 11 (3) ◽

pp. 185-186

Author(s):

Nick R. Anthonise

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Primary Care ◽

Pulmonary Disease ◽

Forced Vital Capacity ◽

Primary Care Physicians ◽

Lung Diseases ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

In this issue of theCanadian Respiratory Journal, Almirall and Bégin (pages 195 to 196) make a suggestion aimed at increasing the use of spirometry by primary care physicians, as well as family and general practitioners. The idea is that spirometry should be performed not necessarily to make specific diagnoses, but to rule in or out the possibility of a number of lung diseases, most notably, chronic obstructive pulmonary disease (COPD). If the patient demonstrates normal forced vital capacity and forced expiratory volume in 1 s, then he or she does not have COPD; if the results are not normal, then COPD is a possibility that can be further investigated.

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