scholarly journals Current situation of asthma–COPD overlap in Chinese patients older than 40 years with airflow limitation: a multicenter, cross-sectional, non-interventional study

2020 ◽  
Vol 14 ◽  
pp. 175346662096169
Author(s):  
Jian Kang ◽  
Jinping Zheng ◽  
Baiqiang Cai ◽  
Fuqiang Wen ◽  
Wanzhen Yao ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Recognition Rate ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chinese Patients ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Interventional Study ◽  
Cross Sectional

Background and aims: Asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) is poorly recognized in China. Our study determined the distribution of ACO and its clinical characteristics among patients (aged ⩾40 years) with airflow limitation at Chinese tertiary hospitals. Methods: This cross-sectional, non-interventional study (NCT02600221), conducted between December 2015 and October 2016 in 20 Tier-3 Chinese hospitals, included patients aged ⩾40 years with post-bronchodilator (BD) FEV1/FVC <0.7. The primary variable was distribution of ACO in adults with post-BD forced expiratory volume /forced vital capacity (FEV1/FVC) <0.7 based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015 and 2017 reports. Other variables included determination of characteristics of ACO and its clinical recognition rate. Results: In 2003 patients (mean age 62.30 ± 9.86 years), distribution of ACO, COPD and asthma were 37.40%, 48.50% and 14.10%, respectively. Proportions of patients with A, B, C and D grouping were 11.70%, 31.00%, 6.90% and 50.30% as per GOLD 2017, whereas they were 15.10%, 51.10%, 3.60% and 30.20% as per GOLD 2015. Similar clinical symptoms were reported in all three groups. A higher percentage of ACO patients presented with dyspnea, wheezing and chest tightness. Compared with the COPD group, a greater proportion of ACO patients reported wheezing (74.6% and 65.40%), while a lower proportion in the ACO group reported cough (79.40% versus 82.70%) and expectoration (76.50% versus 81.60%). Blood eosinophil count ⩾0.3 × 109/L was observed in 34.6% of ACO patients. The clinical recognition rate of ACO was 31.4%. Conclusion: Despite ACO affecting two-fifths of the study population, the initial diagnosis rate was low at 6% in China, thus warranting concerted efforts to improve ACO diagnosis. ClinicalTrials.gov: [ClinicalTrials.gov identifier: NCT02600221] registered 22 October 2015, https://clinicaltrials.gov/ct2/show/NCT02600221 The reviews of this paper are available via the supplemental material section.

scholarly journals Impaired Hemorheology in Exacerbations of COPD

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Erhan Ugurlu ◽  
Emine Kilic-Toprak ◽  
Ilknur Can ◽  
Ozgen Kilic-Erkek ◽  
Goksel Altinisik ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Chronic Obstructive Lung Disease ◽  
Airflow Limitation ◽  
Erythrocyte Aggregation ◽  
Treatment Modalities ◽  
Patient Treatment ◽  
Rheological Parameters ◽  
Chronic Obstructive ◽  
Copd Patients ◽  
Rbc Deformability

Background. Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation. Cardiovascular-related comorbidities are established to contribute to morbidity and mortality especially during exacerbations. The aim of the current study was to determine alterations in hemorheology (erythrocyte aggregation, deformability) in newly diagnosed COPD patients and their response to medical treatment and to compare with values of COPD patients with exacerbations.Materials and Methods. The study comprised 13 COPD patients, 12 controls, and 16 COPD patients with exacerbations. The severity of COPD was determined according toGlobal Initiative for Chronic Obstructive Lung Diseaseguidelines. Red blood cell (RBC) deformability and aggregation were measured by an ektacytometer.Results. RBC deformability of COPD patients with exacerbations was decreased compared to the other groups. Erythrocyte aggregation and plasma fibrinogen of COPD patients determined during exacerbations were higher than control.Conclusion. Decreased RBC deformability and increased aggregation associated with exacerbations of COPD may serve as unfavorable mechanisms to worsen oxygenation and thus clinical symptoms of the patient. Treatment modalities that modify rheological parameters might be beneficial.

scholarly journals Predictive Modelling of Lung Function using Emphysematous Density Distribution

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kuo-Lung Lor ◽  
Cheng-Pei Liu ◽  
Yeun-Chung Chang ◽  
Chong-Jen Yu ◽  
Cheng-Yi Wang ◽  
...  
Keyword(s):  
Lung Function ◽  
Predictive Model ◽  
Lung Volume ◽  
Model Fitting ◽  
Chronic Obstructive Lung Disease ◽  
Correlation Study ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Normal Lung ◽  
Chronic Obstructive

AbstractTarget lung tissue selection remains a challenging task to perform for treating severe emphysema with lung volume reduction (LVR). In order to target the treatment candidate, the percentage of low attenuation volume (LAV%) representing the proportion of emphysema volume to whole lung volume is measured using computed tomography (CT) images. Although LAV% have shown to have a correlation with lung function in patients with chronic obstructive pulmonary disease (COPD), similar measurements of LAV% in whole lung or lobes may have large variations in lung function due to emphysema heterogeneity. The functional information of regional emphysema destruction is required for supporting the choice of optimal target. The purpose of this study is to develop an emphysema heterogeneity descriptor for the three-dimensional emphysematous bullae according to the size variations of emphysematous density (ED) and their spatial distribution. The second purpose is to derive a predictive model of airflow limitation based on the regional emphysema heterogeneity. Deriving the bullous representation and grouping them into four scales in the upper and lower lobes, a predictive model is computed using the linear model fitting to estimate the severity of lung function. A total of 99 subjects, 87 patients with mild to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I~IV) and 12 control participants with normal lung functions (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) > 0.7) were evaluated. The final model was trained with stratified cross-validation on randomly selected 75% of the dataset (n = 76) and tested on the remaining dataset (n = 23). The dispersed cases of LAV% inconsistent with their lung function outcome were evaluated, and the correlation study suggests that comparing to LAV of larger bullae, the widely spread smaller bullae with equivalent LAV has a larger impact on lung function. The testing dataset has the correlation of r = −0.76 (p < 0.01) between the whole lung LAV% and FEV1/FVC, whereas using two ED % of scales and location-dependent variables to predict the emphysema-associated FEV1/FVC, the results shows their correlation of 0.82 (p < 0.001) with clinical FEV1/FVC.

scholarly journals Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

2021 ◽  
Vol 8 (1) ◽  
pp. e001135
Author(s):  
Subash Heraganahally ◽  
Timothy P Howarth ◽  
Elisha White ◽  
Helmi Ben Saad
Keyword(s):  
Indigenous Population ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Indigenous Australians ◽  
Obstructive Pulmonary Disease ◽  
Reference Equations ◽  
Global Initiative ◽  
Lower Limit Of Normal

BackgroundAssessment of airflow limitation (AFL) is crucial in the clinical evaluation of patients with chronic obstructive pulmonary disease (COPD). However, in the absence of normative reference values among adult Australian Indigenous population, the implications of utilising the Global Lung Function Initiative (GLI-2012), Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Australian concise COPD-X recommended severity classifications is not known. Moreover, spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) are observed to be 20%–30% lower in an apparently healthy Indigenous population in comparison to Caucasian counterparts.MethodsAdult Indigenous patients diagnosed to have COPD on spirometry (postbronchodilator (BD) FEV1/FVC <0.7 ((GOLD, (COPD-X)) and ≤lower limit of normal (others/mixed reference equations) for GLI-2012) were assessed for AFL severity classifications on Post-BD FEV1 values (mild, moderate, severe, very severe) as per the recommended classifications.ResultsFrom a total of 742 unique patient records of Indigenous Australians, 253 were identified to have COPD via GOLD/COPD-X criteria (n=238) or GLI-2012 criteria (n=238) with significant agreeance between criteria (96%, κ=0.901). Of these, the majority were classified as having moderate or severe/very-severe AFL with significant variability across classification criteria (COPD-X (40%–43%), GOLD (33%–65%), GLI-2012 (18%–75%)). The FVC and FEV1 values also varied significantly between classification criterion (COPD-X/GOLD/GLI-2012) within the same AFL category, with COPD-X ‘moderate’ AFL almost matching ‘severe’ AFL categorisation by GOLD or GLI-2012.ConclusionsHealth professionals caring for Indigenous patients with COPD should be aware of the clinical implications and consequences of utilising various recommended AFL classifications in the absence of validated spirometry reference norms among adult Indigenous patients.

scholarly journals GOLD criteria overestimate airflow limitation in one-third of cases in the general Finnish population

2016 ◽  
Vol 2 (4) ◽  
pp. 00084-2015 ◽  
Author(s):  
Annette Kainu ◽  
Kirsi Timonen ◽  
Ari Lindqvist ◽  
Päivi Piirilä
Keyword(s):  
Reference Values ◽  
Population Sample ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
International Studies ◽  
Finnish Population ◽  
Obstructive Pulmonary Disease ◽  
Severity Grading

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria for chronic obstructive pulmonary disease (COPD) use a fixed threshold of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (<0.70) in post-bronchodilation spirometry to indicate disease, which has been shown to underestimate and overestimate disease prevalence in younger and older adults, respectively, whilst criteria based on reference values have better accuracy. Differences in reference values have limited their use in international studies. However, the new Global Lung Function Initiative reference values (GLI2012) showed FEV1/FVC to be the least dependent on ethnicity. The aim of this study was to assess the prevalence of airflow limitation with GLI2012 and the degree of underdetection or overestimation related to the use of GOLD in the general population.A Finnish population sample of 1323 subjects (45% male) with post-bronchodilation spirometry was studied.80 subjects (6.0%) and 55 subjects (4.2%) were identified with airflow limitation with GOLD and GLI2012 criteria, respectively. The proportion of overestimation with GOLD increased with age from 25% of cases in 50-year-olds to 54% in 70-year-olds. Using z-score-based grading resulted in more dispersion in severity grading.In conclusion, the GOLD criteria cause a marked overestimation already from 50-year-olds and should be replaced with the GLI2012 criteria to improve diagnostic accuracy.

scholarly journals Pulmonary function testing in COPD: looking beyond the curtain of FEV1

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Sotirios Kakavas ◽  
Ourania S. Kotsiou ◽  
Fotis Perlikos ◽  
Maria Mermiri ◽  
Georgios Mavrovounis ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Clinical Symptoms ◽  
Pulmonary Function Tests ◽  
Cardiopulmonary Exercise Testing ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Forced Oscillation Technique ◽  
Comprehensive Overview ◽  
Obstructive Pulmonary Disease

AbstractChronic obstructive pulmonary disease (COPD) management remains challenging due to the high heterogeneity of clinical symptoms and the complex pathophysiological basis of the disease. Airflow limitation, diagnosed by spirometry, remains the cornerstone of the diagnosis. However, the calculation of the forced expiratory volume in the first second (FEV1) alone, has limitations in uncovering the underlying complexity of the disease. Incorporating additional pulmonary function tests (PFTs) in the everyday clinical evaluation of COPD patients, like resting volume, capacity and airway resistance measurements, diffusion capacity measurements, forced oscillation technique, field and cardiopulmonary exercise testing and muscle strength evaluation, may prove essential in tailoring medical management to meet the needs of such a heterogeneous patient population. We aimed to provide a comprehensive overview of the available PFTs, which can be incorporated into the primary care physician’s practice to enhance the efficiency of COPD management.

scholarly journals Evaluation of the Persian Transcript of the COPD Assessment Test in the Measurement of COPD Health Status in Iranian COPD Patients

2015 ◽  
Vol 8 (5) ◽  
pp. 225 ◽  
Author(s):  
Alireza Azargon ◽  
Mohammadreza Gholami ◽  
Ali Farhadi ◽  
Maryam Hadi Chegni ◽  
Abolfazl Zendedel
Keyword(s):  
Disease Severity ◽  
Chronic Obstructive Lung Disease ◽  
Airway Disease ◽  
Cross Sectional Study ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Copd Assessment Test ◽  
The Relationship ◽  
Obstruction Severity

<p><strong>AIM:</strong> Chronic obstructive pulmonary disease is a completely irreversible obstructive airway disease. The COPD assessment test (CAT) is one of the standard methods for the clinical assessment of the disease, which is translated into Persian. This study investigated the reliability of the test and its relationship with the severity of the disease.</p><p><strong>METHODS:</strong> In this cross-sectional study, 120 patients filled out the Persian transcript of the test. After two weeks, the patients filled out the CAT test again. Obstruction severity was determined for all the patients using spirometry, and the patients were categorized into four groups according to the Global Initiative for Chronic Obstructive Lung Disease criteria. The relationship between the test scores and the disease severity wan validated.</p><p><strong>RESULTS:</strong> The mean age of the patients was 51.5 years. The Cronbach's alpha coefficient of the Persian transcript of the test was 0.872 in the first time, and 0.885 in the second time. Intragroup reliability, test re-test and intragroup correlations were significant for all the questions (&lt;0.001). The relationship between the test mean score and obstruction severity was significant, and the correlation between disease categorization in accordance with obstruction severity and categorization according to the test score was significant as well.</p><p><strong>CONCLUSION:</strong> The Persian transcript of the assessment test for COPD was reliable and is directly related to the disease severity according to airflow limitation.</p>

scholarly journals Gait patterns in COPD: the Rotterdam Study

2015 ◽  
Vol 46 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Lies Lahousse ◽  
Vincentius J.A. Verlinden ◽  
Jos N. van der Geest ◽  
Guy F. Joos ◽  
Albert Hofman ◽  
...  
Keyword(s):  
Chronic Obstructive Lung Disease ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Gait Velocity ◽  
Normal Lung ◽  
Chronic Obstructive ◽  
Rotterdam Study ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Gait disturbances in patients with chronic obstructive pulmonary disease (COPD) may lead to disability and falls. As studies assessing gait kinematics in COPD are sparse, we investigated associations of COPD with various gait domains and explored a potential link with falling.Gait was measured within the prospective, population-based Rotterdam Study (age ≥55 years) using an electronic walkway and summarised into seven gait domains: Rhythm, Variability, Phases, Pace, Tandem, Turning and Base of Support. Rhythm is a temporal gait aspect that includes cadence and reflects how quickly steps are taken.Persons with COPD (n=196) exhibited worse Rhythm (−0.21 sd, 95% CI −0.36– −0.06 sd) compared with persons with normal lung function (n=898), independent of age, sex, height, education, smoking or analgesic use, especially when dyspnoea and severe airflow limitation or frequent exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D: −0.83 sd, 95% CI −1.25– −0.41 sd) were present. A lower forced expiratory volume in 1 s was associated with worse Rhythm and Pace, including lower cadence and gait velocity, respectively. Importantly, fallers with COPD had significantly worse Rhythm than nonfallers with COPD.This study demonstrates that persons with COPD exhibit worse Rhythm, especially fallers with COPD. The degree of Rhythm deterioration was associated with the degree of airflow limitation, symptoms and frequency of exacerbations.

scholarly journals Trends in the prevalence of airflow limitation in a general Japanese population: two serial cross-sectional surveys from the Hisayama Study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023673
Author(s):  
Hiroaki Ogata ◽  
Yoichiro Hirakawa ◽  
Koichiro Matsumoto ◽  
Jun Hata ◽  
Daigo Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Attributable Fraction ◽  
Airway Disease ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Population Attributable Fractions ◽  
Attributable Fractions

ObjectivesChronic obstructive airway disease, which is characterised by airflow limitation, is a major burden on public health. Reductions in environmental pollution in the atmosphere and workplace and a decline in the prevalence of smoking over recent decades may have affected the prevalence of airflow limitation in Japan. The present epidemiological study aimed to evaluate trends in the prevalence of airflow limitation and in the influence of risk factors on airflow limitation in a Japanese community.DesignTwo serial cross-sectional surveys.SettingData from the Hisayama Study, a population-based prospective study that has been longitudinally conducted since 1961.ParticipantsA total of 1842 and 3033 residents aged ≥40 years with proper spirometric measurements participated in the 1967 and 2012 surveys, respectively.Main outcome measuresAirflow limitation was defined as forced expiratory volume in 1 s/forced vital capacity <70% by spirometry. For each survey, the age-adjusted prevalence of airflow limitation was evaluated by sex. ORs and population attributable fractions of risk factors on the presence of airflow limitation were compared between surveys.ResultsThe age-standardised prevalence of airflow limitation decreased from 1967 to 2012 in both sexes (from 26.3% to 16.1% in men and from 19.8% to 10.5% in women). Smoking was significantly associated with higher likelihood of airflow limitation in both surveys, although the magnitude of its influence was greater in 2012 than in 1967 (the multivariable-adjusted OR was 1.63 (95% CI 1.19 to 2.24) in 1967 and 2.26 (95% CI 1.72 to 2.99) in 2012; p=0.007 for heterogeneity). Accordingly, the population attributable fraction of smoking on airflow limitation was 33.5% in 2012, which was 1.5-fold higher than that in 1967 (21.1%).ConclusionsThe prevalence of airflow limitation was decreased over 45 years in Japan, but the influence of smoking on airflow limitation increased with time.

scholarly journals Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity

2015 ◽  
Vol 46 (6) ◽  
pp. 1589-1597 ◽  
Author(s):  
Ben-Gary Harvey ◽  
Yael Strulovici-Barel ◽  
Robert J. Kaner ◽  
Abraham Sanders ◽  
Thomas L. Vincent ◽  
...  
Keyword(s):  
New York ◽  
Complete Blood Count ◽  
Significant Risk ◽  
Chronic Obstructive Lung Disease ◽  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative

Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these “normal spirometry/low DLCO” smokers is unknown.From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers.In the normal spirometry/normal DLCO group assessed over 45±20 months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22% developed GOLD-defined COPD.Despite appearing “normal” according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

scholarly journals Correntional study of the health-related quality of life, chronic obstructive airway disease in Northern India, New Delhi

2018 ◽  
Vol 5 (3) ◽  
pp. 705
Author(s):  
Ved Prakash Ghilley ◽  
D. P. Bhadoria ◽  
Sanjay Pandit
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Health Related Quality ◽  
Copd Patients ◽  
Related Quality ◽  
Health Related

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (COPD) as “a disease state characterized by airflow limitation that is not fully reversible. Due to progressive airflow limitation, the patients become increasingly symptomatic leading to worsening in their health-related quality of life (HRQOL). Objective of present study was to examine that correlation of health related quality of life with the chronic obstructive pulmonary disease.Methods: One hundred twenty consecutive stable COPD patients (diagnosed as per GOLD guidelines), without any co-morbid conditions (diabetes, congestive heart failure, coronary artery disease, hypertension) were recruited in this study after intuitional ethical clearance and informed consents. The health-related quality of life (HRQOL) was assessed using Hindi SGRQ-C. Forced expiratory volume in first one second (FEV1), forced vital capacity (FVC) and FEV1/FVC% and reversibility were measured using Spirolab III (Medical International Research USA, Inc.). The descriptive and the Pearson’s correlation coefficient were done in data treatment with SPSS version 20.Results: The component of SGRQ scores were as follows: Symptom score: 31.27±14.6 (range 2.3-64); Activity score: 59.01±23.08) (range 0-100); Impact score 42.19±22.25 (range 0-88.8) and the total score was = 45.34±17.96 (range 1.1.-88.6). There were significant negative correlations between all the parameters of SGRQ and FEV1% predicted (i.e. with lower FEV1% parameters of SGRQ will be high).Conclusions: Indian patients with COPD show significantly reduced HRQOL as measured by disease specific questionnaire SGRQ, similar to COPD patients in other countries. In our study, only FEV1 % predicted was significantly correlated with HRQOL, all other measures including GOLD staging were not significantly associated with HRQOL.

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