Association Of COPD Research Articles

The impact of chronic obstructive pulmonary disease on the development of osteoporosis in elderly individuals: a systematic review

This review aimed to systematically review and analyze existing literature on the association of COPD with osteoporosis in elderly individuals. For this purpose, a comprehensive search was carried out using the four primary databases including PubMed, MEDLINE, SCOPUS, and Web of Science, to find the relevant literature. The summary tables that were created using information from relevant studies provided a qualitative assessment of the research findings and their constituent parts. A total of nine studies encompassing 3,957 patients were analyzed, of which 1,743 were diagnosed with COPD, and 2,228 (56.3%) were males. Among the COPD patients, 553 (31.7%) were found to have osteoporosis. The prevalence ranged from 18% to 65.7%. Osteoporosis was found prevalent in COPD patients and with higher prevalence when compared to other pulmonary diseases such as bronchial asthma. This prevalence was not related to systemic steroid treatment but multifactorial and associated with pathological fractures. Underweight, older participants, and anemic groups had a higher frequency of osteoporosis. COPD is a significant public health concern. According to the body of research, alarming datum was discovered about the prevalence of COPD by several measures. Therefore, government authorities need to control COPD as a top priority to reduce the global burden of this chronic respiratory disease. One risk factor that needs to be addressed by appropriate treatment and prevention measures is the development of permanent airway obstruction.

Impact of COPD on mortality: An 8-year observational retrospective healthcare claims database cohort study

BackgroundChronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. Here we present a large observational study on the association of COPD and exacerbations with mortality (AvoidEx Mortality). MethodsA real-world, observational cohort study with longitudinal analyses of German healthcare claims data in patients ≥40 years of age with a COPD diagnosis from 2011 to 2018 (n = 250,723) was conducted. Patients entered the cohort (index date) upon the first COPD diagnosis. To assess the impact of COPD on all-cause death, a propensity score-matched control group of non-COPD patients was constructed. The number and severity of exacerbations during a 12-month pre-index period were used to form subgroups. For each exacerbation subgroup the exacerbations during 12 months prior to death were analysed. ResultsCOPD increases the all-cause mortality risk by almost 60% (HR 1.57 (95% CI 1.55–1.59)) in comparison to matched non-COPD controls, when controlling for other baseline covariates. The cumulative risk of death after 8 years was highest in patients with a history of more than one moderate or severe exacerbation. Among all deceased COPD patients, 17.2% had experienced a severe, and 34.8% a moderate exacerbation, within 3 months preceding death. Despite increasing exacerbation rates towards death, more than the half of patients were not receiving any recommended pharmacological COPD therapy in the year before death. ConclusionOur study illustrates the impact of COPD on mortality risk and highlights the need for consequent COPD management comprising exacerbation assessment and treatment.

Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival

BackgroundChronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of β-blockers at discharge and mortality in patients with COPD. MethodsWe studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality. ResultsAfter adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06–1.47; p = .007). The relative risk of death for COPD patients increased steeply from 30 to 180 days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of β-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53–0.83; p ≤.001). ConclusionsOur data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of β-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.

Prevalence of COPD and respiratory symptoms associated with biomass smoke exposure in a suburban area.

IntroductionBiomass smoke exposure (BSE) is a recognized cause of COPD particularly in rural areas. However, little research has been focused on BSE in suburban areas.ObjectiveThe aim of this study was to determine the prevalence of COPD, respiratory symptoms (RS) and BSE in women living in a suburban area of Mexico City exposed to BSE.MethodsA cross-sectional epidemiological survey of a female population aged >35 years was performed using a multistage cluster sampling strategy. The participants completed questionnaires on RS and COPD risk factors. The COPD prevalence was based on the postbronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio. Of the 1,333 women who completed the respiratory questionnaires, spirometry data were obtained from 1,190, and 969 of these were scored as A–C.ResultsThe prevalence of BSE was 47%, and the estimated prevalence of COPD was 2.5% for the total population (n=969) and 3.1% for those with BSE only. The spirometry and oximetry values were significantly lower in women with greater exposure levels. The prevalence of RS (cough, phlegm, wheezing and dyspnea) was significantly higher in the women with BSE compared to those without exposure. We concluded that the association of COPD with biomass exposure is not only a rural phenomenon but also may be observed in the suburban areas of the big cities.

Peripheral neuropathy in Chronic Obstructive Airway Disease

Peripheral neuropathy in COPD has received scanty attention despite the fact that very often clinicians come across COPD patients having clinical features suggestive of peripheral neuropathy while this comorbidity is often overlooked & considered a separate entity. A number of studies have now confirmed the association of COPD and peripheral neuropathy with hypoxaemia being a dominant etiopathogenic factor among others. We report a case a demyelinating polyradiculopathy in a patient with COPD along with a brief review of literature.

Influence of smoking dosage and chronic obstructive lung disease on the incidence of appropriate therapies and mortality in patients with structural heart disease and an implantable cardioverter defibrillator.

Smoking is known as a relevant risk factor for severe cardiac morbidities and mortality. This study was initiated to explore the influence of smoking dosage and presence of chronic obstructive lung disease (COPD) on the incidence of appropriate implantable cardioverter defibrillator (ICD) interventions and on mortality. Prior studies on patients equipped with an ICD suggested that nicotine consumption increases the risk of experiencing an appropriate ICD therapy. There is no substantial data regarding the influence of cigarette smoking dosage on overall mortality in such endangered patients. A total of 349 patients with structural heart disease, either coronary artery disease or nonischemic cardiomyopathy equipped with an ICD, were included. Every patient answered a questionnaire regarding his smoking status and performed a spirometry and body plethysmography. A total of 104 patients (30%) suffered from COPD. Fifty-eight patients (17%) were "current smokers," 196 patients (56%) were revealed as "former smokers," while 93 (27%) patients were registered as "never smokers." A total of 163 patients (47%) received at least one appropriate ICD intervention during follow-up (median 48 ± 8 months). Twenty-three patients died during this study (6.6%). There was no association of COPD with the incidence of appropriate ICD therapies or mortality. Smoking dosage revealed as a significant risk factor for both appropriate ICD interventions (hazard ratio [HR] 1.5 for 60 pack years [PY] P = 0.04) and mortality (HR 2.3 for 60 PY P = 0.02). This study demonstrates a dose-related increased risk of smokers for appropriate ICD interventions and mortality. The results of this trail urge a strict nicotine abstinence, especially in patients with a structural heart disease undergoing ICD therapy.

Passive Smoking Exposure Is Associated With Increased Risk of COPD in Never Smokers

Passive smoking, or environmental tobacco smoke (ETS), is a risk factor for lung cancer, cardiovascular disease, and childhood asthma, but a relationship with COPD has not been fully established. Our aim was to study ETS as a risk factor for COPD in never smokers. Data from three cross-sectional studies within the Obstructive Lung Disease in Northern Sweden (OLIN) database were pooled. Of the 2,182 lifelong never smokers, 2,118 completed structured interviews and spirometry of acceptable quality. COPD was defined according to the GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria using postbronchodilator spirometry. The association of COPD with ETS in single and multiple settings was calculated by multivariate logistic regression adjusting for known risk factors for COPD. COPD prevalence was associated with increased ETS exposure: 4.2% (no ETS), 8.0% (ETS ever at home), 8.3% (ETS at previous work), and 14.7% (ETS ever at home and at both previous and current work), test for trend P = .003. Exclusion of subjects aged ≥ 65 years and subjects reporting asthma yielded similar results. ETS in multiple settings, such as ever at home and at both previous and current work, was strongly associated to COPD (OR, 3.80; 95% CI, 1.29-11.2). In this population-based sample of never smokers, ETS was independently associated with COPD. The association was stronger for ETS in multiple settings. ETS in multiple settings was, after age, the strongest risk factor for COPD and comparable to personal smoking of up to 14 cigarettes/d in comparable materials. The findings strongly advocate measures against smoking in public places.

Improving Hip Fractures Outcomes for COPD Patients

Hip fractures in the elderly have high rates of mortality and perioperative complications. Both men and COPD patients have worse mortality and complications but this may be due to more co-morbid disease. We assessed mortality and complications in a large cohort (n = 12,646) of men undergoing hip fracture surgery within the Veteran's Health Affairs (VHA) to define the association of COPD to these outcomes after adjusting for other key factors. We looked for opportunities to improve outcomes for COPD patients. Methods: Using the VA Surgical Quality Improvement Program (VASQIP), and administrative databases, we determined COPD status, types of co-morbid conditions and surgical factors, and compared these to outcomes of surgical complications, 30-day and one-year mortality for patients who underwent hip fracture repair during 1998 to 2005. Results: COPD was noted in 47% of the hip fracture patients studied. In 3,261 (26%) cases, the COPD was “severe: (indicated by functional disability, previous hospitalization for exacerbation, chronic drug treatment or record of FEV1 <75% predicted), and in 2,736 (21%) cases it was considered “mild” (any previous outpatient visit or hospitalization with a coded diagnosis of COPD). Severe COPD patients had one year mortality of 40.2% compared to 31.0% in mild COPD and 28.8% in non-COPD subjects. Current smoking, use of general anesthesia and delays to surgery were significant modifiable risk factors identified in adjusted models. Osteoporosis was known pre-fracture in only 3% of subjects. Conclusions: COPD was very common in male veterans with hip fractures and was associated with increased risk of death and complications. Increased use of regional anesthesia and urgent scheduling of hip fracture surgery may improve outcomes for patients with COPD. Osteoporosis was rarely identified preoperatively. Improving diagnosis and treatment of osteoporosis in COPD patients could reduce the incidence of hip fractures.

Does Low Vitamin D Amplify the Association of COPD With Total and Cardiovascular Disease Mortality

Does Low Vitamin D Amplify the Association of COPD With Total and Cardiovascular Disease Mortality

The Role of Sleep Time in Weight Status, Cardiovascular Disease and Diabetes Mellitus

S (ACE) AEP Vol. 20, No. 9 September 2010: 691–724 702 69 cross-sectional, 34 prospective, and 14 case-control studies. An association of COPD risk with smoking was consistently seen. Random-effects RR estimates compared to never smokers were 2.85 (95% confidence interval CI 2.60–3.13) for ever smoking and 3.48 (95% CI 3.07–3.94) for current smoking. Risk increased monotonically with increasing amount smoked with RRs of 2.77, 5.91, and 8.76 for approximately 5, 20, and 45 cigarettes per day and RRs of 1.25, 2.51, and 3.88 for approximately 5, 20, and 45 pack-years. There was marked heterogeneity between study-specific RR estimates. RRs were higher for studies of mortality and incidence, particularly for studies excluding asthma from their definition of COPD, and lower for studies of prevalent COPD, especially those based on lung function criteria. CONCLUSION: There is highly consistent evidence of an association of COPD with smoking, but the magnitude of the observed association varies. P32 FRUIT AND VEGETABLE INTAKE AND STROKE MORTALITY: RESULTS FROM THE ADVENTIST HEALTH STUDY-1 T Zamansani, L Beeson, S Knutsen, Department of Epidemiology, Loma Linda University, Loma Linda, CA PURPOSE: The association between dietary factors and risk of cerebrovascular disease is unclear. Intake of vegetables and fruit has been reported as protective for stroke in some studies. METHODS: During a 13-year follow-up 34,198 subjects aged 25-100 completed a comprehensive lifestyle and diet questionnaire and were enrolled in the Adventist Health Study-1 (AHS–1).This is a health conscious population where about 50% are lacto-ovo vegetarian. A total of 434 fatal strokes were identified by record linkage with the California Death Certificate Files and the National Death Index (1976–1988). The independent effects of a priori dietary factors were assessed using the Cox proportional-hazards model. RESULTS: Compared to very low (i.e.!3 times per week) fresh fruit intake (citrus fruit, winter fruit and other fresh fruit), consumption of fresh fruits for O2 times per day showed a strong inverse association with stroke mortality (HR Z 0.54, 95% CIZ 0.29–0.99) with statistically significant (pZ0.028) trend adjusted for sex, BMI, smoking status, education, exercise, high blood pressure, whole milk, nuts, coffee and current sweets/desserts. Sensitivity analysis with inclusion of those with diabetes and coronary heart disease at baseline, did not change the HR appreciably (HRZ0.59, 95% CIZ0.35–1.01) with the trend remaining statistically significant (pZ0.047). Higher consumption of cooked green vegetables showed a protective effect (HR Z 0.87, 95%CI 0.43–1.76) although not statistically significant. CONCLUSION: We conclude that fresh fruit consumption is associated with reduces risk of fatal stroke in this population. P33 THE ROLE OF SLEEP TIME IN WEIGHT STATUS, CARDIOVASCULAR DISEASE AND DIABETES MELLITUS E Velasco, M Koban, G Hoffman, Morgan State University School of Community Health and Policy, Baltimore, MD PURPOSE: Sleep restriction has been shown to be associated with overweight and obesity in children and adults. It has also been implicated in impaired insulin resistance, increased risk of cardiovascular disease and excess morbidity. The objective of this study is to assess the role of sleep time in weight status and its association with biomarkers of cardiovascular disease and diabetes mellitus. METHODS: The sample included 5701 subjects 20–80 years of age in the 2007–2008 NHANES. Linear regression models were fit to obtain beta coefficients and 95% confidence intervals, accounting for the complex sampling and weighting of the survey. RESULTS: The mean (SD) sleep time was 6.8 (1.2) hrs.; Mexican Americans slept 13.2 minutes more and African Americans slept 32.6 minutes less than Whites on average. Divorced and widow(er)s slept 17 minutes less, on average, than married subjects. Obese subjects slept 14.5 minutes less than normalweight subjects (95%CI 24.9, 4.1). Ten unit elevation of mean blood pressure elicited a 2.7 minute (95% CI 5.1, 0.3) sleep time reduction. Other positively associated factors were age and vigorous physical activity. Gender, income, education, high cholesterol, high triglyceride, glucose, hematocrit, hemoglobin and C-reactive protein levels were not significantly associated with sleep time. CONCLUSION: Decreased sleep time association with increased weight and mean blood pressure in addition to age, marital status and African American ethnicity warrants further research into modeling a framework that includes stressor, genetic and psychosocial factors through which sleep deprivation may cause obesity and cardiovascular disease. P34 HEALTH CARE RESOURCE USE AMONG PEOPLE WITH MULTIPLE SCLEROSIS JJ Korelitz, HB Dastani, SX Li, Y Xu, JW Wilson, BK Gustavson, Westat, Rockville, MD PURPOSE: To obtain estimates of health care resource use (HCRU) among people with multiple sclerosis (MS) and examine factors associated with the number of medical care provider visits.

Association of COPD with carotid wall intima-media thickness in vascular surgery patients

There is increasing evidence that non-invasive imaging modalities such as ultrasonography may be able to detect subclinical atherosclerotic lesions, and as such may be useful tools for risk-stratification. However, the clinical relevance of these observations remains unknown in patients with COPD. Therefore we investigated the association between COPD and carotid wall intima-media thickness (IMT) in patients undergoing vascular surgery and its relationship with mortality in these patients. Carotid wall IMT was measured in 585 patients who underwent lower extremity, aortic aneurysm or stenosis repair. Primary study endpoint was increased carotid wall IMT which was defined as IMT>or=1.25mm. Secondary study endpoints included total and cardiovascular mortality over a mean follow-up of 1.5 years. Thirty-two percent of patients with mild COPD and 36% of the patients with moderate/severe COPD had increased carotid wall IMT, while only 23% had an increased carotid wall IMT in patients without COPD (p<0.01). COPD was independently associated with an increased carotid wall IMT (OR 1.60; 95% CI 1.08-2.36). Among patients with COPD, increased carotid wall IMT was associated with an increased risk of total (HR, 3.18 95% CI 1.93-5.24) and cardiovascular mortality (HR 7.28, 95% CI 3.76-14.07). COPD is associated with increased carotid wall IMT independent of age and smoking status. Increased carotid wall IMT is associated with increased total and cardiovascular mortality in patients with COPD suggesting that carotid wall measurements may be a good biomarker for morbidity and mortality in these patients.

Alpha-1-antitrypsin: physiology, genetics and pathology.

Alpha1-antitrypsin (α1) is a glycoprotein in human serum that inhibits the enzymatic activity of trypsin and other proteolytic enzymes. Its concentration in normal serum is 200–250 mg/100 ml. In certain physiological and pathological situations, such as pregnancy, under contraceptive medication and during inflammation, the level of α1-at is elevated. The physiological role of α1 is not known, but the interaction with proteolytic enzymes from white blood cells is probably important. Electrophoretic techniques distinguish several phenotypes, which can be explained by the existence of several codominant alleles at one locus (probably the structural locus). Two alleles PiZ and PiS cause low concentrations of α1-at in serum: the approximate concentrations of α1-at for the different phenotypes are Z/Z 10%, M/Z 50–60%, S/S 60%, M/S 80%, where the level of 212 mg/100 ml found in the M/M phenotype is taken as 100%; thus the effect of these alleles on the α1-at concentration is additive. Homozygosity for the PiZ allele is strongly associated with chronic obstructive lung disease and there is also an association of COPD and heterozygosity for the PiZ or PiS or both, but to a lesser degree.