RESUMEN
Introduction: There is a need to better understand the etiotypes of chronic obstructive pulmonary disease (COPD) beyond the tobacco-smoke (TS-COPD). Wood smoke COPD (WS-COPD) is characterized by greater airway compromise, milder emphysema, and slower rate of lung function decline than TS-COPD. However, it is unclear if these two etiotypes of COPD have differences in sputum biomarker concentrations. Objective was to compare sputum levels of selected sputum biomarkers between WS-COPD and TS-COPD, and healthy controls. Methods: Eighty-eight women (69±12 years) were recruited and classified into: WS-COPD (n=31), TS-COPD (n=29) and controls (n=28). Using ELISA, we determined induced sputum levels of metalloproteinase 9 (MMP-9), chemokine ligand 5 (CCL5), interleukin-8 (IL-8), chemokine ligand 16 (CCL16/HCC-4) and vascular endothelial growth factor (VEGF-1). Differences were analyzed by Kruskal-Wallis and Mann-Whitney-U tests and correlation between airflow limitation and biomarkers by Spearman's test. Results: At similar degree of airflow obstruction, anthropometrics and medications use, the level of sputum CCL5 was higher in TS-COPD than WS-COPD (p=0.03) without differences in MMP-9, IL-8, CCL16/HCC-4, and VEGF-1. Women with WS-COPD and TS-COPD showed significantly higher sputum levels of MMP-9, IL-8 and CCL5 compared with controls (p<0.001). FEV1% predicted correlated negatively with levels of MMP-9 (rho:-0.26; P=0.016), CCL5 (rho:-0.37; P=0.001), IL-8 (rho:-0.42; P<0.001) and VEGF (rho:-0.22; P=0.04). Conclusion: While sputum concentrations of MMP-9, IL-8, and CCL5 were higher in COPD women compared with controls, women with TS-COPD had higher levels of CCL5 compared with those with WS-COPD. Whether this finding relates to differences in pathobiological pathways remains to be determined.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Enfermedad Pulmonar Obstructiva Crónica , Contaminación por Humo de Tabaco , Humanos , Femenino , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/etiología , Enfermedad Pulmonar Obstructiva Crónica/metabolismo , Interleucina-8/metabolismo , Esputo/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Madera , Metaloproteinasa 9 de la Matriz/metabolismo , Carcinoma Hepatocelular/metabolismo , Ligandos , Neoplasias Hepáticas/metabolismo , Humo/efectos adversos , Biomarcadores/metabolismo , Quimiocinas/metabolismo , Productos de TabacoRESUMEN
BACKGROUND: Whether Native American ancestry (NAA) is associated with COPD or lung function in a racially admixed Hispanic population is unknown. METHODS: We recruited 578 Costa Ricans with and without COPD into a hybrid case-control/family-based cohort, including 316 members of families of index case subjects. All participants completed questionnaires and spirometry and gave a blood sample for DNA extraction. Genome-wide genotyping was conducted with the Illumina Human610-Quad and HumanOmniExpress BeadChip kits (Illumina Inc), and individual ancestral proportions were estimated from these genotypic data and reference panels. For unrelated individuals, linear or logistic regression was used for the analysis of NAA and COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stage II or greater) or lung function. For extended families, linear mixed models and generalized estimating equations were used for the analysis. All models were adjusted for age, sex, educational level, and smoking behavior; models for FEV1 were also adjusted for height. RESULTS: The average proportion of European, Native American, and African ancestry among participants was 62%, 35%, and 3%, respectively. After adjustment for current smoking and other covariates, NAA was inversely associated with COPD (OR per 10% increment, 0.55; 95% CI, 0.41-0.75) but positively associated with FEV1, FVC, and FEV1/FVC. After additional adjustment for pack-years of smoking, the association between NAA and COPD or lung function measures was slightly attenuated. We found that about 31% of the estimated effect of NAA on COPD is mediated by pack-years of smoking. CONCLUSIONS: NAA is inversely associated with COPD but positively associated with FEV1 or FVC in Costa Ricans. Ancestral effects on smoking behavior partly explain the findings for COPD but not for FEV1 or FVC.
Asunto(s)
Volumen Espiratorio Forzado , Hispánicos o Latinos/genética , Indígenas Norteamericanos/genética , Enfermedad Pulmonar Obstructiva Crónica/genética , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Capacidad Vital , Adulto , Estudios de Casos y Controles , Costa Rica , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Fumar/genética , Fumar/fisiopatologíaRESUMEN
QUESTION: A 6-second spirometry test is easier than full exhalations. We compared the reliability of the ratio of the Forced expiratory volume in 1 second/Forced expiratory volume in 6 seconds (FEV1/FEV6) to the ratio of the FEV1/Forced vital capacity (FEV1/FVC) for the detection of airway obstruction. METHODS: The PLATINO population-based survey in individuals aged 40 years and over designed to estimate the prevalence of post-Bronchodilator airway obstruction repeated for the same study participants after 5-9 years in three Latin-American cities. RESULTS: Using the FEV1/FVCAsunto(s)
Enfermedad Pulmonar Obstructiva Crónica/diagnóstico
, Enfermedad Pulmonar Obstructiva Crónica/fisiopatología
, Pruebas de Función Respiratoria/métodos
, Ciudades/estadística & datos numéricos
, Femenino
, Estudios de Seguimiento
, Volumen Espiratorio Forzado
, Humanos
, América Latina/epidemiología
, Estudios Longitudinales
, Masculino
, Persona de Mediana Edad
, Prevalencia
, Enfermedad Pulmonar Obstructiva Crónica/epidemiología
, Reproducibilidad de los Resultados
, Espirometría
, Capacidad Vital
RESUMEN
OBJECTIVE: To determine the impact of an 8-wk program of comprehensive pulmonary rehabilitation on depression, anxiety, dyspnea, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). DESIGN: We studied 24 patients with severe COPD randomized either to pulmonary rehabilitation (PR), (n = 10; FEV1 30 +/- 9%) or control (C; n = 14; FEV1 34 +/- 11%). The PR program included disease education, energy conservation techniques, relaxation, and exercise including 20-min arm elevation with dumbbells and 20-min leg exercise sessions three times a week for 8 wks. At baseline and after completion of the program, all patients were evaluated using the Beck Depression Inventory, State Trait Anxiety Inventory (STAI), Modified Medical Research Council Scale (MRC), and St. George's Respiratory Questionnaire (SGRQ). RESULTS: After PR, there was a significant improvement in the severity of depression (P < 0.01), a decrease in symptoms (P < 0.05), an increase in daily living activities (P < 0.05), and a decrease in the total score of the SGRO (P < 0.01). Dyspnea measured by the MRC scale was significantly better in the PR group (P < 0.01). CONCLUSIONS: The present study shows that in patients with severe COPD, pulmonary rehabilitation induces important changes on depression and anxiety independent of changes in dyspnea and health-related quality-of-life.