RESUMEN
PURPOSE: The purpose of this study was to assess the prevalence of COPD phenotypes at a national level and to determine their geographic distribution among different autonomous communities in Spain. PATIENTS AND METHODS: A total of 1,610 patients (82% men, median age 67 years) recruited in primary care centers and pneumology services participated in an observational, cross-sectional, and multicenter study. Phenotypes evaluated were the non-exacerbator phenotype, the asthma-COPD overlap syndrome (ACOS), the exacerbator phenotype with emphysema, and the exacerbator phenotype with chronic bronchitis. RESULTS: The non-exacerbator phenotype was the most common (46.7%) followed by exacerbator with chronic bronchitis (22.4%) and exacerbator with emphysema (16.4%). The ACOS phenotype accounted for the lowest rate (14.5%). For each phenotype, the highest prevalence rates were concentrated in two or three autonomous communities, with relatively similar rates for the remaining regions. Overall prevalence rates were higher for the non-exacerbator and the exacerbator with chronic bronchitis phenotypes than for ACOS and the exacerbator with chronic bronchitis phenotypes. Differences in the distribution of COPD phenotypes according to gender, age, physician specialty, smoking habit, number of comorbidities, quality of life assessed with the COPD Assessment Test, and BODEx index (body mass index, airflow obstruction, dyspnea, and exacerbations) were all statistically significant. CONCLUSION: Differences in the prevalence rates of COPD phenotypes among the Spanish autonomous communities have been documented. Mapping the distribution of COPD phenotypes is useful to highlight regional differences as starting point for comparisons across time. This geographic analysis provides health-care planners a valuable platform to assess changes in COPD burden at nationwide and regional levels.
Asunto(s)
Asma/epidemiología , Bronquitis Crónica/epidemiología , Pulmón/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfisema Pulmonar/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Asma/diagnóstico , Asma/fisiopatología , Bronquitis Crónica/diagnóstico , Bronquitis Crónica/fisiopatología , Estudios Transversales , Progresión de la Enfermedad , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatología , Calidad de Vida , Factores de Riesgo , España/epidemiologíaRESUMEN
PURPOSE: Body composition is known to influence the development and progression of chronic respiratory diseases (CRDs). We sought to characterize the unique anthropometric phenotypes that present with asthma, chronic obstructive pulmonary disease (COPD), and chronic bronchitis across four distinct settings in Peru. METHODS: We collected sociodemographic, clinical history, and spirometry data from 2959 participants from Lima, Tumbes, and rural and urban Puno. We compared the prevalence of CRDs among different study sites and described disease phenotypes. We used single and multivariable linear regression to model the influence of CRD status on various descriptors of body composition. RESULTS: Overall prevalence of CRDs varied across sites with the highest prevalence of asthma in Lima (14.5%) and the highest prevalence of COPD in rural Puno (9.9%). Measures of body composition also varied across sites, with highest mean body mass index (BMI) in Lima (28.4 kg/m2) and the lowest mean BMI in rural Puno (25.2 kg/m2). Participants with COPD had the lowest mean fat mass index (FMI) (10.5 kg/m2) and waist circumference (88.3 cm), whereas participants with asthma had the highest mean FMI (14.5 kg/m2), and waist circumference (94.8 cm). In multivariable analysis, participants with COPD had a lower waist circumference (adjusted mean - 2.97 cm, 95% CI 4.62 to - 1.32 cm) when compared to non-CRD participants. CONCLUSIONS: Our findings provide evidence that asthma and chronic bronchitis are more likely to be associated with obesity and higher fat mass, while COPD is associated with being underweight and having less lean mass.
Asunto(s)
Asma/epidemiología , Composición Corporal , Bronquitis Crónica/epidemiología , Recursos en Salud , Obesidad/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Delgadez/epidemiología , Tejido Adiposo , Adulto , Anciano , Asma/fisiopatología , Índice de Masa Corporal , Bronquitis Crónica/fisiopatología , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Perú/epidemiología , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Población Rural , Población Urbana , Circunferencia de la CinturaRESUMEN
BACKGROUND: Smoking is associated with impaired health-related quality of life (HRQL) across all populations. Because decline in lung function and risk for COPD are lower in New Mexican Hispanic smokers compared with their non-Hispanic white (NHW) counterparts, the goal of this study was to ascertain whether HRQL differs between these two racial/ethnic groups and determine the factors that contribute to this difference. METHODS: We compared the score results of the Medical Outcomes Short-Form 36 Health Survey (SF-36) and St. George's Respiratory Questionnaire (SGRQ) in 378 Hispanic subjects and 1,597 NHW subjects enrolled in the Lovelace Smokers' Cohort (LSC) from New Mexico. The associations of race/ethnicity with SGRQ and SF-36 were assessed by using multivariable regression. RESULTS: Physical functioning (difference, -4.5; P = .0008) but not mental health or role emotional domains of the SF-36 was worse in Hispanic smokers than in their NWH counterparts in multivariable analysis. SGRQ total score and its activity and impact subscores were worse in Hispanic (vs NHW) smokers after adjustment for education level, current smoking, pack-years smoked, BMI, number of comorbidities, and FEV1 % predicted (difference range, 2.9-5.0; all comparisons, P ≤ .001). Although the difference in the SGRQ activity domain was above the clinically important difference of four units, the total score was not. CONCLUSIONS: New Mexican Hispanic smokers have clinically relevant, lower HRQL than their NHW counterparts. A perception of diminished physical functioning and impairment in daily life activities contribute to the poorer HRQL among Hispanic subjects.
Asunto(s)
Asma/fisiopatología , Disparidades en el Estado de Salud , Estado de Salud , Hispánicos o Latinos , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Fumar/fisiopatología , Población Blanca , Actividades Cotidianas , Adulto , Anciano , Asma/etnología , Asma/psicología , Bronquitis Crónica/etnología , Bronquitis Crónica/fisiopatología , Bronquitis Crónica/psicología , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , New Mexico , Enfermedad Pulmonar Obstructiva Crónica/etnología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Fumar/etnología , Fumar/psicología , Encuestas y Cuestionarios , Capacidad VitalRESUMEN
BACKGROUND: COPD includes the chronic bronchitis (CB) and emphysema phenotypes. Although it is generally assumed that emphysema or chronic airflow obstruction (CAO) is associated with worse quality of life (QOL) than is CB, this assumption has not been tested. METHODS: The current study's analyses from the Lovelace Smokers' Cohort (LSC) were validated in the COPD Gene Cohort (COPDGene). CB without CAO (CB only) was defined as self-reported cough productive of phlegm for ≥ 3 mo/y for 2 consecutive years and postbronchodilator FEV1/FVC ≥ 70%. CAO without CB (CAO only) was defined as a postbronchodilator FEV1/FVC < 70% with no evidence of CB. QOL outcomes were obtained from the St. George's Respiratory Questionnaire (SGRQ) and the 36-Item Short Form Health Survey (SF-36) questionnaires. A priori covariates included age, sex, pack-years of smoking, current smoking, and FEV1. RESULTS: Smokers with CB without CAO (LSC = 341; COPDGene = 523) were younger and had a greater BMI and less smoking exposure than did those with CAO only (LSC = 302; COPDGene = 2,208). Compared with the latter group, QOL scores were worse for those with CB only. Despite similar SGRQ Activity and SF-36 Role Physical and Physical Functioning, SGRQ Symptoms and Impact scores and SF-36 emotional and social measures were worse in the CB-only group, in both cohorts. After adjustment for covariates, the CB-only group remained a significant predictor for "worse" symptoms and emotional and social measures. CONCLUSIONS: To our knowledge, this analysis is the first to suggest that among subjects with COPD, those with CB only present worse QOL symptoms and mental well-being than do those with CAO only.
Asunto(s)
Actividades Cotidianas , Bronquitis Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Calidad de Vida , Adulto , Anciano , Bronquitis Crónica/psicología , Estudios de Cohortes , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/psicología , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To test whether chronic bronchial inflammation may be a contributing risk factor for persistent airflow limitation in children born before 32 weeks of gestation in later life. STUDY DESIGN: Thirty-six of 160 children born before 32 completed weeks of gestation who were born between 1988 and 1992 were recruited at a median age of 11 years. Eighteen age-matched children born at term were controls; 47% of the premature infants and 61% of the term born children produced sputum of sufficient quality for interleukin (IL)-8, cell numbers, and differential counts. RESULTS: Compared with term born children, sputum from the premature group had a higher proportion of neutrophils (62% vs 3.8%; P < .001) and higher IL-8/protein values (1.93 µg/g vs 0.64 µg/g; P = .008). Forced expiratory flow 25%-75% and forced expiratory volume in 1 second/vital capacity were significantly lower (73.4 % vs 116% predicted, P = .002 and 97% vs 101%, P = .012, respectively). Lung function values and sputum indices did not correlate. IL-8/protein and neutrophil percentages correlated significantly with decreasing gestational age (Spearman rank coefficient = -0.58, P = .020 and -.70, P =.03 respectively). CONCLUSION: A significant proportion of school children born very preterm demonstrate persistent peripheral airway obstruction that is accompanied by neutrophilic lower airway inflammation.
Asunto(s)
Obstrucción de las Vías Aéreas/fisiopatología , Bronquitis Crónica/fisiopatología , Enfermedades del Prematuro/fisiopatología , Interleucina-8/metabolismo , Neutrófilos/metabolismo , Esputo/metabolismo , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/metabolismo , Biomarcadores/metabolismo , Bronquitis Crónica/diagnóstico , Bronquitis Crónica/metabolismo , Estudios de Casos y Controles , Niño , Estudios Transversales , Femenino , Flujo Espiratorio Forzado , Volumen Espiratorio Forzado , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/metabolismo , Modelos Logísticos , Masculino , Encuestas y Cuestionarios , Capacidad VitalRESUMEN
BACKGROUND AND OBJECTIVE: Hyperinflation with a decrease in inspiratory capacity (IC) is a common presentation for both unstable and stable COPD patients. As CPAP can reduce inspiratory load, possibly secondary to a reduction in hyperinflation, this study examined whether CPAP would increase IC in stable COPD patients. METHODS: Twenty-one stable COPD patients (nine emphysema, 12 chronic bronchitis) received a trial of CPAP for 5 min at 4, 7 and 11 cmH(2)O. Fast and slow VC (SVC) were measured before and after each CPAP trial. In patients in whom all three CPAP levels resulted in a decreased IC, an additional trial of CPAP at 2 cmH(2)O was conducted. For each patient, a 'best CPAP' level was defined as the one associated with the greatest IC. This pressure was then applied for an additional 10 min followed by spirometry. RESULTS: Following application of the 'best CPAP', the IC and SVC increased in 15 patients (nine emphysema, six chronic bronchitis). The mean change in IC was 159 mL (95% CI: 80-237 mL) and the mean change in SVC was 240 mL (95% CI: 97-386 mL). Among these patients, those with emphysema demonstrated a mean increase in IC of 216 mL (95% CI: 94-337 mL). Six patients (all with chronic bronchitis) did not demonstrate any improvement in IC. CONCLUSIONS: The best individualized CPAP can increase inspiratory capacity in patients with stable COPD, especially in those with emphysema.