Burden Of Chronic Obstructive Pulmonary Disease Research Articles

Evaluation of the economic and social burden of chronic obstructive pulmonary disease (COPD)

ABSTRACTThe aim of this study was to calculate the economic and social burden of chronic obstructive pulmonary disease (COPD) in Bulgaria generated from the loss of productivity due to absence from work (absenteeism), due to premature retirement, due to reduced productivity (presenteeism), and the disability adjusted life years (DALY). An observational study among 426 Bulgarian COPD patients was conducted for the period 2014–2015. Human capital approach was used to calculate the productivity losses and the DALY methodology of the World Health Organization was applied. The patients with moderate (50%) and severe (48%) disease were absent from work more frequently than those with mild COPD (2%) and generated productivity losses of 521.45€ per patient per year. The average indirect costs per patient for the remaining working ages due to premature retirement account for 25,000€ (6250 per patient on average), while those due to presenteeism, for about 3750.64€ per year. Accordingly, the DALYs in the group of patients with mild severity were lowest due to the low disutility index and number of patients in this sample group. On average, a patient with mild COPD spends 0.62 years of his life in disability due to the disease, while those with moderate and severe disease spend 6.00 and 9.00 years, respectively. This amounted to the following indirect costs experienced by patients: 3596.52€; 34,204.01€; 51,332.20€, respectively. We demonstrated a significant indirect financial and societal burden of COPD in Bulgaria, which is in correlation with the severity of the disease.

A cross-sectional study on prevalence of chronic obstructive pulmonary disease (COPD) in India: rationale and methods

BackgroundChronic obstructive pulmonary disease (COPD) is a common preventable and treatable chronic respiratory disease, which affects 210 million people globally. Global and national guidelines exist for the management of COPD....

Insights on persistent airway infection by non-typeable Haemophilus influenzae in chronic obstructive pulmonary disease.

Non-typeable Haemophilus influenzae (NTHi) is the most common bacterial cause of infection of the lower airways in adults with chronic obstructive pulmonary disease (COPD). Infection of the COPD airways causes acute exacerbations, resulting in substantial morbidity and mortality. NTHi has evolved multiple mechanisms to establish infection in the hostile environment of the COPD airways, allowing the pathogen to persist in the airways for months to years. Persistent infection of the COPD airways contributes to chronic airway inflammation that increases symptoms and accelerates the progressive loss of pulmonary function, which is a hallmark of the disease. Persistence mechanisms of NTHi include the expression of multiple redundant adhesins that mediate binding to host cellular and extracellular matrix components. NTHi evades host immune recognition and clearance by invading host epithelial cells, forming biofilms, altering gene expression and displaying surface antigenic variation. NTHi also binds host serum factors that confer serum resistance. Here we discuss the burden of COPD and the role of NTHi infections in the course of the disease. We provide an overview of NTHi mechanisms of persistence that allow the pathogen to establish a niche in the hostile COPD airways.

Epidemiology of chronic obstructive pulmonary disease in the global HIV-infected population: a systematic review and meta-analysis protocol

BackgroundEvidence suggests a relationship between human immunodeficiency virus (HIV) infection and chronic obstructive pulmonary disease (COPD). Although the high burden of COPD and the HIV disease is clearly demonstrated, to the best of our knowledge, there is a lack of summary and meta-analysis data on the epidemiology of COPD in the global HIV-infected population to date. The present protocol for a systematic review and meta-analysis intends to summarize existing data on the prevalence, incidence, and risk factors of COPD in the global HIV-infected population.Methods and designThe present review will include cohort, cross-sectional, and case-control studies conducted among HIV infected people, which report prevalence, incidence, and factors associated with COPD or enough data for their estimation. We will consider published and unpublished studies in English and French language, regardless of geographical location. Relevant records will be searched using PubMed/Medline, and Scopus from inception to December 31st, 2016. Reference lists of eligible papers and relevant review articles will be screened. Two investigators will independently screen, select studies, and extract data, with discrepancies resolved by consensus or arbitrarily by a third investigator. Risk of bias and methodological quality of the included studies will be assessed using the Newcastle-Ottawa Scale. Funnel-plots and Egger’s test will be used to determine publication bias. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate. To keep the effect of studies with extremely small or extremely large estimates on the overall estimate to a minimum, the variance of the study-specific prevalence/incidence will be stabilized with the Freeman-Tukey single arc-sine transformation. The heterogeneity will be evaluated by the χ2 test on Cochrane’s Q statistic. Results will be presented by geographic region and by antiretroviral therapy status. We plan to summarize data on factors associated with COPD in narrative format.DiscussionThis systematic review and meta-analysis will give an overview of the epidemiology of COPD in the global HIV population to inform policy-makers and to provide accurate data that can underpin effective interventions for optimizing their detection and management.Systematic review registrationPROSPERO CRD42016052639.

A prospective study of the predictors of mortality in acute exacerbation of COPD: an Indian perspective

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality world-wide. In 2011, COPD was the third leading cause of death. The prevalence and burden of COPD are projected to increase over the coming decades due to continued exposure to COPD risk factors. Thus prevention, early detection and prompt treatment of COPD and it’s exacerbations may have an impact on the clinical progression and the risk of hospitalization. This is a prospective study to determine the predictors of mortality in COPD patients hospitalized for an acute exacerbation.Methods: This was a prospective study of 94 patients admitted for acute exacerbation of COPD in a tertiary care hospital over a period of 18 months. After a detailed medical history and physical examination, patient’s blood sample was sent for Arterial Blood Gas (ABG) analysis, a complete hemogram, blood sugar levels, serum albumin levels, blood urea nitrogen levels (BUN), serum creatinin levels, SGPT, SGOT and serum sodium and potassium levels. We then compared these parameters in patients who died with those who survived to determine the mortality predictors. Results: A statistically significant relation was obtained between male gender, smoking history (odd ratio of 1.5), number of pack years (p = 0.029), history of prior admission (odds ratio of 2), longer duration of illness (p = 0.045), elevated blood sugar levels (p = 0.035), hypoalbuminaemia (0.001), hypopnatremia (0.001), respiratory acidosis (0.003), elevated partial pressure of CO2 (0.001) and mortality.Conclusions: We found a male preponderance, with increase in mortality with the increase in the number of smoking pack years. Longer duration of illness was also an important predictor of mortality. Respiratory acidosis, hyponatremia, elevated blood sugar levels and hypoalbuminemia at the time of presentation were other important predictors of mortality in patients hospitalized for acute exacerbation of COPD.

Concurrent physician-diagnosed asthma and chronic obstructive pulmonary disease: A population study of prevalence, incidence and mortality.

ObjectiveWe conducted a population-based cohort study to estimate trends in prevalence, incidence, and mortality of concurrent physician-diagnosed asthma and chronic obstructive pulmonary disease (COPD).Study design and settingTwo validated health administrative case definitions were used to identify asthma and COPD among all individuals aged 35 years and older living in Ontario, Canada. Annual asthma, COPD, and concurrent asthma and COPD prevalence, incidence, and mortality, standardized for age and sex, were estimated, and compared from 2002 to 2012, using generalized linear models.ResultsStandardized prevalence of concurrent asthma and COPD increased by 10.5%, from 2.9% in 2002 to 3.2% in 2012 overall, but more prominently in women compared to men. Overall, standardized incidence decreased by16%, from 2.5 to 2.1 per 1000 individuals, but increased significantly in young adults. All-cause mortality among patients with concurrent asthma and COPD decreased by 11.2%, from 2.6% to 2.2%. Being diagnosed with both diseases was significantly associated with higher all-cause mortality compared to asthma (OR = 1.56, 95% CI: 1.50–1.58), but not compared to COPD (OR = 0.97, 0.96–0.98), except in young adults aged 35 to 49 years where people with asthma and COPD had higher mortality (OR = 1.21, 1.15–1.27).ConclusionsIn a large North American population, the burden of concurrent physician-diagnosed asthma and COPD is increasing, particularly in women and young adults.

'To use or not to use': a qualitative study to evaluate experiences of healthcare providers and patients with the assessment of burden of COPD (ABC) tool.

In the management of chronic conditions, such as chronic obstructive pulmonary disease (COPD), there is a shift from doctor-driven care to patient-centred integrated care with active involvement of and self-management by the patient. A recently developed tool, the assessment of burden of COPD (ABC) tool, can be used in this transition to facilitate self-management support and shared decision-making. We performed a qualitative study, in which we collected and analysed the data using the methods of conventional content analyses. We performed in-depth interviews consisting of mainly open questions. Fifteen healthcare providers and 21 patients were interviewed who had worked with the ABC tool in daily care. In general, participants responded positively to the tool. Healthcare providers felt the visual representation provided was effective and comprehensible for patients and provided them with insight into their disease, a finding that patients confirmed. If patients were allowed to choose between a consultation with or without the ABC tool, the majority would prefer using the tool: it provides them with an overview and insight, which makes it easier to discuss all relevant topics related to COPD. The tool can provide structure in consultations, and is compatible with the concepts of ‘motivational interviewing’ and ‘individualised care-planning’. Suggestions for improvement related to content and layout. So far, the tool has only been available as a stand-alone online program, that is not connected to the electronic medical record systems. It was therefore suggested that the tool be integrated into the systems to enhance its usability and its uptake by healthcare providers.

Defining and targeting health disparities in chronic obstructive pulmonary disease.

The global burden of chronic obstructive pulmonary disease (COPD) continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES) due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF) exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and etiologies, it is also associated with worsened COPD health outcomes. Effective interventions in these people are needed to decrease these disparities. Efforts that may help lessen these health inequities in low SES include 1) better surveillance targeting diagnosed and undiagnosed COPD in disadvantaged people, 2) educating the public and those involved in health care provision about the disease, 3) improving access to cost-effective and affordable health care, and 4) markedly increasing the efforts to prevent disease through smoking cessation, minimizing use and exposure to BF, and decreasing occupational exposures. COPD is considered to be one the most preventable major causes of death from a chronic disease in the world; therefore, effective interventions could have a major impact on reducing the global burden of the disease, especially in socioeconomically disadvantaged populations.

Burden of COPD in patients treated in different care settings in the Netherlands

IntroductionCare for patients with chronic obstructive pulmonary disease (COPD) can be provided in primary, secondary or tertiary care. Whether and to what extent patients with COPD treated in various healthcare settings differ in disease burden and healthcare utilization remains unknown. Therefore, daily symptoms, functional mobility, mood status, health status and healthcare utilization were compared between COPD patients in various care settings, to explore possibilities for healthcare-optimization. MethodsCurrent data are part of the Chance study. Demographics, functional mobility (Care Dependency Scale (CDS); Timed-Up-and-Go (TUG) test), mood status (Hospital Anxiety and Depression scale (HADS)), health status (COPD Assessment test (CAT); Clinical COPD questionnaire (CCQ); COPD specific St. George Respiratory questionnaire (SGRQ-C)), received treatments and severity of physical and psychological symptoms were assessed in subjects with and without COPD. Results836 subjects (100 primary care patients, 100 secondary care patients, 518 tertiary care patients and 118 non-COPD subjects) were included. The burden of disease significantly increased from primary care to tertiary care. However, in all three healthcare settings a high percentage of patients with an impaired health status was observed (i.e. CAT ≥10 points, 68.0% vs. 91.0% vs. 94.5%, respectively). Furthermore, many patients treated in secondary care remain highly symptomatic despite treatment, while others with low burden of disease would allow for de-intensification of care. ConclusionThis study revealed important shortcomings and challenges for the care of COPD patients in the Netherlands. It emphasizes the need for detailed patient characterization and more individualized treatment, independent of the healthcare setting.

Costs of Tiotropium Bromide Delivered via the Respimat® Inhaler in COPD Patients in Italy

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality worldwide. The clinical trial by Bateman and colleagues, that enrolled 3,991 moderate to very severe COPD patients in 31 Countries, demonstrated that tiotropium bromide delivered via the Respimat® inhaler can delay the time to first exacerbation and reduce overall exacerbation rates. The aim of our study was to estimate the costs associated with this device utilization to treat COPD in Italy. The analysis was conducted from the perspective of the Italian National Health Service (INHS) with a time horizon of one year. Tiotropium delivered with the Respimat® inhaler on top of the standard of care (SoC) was compared with SoC alone. Effectiveness was measured in terms of relative risk of exacerbations, derived from the Bateman trial. The average costs for routine COPD treatment and for the management of exacerbations were based on the economic literature. The total cost per patient/year was €3,469 (routine cost €670; exacerbation cost €2,799) with SoC and €3,369 (routine cost €840; exacerbation cost €2,529) with tiotropium in add-on to the SoC. The total saving per patient/year was about €100, corresponding to 2.9% of the total annual cost. Taking into account the total population with moderate to very severe COPD in Italy (1,880,500 patients, according to the available epidemiological data), this treatment strategy would result in a total saving of about €188 million per year. In conclusion, this study showed that adoption of tiotropium bromide delivered via the Respimat® inhaler has the potential to reduce the economic burden of COPD in Italy.

Prevalence and burden of dyspnoea among COPD patients in Japan.

Dyspnoea is the most common symptom of chronic obstructive pulmonary disease (COPD) significantly affecting activity, impairing patients' well-being and contributing to the economic burden of COPD. The objective of this study was to estimate the prevalence of dyspnoea and its impact on COPD management costs in Japan. A cross-sectional survey was conducted among 82 internal medicine physicians and 85 respiratory specialists representing 420 patients with COPD in Japan. Information was collected on demographic and clinical characteristics, dyspnoea (mMRC scale), and healthcare resource use. Dyspnoea prevalence was estimated among all patients and those on specific COPD treatments. The economic burden was derived from two cohorts based on their level of dyspnoea that were matched by propensity scores balancing their demographic and disease burden characteristics. Moderate-severe dyspnoea (mMRC score ≥ 2) was reported by 37.5% of COPD patients and ranging from 21.5% among patients treated with a mono bronchodilator to 59.8% among patients treated with triple therapy. Descriptive analysis showed that dyspnoeic patients have higher annual costs attributable to consultations (€2999 vs. €1906), medications (€1139 vs. €716), exacerbations (€674 vs. €36), other resources (€1789 vs. €140) and in total (€6348 vs. €2797) (p < 0.0001 for all comparisons) compared to patients with mild or no dyspnoea (mMRC score < 2). The total costs remained significantly higher in a propensity-matched cohort adjusted for severity and cardiovascular comorbidity [€6776.1 vs. €4461.3, p = 0.0236]. Moderate-severe dyspnoea is common among consulting COPD patients in Japan and is a significant cost driver for the healthcare system.

Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study.

Chronic obstructive pulmonary disease (COPD) affects 5–10% of people worldwide, 1 is rising in prevalence 2 and is the third most common cause of death. 3 The annual burden of COPD regarding healthcare (mainly exacerbations resulting in emergency admissions) and societal (predominantly lost productivity) costs was estimated to be around $49.9 billion in the USA (2010 prices 4 ) and €48.4 billion in the EU (2011 prices 5 ). A substantial proportion of those with COPD are of working age, but there is some evidence that they have poorer employment history, 6 higher rate of sickness absence 7 and poorer work performance (presenteeism) 8 compared with the general population.

Effectiveness of the Assessment of Burden of COPD (ABC) tool on health-related quality of life in patients with COPD: a cluster randomised controlled trial in primary and hospital care.

ObjectiveAssessing the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with chronic obstructive pulmonary disease (COPD) measured with the St. George's Respiratory Questionnaire (SGRQ), compared with usual care.MethodsA pragmatic cluster randomised controlled trial, in 39 Dutch primary care practices and 17 hospitals, with 357 patients with COPD (postbronchodilator FEV1/FVC ratio <0.7) aged ≥40 years, who could understand and read the Dutch language. Healthcare providers were randomly assigned to the intervention or control group. The intervention group applied the ABC tool, which consists of a short validated questionnaire assessing the experienced burden of COPD, objective COPD parameter (eg, lung function) and a treatment algorithm including a visual display and treatment advice. The control group provided usual care. Researchers were blinded to group allocation during analyses. Primary outcome was the number of patients with a clinically relevant improvement in SGRQ score between baseline and 18-month follow-up. Secondary outcomes were the COPD Assessment Test (CAT) and the Patient Assessment of Chronic Illness Care (PACIC; a measurement of perceived quality of care).ResultsAt 18-month follow-up, 34% of the 146 patients from 27 healthcare providers in the intervention group showed a clinically relevant improvement in the SGRQ, compared with 22% of the 148 patients from 29 healthcare providers in the control group (OR 1.85, 95% CI 1.08 to 3.16). No difference was found on the CAT (−0.26 points (scores ranging from 0 to 40); 95% CI −1.52 to 0.99). The PACIC showed a higher improvement in the intervention group (0.32 points (scores ranging from 1 to 5); 95% CI 0.14 to 0.50).ConclusionsThis study showed that use of the ABC tool may increase quality of life and perceived quality of care.Trial registration numberNTR3788; Results.

Respiratory diseases and the impact of cough in Taiwan: Results from the APBORD observational study.

Chronic respiratory diseases such as asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), and rhinosinusitis are becoming increasingly prevalent in the Asia-Pacific region. The Asia-Pacific Burden of Respiratory Diseases (APBORD) study was a cross-sectional, observational study which examined the disease and economic burden of AR, asthma, COPD, and rhinosinusitis across Asia-Pacific using 1 standard protocol. Here we report symptoms, healthcare resource use (HCRU), work impairment, and associated cost in Taiwan.Consecutive participants aged ≥ 18 years presenting to a physician with symptoms meeting the diagnostic criteria for a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed surveys detailing respiratory symptoms, HCRU, work productivity, and activity impairment. Costs including direct medical costs and indirect costs associated with lost work productivity were calculated.The study enrolled 1001 patients. AR was the most frequent primary diagnosis (31.2%). A quarter of patients presented with a combination of respiratory diseases, with AR and asthma being the most frequent combination (14.1%). Cough or coughing up phlegm was the primary reason for the medical visit for patients with asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the primary reasons for AR and rhinosinusitis. Specialists were the most frequently used healthcare resource by patients with AR (26.1%), asthma (26.4%), COPD (26.6%), and rhinosinusitis (47.3%). The mean annual cost per patient with a respiratory disease was US$4511 (SD 5395). The cost was almost double for employed patients (US$8047, SD 6175), with the majority attributable to lost productivity.Respiratory diseases have a significant impact on disease burden in Taiwan. Treatment strategies that prevent lost work productivity could greatly reduce the economic burden of these diseases.

HIV and COPD: a conspiracy of risk factors.

Chronic obstructive pulmonary disease (COPD) is an under recognized complication of HIV infection. It is estimated that up to 25% of HIV infected people may have COPD. HIV is associated with COPD as a result of a complex interplay of multiple factors such as pulmonary inflammation, recurrent pulmonary infections especially tuberculosis (TB), increased cigarette smoking, socio-economic status, childhood respiratory illnesses and industrial and environmental exposures; each of which are risk factors for COPD in their own right. COPD presents at an earlier age in people with HIV infection. There are over 35 million people living with HIV, and most people infected with HIV live in developing regions of the world where they are faced with multiple risk factors for COPD and suboptimal access to health care. TB is the commonest infectious complication of HIV, and HIV infected persons often experience multiple episodes of TB. Cigarette smoking is increasing in developing countries where the greatest burden of TB and HIV is experienced. Cigarette smoking is associated with increased risk of TB and may be associated with acquisition of HIV infection and progression. It is not clear whether non-infectious pulmonary inflammation persists in the lung when immune reconstitution occurs. Prevention and control of HIV infection must be part of the multiple interventions to reduce the global burden of COPD. A multidisciplinary approach, including behavioural science is required to address this challenge. It presents research opportunities that should be driven by the pulmonology community.

Burden of chronic obstructive pulmonary disease attributable to ambient ozone pollution in 1990 and 2013 in China

To investigate the burden of chronic obstructive pulmonary disease (COPD) in China attributable to ambient ozone pollution in 1990 and 2013. Based on the results of the China Global Burden of Disease Study (GBD) 2013, the population attributable fractions was used to analyze the deaths and disability-adjusted life years (DALY) of COPD attributable to ambient ozone pollution in all provinces (not including Taiwan, China) in 1990 and 2013, and to compare changes of the attributable disease burden in 1990 and 2013. In 2013, 7.4% (95% uncertainty interval (95% UI): 6.1%-8.6%) of COPD were attributable to ambient ozone pollution, with the highest rate in Hebei province (15.0%, 95%UI: 12.0%-18.7%) and the lowest in Heilongjiang province (2.8%,95%UI: 0.9%-5.3%). In 2013, 67 485 COPD deaths in China were due to ambient ozone pollution, with the highest number in Sichuan province (11 929) and in China lowest in Macao (11). A total of 1.168 million DALYs caused by COPD were due to ambient ozone pollution, with the highest in Sichuan province (0.189 million) and lowest in Macao (257.4). In 2013, the DALY per 100 000 population caused by COPD due to ambient ozone pollution after age standardization was lowest in Heilongjiang province (21.9), Shanghai (26.7), Beijing (38.4), Tianjin (39.3), and Jilin province (39.7) and highest in Sichuan province (206.4), Qinghai province (202.5), Guizhou province (175.3), and Gansu province (171.4). DALYs caused by COPD attributable to ambient ozone pollution increased with age (0.144 million person years for ages 15-49 years, 0.43 million person years for age 50-69 years and 0.594 million person years for age 70 years and above), which were higher in men than in women (0.708 million person years for men and 0.459 million person years for women in 2013). Deaths of COPD attributable to ambient ozone pollution were 49 514 and 67 485 in 1990 and 2013, respectively. DALYs caused by COPD attributable to ozone pollution totaled 0.894 million and 1.168 million person years in 1990 and 2013, respectively. Ambient ozone pollution-related deaths and DALYs increased 36.3% and 30.6%, respectively. Compared with 1990, the disease burden of COPD in 2013 attributed to ambient ozone pollution in China increased substantially. Ambient ozone pollution caused great losses among Chinese residents. More attention should be directed toward western provinces with a particularly high disease burden due to ambient ozone pollution.

Activity-Based Costing Management and Hospital Cost in Patients with Chronic Obstructive Pulmonary Disease

Objective:Chronic obstructive pulmonary disease (COPD), one of the most important causes of morbidity and mortality worldwide, is an important economic burden due to hospitalizations, incapacity to work, and disability. The present study aimed to demonstrate one-year activity-based costing of services provided by service-providing centers of Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, which provides services for a wide region, and to present the share of COPD in this cost.Method:Income and expense cost sheets of the year 2011 of the hospital was reviewed. The activity-based costing system was used for calculations. After the identification of the main service centers's expenses of the hospital,the annual expenditure of each unit was calculated. The cost of COPD patients was calculated based on the expenditures of the units caring for COPD patients. The cost per unit of services like radiography, laboratory and pulmonary function tests was calculated and added to the cost of COPD patients.Results:Annual cost according to the activity-based costing system was found to be 3,839,788.32 US Dollars ($) for COPD patients examined and treated as inpatient (2,531,290.9 $ ) , or at emergency room (586,170.7 $) , or at respiratory intensive care unit (419,282.11$) , or at polyclinics (303,044.5 . It accounted for 19.5% of one-year hospital cost (total annual hospital cost was 20,055,400.8 US Dollars).Conclusion:The rising economic burden of COPD corralates with acute exacerbations. As COPD is a high-cost disease, measures should be of priority to reduce economic burden of the disease.

The Risk Factors and Characteristics of COPD Among Nonsmokers in Korea: An Analysis of KNHANES IV and V.

Chronic obstructive pulmonary disease (COPD) is increasing in prevalence and mortality. This study evaluated the prevalence, risk factors, characteristics, and health-related quality of life (HRQoL) of COPD among nonsmokers in Korea. This was a population-based cross-sectional study using data obtained from the Fourth and Fifth Korean National Health and Nutrition Examination Survey, which was conducted from 2007 to 2011. A total of 15,063 participants completely answered the questionnaire and performed the spirometry. Among them, 59.6% were nonsmokers and 40.4% were smokers. The prevalence of nonsmoker COPD was 7.1%. On multivariate analysis, age ≥65years (OR, 2.93; 95% CI, 2.44-3.51), male sex (OR, 2.98; 95% CI, 2.40-3.71), living in rural area (OR, 1.26; 95% CI, 1.05-1.51), lower body mass index (BMI) (<18.5kg/m(2)) (OR, 3.00; 95% CI, 1.78-5.01), self-reported asthma (OR, 2.72; 95% CI, 2.05-3.60), and self-reported tuberculosis (OR, 4.73; 95% CI, 3.63-6.17) showed a significantly higher risk of nonsmoker COPD. Analysis of nonsmoker and smoker COPD revealed that there are more females in nonsmoker COPD patients (73.9 vs. 6.9%, P<0.001). Nonsmoker COPD patients presented with impaired mobility, pain/discomfort, and anxiety/depression functions as well as a lower mean EuroQol Five-Dimension Questionnaire utility score, which showed HRQoL. The burden of nonsmoker COPD was considerable. Older age, male sex, lower BMI, self-reported asthma, and self-reported tuberculosis were risk factors for nonsmoker COPD and there were differences between nonsmoker and smoker COPD in terms of sex, comorbidities, and HRQoL.

Cigarette Smoking, Tooth Loss, and Chronic Obstructive Pulmonary Disease: Findings From the Behavioral Risk Factor Surveillance System.

Cigarette smoking and tooth loss are seldom considered concurrently as determinants of chronic obstructive pulmonary disease (COPD). This study examines the multiplicative effect of self-reported tooth loss and cigarette smoking on COPD among United States adults aged ≥18 years. Data were taken from the 2012 Behavioral Risk Factor Surveillance System (n = 439,637). Log-linear regression-estimated prevalence ratios (PRs) are reported for the interaction of combinations of tooth loss (0, 1 to 5, 6 to 31, or all) and cigarettes smoking status (never, former, or current) with COPD after adjusting for age, sex, race/ethnicity, marital status, educational attainment, employment, health insurance coverage, dental care utilization, and diabetes. Overall, 45.7% respondents reported having ≥1 teeth removed from tooth decay or gum disease, 18.9% reported being current cigarette smokers, and 6.3% reported having COPD. Smoking and tooth loss from tooth decay or gum disease were associated with an increased likelihood of COPD. Compared with never smokers with no teeth removed, all combinations of smoking status categories and tooth loss had a higher likelihood of COPD, with adjusted PRs ranging from 1.5 (never smoker with 1 to 5 teeth removed) to 6.5 (current smoker with all teeth removed) (all P <0.05). Tooth loss status significantly modifies the association between cigarette smoking and COPD. An increased understanding of causal mechanisms linking cigarette smoking, oral health, and COPD, particularly the role of tooth loss, infection, and subsequent inflammation, is essential to reduce the burden of COPD. Health providers should counsel their patients about cigarette smoking, preventive dental care, and COPD risk.

The relationship between chronic obstructive pulmonary disease and transcatheter aortic valve implantation--A systematic review and meta-analysis.

The present study was performed to investigate the relationship between chronic obstructive pulmonary disease (COPD) and transcatheter aortic valve implantation (TAVI). Controversies regarding the relationship between COPD and TAVI have intensified. A literature review of the PubMed online database was performed, and articles published between January 1, 2002 and March 20, 2015 were analyzed. Random-effect and fixed-effect models were used, depending on the between-study heterogeneity. A total of 28 studies, involving 51,530 patients, were identified in our review. The burden of COPD ranged from 12.5% to 43.4%, and COPD negatively impacted both short-term and long-term all-cause survival (30 days: odds ratio [OR], 1.43, 95% CI, 1.14-1.79; >2 years: hazard ratio [HR], 1.34, 95% CI, 1.12-1.61). COPD was also associated with increased short-term and mid-term cardiac-cause mortality (30 days: OR, 1.29, 95% CI, 1.02-1.64; 1 year: HR: 1.09, 1.02-1.17). Moreover, COPD (OR, 1.97, 95% CI, 1.29-3.0) predicted post-TAVI acute kidney disease. Importantly, chronic kidney disease (CKD) (HR, 1.2, 95% CI, 1.1-1.32) and the distance of the 6 minute walk test (6MWT) (HR, 1.16, 1.06-1.27) predicted TAVI futility in patients with COPD. COPD is common among patients undergoing TAVI, and COPD impacts both short- and long-term survival. COPD patients, who had a lower BMI, shorter distance of 6MWT and CKD, were at higher risk for TAVI futility.