Follow-up desaturation in 6 minute walk tests and lung function decline in COPD patients

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.

Download Full-text

Accelerated FEV1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients

European Respiratory Journal ◽

10.1183/13993003.00918-2020 ◽

2020 ◽

pp. 2000918

Author(s):

Hannah R. Whittaker ◽

Chloe Bloom ◽

Ann Morgan ◽

Deborah Jarvis ◽

Steven J. Kiddle ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Primary Care ◽

Lung Function Decline ◽

Copd Patients ◽

History Of ◽

Artery Disease ◽

Cvd Mortality

Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD-GOLD) primary care dataset (n=36 282). Accelerated FEV1 decline was defined using the fastest quartile of the COPD population's decline. Cox regression assessed the association between baseline accelerated FEV1 decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease, and CVD mortality). The model was adjusted for age, gender, smoking status, BMI, history of asthma, hypertension, diabetes, statin use, mMRC dyspnoea, exacerbation frequency, and baseline FEV1 percent predicted.6110 (16.8%) COPD patients had a CVD event during follow-up; median length of follow-up was 3.6 years [IQR 1.7–6.1]). Median rate of FEV1 decline was –19.4 mL·year−1 (IQR, –40.5 to 1.9); 9095 (25%) patients had accelerated FEV1 decline (>–40.5 mL·year−1), 27 287 (75%) did not (≤ –40.5 mL·year−1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1 decline (HRadj 0.98 [95%CI, 0.90–1.06]). Corresponding risk estimates were 0.99 (95%CI 0.83–1.20) for heart failure, 0.89 (95%CI 0.70–1.12) for myocardial infarction, 1.01 (95%CI 0.82–1.23) for stroke, 0.97 (95%CI 0.81–1.15) for atrial fibrillation, 1.02 (95%CI 0.87–1.19) for coronary artery disease, and 0.94 (95%CI 0.71–1.25) for CVD mortality. Rather, risk of CVD was associated with mMRC score ≥2 and ≥2 exacerbations in the year prior.CVD outcomes and mortality were associated with exacerbation frequency and severity and increased mMRC dyspnoea but not with accelerated FEV1 decline.

Download Full-text

Late Breaking Abstract - The effects of smoking cessation and FAM13A gene susceptibility on lung function decline: A 16-year follow-up study among male smokers

10.1183/13993003.congress-2018.oa1932 ◽

2018 ◽

Cited By ~ 1

Author(s):

Soriul Kim ◽

Ki Yeol Lee ◽

Seung Ku Lee ◽

Hyeon Min Ahn ◽

Regina Ey Kim ◽

...

Keyword(s):

Smoking Cessation ◽

Lung Function ◽

Lung Function Decline ◽

Follow Up Study

Download Full-text

Comparison of Different Dyspnea Scales and Questionnaires with Six Minute Walk Test and Lung Function Tests in Symptomatic COPD Patients.

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a2931 ◽

2009 ◽

Author(s):

LA Camargo ◽

CC Pereira

Keyword(s):

Lung Function ◽

Lung Function Tests ◽

Walk Test ◽

Six Minute Walk Test ◽

Function Tests ◽

Copd Patients ◽

Minute Walk

Download Full-text

Lung function decline in asthma patients with elevated bronchial CD8, CD4 and CD3 cells

European Respiratory Journal ◽

10.1183/13993003.01525-2015 ◽

2016 ◽

Vol 48 (2) ◽

pp. 393-402 ◽

Cited By ~ 22

Author(s):

Irene den Otter ◽

Luuk N.A. Willems ◽

Annemarie van Schadewijk ◽

Simone van Wijngaarden ◽

Kirsten Janssen ◽

...

Keyword(s):

Lung Function ◽

Granzyme B ◽

Eosinophil Cationic Protein ◽

Risk Groups ◽

Forced Expiratory Volume ◽

Lung Function Decline ◽

Cationic Protein ◽

Asthmatic Patients ◽

Asthma Patients

Which inflammatory markers in the bronchial mucosa of asthma patients are associated with decline of lung function during 14 years of prospective follow-up?To address this question, 19 mild-to-moderate, atopic asthmatic patients underwent spirometry and bronchoscopy at baseline and after 14 years of follow-up (t=14). Baseline bronchial biopsies were analysed for reticular layer thickness, eosinophil cationic protein (EG2), mast cell tryptase (AA1), CD3, CD4 and CD8. Follow-up biopsies were stained for EG2, AA1, neutrophil elastase, CD3, CD4, CD8, CD20, granzyme B, CD68, DC-SIGN, Ki67 and mucins.Decline in forced expiratory volume in 1 s (FEV1) % predicted was highest in patients with high CD8 (p=0.01, both pre- and post-bronchodilator) or high CD4 counts at baseline (p=0.04 pre-bronchodilator, p=0.03 post-bronchodilator). Patients with high CD8, CD3 or granzyme B counts at t=14 also exhibited faster decline in FEV1 (p=0.00 CD8 pre-bronchodilator, p=0.04 CD8 post-bronchodilator, p=0.01 granzyme B pre-bronchodilator, and p<0.01 CD3 pre-bronchodilator).Long-term lung function decline in asthma is associated with elevation of bronchial CD8 and CD4 at baseline, and CD8, CD3 and granzyme B at follow-up. This suggests that high-risk groups can be identified on the basis of inflammatory phenotypes.

Download Full-text

Clinical characteristics of people with cystic fibrosis and frequent fungal infection

10.22541/au.162429453.38832591/v1 ◽

2021 ◽

Author(s):

Thomas Poore ◽

Maxene Meier ◽

Elin Towler ◽

John Brinton ◽

Stacey Martiniano ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Fungal Infection ◽

Clinical Characteristics ◽

Allergic Bronchopulmonary Aspergillosis ◽

Baseline Period ◽

Lower Airway ◽

Potential Contribution ◽

Lung Function Decline

Background: Individuals with cystic fibrosis (CF) and fungal airway infection may present with fungal bronchitis, allergic bronchopulmonary aspergillosis (ABPA) or may appear unaffected despite fungal detection. We sought to characterize people with CF with frequent detection of fungi from airway samples and determine clinical outcomes. Methods: This retrospective study included individuals with CF with ≥ 4 lower airway cultures over a 2-year baseline period and ≥ 2 years of follow-up. We defined two groups: ≤ 1 positive fungus culture (rare) or ≥ 2 positive cultures during baseline (frequent). Clinical characteristics and outcomes were determined. Results: Between 2004-2016, 294 individuals met inclusion with 62% classified as rare and 38% as frequent fungi during baseline. Median follow-up was 6 years (range 2-9 years). Aspergillus fumigatus was the most common fungal species detected. Individuals with frequent fungi were older (13.7 vs. 11.7 yrs, p = 0.02) and more likely to have Stenotrophomonas maltophilia (35% vs 17%, p < 0.001) at baseline, but did not differ in lung function or ABPA diagnosis. During follow-up, those with frequent fungi were more likely to have chronic P. aeruginosa and S. maltophilia. Individuals with ABPA and frequent fungi had the highest rates of co-infection and co-morbidities, and a trend towards more rapid lung function decline. Discussion: Fungal infection in CF was associated with frequent P. aeruginosa and S. maltophilia co-infection even in those without ABPA. Individuals with frequent fungi and ABPA had worse outcomes, highlighting the potential contribution of fungi to CF pulmonary disease.

Download Full-text