Chronic Obstructive Pulmonary Disease Deaths Research Articles

Residential proximity to animal feeding operations and mortality among postmenopausal women in the Iowa Women’s Health Study

BACKGROUND AND AIM: Industrialized animal feeding operations (AFOs) are sources of numerous pollutants (e.g., particulates, pathogens, nitrate). Evidence links residential proximity to AFOs to respiratory diseases and cancer incidence, but directions of associations are inconsistent, and no studies have investigated associations with mortality. We examined these relationships in a population-based cohort of postmenopausal women. METHODS: We linked enrollment (1986) addresses of 25,285 Iowa Women’s Health Study participants with street-level geocodes to a statewide database of permitted AFOs that included animal counts standardized by animal size and manure production (animal units; AUs). Underlying causes of death (n=15,330) were identified through 2014, including 3,468 cancer, 4,038 cardiovascular, and 1,638 respiratory (n=911 chronic obstructive pulmonary disease (COPD)) deaths. Cox models estimated hazard ratios (HR) and 95% confidence intervals (CIs) for quartiles or tertiles (based on the number of cases for each outcome) of total inverse distance-weighted AUs within 5km, after adjusting for demographics, residence type/size, smoking pack-years, and occupation. RESULTS:Sixty-three percent of women had ≥1 AFO within 5km of their residence. Participants in the highest exposure quartile had non-significantly elevated risks for death from any cancer (HR Q4.vs.none=1.07, 95%CI 0.96-1.19, p-trend=0.13). Risk of death from non-Hodgkin lymphoma was non-significantly elevated (HR T3 vs.none=1.35, 95%CI 0.93-1.94, p-trend=0.15). Participants in the highest quartile had decreased risk of mortality from respiratory disease (HR Q4.vs.none=0.84, 95%CI 0.71-0.99, p-trend=0.03); this persisted in the subset of COPD deaths (HR T3.vs.none=0.83, 95%CI 0.70-0.99, p-trend=0.05). The highest AU tertile was non-significantly associated with elevated risks of cardiovascular mortality (HR T3.vs.none=1.06, 95%CI 0.98-1.15, p-trend=0.13). No associations were observed for other cancers or other non-cancer causes of death. CONCLUSIONS:Our novel analysis suggests that higher exposure to animals from AFOs may increase risk of mortality from cancer and cardiovascular diseases. Consistent with limited agricultural/occupational studies, higher AFO exposures were associated with decreased mortality from respiratory diseases, including COPD. KEYWORDS: Mortality, Environmental epidemiology, Female, Respiratory outcomes

Associations of toothbrushing behaviour with risks of vascular and nonvascular diseases in Chinese adults

Accumulating evidence has shown that poor oral hygiene is associated with increased risk of cardiometabolic diseases in Western populations. However, its relevance about the relationships in Chinese adults remains unclear. The China Kadoorie Biobank enrolled 512715 adults aged 30-79years in China during 2004-2008. Cox regression was used to estimate adjusted hazard ratios (HRs) for each disease associated with measures of oral hygiene. Overall 9.3% of the participants reported rarely or never brushing teeth at baseline. Participants who rarely or never brushed teeth had adjusted HR of 1.12 (95% CI: 1.09, 1.15) for MVE, with similar HRs for stroke (1.08, 1.05-1.12), intracerebral haemorrhage (1.18, 1.11-1.26) and pulmonary heart disease (1.22, 1.13-1.32) compared with those who brushed teeth regularly. Those who did not brush teeth also had increased risk of cancer (1.09, 1.04-1.14), chronic obstructive pulmonary disease (COPD) (1.12, 1.05-1.20), liver cirrhosis (1.25, 1.09-1.44) and all-cause death (1.25, 1.21-1.28) but not type 2 diabetes (0.94, 0.86-1.03) and chronic kidney disease (0.98, 0.81-1.18). Among Chinese adults, we found that poor oral hygiene is associated with higher risks of major vascular disease, cancer, COPD, liver cirrhosis and all-cause deaths, but not type 2 diabetes and chronic kidney disease.

Risk of Chronic Obstructive Pulmonary Disease Exacerbation in Patients Who Use Methotrexate-A Nationwide Study of 58,580 Outpatients.

Patients with severe chronic obstructive pulmonary disease (COPD) experience frequent acute exacerbations and require repeated courses of corticosteroid therapy, which may lead to adverse effects. Methotrexate (MTX) has anti-inflammatory properties. The objective of this study was to describe the risk of COPD exacerbation in patients exposed to MTX. In this nationwide cohort study of 58,580 COPD outpatients, we compared the risk of hospitalization-requiring COPD exacerbation or death within 180 days in MTX vs. non-MTX users in a propensity-score matched study population as well as an unmatched cohort, in which we adjusted for confounders. The use of MTX was associated with a reduction in risk of COPD exacerbation in the propensity-score matched population at 180 days follow-up (HR 0.66, CI 0.66–0.66, p < 0.001). Similar results were shown in our sensitivity analyses at 180-day follow-up on unmatched population and 365-day follow-up on matched and unmatched population (HR 0.76 CI 0.59–0.99, HR 0.81 CI 0.81–0.82 and HR 0.92 CI 0.76–1.11, respectively). MTX was associated with a lower risk of COPD exacerbation within the first six months after study entry. The finding seems biologically plausible and could potentially be a part of the management of COPD patients with many exacerbations.

Mechanisms Underlying the Association of Chronic Obstructive Pulmonary Disease With Heart Failure

ObjectivesThe purposes of this study were to determine why chronic obstructive pulmonary disease (COPD) is associated with heart failure (HF). Specific objectives included whether COPD is associated with myocardial fibrosis, whether myocardial fibrosis is associated with hospitalization for HF and death in COPD, and whether COPD and smoking are associated with myocardial inflammation. BackgroundCOPD is associated with HF independent of shared risk factors. The underlying pathophysiological mechanism is unknown. MethodsA prospective, multicenter, longitudinal cohort study of 572 patients undergoing cardiac magnetic resonance (CMR), including 450 patients with COPD and 122 age- and sex-matched patients with a median: 726 days (interquartile range: 492 to 1,160 days) follow-up. Multivariate analysis was used to examine the relationship between COPD and myocardial fibrosis, measured using cardiac magnetic resonance (CMR). Cox regression analysis was used to examine the relationship between myocardial fibrosis and outcomes; the primary endpoint was composite of hospitalizations for HF or all-cause mortality; secondary endpoints included hospitalizations for HF and all-cause mortality. Fifteen patients with COPD, 15 current smokers, and 15 healthy volunteers underwent evaluation for myocardial inflammation, including ultrasmall superparamagnetic particles of iron oxide CMR. ResultsCOPD was independently associated with myocardial fibrosis (p < 0.001). Myocardial fibrosis was independently associated with the primary outcome (hazard ratio [HR]: 1.14; 95% confidence interval [CI]: 1.08 to 1.20; p < 0.001), hospitalization for HF (HR: 1.25 [95% CI: 1.14 to 1.36]); p < 0.001), and all-cause mortality. Myocardial fibrosis was associated with outcome measurements more strongly than any other variable. Acute and stable COPD were associated with myocardial inflammation. ConclusionsThe associations between COPD, myocardial inflammation and myocardial fibrosis, and the independent prognostic value of myocardial fibrosis elucidate a potential pathophysiological link between COPD and HF.

Impact of COVID-19 lockdown on the incidence and mortality of acute exacerbations of chronic obstructive pulmonary disease: national interrupted time series analyses for Scotland and Wales

BackgroundThe COVID-19 pandemic and ensuing national lockdowns have dramatically changed the healthcare landscape. The pandemic’s impact on people with chronic obstructive pulmonary disease (COPD) remains poorly understood. We hypothesised that the UK-wide lockdown restrictions were associated with reductions in severe COPD exacerbations. We provide the first national level analyses of the impact of the COVID-19 pandemic and first lockdown on severe COPD exacerbations resulting in emergency hospital admissions and/or leading to death as well as those recorded in primary care or emergency departments.MethodsUsing data from Public Health Scotland and the Secure Anonymised Information Linkage Databank in Wales, we accessed weekly counts of emergency hospital admissions and deaths due to COPD over the first 30 weeks of 2020 and compared these to the national averages over the preceding 5 years. For both Scotland and Wales, we undertook interrupted time-series analyses to model the impact of instigating lockdown on these outcomes. Using fixed-effect meta-analysis, we derived pooled estimates of the overall changes in trends across the two nations.ResultsLockdown was associated with 48% pooled reduction in emergency admissions for COPD in both countries (incidence rate ratio, IRR 0.52, 95% CI 0.46 to 0.58), relative to the 5-year averages. There was no statistically significant change in deaths due to COPD (pooled IRR 1.08, 95% CI 0.87 to 1.33). In Wales, lockdown was associated with 39% reduction in primary care consultations for acute exacerbation of COPD (IRR 0.61, 95% CI 0.52 to 0.71) and 46% reduction in COPD-related emergency department attendances (IRR 0.54, 95% CI 0.36 to 0.81).ConclusionsThe UK-wide lockdown was associated with the most substantial reductions in COPD exacerbations ever seen across Scotland and Wales, with no corresponding increase in COPD deaths. This may have resulted from reduced transmission of respiratory infections, reduced exposure to outdoor air pollution and/or improved COPD self-management.

Deaths from COPD in patients with cancer: a population-based study.

Features of the deaths caused by COPD (chronic obstructive pulmonary disease) in cancer patients remained a controversial issue. This study aimed to characterize the demographic characteristics and mortality rates of the deaths from COPD in patients with cancer. In total, 7,846,370 cancer patients aged 40 years or older in the United States were identified from the Surveillance, Epidemiology, and End Results database (1975–2016). Mortality rates and SMRs (standardized mortality ratios) adjusted by age, race, sex, and calendar year were calculated to investigate the risk of COPD deaths in cancer survivors and to compare it with the general population. A total of 119,228 COPD deaths in patients with cancer were recorded, with a mortality rate of 261.5/100,000 person-years, nearly two-fold that of the general population (SMR, 2.17; 95% CI [confidence interval], 2.16–2.18). The proportion of cancer survivors dying from COPD increased from 0.9% in 1975 to 3.4% in 2016. Patients with lung cancer had a higher overall risk (SMR, 9.23; 95% CI, 9.12–9.35) than those with extrapulmonary malignancies. Among all extrapulmonary sites, laryngeal (SMR, 5.54; 95% CI, 5.34–5.75) and esophageal cancers (SMR, 4.33; 95% CI, 4.04–4.63) had the highest SMR. The risk of death from COPD increased with follow-up time.

F-Box Protein FBXW17-Mediated Proteasomal Degradation of Protein Methyltransferase PRMT6 Exaggerates CSE-Induced Lung Epithelial Inflammation and Apoptosis.

Chronic obstructive pulmonary disease (COPD) is a chronic debilitating lung disease, characterized by progressive airway inflammation and lung structural cell death. Cigarette smoke is considered the most common risk factor of COPD pathogenesis. Understanding the molecular mechanisms of persistent inflammation and epithelial apoptosis induced by cigarette smoke would be extremely beneficial for improving the treatment and prevention of COPD. A histone methyl modifier, protein arginine N-methyltransferase 6 (PRMT6), is reported to alleviate cigarette smoke extract (CSE)-induced emphysema through inhibiting inflammation and cell apoptosis. However, few studies have focused on the modulation of PRMT6 in regulating inflammation and cell apoptosis. In this study, we showed that protein expression of PRMT6 was aberrantly decreased in the lung tissue of COPD patients and CSE-treated epithelial cells. FBXW17, a member of the Skp1-Cullin-F-box (SCF) family of E3 ubiquitin ligases, selectively bound to PRMT6 in nuclei to modulate its elimination in the proteasome system. Proteasome inhibitor or silencing of FBXW17 abrogated CSE-induced PRMT6 protein degradation. Furthermore, negative alteration of FBXW17/PRMT6 signaling lessened the proapoptotic and proinflammatory effects of CSE in lung epithelial cells. Our study, therefore, provides a potential therapeutic target against the airway inflammation and cell death in CS-induced COPD.

Is Rural Kansas Prepared? An Assessment of Resources Related to the COVID-19 Pandemic.

IntroductionThis cross-sectional study investigated rural Kansas healthcare resources relevant to COVID-19 at the county level in the context of population characteristics.MethodsThe federal Area Health Resource File was used to assess system capacity and critical care-related resources and COVID-19-related risk factors at the county level. Data were described with summary statistics, cross-tabulations, and bivariate tests to discern differences across county rurality categories (2013 Rural-Urban Continuum Codes).ResultsKansas has 105 counties. Metropolitan counties had an average of 1.5 physicians (M.D. or D.O., any specialty) per 1,000 people, while rural counties had 0.8. A total of 63.5% of rural counties had no anesthesia providers and 100.0% of rural counties had no pulmonary disease physicians. While 96 counties have at least one hospital, nearly 90% rural counties had no intensive care unit (ICU) services. The percent of the population estimated to be over 65 was higher among rural counties (24.2%) than metropolitan counties (19.3%). On average, rural counties had nearly twice as many deaths per 1,000 people by cardiovascular disease and more chronic obstructive pulmonary disease deaths than metropolitan and nonmetropolitan/urban adjacent counties.ConclusionsKansas faced limited ICU capabilities and physician workforce shortages in rural counties, both in primary care and specialties such as anesthesia and pulmonology. In addition, nonmetropolitan/urban adjacent and rural population age structures and mortality rates potentially demonstrated an increased risk to overwhelm local healthcare systems. This may have serious implications for rural health, particularly in the context of the COVID-19 pandemic.

Effect of Indoor Air Pollution on Chronic Obstructive Pulmonary Disease (COPD) Deaths in Southern Asia-A Systematic Review and Meta-Analysis.

Background: About half of the population in developing countries are exposed to indoor pollution such as combustion fuels at present. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality globally and the primary cause of COPD in women is indoor air pollution exposure, while tobacco smoking is the leading cause in men. The aim of this systematic review and meta-analysis is to evaluate the correlation between the indoor air pollution and deaths related to COPD and COPD prevalence in South Asia. Methods: A systematic search on studies with sufficient statistical power has been conducted from 1985 until 30 June 2020, in English electronic databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in MEDLINE and PubMed databases with the terms Chronic Obstructive Pulmonary disease COPD or Chronic Bronchitis or Emphysema or COPD Deaths or Chronic Obstructive Lung Disease or Airflow Obstruction or Chronic Airflow Obstruction or Airflow Obstruction, Chronic or Bronchitis, Chronic and Mortality or Death or Deceased was conducted. Studies were eligible if they were Prospective controlled or non-controlled trials conducted in Southern Asia/ Asia and Retrospective studies conducted in Southern Asia/ Asia. Results: The results have concluded that long term exposure to indoor pollution had a significant effect on COPD deaths as well as its symptoms. Odd’s ratio was in a range of 1.05 (Randomized controlled trials) to 7.87 (Cross sectional studies) for all the studies mentioned. Meta-analysis observed a significantly higher Odds Ratio of 2.13 for COPD mortality and 2.08 for COPD prevalence on exposure to indoor air pollution. Conclusion: Exposure to solid fuel smoke is consistently and significantly correlated with COPD mortality and COPD prevalence in South Asian countries, in spite of heterogeneity observed in the studies included. For performing domestic tasks, initiatives are to be taken to reduce dependency on solid fuel by using cleaner alternatives or comparatively cleaner technology.

Four Decades of COPD Mortality Trends: Analysis of Trends and Multiple Causes of Death.

There is little information on chronic obstructive pulmonary disease (COPD) mortality trends, age of death, or male:female ratio. This study therefore sought to analyze time trends in mortality with COPD recorded as the underlying cause of death from 1980 through 2017, and with COPD recorded other than as the underlying cause of death. We conducted an analysis of COPD deaths in Galicia (Spain) from 1980 through 2017, including those in which COPD was recorded other than as the underlying cause of death from 2015 through 2017. We calculated the crude and standardized rates, and analyzed mortality trends using joinpoint regression models. There were 43,234 COPD deaths, with a male:female ratio of 2.4. Median age of death was 82 years. A change point in the mortality trend was detected in 1996 with a significant decrease across the sexes, reflected by an annual percentage change of −3.8%. Taking deaths into account in which COPD participated or contributed without being the underlying cause led to an overall 42% increase in the mortality burden. The most frequent causes of death when COPD was not considered to be the underlying cause were bronchopulmonary neoplasms and cardiovascular diseases. COPD mortality has decreased steadily across the sexes in Galicia since 1996, and age of death has also gradually increased. Multiple-cause death analysis may help prevent the underestimation of COPD mortality.

Low BMI and weight loss aggravate COPD mortality in men, findings from a large prospective cohort: the JACC study

To clarify how low BMI and weight loss were associated with risk of chronic obstructive pulmonary disease (COPD) mortality, in a large prospective cohort of the general population across Japan, the Japan Collaborative Cohort Study, conducted between 1988 and 2009. A total of 45,837 male residents were observed for a median period of 19.1 years. Self-administered questionnaires, collecting information on BMI, weight loss since the age of 20, lifestyles, history of diseases, as well as records of COPD mortality, were analysed at 2019. During follow-up, 268 participants died from COPD. The multivariate-adjusted hazard ratio (95% confidence interval) of COPD mortality associated with a 1-SD increment of body mass index (BMI) was 0.48 (0.41–0.57), while for weight change from age of 20 (+ 2.0 kg) it was 0.63 (0.59–0.68). These associations were persistently observed after stratifications with smoking status, excluding those having airway symptoms in the baseline survey, and excluding early COPD deaths within 5, 10 and 15 years. Our study suggests that BMI and weight change since the age of 20 could be markers for COPD prognosis, indicated by risk of COPD mortality.

Investigation Regarding the Correlation between Particulate Matter 2.5 Air Pollution and Mortality Rates due to Chronic Obstructive Pulmonary Disease

In 2015, 3.2 million people died due to Chronic Obstructive Pulmonary Disease (COPD), worldwide. In fact, survival rates for those living with severe COPD are lower than for those with cancer. The one known contributor to this disease is air pollution, and with its rising levels every year, it is necessary to determine the exact correlation between air pollution and COPD. Data was gathered for a selection of 20 countries from the World Bank Database and Health Data Database. This data was graphed and analyzed using the Pearson correlation coefficient, which is a statistical test that measures the relationship between 2 variables. When calculated, the Pearson correlation coefficient was 0.756, determining that there is a significant relationship between air pollution and COPD. Through the investigation, it is concluded that there is a positive correlation between PM2.5 air pollution and mortality rate due to COPD. PM2.5 is a component of air pollution defined as the amount of atmospheric particulate matter with a diameter less than 2.5 micrometers. Due to its small physical nature, PM2.5 can easily infiltrate the lungs, causing infections in the respiratory organs. They can reach the bronchi and even the alveoli, causing inflammation which ultimately results in COPD and premature deaths. Therefore, this research will aim to investigate the relationship between PM2.5 air pollution and COPD, allowing for a better understanding of these variables.

Cigarette smoke extract induces airway epithelial cell death via repressing PRMT6/AKT signaling.

Chronic obstructive pulmonary disease (COPD) is a severe public health threat world-wide. Cigarette smoke (CS)-induced airway epithelial cell death is a major pathway of pathogenesis in emphysema, a subtype of COPD. Protein arginine methyltransferase 6 (PRMT6) is a type I PRMT that catalyzes mono- and di-methylation on arginine residues within histone and non-histone proteins to modulate a variety of life processes, such as apoptosis. However, its role in CS-induced lung epithelial death has not been fully elucidated. Here we report that PRMT6 was decreased in mouse lung tissues from a cigarette smoke extract (CSE)-mediated experimental emphysematous model and in CSE treated or cigarette smoke exposed lung epithelial cells. Depletion of PRMT6 increased the protein levels of phosphatase PTEN and PI3K regulatory subunit p85 but decreased a downstream kinase PDK1, resulting in AKT dephosphorylation and thereafter, lung epithelial cell death. Knockout of PRMT6 inhibited epithelial survival and promoted CSE-mediated epithelial cell death, while ectopic expression of PRMT6 protein partially reversed epithelial cell death via PI3K/AKT-mediated cell survival signaling in CSE cellular models. These findings demonstrate that PRMT6 plays a crucial role in CS-induced bronchial epithelial cell death that may be a potential therapeutic target against the airway cell death in CS-induced COPD.

Iron and copper in fine particulate matter, reactive oxygen species concentration in lung epithelial fluid and respiratory health: A population-based cohort study

Background: Metal components in fine particulate matter (PM2.5) originating from non-tailpipe emissions may play important roles in underlying its adverse effects on respiratory health due to the potential in generating reactive oxygen species (ROS). However, relevant epidemiological evidence is scarce. Methods: We investigated the associations of long-term exposure to iron (Fe) and copper (Cu) in PM2.5 (two metal components mainly originating from non-tailpipe emissions), and their combined impact on the concentration of reactive oxygen species (ROS) with respiratory health in a population-based cohort of ~0.8 million adults in Toronto, Canada. Incidence of asthma, chronic obstructive pulmonary disease (COPD) and respiratory mortality was ascertained using health administrative databases. Exposures to Fe and Cu in PM2.5 and their combined impact on ROS were estimated using land use regression models. We used mixed-effects Cox regression models to examine the associations between the exposures and health outcomes. Results: We found positive associations between long-term exposure to Fe, Cu and ROS, and the risks of all three respiratory outcomes. The associations were more robust for COPD and respiratory disease death than for asthma. In terms of exposures, we observed stronger associations for ROS than for Fe or Cu individually. For example, the hazard ratios (95% confidence interval) for respiratory death associated with an interquartile-range increment in Fe, Cu and ROS were 1.046 (1.034, 1.058), 1.020 (1.008, 1.033) and 1.076 (1.058, 1.094), respectively. In two-pollutant models, adjustment for NO2 attenuated the associations while PM2.5 had little influence. Conclusions: Long-term exposure to Fe and Cu in PM2.5 and estimated ROS concentration in lung fluid was associated with increased incidence of respiratory outcomes, particularly COPD and respiratory mortality, suggesting adverse respiratory effects of non-tailpipe emitted air pollution.

Epilepsy and chronic obstructive pulmonary disease among U.S. adults: National Health Interview Survey 2013, 2015, and 2017

BackgroundAmong U.S. adults, over 4 million report a history of epilepsy, and more than 15 million report a history of chronic obstructive pulmonary disease (COPD); Chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema, is a common somatic comorbidity of epilepsy. This study assessed the relationship between self-reported physician-diagnosed epilepsy and COPD in a large representative sample of the U.S. adult population and explored possible mechanisms. MethodsCross-sectional National Health Interview Surveys for 2013, 2015, and 2017 were aggregated to compare the prevalence of COPD between U.S. respondents aged ≥18 years with a history of physician-diagnosed epilepsy (n = 1783) and without epilepsy (n = 93,126). We calculated prevalence of COPD by age-standardized adjustment and prevalence ratios of COPD overall adjusted for sociodemographic and risk factors, by using multivariable logistic regression analyses. A Z-test was conducted to compare the prevalence between people with and without epilepsy at the statistical significance level of 0.05. Prevalence ratios whose 95% confidence intervals did not overlap 1.00 were considered statistically significant. ResultsThe overall age-standardized prevalence was 5.7% for COPD and 1.8% for epilepsy. Age-standardized prevalence of COPD among respondents with epilepsy (15.4%) exceeded that among those without epilepsy (5.5%). The association remained significantly different among all sociodemographic and risk factor subgroups (p < .05). In the adjusted analyses, epilepsy was also significantly associated with COPD, overall (adjusted prevalence ratio = 1.8, 95% confidence interval = 1.6–2.1) and in nearly all subgroups defined by selected characteristics. ConclusionsEpilepsy is associated with a higher prevalence of COPD in U.S. adults. Public health interventions targeting modifiable behavioral and socioeconomic risk factors among people with epilepsy may help prevent COPD and related premature death.

Mortality and morbidity economic burden due to PM2.5 and ozone; an AirQ+ modelling in Iran

Introduction: Attributable health impacts of air pollution result in economic costs to societies. In this study, the WHO AirQ+ model was used to estimate the health impacts and health-related economic costs of PM2.5 and O3 in Karaj, the fourth largest city in Iran, from March 2015 to March 2016. Materials and methods: For PM2.5, long-term mortality due to ischemic heart disease (IHD), lung cancer, chronic obstructive pulmonary disease (COPD), and morbidity such as acute lower respiratory infection (ALRI), and short-term cardiovascular and respiratory hospitalizations were calculated. For ozone, short-term mortality and hospitalizations due to cardiovascular and respiratory diseases were estimated. The human capital method (HCM) was used to monetize the mortality impact attributed to selected air pollutants. Direct and indirect costs of morbidity were estimated using available local data on the costs related to cardiovascular and respiratory diseases. Results: The total number of IHD, COPD, LC and ALRI deaths attributed to PM2.5 in selected age groups was 576. The total number of cardiovascular and respiratory deaths attributed to O3 was 46 cases. For hospitalization, the aggregate cardiovascular and respiratory hospital admissions for both pollut- ants were 552. The total economic loss due to mortality and morbidity from selected health endpoints was approximately 44 million USD. Conclusion: Despite the limitations, such methodologies can be useful for policy-makers. Therefore, there is a compelling need to conduct cost of ill- ness’s studies in other areas.

Socio-demographic factors of COPD mortality in India

ObjectiveThe epidemiology of Chronic Obstructive Pulmonary Disease (COPD), one of the major killers in India, has been inadequately studied. There is dearth of national data and analysis on its associates. The present article aims to find out socio-demographic factors associated with it. Materials and methodsData taken from National Family Health Survey (NFHS 4) (2015-16), Global Adult Tobacco Survey (GATS) 2: India 2016-17 and India: Health of the Nation's States were analyzed with scatter plot and multivariate regression. ResultsCOPD mortality has negative relationships with use of clean fuel and economic condition and positive relationships with smoking and Second Hand Smoking (SHS). On regression, use of clean fuel reduces and SHS at home increases COPD deaths. ConclusionFor preventing deaths from COPD, focus should be on up scaling use of clean fuel and improvement in economic condition.

Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study.

BackgroundInhaled corticosteroids (ICSs) are used for advanced-stage chronic obstructive pulmonary disease (COPD). The application and safety of ICS withdrawal remain controversial.This study aimed to evaluate the association between ICS withdrawal and outcomes in elderly patients with COPD with or without comorbid bronchial asthma, who were hospitalised for exacerbation.Patients and methodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016. We identified patients aged ≥65 years who were hospitalised for COPD exacerbation. Re-hospitalisation for COPD exacerbation or death, frequency of antimicrobial medicine prescriptions and frequency of oral corticosteroid prescriptions after discharge were compared between patients with withdrawal and continuation of ICSs using propensity score analyses, namely 1–2 propensity score matching and stabilised inverse probability of treatment weighting.ResultsAmong 3735 eligible patients, 971 and 2764 patients had ICS withdrawal and continuation, respectively. The hazard ratios (95% confidence intervals) of re-hospitalisation for COPD exacerbation or death for ICS withdrawal compared to continuation were 0.65 (0.52–0.80) in the propensity score matching and 0.71 (0.56–0.90) in the inverse probability of treatment weighting. The frequency of antimicrobial prescriptions but not corticosteroid prescriptions within 1 year was significantly less in the ICS withdrawal group. Among patients with comorbid bronchial asthma, ICS withdrawal was significantly associated with reduced re-hospitalisation for COPD exacerbation or death only in the propensity score matching analysis.ConclusionICS withdrawal after COPD exacerbation was significantly associated with reduced incidences of re-hospitalisation or death among elderly patients, including those with comorbid bronchial asthma.

Effects of meteorological conditions on mortality from chronic obstructive pulmonary disease

Introduction/Objective. Previous studies have confirmed the effect of different meteorological parameters on patients suffering from lung diseases. The objective of the study is to investigate the impact of meteorological phases on the death rate from chronic obstructive pulmonary disease (COPD). Methods. The data on the number of deaths caused by COPD and meteorological phases during a five-year period (2011?2015) in Sumadija District (Central Serbia) were obtained from the Republic Hydrometeorological Service and the Center for Biostatistics and Informatics of the Kragujevac Institute of Public Health. Results. A statistically significant correlation was determined between certain meteorological phases and COPD death rate. The highest death rate was determined during colder months, February and March. The lowest death rate was detected during the warm months (June?September). Although men died more often from COPD than women, the death rate of women showed a considerable increase during the five-year period. Conclusion. COPD death rate is highly dependent on the season of the year and might be associated with certain meteorological phases. There is a need for further research of the impact of meteorological phases on the morbidity and mortality from COPD.

Heart rate variability in chronic obstructive pulmonary disease and its correlation with disease severity in South Indian population

Background: Cardiovascular diseases associated with chronic obstructive pulmonary disease (COPD) account for 50% of COPD deaths. Autonomic dysfunction and poor pulmonary function increase the cardiovascular risk in COPD patients. Severity of COPD can be assessed by forced expiratory volume in 1 s. Autonomic balance can be assessed by heart rate variability (HRV). There are variations in the reports of COPD patients regarding the level or onset of dysfunction is a sympathetic or parasympathetic system in them. Aims and Objectives: In our study, we intended to assess HRV parameters such as, total power (TP), high frequency normalized units (HFnu), low frequency normalized units (LFnu), LF/HF ratio, mean HR, root mean square of the successive differences (RMSSD), NN50, and pNN50 among different stages of COPD and also to identify the association of these HRV parameters with disease severity. Materials and Methods: It is a cross-sectional study done on (n = 130) male stable COPD patients. Anthropometric parameters, HRV parameters, and pulmonary function test were assessed. Later, based on the Global Initiative for Chronic Obstructive Lung Disease stage criteria (mild, moderate, severe, and very severe), they were divided into four subgroups. Data were analyzed by SPSS 19.0 version software. Kruskal–Wallis test was used to find a statistical difference between the groups. Correlations between the variables were done using Spearman correlation test. Results: LF/HF ratio (2 ± 0.5) was increased when compared to reference value reported by the previous studies. TP, HFnu, and RMSSD levels were significantly decreased in very severe, severe, and moderate COPD patients when compared to mild COPD patients. The mean HR, LFnu, and LF/HF ratio levels were significantly increased in very severe, severe, and moderate COPD patients when compared to mild COPD patients. TP, HFnu, and RMSSD levels negatively correlated with disease severity and mean HR, LFnu, and LF/HF ratio positively correlated with disease severity. Conclusion: We have noted that cardiac autonomic dysfunction in the form of increased sympathetic and reduced parasympathetic activity occurs in COPD patients and the association was more prominent when the disease severity increased.