Annual Decline In FEV1 Research Articles

Annual progression of endothelial dysfunction in patients with COPD.

The risk to die from cardiovascular disease is particularly high in patients with COPD. This longitudinal study aims to evaluate changes of endothelial function over time and identify underlying mechanisms in COPD patients. In stable COPD patients we performed annual assessments of endothelial function by flow-mediated dilatation (FMD), lung function, systemic inflammation and cholesterol, sympathetic activation, oxygenation, physical activity and exercise capacity. Associations between annual changes of potential predictors and FMD were investigated in mixed analysis. 76 patients (41% GOLD stage 1/2, 30% 3, 29% 4) were included. Endothelial function significantly decreased annually by-0.14% (95%CI -0.25/-0.04), equal to a relative decrease of-5.6%. Yearly change in 6-min walking distance was significantly associated with FMD in univariable analysis (Coef.-0.00, p=0.045). Progressive airway obstruction and increase in level of total cholesterol were borderline significant with a greater decrease in FMD (Coeff.-0.02, p=0.097 and Coeff.-0.16, p=0.080, respectively). In multivariable analysis a greater annual decline in FEV1 tends to be independently associated with a decrease in FMD (p=0.085). The findings of this study demonstrated that COPD patients experience a significant decrease in endothelial function over time. A greater annual decline in lung function tends to be associated with greater decrease in FMD. However, no other independent predictors for endothelial dysfunction could be identified. www.ClinicalTrials.gov, NCT01527773.

Incident Stenotrophomonas maltophilia infection and lung function decline in cystic fibrosis.

To determine whether incident detection of Stenotrophomonas maltophilia (SM) in patients with cystic fibrosis (CF) is associated with accelerated lung function decline and increased hospitalizations and to determine whether this effect is more pronounced in individuals with subsequent chronic infection. We performed a longitudinal, retrospective single-center, pre-post study of 88 patients with CF, ages 6-51 years, with first positive respiratory culture for SM between 2008 and 2014. Rate of decline in FEV1 and hospitalization rates prior to and following incident SM infection were analyzed using segmented regression analysis of interrupted time series. Mean (SD) age was 17.4 (9.2) years and the mean (SD) FEV1 % predicted at acquisition was 90.0% (25.2). A total of 44% developed chronic SM infection. In regression analysis adjusted for clinical and demographic factors, there was worsening of the mean annual decline in FEV1 % predicted from -1.79 (95%CI: -2.43, -1.15) pre-acquisition to -2.14 (95%CI: -2.61, -1.67) post-acquisition (P = 0.005). A significant change was observed in those with either subsequent intermittent or chronic infection. The mean annual hospitalization rate increased significantly in the subgroup with chronic infection from 0.46 (95%CI: 0.33, 0.60) to 0.88 (95%CI: 0.68, 1.07) (P = 0.007). In this single-center cohort, acquisition of SM in CF was associated with an acceleration in lung function decline. Among those with chronic colonization, acquisition was also associated with increased hospitalization rates.

Lung function and respiratory symptoms among female hairdressers in Palestine: a 5-year prospective study

BackgroundHairdressers are at risk of respiratory health problems due to exposure to chemicals in the workplace. We aimed to examine possible changes in self-reported respiratory symptoms and lung function over 5 years. Also, we examined the associations between occupational factors and lung function changes between baseline and follow-up. MethodsA cohort of 170 female hairdressers in Hebron answered a questionnaire and did a lung function test in 2008. A follow-up study was conducted on the same cohort in 2013. Changes in respiratory symptoms and lung function over the period were measured using generalised and linear mixed models. The lung function test was done using a PC spirometer and a disposable mouthpiece filter and nose clip. Participants were given instructions on the forced maximal expiratory manoeuvres. Respiratory symptoms that were assessed with the questionnaire included chest tightness, shortness of breath, wheezing, cough, and phlegm during the past 12 months. Furthermore, we asked questions on doctor-diagnosed asthma. Differences between current and former hairdressers in respiratory symptoms and lung function at follow-up were measured using mixed models. Written informed consent was obtained from all participants. Findings161 individuals participated in the follow-up study. 28 (16%) of the participants had left their profession. Current hairdressers reported significantly greater changes in chest tightness (prevalence difference [PD] 0·037, 95% CI 0·005 to 0·069) and shortness of breath (0·038, 0·001 to 0·076) between baseline and 2013, compared with former hairdressers Former hairdressers reported fewer symptoms at follow-up than did current hairdressers (PD 0·071, 95% CI –0·0167 to 0·024 for wheezing; 0·071, CI –0·167 to 0·023 for shortness of breath). At follow-up current hairdressers showed a significant decrease in forced expiratory volume in 1 s (FEV1) of 31 mL per year (95% CI 25 to 36). Hairdressers who had been working for 4 years or longer at baseline showed a stronger annual mean decline in FEV1 than those who had worked for less than 4 years (difference 13 mL, 95% CI 1 to 25). InterpretationCurrent hairdressers developed more respiratory symptoms and had a larger lung function decline than former hairdressers. Working for more years was associated with increased lung function decline. These findings suggest that workplace-related factors, including chemical exposures, might have a negative effect on the respiratory health of hairdressers. Thus, there might be a need to monitor exposures and eventually improve the workplace conditions. FundingNUFU “Building Competence in Epidemiology in Palestine” Pro 50-2002 and supportive measures 2008–2009.

Lung function decline in subjects with and without COPD in a population-based cohort in Latin-America.

BackgroundLung-function decline is one of the possible mechanisms leading to Chronic Obstructive Pulmonary Disease (COPD).MethodsWe analyzed data obtained from two population-based surveys of adults (n = 2026) conducted in the same individuals 5–9 years (y) after their baseline examination in three Latin-American cities. Post BronchoDilator (postBD) FEV1 decline in mL/y, as %predicted/y (%P/y) and % of baseline/y (%B/y) was calculated and the influence of age, gender, BMI, baseline lung function, BD response, exacerbations rate evaluated using multivariate models.ResultsExpressed in ml/y, the mean annual postBD FEV1 decline was 27 mL (0.22%P, 1.32%B) in patients with baseline COPD and 36 (0.14%P, 1.36%B) in those without. Faster decline (in mL/y) was associated with higher baseline lung function, with significant response to bronchodilators, older age and smoking at baseline, also in women with chronic cough and phlegm, or ≥2 respiratory exacerbations in the previous year, and in men with asthma.ConclusionsLung function decline in a population-based cohort did not differ in obstructed and non-obstructed individuals, it was proportional to baseline FEV1, and was higher in smokers, elderly, and women with respiratory symptoms.

Long-term effects of beta-blocker use on lung function in Japanese patients with chronic obstructive pulmonary disease.

BackgroundSome recent studies have suggested that beta-blocker use in patients with chronic obstructive pulmonary disease (COPD) is associated with a reduction in the frequency of acute exacerbations. However, the long-term effects of beta-blocker use on lung function of COPD patients have hardly been evaluated.Patients and methodsWe retrospectively reviewed 31 Japanese COPD patients taking beta-blockers for >1 year and 72 patients not taking them. The association between beta-blocker use and the annual change in forced expiratory volume in 1 second (FEV1) was assessed.ResultsAt baseline, patient demographic characteristics were as follows: 97 males (mean age 67.0±8.2 years); 32 current smokers; and Global Initiative for Chronic Obstructive Lung disease (GOLD) stages I: n=26, II: n=52, III: n=19, and IV: n=6. Patients taking beta-blockers exhibited a significantly lower forced vital capacity (FVC), FEV1, and %FVC, and a more advanced GOLD stage. The mean duration of beta-blocker administration was 2.8±1.7 years. There were no differences in the annual change in FEV1 between patients who did and did not use beta-blockers (−7.6±93.5 mL/year vs −4.7±118.9 mL/year, P=0.671). After controlling for relevant confounders in multivariate analyses, it was found that beta-blocker use was not significantly associated with the annual decline in FEV1 (β=−0.019; 95% confidence interval: −0.073 to 0.036; P=0.503).ConclusionLong-term beta-blocker use in Japanese COPD patients might not affect the FEV1, one of the most important parameters of lung function in COPD patients.

Dietary Patterns and Lung Function: Assessment of the Alternative Health Eating Index‐2010 (AHEI‐2010) and Rate of Change in Forced Expiratory Volume in the First Second (FEV1)

ObjectivePrior studies of diet and lung function focus on individual nutrients or foods, whereas US Dietary Guidelines focus on dietary patterns. We investigated the association of the Alternative Healthy Eating Index‐2010 (AHEI‐2010), a measure of overall dietary quality and compliance to the US dietary guidelines, and lung function, quantified by the rate of change in forced expiratory volume in the first second (FEV1).MethodsThe Respiratory Ancillary Study (RAS; N=2,920), which was nested within SELECT (Selenium and Vitamin E Cancer Prevention Trial), studied the effect of supplementation with vitamin E and selenium on the longitudinal trajectory in lung function. RAS also assessed usual dietary intake with a food frequency questionnaire (FFQ) at study baseline; the current analysis investigated the AHEI‐2010 score (higher score indicates greater compliance to dietary guidelines), derived from the FFQ, in relation to rate of change in FEV1. Linear mixed‐effects models estimated the AHEI‐2010—rate of change in FEV1 association, with AHEI‐2010 as a continuous variable (null hypothesis β=0). Models were adjusted for race, age, height, weight, smoking status and pack‐years, education, marital status, residence status, treatment arm, multivitamin use, and energy intake, and extended to test the AHEI‐2010 score × smoking interaction.ResultsA higher AHEI‐2010 score was associated with a slower rate of decline in FEV1 across the full cohort such that an increase of 10 (~1SD) in AHEI‐2010 was associated with a 7.0 mL/year attenuation in the rate of decline (P=0.0009). Models confirmed a statistically significant interaction of AHEI‐2010 and smoking status (P=0.0278), which indicated a stronger association of AHEI‐2010—rate of decline in FEV1 in current smokers compared to never/former smokers. In current smokers, an increase of 10 (~1SD) in AHEI‐2010 was associated with a 17 mL/year attenuation in the annual decline in FEV1 (95% CI: 7, 26); in never/former smokers the same increase in AHEI‐2010 was associated with a 5mL/year (95% CI: 0.4, 9) attenuation in rate of decline.ConclusionsIn a population of North American men, a higher AHEI‐2010 score was associated with a slower decline in lung function, and the association was 3‐fold stronger in current smokers compared to never/former smokers. Translating this to dietary intake, in smoking men consuming one additional serving of vegetables or fruit/day (i.e., increase of 2 in AHEI‐2010), the annual rate of decline in FEV1 was attenuated by 3.3 mL/year.Support or Funding InformationFunding: NHLBI R01HL071022 (PAC), and, in part, by NCI U10CA37429 and 5UM1CA182883

High incidence of non-tuberculous mycobacteria-positive cultures among adolescent with cystic fibrosis

BackgroundWe evaluated the prevalence of non-tuberculous mycobacteria (NTM)-positive cultures among our cystic fibrosis (CF) center patients, reviewed risk factors for NTM positivity, and determined its impact on lung function evolution. MethodsFrom 2009 to 2014, CF adults and children attending the CF center of Lyon (France) and having at least one positive NTM isolate were included. Each case was matched by age and gender with two CF patients with no NTM isolate (controls). Results48 CF patients with NTM-positive isolates were matched to 96 controls. The age group for whom incident NTM was higher was young adolescents aged 13 to 17. A significant association for NTM positivity was found with Staphylococcusaureus in multivariate analysis and with allergic bronchopulmonary aspergillosis, corticosteroid and itraconazole in univariate analysis. Mean annual FEV1 decline was faster for NTM-positive patients compared to controls. ConclusionThese data highlight the high incidence of NTM-positive cultures among young adolescents with CF.

Impact of exacerbations on respiratory system impedance measured by a forced oscillation technique in COPD: a prospective observational study.

BackgroundForced oscillation technique (FOT) has been reported to be useful in the evaluation and management of obstructive lung disease, including COPD. To date, no data are available concerning long-term changes in respiratory system impedance measured by FOT. Additionally, although exacerbations have been reported to be associated with excessive lung function decline in COPD, the impact of exacerbations on the results of FOT has not been demonstrated. The aim of this study was to investigate the longitudinal changes in respiratory system impedance and the influence of exacerbations thereon.MethodsBetween March 2011 and March 2012, outpatients who attended Kobe City Medical Center West Hospital with a diagnosis of COPD were assessed for eligibility. Baseline patient characteristics (age, sex, body mass index, smoking history, current smoking status, COPD stage), lung function (post-bronchodilator forced expiratory volume in 1 second [FEV1]), blood tests (neutrophils and eosinophils), FOT, and COPD assessment test results were collected at enrollment. Lung function and FOT were examined every 6 months until March 2016. Annual changes in FEV1 and FOT parameters were obtained from the slope of the linear regression curve. The patients were divided into 2 groups based on exacerbation history.ResultsFifty-one of 58 patients with COPD were enrolled in this study. The median follow-up period was 57 (52–59) months. Twenty-five (49%) patients experienced exacerbations. A significant annual decline in FEV1 and respiratory system impedance were shown. Additionally, annual changes in FEV1, respiratory system resistance at 5 Hz, respiratory system reactance at 5 Hz, and resonant frequency were greater in patients with exacerbations than in those without exacerbations.ConclusionExacerbations of COPD lead not only to a decline in lung function but also to an increase in respiratory system impedance.

Asthma-like Features and Clinical Course of Chronic Obstructive Pulmonary Disease. An Analysis from the Hokkaido COPD Cohort Study

Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features, such as significant bronchodilator reversibility, blood eosinophilia, and/or atopy, even if they are not clinically diagnosed as having asthma. However, the clinical significance of asthma-like features overlapping with COPD remains unclear. The aim of this study was to assess the effect of asthma-like features on the clinical course of patients with COPD who were adequately treated and followed-up over 10 years. A total of 268 patients with COPD who had been clinically considered as not having asthma by respiratory specialists were included in this study. The asthma-like features included in this study were bronchodilator reversibility (ΔFEV1, ≥12% and ≥200 ml), blood eosinophilia (≥300 cells/μl), and atopy (positive specific IgE for any inhaled antigen). The annual changes in post-bronchodilator FEV1 and COPD exacerbations were monitored during the first 5 years, and mortality was followed during the entire 10 years of the study. Fifty-seven subjects (21%) had bronchodilator reversibility, 52 (19%) had blood eosinophilia, and 67 (25%) had atopy. Subjects with blood eosinophilia had significantly slower annual post-bronchodilator FEV1 decline; bronchodilator reversibility and atopy did not affect the annual post-bronchodilator FEV1 decline, and none of the asthma-like features was associated with development of COPD exacerbation. Even if subjects had two or more asthma-like features, they displayed annual post-bronchodilator FEV1 declines and exacerbation rates similar to those of subjects with one or zero asthma-like features, as well as a lower 10-year mortality rate (P = 0.02). The presence of asthma-like features was associated with better clinical course in patients with COPD receiving appropriate treatment.

Lung function in asphalt pavers: a longitudinal study.

To study longitudinal changes in lung function in asphalt pavers and a reference group of road maintenance workers, and to detect possible signs of lung disease by high-resolution computed tomography (HRCT) scans. Seventy-five asphalt pavers and 71 road maintenance workers were followed up with questionnaires and measurements of lung function. Not every worker was tested every year, but most of them had four or more measurement points. The 75 asphalt pavers were also invited to have HRCT scans of the lungs at the end of the follow-up period. Mean annual decline in forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1) of the asphalt pavers was 58 and 35ml, respectively. Adjusted for age at baseline, packyears of smoking and BMI, the asphalt pavers had a significant excess annual decline in FVC and FEV1 compared to the references. The screedmen, the most exposed group of the asphalt pavers, showed a significantly larger decline in FVC than the other asphalt pavers (P=0.029). Fine intralobular fibrosis without evident cysts was identified with HRCT in three subjects (4%). We conclude that our findings may indicate an excess annual decline in FVC and FEV1 related to exposure to asphalt fumes. The screedmen, who carry out their work behind and close to the paving machine, had the largest decline in lung function. The finding of adverse pulmonary effects in asphalt pavers calls for better technological solutions to prevent exposure.

Bronchial Reactivity and Lung Function After World Trade Center Exposure

World Trade Center (WTC)-exposed rescue/recovery workers endured massive respiratory insult from inhalation of particulate matter and gases, resulting in respiratory symptoms, loss of lung function, and, for many, bronchial hyperreactivity (BHR). The persistence of respiratory symptoms and lung function abnormalities has been well-documented, whereas persistence of BHR has not been investigated. A total of 173 WTC-exposed firefighters with bronchial reactivity measured within 2 years after September 11, 2001 (9/11) (baseline methacholine challenge test), were reevaluated in 2013 and 2014 (follow-up methacholine challenge test). FEV1 measurements were obtained from the late pre-9/11, early post-9/11, and late post-9/11 periods. Respiratory symptoms and corticosteroid treatment were recorded. Bronchial reactivity remained stable (within 1 doubling dilution) for most (n= 101, 58%). Sixteen of 28 (57%) with BHR (provocative concentration of methacholine producing a 20%decline in FEV1<8mg/mL) at baseline had BHR at follow-up, and an additional 27 of the 145 (19%) without BHR at baseline had BHR at follow-up. In multivariable models, we found that BHR baseline was strongly associated with BHR follow-up (OR, 6.46) and that BHR at follow-up was associated with an estimated 15.4mL/y greater FEV1 decline than experienced by those without BHR at follow-up. Annual FEV1 decline was moderated by corticosteroid use. Persistent BHR and its deleterious influence on lung function suggest a role for airway inflammation in perpetuation of WTC-associated airway disease. In future massive occupational exposure to inorganic dust/gases, we recommend early and serial pulmonary function testing, including measurements of bronchial reactivity, when possible, and inhaled corticosteroid therapy for those with symptoms or pulmonary function tests consistent with airway disease.

Impact of Long-Term Tiotropium Bromide Therapy on Annual Lung Function Decline in Adult Patients with Cystic Fibrosis.

BackgroundChronic lung disease is the leading cause of death in patients with Cystic Fibrosis (CF) and is often treated with bronchodilators. It is not known whether long-term tiotropium bromide treatment may have a positive impact on lung function.MethodsThis retrospective cohort study estimated annual lung function decline utilizing longitudinal data for forced expiratory volume in 1 s (FEV1).ResultsA total of 160 adult patients with CF were analyzed. The subjects treated for 24 months with tiotropium bromide had a significantly slower decline of mean annual change of FEV1 (treated: -0.3±4.0%; control: -2.3±5.0%; p = 0.0130). In patients with FEV1 ≥70% predicted, long-term tiotropium bromide treatment was associated with greater improvements in annual lung function decline (FEV1 ≥70% predicted: treated: +0.5±4.7%; control: -4.0±6.3%; p = 0.0132; FEV1 50–69% predicted: treated: -0.5±4.4%; control: -0.8±3.8%; p = 0.7142; FEV1 ≤49% predicted: treated: -0.6±3.4%; control: -2.4±4.8%; p = 0.0898).ConclusionThis study suggests that long-term tiotropium bromide treatment may be associated with reduced annual decline of FEV1 in patients with CF, particularly in adults with a mild degree of severity.

Sputum neutrophils are elevated in smelter workers, and systemic neutrophils are associated with rapid decline in FEV1

ObjectivesIn a previous study on smelter workers we, found significant relationship between exposure to dust and accelerated annual decline in forced expiratory volume in 1 s (FEV1). In this cross-sectional...

A three years longitudinal follow-up study of pulmonary function changes in patients with chronic obstructive pulmonary disease

To investigate the characteristics and the risk factors of pulmonary function in patients with chronic obstructive pulmonary disease (COPD) for a 3 year follow-up. Subjects diagnosed as COPD were followed up for 3 years in the Management Center of Chronic Respiratory Disease at XINQIAO Hospital from September 2009 to June 2012.This was a retrospective study. Parameters related to respiratory function mainly first second forced expiratory volume (FEV1), COPD assessment test (CAT), 6 minutes walking distance (6MWD) and acute exacerbation were recorded during follow-up. Although the majority of patients were treated with drugs such as inhaled corticosteroid combined with long-term bronchial dilatation during the three years, FEV1 decreased progressively. The average annual decline of FEV1 was(31.80±61.99)ml, translating into a mean annual decline of(3.74±6.18)%. However, there were significant differences in changes of FEV1. Approximately, FEV1 in 78.3% (47/60) patients decreased, only 21.7%(13/60) patients kept stable FEV1. There was a correlation between decrease of FEV1, FEV1%predicted and the exacerbation (r=0.298, 0.361, 0.273; P<0.05). Logistic regression showed that the positive bronchodilator reversibility and the initial FEV1 were the independent factors associated with significant changes in FEV1 (respectively, OR=5.54, 95%CI 1.55-19.73; OR=8.28, 95%CI 1.42-48.32). The changes of pulmonary function in patients with COPD are heterogeneous, although most patients are treated in a standard way. Nearly 80% patients still represent deterioration of pulmonary function. Decline of FEV1 is closely related to the initial pulmonary function and bronchodilator reversibility.

Aging-Related Considerations When Evaluating the Forced Expiratory Volume in 1 Second (FEV1) Over Time.

Forced expiratory volume in 1 second (FEV1) over time is commonly expressed in liters and percent predicted (%Pred), or alternatively in L/m(3) and Z-scores-which approach is more clinically meaningful has not been evaluated. Because it uniquely accounts for the effect of aging on FEV1 and spirometric performance, we hypothesized that the Z-score approach is more clinically meaningful, based on associations between cardiopulmonary predictors and FEV1 over time. Using linear mixed-effects models and data from the Baltimore Longitudinal Study on Aging, including 501 white participants aged 40-95 who had completed at least three longitudinal spirometric assessments, we evaluated the associations between cardiopulmonary predictors (obesity, smoking status, hypertension, chronic bronchitis, diabetes mellitus, and myocardial infarction) and FEV1 over time, in liters, %Pred, L/m(3), and Z-scores. Mean baseline values for FEV1 were 3.240L, 96.4%Pred, 0.621L/m(3), and -0.239 as a Z-score (40.6th percentile). The annual decline in FEV1 was 0.040L, 0.234 %Pred, 0.007L/m(3), and 0.008 Z-score units. Baseline age was associated with FEV1 over time in liters and L/m(3) (p < .001), and included a time interaction for %Pred (p < .001), but was not associated with Z-scores (p = .933). The associations of cardiopulmonary predictors with FEV1 over time were all significant when using Z-scores (p < .05), but varied for other methods of expressing FEV1. A Z-score approach is more clinically meaningful when evaluating FEV1 over time, as it accounted for the effect of aging and was more frequently associated with multiple cardiopulmonary predictors.

Relapse in FEV1 Decline After Steroid Withdrawal in COPD

We previously observed that 30 months of inhaled corticosteroid (ICS) treatment can attenuate FEV1 decline in COPD, but it is unclear whether withdrawal induces a relapse. We hypothesized that FEV1 decline, airway hyperresponsiveness (AHR), and quality of life (QOL) deteriorate after ICS cessation even after prolonged use. One hundred fourteen patients with moderate to severe COPD finished randomized 6-month or 30-month treatment with fluticasone (500 μg bid), 30-month treatment with fluticasone and salmeterol (500/50 μg bid), or placebo (first part of the Groningen and Leiden Universities Corticosteroids in Obstructive Lung Disease [GLUCOLD] study [GL1]). The subsequent 5 years, patients were prospectively followed annually, treated by their physician (GLUCOLD follow-up study [GL2]). Postbronchodilator FEV1, AHR, and QOL were initially recorded at baseline, at 30 months (GL1), and annually during GL2. Analysis was performed by linear mixed-effects models. Among 101 adherent patients during GL1, 79 patients started and 58 completed GL2. Patients using ICSs during GL1, but only using ICSs 0% to 50% of the time during GL2 (n = 56 of 79), had significantly accelerated annual FEV1 decline compared with GL1 (difference GL2-GL1 [95% CI]: 30-month treatment with fluticasone and salmeterol, -68 mL/y [-112 to -25], P = .002; 30-month treatment with fluticasone, -73 mL/y [-119 to -26], P = .002), accompanied by deterioration in AHR and QOL. ICS discontinuation after 30 months in COPD can worsen lung function decline, AHR, and QOL during 5-year follow-up. This suggests that ICS treatment lacks sustained disease-modifying effect after treatment cessation. ClinicalTrials.gov; No.: NCT00158847; URL: www.clinicaltrials.gov.

Serum Bilirubin and Disease Progression in Mild COPD

COPD is a chronic inflammatory disorder associated with oxidative stress. Serum bilirubin has potent antioxidant actions, and higher concentrations have been shown to protect against oxidative stress. The relation between serum bilirubin and COPD progression is unknown. Serum bilirubin was measured in 4,680 smokers aged 35 to 60 years old with mild to moderate airflow limitation. The relationship of serum bilirubin to postbronchodilator FEV₁ and rate of FEV1 decline over 3 to 9 years was determined using regression modeling. Total and disease-specific mortality were also ascertained. Serum bilirubin was positively related to FEV₁ (P < .001). Serum bilirubin was also negatively related to the annual decline in FEV₁ when adjusted for baseline demographics, pack-years smoked, and baseline measures of lung function (P = .01). Additionally, serum bilirubin was negatively associated with risk of death from coronary heart disease (P = .03); however, the relationships between bilirubin and other mortality end points were not statistically significant (P > .05). Bilirubin is inversely related to COPD disease severity and progression. Higher serum bilirubin concentration was associated with a higher FEV₁ and less annual decline in FEV₁. Bilirubin was also associated with less coronary heart disease mortality. These data support the hypothesis that bilirubin has a protective effect on COPD disease progression, possibly through its antioxidant actions. Bilirubin may prove useful as an easily accessible and readily available blood-based COPD biomarker.

Asthma exacerbations and lung function in patients with severe or difficult-to-treat asthma

Asthma exacerbations and lung function in patients with severe or difficult-to-treat asthma

Risk factors for lung function decline in a large cohort of young cystic fibrosis patients.

To identify novel risk factors and corroborate previously identified risk factors for mean annual decline in FEV1% predicted in a large, contemporary, United States cohort of young cystic fibrosis (CF) patients. Retrospective observational study of participants in the EPIC Observational Study, who were Pseudomonas-negative and ≤12 years of age at enrollment in 2004-2006. The associations between potential demographic, clinical, and environmental risk factors evaluated during the baseline year and subsequent mean annual decline in FEV1 percent predicted were evaluated using generalized estimating equations. The 946 participants in the current analysis were followed for a mean of 6.2 (SD 1.3) years. Mean annual decline in FEV1% predicted was 1.01% (95%CI 0.85-1.17%). Children with one or no F508del mutations had a significantly smaller annual decline in FEV1 compared to F508del homozygotes. In a multivariable model, risk factors during the baseline year associated with a larger subsequent mean annual lung function decline included female gender, frequent or productive cough, low BMI (<66th percentile, median in the cohort), ≥1 pulmonary exacerbation, high FEV1 (≥115% predicted, in the top quartile), and respiratory culture positive for methicillin-sensitive Staphylococcus aureus, methicillin-resistant S. aureus, or Stenotrophomonas maltophilia. We have identified a range of risk factors for FEV1 decline in a large cohort of young, CF patients who were Pa negative at enrollment, including novel as well as previously identified characteristics. These results could inform the design of a clinical trial in which rate of FEV1 decline is the primary endpoint and identify high-risk groups that may benefit from closer monitoring.

Lobe-based computed tomography assessment of airway diameter, airway or vessel number, and emphysema extent in relation to the clinical outcomes of COPD

ObjectiveThe aim of this study was to evaluate the relationship between computed tomography assessed lobe-based lung parameters and the clinical outcomes of patients with chronic obstructive pulmonary disease (COPD), including the frequency of exacerbation and annual change in forced expiratory volume in 1 second (FEV1).Patients and methodsWe studied 65 patients with COPD. We reconstructed computed tomography images to trace the bronchial tree from right B1 to B10 and created 3 cm circle images around the airways exactly perpendicular to the airway axis in the central, middle, and peripheral zones of the bronchi. The number of airways and vessels, airway inner diameter and area of emphysema in the circles were calculated for each segment. Then, we analyzed the relationships between the lobe-based image parameters and the frequency of exacerbation and annual decline in the FEV1. In addition, we assessed the effects of proximal airway lumen-obliterated emphysema (ALOE) on these clinical features.ResultsThe airway diameter was not associated with the frequency of exacerbation or annual decline in FEV1. Among the structural parameters, lower lobe emphysema was most associated with the frequency of exacerbation. The reductions in the number of airways and vessels in total lobe were associated with the annual decline in FEV1. The subgroup of patients with ALOE demonstrated lower FEV1 and more frequent exacerbation than those without ALOE.ConclusionLower lobe emphysema predicts frequent COPD exacerbation, whereas the annual decline in FEV1 is associated with the number of airways and vessels in total lobe.