Association between chronic airflow obstruction and socio-economic position in Morocco: BOLD results

BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0–10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV1/FVC increased by 0.4% (95%CI 0.01–0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.

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Dyspnoea and Symptom Burden in Mild-Moderate COPD: the Canadian Cohort Obstructive Lung Disease Study

ERJ Open Research ◽

10.1183/23120541.00960-2020 ◽

2021 ◽

pp. 00960-2020

Author(s):

Mathew Cherian ◽

Dennis Jensen ◽

Wan C. Tan ◽

Sara Mursleen ◽

Emma C. Goodall ◽

...

Keyword(s):

General Population ◽

Lung Disease ◽

Obstructive Lung Disease ◽

Chronic Obstructive Lung Disease ◽

Symptom Burden ◽

Secondary Outcome ◽

Chronic Obstructive ◽

Never Smokers ◽

Disease Study ◽

Severe Dyspnoea

RationaleStudies assessing dyspnoea and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) have focused on patients in clinical settings, not the general population.ObjectivesCompare the prevalence and severity of dyspnoea and impaired HRQoL in individuals with and without COPD from the general population, focusing on mild-moderate COPD.MethodsAnalysis of the 3-year Canadian Cohort Obstructive Lung Disease (CanCOLD) study included four subgroups: mild-COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] 1); moderate-COPD (GOLD 2); non-COPD smokers; and non-COPD never-smokers. The primary outcome was dyspnoea (Medical Research Council [MRC] scale), and the secondary outcome was HRQoL (COPD Assessment Test [CAT] score; Saint George's Respiratory Questionnaire [SGRQ] score). Subgroups were analysed by sex, physician-diagnosed COPD status, and exacerbations.Results1443 participants (mild-COPD [n=397]; moderate-COPD [n=262]; smokers [n=449], and never-smokers [n=335]) were studied. People with mild-COPD were more likely to report more severe dyspnoea (MRC 2 versus 1 [MRC2 versus 1]) than those without COPD (OR [95%CI]: 1.42 [1.05,1.91]), and non-COPD never-smokers (OR [95%CI]: 1.64 [1.07,2.52]). Among people with mild-COPD, more severe dyspnoea was reported in women versus men (MRC2 versus 1; OR [95%CI]: 3.70 [2.23,6.14]); people with, versus without, physician-diagnosed COPD (MRC2 versus 1; OR [95%CI]: 3.27 [1.71,6.23]), and people with, versus without, recent exacerbations (MRC2 versus 1; ≥2 versus 0 exacerbations: OR [95%CI]: 3.62 [1.02,12.86]; MRC≥3 versus 1 [MRC≥3 versuss 1]; 1 versus 0 exacerbation: OR [95%CI]: 9.24 [2.01,42.42]). Similar between-group differences were obtained for CAT and SGRQ scores.ConclusionsCareful assessment of dyspnoea and HRQoL could help identify individuals for earlier diagnosis and treatment.

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Genetic, host, and environmental interactions in a 19 year old with severe chronic obstructive lung disease; observations regarding the pathophysiology of airflow obstruction

International Journal of Chronic Obstructive Pulmonary Disease ◽

10.2147/copd.s30325 ◽

2012 ◽

pp. 383

Author(s):

Edward Eden ◽

Grosu ◽

Killam ◽

Khusainova ◽

Needelman ◽

...

Keyword(s):

Lung Disease ◽

Obstructive Lung Disease ◽

Airflow Obstruction ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Environmental Interactions

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Clinical Use of Controlled-Release Theophylline in Chronic Airways Obstruction

Journal of International Medical Research ◽

10.1177/030006058701500610 ◽

1987 ◽

Vol 15 (6) ◽

pp. 391-396 ◽

Cited By ~ 1

Author(s):

R. Dal Negro ◽

P. Turco ◽

C. Pomari ◽

C. I. Cordaro

Keyword(s):

Steady State ◽

Controlled Release ◽

Lung Disease ◽

Obstructive Lung Disease ◽

Plasma Concentrations ◽

Chronic Obstructive Lung Disease ◽

Forced Expiratory Volume ◽

Clinical Severity ◽

Chronic Obstructive ◽

Post Marketing

Daily general practice of theophylline dosing in chronic obstructive lung disease seems not strictly to follow therapeutic guidelines. To evaluate the efficacy of such an approach with regard to attaining therapeutic and safe plasma theophylline concentrations and clinical benefit, 103 patients with chronic obstructive lung disease were selected from the computerized database of a post-marketing survey. Dosing of theophylline was found to be independent of reference parameters, i.e. anthropometric data, age and clinical severity of the disease. Standard doses of 400 and/or 600 mg controlled-release theophylline, i.e. 7.9 mg/kg·day resulted in steady-state plasma concentrations of 10–20 μg/ml in 45.1% of patients and 5–10 μg/ml in 52.9% of cases. The increase in forced expiratory volume in 1 s at steady-state, evaluated by the percentage frequency distribution of changes from baseline was significant in all patients. In conclusion, not withstanding the daily therapeutic practice of controlled-release theophylline dosing and, at times, lower than optimal plasma levels, clinical and functional recovery was obtained in a large percentage of cases.

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Early respiratory diagnosis: benefits of enhanced lung function assessment

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2021-001012 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001012

Author(s):

Karl P Sylvester ◽

Luke Youngs ◽

M A Rutter ◽

Ross Beech ◽

Ravi Mahadeva

Keyword(s):

Carbon Monoxide ◽

Lung Function ◽

Gas Exchange ◽

Lung Disease ◽

Obstructive Lung Disease ◽

Chronic Obstructive Lung Disease ◽

Forced Expiratory Volume ◽

Chronic Obstructive ◽

Gas Transfer ◽

Function Assessment

IntroductionThe National Health Service for England Long Term Plan identifies respiratory disease as one of its priority workstreams. To assist with earlier and more accurate diagnosis of lung disease they recommend improvement in delivery of quality-assured spirometry. However, there is a likelihood that patients will present with abnormal gas exchange when spirometry results are normal and therefore there will be a proportion of patients whose time to diagnosis is still protracted. We wished to determine the incidence rate of this occurring within our Trust.MethodsA retrospective review of all patients attending the lung function laboratory for their first pulmonary function assessment from June 2006 to December 2020 was undertaken. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) >−1.64 standardised residual (SR) was used to confirm no obstructive lung function abnormality and FVC >−1.64 SR to confirm no suggestion of a restrictive lung function abnormality. Lung gas transfer for carbon monoxide (TLCO) and transfer coefficient of the lung for carbon monoxide (KCO) <−1.64 SR confirmed the presence of a gas exchange abnormality. Spirometry and gas transfer reference values generated by the Global Lung Initiative were used to determine normality.ResultsOf 12 835 eligible first visits with normal FEV1/FVC and FVC, 4856 (37.8%) were identified as having an abnormally low TLCO and 3302 (25.7%) presenting with an abnormally low KCO. Of 3494 with FEV1/FVC SR <−1.64, 3316 also had a ratio of <0.70, meaning 178 (5%) of patients in this cohort would have been misclassified as having obstructive lung disease using the 0.70 cut-off recommended by the Global Initiative for Chronic Obstructive Lung Disease for diagnosing obstructive lung disease.DiscussionIn conclusion, to assist with ensuring more accurate and timely diagnosis of lung disease and enhance patients’ diagnostic pathway, we recommend the performance of lung gas transfer measurements alongside spirometry in all healthcare settings. To assess and monitor gas transfer at the earliest opportunity we recommend this is implemented into new models being developed within community hubs. This will increase the identification of lung function abnormalities and provide patients with a definitive diagnosis earlier.

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