Prevalence Of COPD Research Articles

Clinical symptoms and conditions leading to metastatic non–small cell lung cancer diagnosis in patients with and without targeted mutations.

401 Background: This study compares patient characteristics, clinical conditions, the prevalence and timing of lung cancer symptoms, and diagnostic procedures from onset to mNCSLC diagnosis for patients with and without targetable mutations. Methods: This was a retrospective claims analysis of Medicare Advantage and commercially insured adult mNSCLC patients (11/01/2012 - 01/31/2020) with continuous health plan enrollment (24 months pre-index and ≥2 months post-index) around the index date (mNSCLC diagnosis). Patients on targeted therapy post-diagnosis were assigned to the targeted group (TG); non-targeted group (NTG) otherwise. Twenty pre-specified lung cancer related symptoms, baseline comorbidities, and diagnostic procedures were examined in the pre-index period. Results: The study comprised 2,940 patients (TG: 390; NTG: 2,550); TG had lower mean age (65.8yrs vs 69.2yrs; p < 0.001), more females (59.5% vs 50.6%; p = 0.001), and lower tobacco use (55.9% vs 92.5%; p < 0.001). Mean TG Charlson score was 1.37 in the TG vs 1.93 in the NTG; p < 0.001. There were no significant differences in prevalence of any lung cancer related symptoms (TG 81.8% vs NTG 83.5%; p = 0.4). When comparing the 20 individual, pre-specified lung cancer related symptoms (cough, dyspnea, hemoptysis, etc.), there were also no significant differences between the study cohorts. For patients with symptoms, the mean times from the first symptom to mNSCLC diagnosis were similar (TG: 339.3 days; NTG: 363.1 days; p = 0.13)(Table). There were significant differences in the proportion of patients with comorbidities between study cohorts (TG 64.4% vs NTG 73.5%; p < 0.001). Among patients within TG, there was higher prevalence of pleural effusion (22.1% vs 12.6%; p < 0.001) and lower prevalence of COPD (17.7% vs 50.8%; p < 0.001). For diagnostic procedures, patients in TG had fewer imaging procedures than NTG (Chest x-ray 67.7% vs. 74.1%; p = 0.008, CT scan 57.2% vs 63.5%; p = 0.016, PET scan 19.0% vs 27.1%; p < 0.001); and a longer mean time from first symptom to first imaging procedure (TG: 220 days; NTG: 184 days; p = 0.015)(Table). Conclusions: Patients with and without targetable mutations may differ by some patient characteristics, but they may not differ by presentation and type of lung cancer related symptoms leading up to diagnosis.[Table: see text]

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SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Living in rural areas is associated with higher COPD prevalence, even among never-smokers. In addition, the rural residence increased a 70% increase in the odds of total COPD exacerbations. Patients living in rural areas have a 46% higher incidence rate of COPD exacerbations. In this study, we explored the impact of a residential area on the COPD outcomes such as exacerbation, change in pulmonary function, and quality of life in a highly urbanized country. METHODS: This study was a prospective, non-interventional, observational cohort study. Patients were recruited from 54 medical centers in South Korea between December 2011 and January 2018. Using data of 2,119 patients from the KOCOSS (Korea COPD Subgroup Study) cohort, we compared the demographic and residential characteristics, development of exacerbation, change of pulmonary function, and quality of life according to the residential area. RESULTS: A total of 1,083 (51.1%) patients were living in the large city, 548 (25.9%) in small & medium-sized cities, and 488 (23.0%) in the rural area at the enrollment. According to the residential area, there was a significant difference in dyspnea severity and quality of life at baseline. The mean mMRC score was 1.42 for patients living in the rural area, 1.35 for those from small and medium-sized cities, and 1.24 for large cities, respectively (p<0.001). The mean SGRQc for the rural area was 33.7 and 31.8 for small and medium-sized cities and 30.6 for large cities (p=0.028). The CAT score was not different at baseline. The moderate exacerbations developed more frequently in rural areas than urban areas during follow-up (3.56 for rural areas, 3.44 for small & medium-sized cities, and 2.39 for large cities, p=0.001). A similar trend was observed for severe exacerbations but statistically not significant (0.74 for rural areas, 0.72 for small & medium-sized cities, and 0.49 for large cities, p=0.054). FEV1 and FVC were highest for patients from large cities in the first and second years of follow-up. There were no significant differences in total CAT scores and SGRQc during follow-up. CONCLUSIONS: This study showed the clinical COPD outcomes between residential area groups. Patients living in rural areas experienced moderate exacerbation more frequently. Other outcomes, such as severe exacerbation, quality of life, or lung function, had similar development patterns but did not meet the statistical significance. CLINICAL IMPLICATIONS: The residential area does not seem to impact the clinical outcome of COPD patients except for moderate exacerbation. The good accessibility to health care facilities in South Korea can partly explain our findings. DISCLOSURES: No relevant relationships by Yong Il Hwang No relevant relationships by Chang Youl Lee No relevant relationships by Kyu Jin Lee no disclosure submitted for Yong Bum Park; No relevant relationships by KWANG HA YOO

Factors Related to Complaints of Lung Function Disorders In UPN Veteran Jakarta Employees

Background: One characteristic of lung dysfunction is obstruction of airflow in the respiratory tract. The prevalence of COPD as lung function disorder among men in Indonesia is 3.7% and 2.7% in DKI Jakarta. One of the causes of decreased lung function is smoking. A large portion of UPN Veteran Jakarta employees is smoker. This research was aimed to determine risk factors of lung dysfunction among employees in UPN Veteran Jakarta. Method: A cross sectional study was conducted from April to May 2019 in UPN Veteran Jakarta. Total 102 samples of employees who work at UPN includes staff, lecturers, cooperative officers, office boys, and security guards were selected using purposive sampling. Measuring instruments used in this study were questionnaires, scales, microtoise and spirometer. Spirometer was used to measure lung function. Questionnaires to obtain data on gender, age, body mass index (BMI), employment status, education, allergies, history of lung disease, family history, Brinkman index, physical activity, vehicle emissions exposure and smoking environment. The data was analysed using the chi square test and logistic regression test Results: The results of the logistic regression test showed risk factors of lung dysfunction were BMI (POR: 4.718; 95% CI 1.673-13.305), history of lung disease (POR: 3,424; 95% CI 0.836-14.028) and smoking environment (POR: 2.956; 95% CI 0.953-9.168). Conclusion: The most influencing factors for lung dysfunction were BMI, history of lung disease, and smoking environment.

Lung function in Lolland-Falster Health Study (LOFUS).

BackgroundCOPD prevalence in Denmark is estimated at 18% based on data from urban populations. However, studies suggest that using the clinical cut‐off for airway obstruction in population studies may overestimate prevalence. The present study aims to compare estimated prevalence of airway obstruction using different cut‐offs and to present lung function data from the Lolland‐Falster Health Study, set in a rural‐provincial area.MethodsDescriptive analysis of participant characteristics and self‐reported respiratory disease and of spirometry results in the total population and in subgroups defined by these characteristics. Airway obstruction was assessed using previously published Danish reference values and defined according to either FEV1/FVC below lower limit of normal (LLN) 5% (as in clinical diagnosis) or 2.5% (suggested for population studies), or as FEV1/FVC < 70%.ResultsUsing either FEV1/FVC < 70% or LLN 5% cut‐off, 19.0% of LOFUS participants aged 35 years or older had spirometry, suggesting airway obstruction. By the LLN 2.5% criterion, the proportion was considerably lower, 12.2%. The prevalence of airway obstruction was higher among current smokers, in participants with short education or reporting low leisure‐time physical activity and in those with known respiratory disease. Approximately 40% of participants reporting known respiratory disease had normal spirometry, and 8.7% without known respiratory disease had airway obstruction.ConclusionPrevalence of airway obstruction in this rural population was comparable to previous estimates from urban Danish population studies. The choice of cut‐off impacts the estimated prevalence, and using the FEV1/FVC cut‐off may overestimate prevalence. However, many participants with known respiratory disease had normal spirometry in this health study.

Chronic Obstructive Pulmonary Disease Prevalence and Associated Risk Factors in Adults Aged 40 Years and Older in Southeast China: A Cross-Sectional Study During 2019-2020.

PurposeChronic obstructive pulmonary disease (COPD) is one of many major public health problems in China, and its prevalence and associated risk factors in the southeast of China need to be determined to facilitate disease control and prevention.MethodsA multistage stratified cluster sampling method was used to select 5486 participants aged ≥ 40 years from nine COPD monitoring districts in Fujian Province during 2019–2020. Participants were interviewed using a laptop-based questionnaire and underwent pulmonary function tests. COPD was diagnosed according to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.ResultsFinal analysis was conducted using data from 4999 participants with qualified post-bronchodilator results. The prevalence of COPD was 11.6% (95% confidence interval [CI]: 10.5–12.7). Risk factors for COPD in the logistic regression model were being male (odds ratio [OR] = 2.83, 95% CI: 2.01–3.98), > 70 years old (OR = 16.16, 95% CI: 8.14–32.08), having a low body mass index (BMI) (OR = 1.81, 95% CI: 1.13–2.89), parental history of respiratory disease (OR = 1.78, 95% CI: 1.50–2.10), being a current (OR = 2.82, 95% CI: 1.83–4.36) or former (OR = 2.47, 95% CI: 1.45–4.19) smoker, and indoor exposure to biomass (OR = 1.28, 95% CI: 1.05–1.58).ConclusionThe estimated prevalence of COPD in southeast China is high. COPD was strongly associated with sex, aging, a low BMI, parental history of respiratory diseases, smoking, and indoor exposure to biomass in adults aged ≥ 40 years. The government should urgently implement comprehensive measures to reduce the risk factors for COPD.

Prevalence of mortality among covid-19 patients in Kurdistan Region and various parts of the world and the role of ecological and environmental factors in shaping SARS-CoV-2 virulence

Evolutionary theories predict that virulence (host death due to a pathogen) positively associates with the pathogen transmission rates to new susceptible hosts. Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), the causative agent of coronavirus disease 2019 (covid-19) pandemic, like other RNA viruses, has quite variable genetic content due to its unique nucleus enzymes thus mutations can continuously occur during viral replications. Phenotype variations among new viral progeny can include individuals with different replication rates, infectivity, stability in the abiotic environment, and transmission rate. Here, the rate of transmission to new susceptible hosts may be affected by the pathogen’s vitality in the physical environments, and host-related factors such as control measures and vaccination. In this study, we analyzed the mortality rates of covid-19 positive patients among various parts of the world and explain the role of several factors in determining SARS-CoV-2 virulence. We found a weak negative correlation (R2 = 0.3) between the mortality rate of covid-19 patients and each of death rates due to cancer diseases (F = 9.135, P = 0.006) and the number of medical doctors per 10,000 populations (F = 8.104, P = 0.009). Other factors such as the prevalence of current daily tobacco smoking in males/females, life expectancy in males/females, general death rates, cardiovascular diseases, prevalence of COPD, prevalence of asthma and average yearly temperature did not associate with death rates among covid-19 patients. Inclusion, adequacy of healthcare services and proper infection prevention measures are the key factors to reduce the covid-19 mortality rate. More studies are required to better understand the management of SARS-CoV-2 virulence management.

Chronic obstructive pulmonary disease as a comorbidity in pulmonary tuberculosis patients in Manjeri, Kerala

Chronic obstructive pulmonary disease as a comorbidity among pulmonary tuberculosis patients is less studied in south India. To determine the proportion of Pulmonary tuberculosis patients in Manjeri Tuberculosis Unit who have COPD as a co-morbidity. Study design -Cross sectional study. Study setting -Manjeri Tuberculosis unit of Malapuram district. Study population -All diagnosed Pulmonary Tuberculosis patients registered in the Manjeri Tuberculosis unit of Malapuram district. Sample size-178 patients satisfying inclusion criteria. Study tools- Questionnaire – A structured questionnaire used for collecting the basic demographic data and patient characteristics. COPD screener tool to be applied at the start of treatment. Pulmonary function test at end of intensive phase in patients or when patients are sputum smear negative, whichever is later. Of the total 181 persons who participated in the study 114[62.98%] were males. 35[19.34%] were smokers. 70 persons reported to have some form of chronic respiratory illness in the past. By using the COPD screener tool, 70 persons [38.89%] had score from 5 to 10 implying that they had high chance of having COPD. Spirometry was done for 174 persons. 31(17.81%) persons showed evidence of obstructive airway disease. The prevalence of COPD among pulmonary tuberculosis patients was 17.81%. In a high tuberculosis burden country like India, more studies are needed to find out how COPD in tuberculosis patients adversely affects the disease progression, morbidity, and mortality.

Investigation of the prevalence of COPD in the relatives of COPD patients aged 35 and over

Investigation of the prevalence of COPD in the relatives of COPD patients aged 35 and over

Chronic Obstructive Pulmonary Disease and Smoking in India: A Meta-Analysis

Introduction: WHO estimates show Chronic obstructive pulmonary disease [COPD] as a growing major global cause of morbidity as well as mortality. An estimated 90% of COPD- related deaths occur in low/middle income countries. India and China together constitutes about one third of the total humanpopulation, accounting for 66% of COPD mortality globally. In the south east Asia region, COPD associated mortality is projected to grow by 160% in the decades ahead. Much of this projection holds pansexual cigarette smoking, improved life expectancy, bulging geriatric population and high levels ofsmall particle pollution, as major causes behind increase in COPD case burden. Methods: The aim of the meta-analysis was to investigate association between COPD and risk factors by pooled and subgroup analysis. We searched for case control studies and studies which are meeting the inclusion criteria. The publications listed in the NCBI PubMed and Cochrane library were searched using the following combination of the key words “COPD”; “smokers”; “health”; “risk” or “factors”;“diagnostic”; “burden”; “exposure”; “disease” or “prevalence” or “morbidity ” or “mortality”; “tobacco”; “smoking”; “smoke”, “India”. Random effects meta-analysis was applied to generate pooled SMD by using CMA software. Results: Data base search identified twenty-nine thousand two hundred twenty-two records and 14 articles made to the cut after implementing the inclusion and exclusion criteria. Main risk factors for COPD were higher age [SMD=0.53, CI= (0.0018-1.05)], total pack years of Smoking [SMD=13.83,CI (10.060-17.616)], FEV1 [SMD=-13.15, CI= (-16.234 to -10.085) and FEV/FVC ratio [SMD=0.915.CI= (0.767-1.063)]. Higher age, smoking, low values of FEV1 and FEV/FVC ratio is directly associated with high risk of COPD. Discussions: The findings of the study shows evidence of smoking history in terms of pack of years as a major risk factor for COPD prevalence. Further research is needed on COPD prevalence andincidence associated with other chemical exposure, to identify how to effectively reduce risks fromexposure to smoking.

Impact of Sex on Proper Use of Inhaler Devices in Asthma and COPD: A Systematic Review and Meta-Analysis.

Despite females being more often affected by asthma than males and the prevalence of COPD rising in females, conflicting evidence exists as to whether sex may modulate the correct inhaler technique. The aim of this study was to assess the impact of sex on the proper use of inhaler devices in asthma and COPD. A pairwise meta-analysis was performed on studies enrolling adult males and females with asthma or COPD and reporting data of patients making at least one error by inhaler device type (DPI, MDI, and SMI). The data of 6,571 patients with asthma or COPD were extracted from 12 studies. A moderate quality of evidence (GRADE +++) indicated that sex may influence the correct use of inhaler device in both asthma and COPD. The critical error rate was higher in females with asthma (OR 1.31, 95%CI 1.14–1.50) and COPD (OR 1.80, 95%CI 1.22–2.67) using DPI vs. males (p < 0.01). In addition, the use of SMI in COPD was associated with a greater rate of critical errors in females vs. males (OR 5.36, 95%CI 1.48–19.32; p < 0.05). No significant difference resulted for MDI. In conclusion, choosing the right inhaler device in agreement with sex may optimize the pharmacological treatment of asthma and COPD.

Trends in prevalence, mortality, and disability-adjusted life-years relating to chronic obstructive pulmonary disease in Europe: an observational study of the global burden of disease database, 2001–2019

IntroductionChronic Obstructive Pulmonary Disease (COPD) is associated with significant mortality and well-defined aetiological factors. Previous reports indicate that mortality from COPD is falling worldwide. This study aims to assess the burden of COPD using prevalence, mortality, and disability-adjusted life years (DALYs) between 2001 and 2019 in 28 European countries (the European Union and the United Kingdom).MethodsWe extracted COPD data from the Global Burden of Disease database based on the International Classification of Diseases versions 10 (J41, 42, 43, 44 and 47). Age-standardised prevalence rates (ASPRs), age-standardised mortality rates (ASMRs), and DALYs were analysed for European countries by sex for each year (2001–2019) and reported per 100,000 population. We used Joinpoint regression analysis to quantify changing trends in the burden of COPD. ResultsIn 2019, the median ASPR across Europe was 3230/100,000 for males and 2202/100,000 for females. Between 2001 and 2019, the median percentage change in ASPR was − 9.7% for males and 4.3% for females. 23/28 countries demonstrated a decrease in ASPRs in males, and 11/28 demonstrated a decrease in females. The median percentage change in ASMR between 2001 and 2019 was − 27.5% for males and − 10.4% for females. 25/28 and 19/28 countries demonstrated a decrease in ASMR in males and females, respectively. ConclusionIn the EU between 2001 and 2019 COPD prevalence has overall increased in females but continues to decrease in males and in some countries, female prevalence now exceeds that of males. COPD mortality in the EU has decreased overall between 2001 and 2019; however, this decrease is not universal, particularly in females, and therefore remains a substantial source of amenable mortality.

Detection of COPD in the SUMMIT Study lung cancer screening cohort using symptoms and spirometry.

COPD is a major comorbidity in lung cancer screening (LCS) cohorts, with a high prevalence of undiagnosed COPD. Combining symptom assessment with spirometry in this setting may enable earlier diagnosis of clinically significant COPD and facilitate increased understanding of lung cancer risk in COPD. In this study, we wished to understand the prevalence, severity, clinical phenotype and lung cancer risk of individuals with symptomatic undiagnosed COPD in a LCS cohort. 16 010 current or former smokers aged 55-77 years attended a lung health check as part of the SUMMIT Study. A respiratory consultation and spirometry were performed alongside LCS eligibility assessment. Those with symptoms, no previous COPD diagnosis and airflow obstruction were labelled as undiagnosed COPD. Baseline low-dose computed tomography (LDCT) was performed in those at high risk of lung cancer (PLCOm2012 score ≥1.3% and/or meeting USPSTF 2013 criteria). Nearly one in five (19.7%) met criteria for undiagnosed COPD. Compared with those previously diagnosed, those undiagnosed were more likely to be male (59.1% versus 53.2%; p<0.001), currently smoking (54.9% versus 47.6%; p<0.001) and from an ethnic minority group (p<0.001). Undiagnosed COPD was associated with less forced expiratory volume in 1 s impairment (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 and 2: 85.3% versus 68.4%; p<0.001) and lower symptom/exacerbation burden (GOLD A and B groups: 95.6% versus 77.9%; p<0.001) than those with known COPD. Multivariate analysis demonstrated that airflow obstruction was an independent risk factor for lung cancer risk on baseline LDCT (adjusted OR 2.74, 95% CI 1.73-4.34; p<0.001), with a high risk seen in those with undiagnosed COPD (adjusted OR 2.79, 95% CI 1.67-4.64; p<0.001). Targeted case-finding within LCS detects high rates of undiagnosed symptomatic COPD in those most at risk. Individuals with undiagnosed COPD are at high risk for lung cancer.

Prevalence and incidence of chronic obstructive pulmonary disease in Latin America and the Caribbean: a systematic review and meta-analysis

BackgroundChronic Obstructive Pulmonary Disease (COPD) remains one of the leading causes of morbidity and mortality worldwide, and its epidemiology in Latin America and the Caribbean is not well described. The aim of this study was to evaluate the prevalence and incidence of COPD in Latin America and the Caribbean.MethodsWe searched systematically in Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed, and Embase from 2010 to 2021. Studies assessing the prevalence and incidence of COPD according to the GOLD classification were included. The overall prevalence of COPD was calculated as a function of the general population using a random-effects model.Results20 studies (19 cross-sectional and 1 cohort) met the inclusion criteria. The prevalence of COPD in the general population older than 35 years was 8.9%. The prevalence in men was 13.7% and in women 6.7%. The prevalence in smokers and ex-smokers was 24.3%. The incidence in the general population of COPD according to one study was 3.4% at 9 years of follow-up.ConclusionsCOPD is prevalent in Latin America, especially in men and in smokers and ex-smokers. Further prevalence and incidence studies in the general population are needed, as well as health policies and strategies to address the disease.

Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center.

IntroductionThere is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients.PurposeThe primary endpoint was to investigate the differences in characteristics, management, and in-hospital mortality according to gender in a cohort of CS patients admitted to a tertiary hub center. The secondary endpoint was to evaluate the prognostic performance of the Society of Cardiovascular Angiography and Interventions (SCAI) classification in predicting in-hospital mortality according to sex.MethodsThis is a retrospective single-Center cohort study of CS patients treated by a multidisciplinary shock team between September 2014 and December 2020. Baseline characteristics and clinical outcomes according to gender were registered. Discrimination of SCAI classification was assessed using the area under the receiver operating characteristic curve (AUC).ResultsOverall, 163 patients were included, 39 of them female (24%). Mean age of the overall cohort was 55 years (44–62), similar between groups. Compared with men, women were less likely to be smokers and the prevalence of COPD and diabetes mellitus was significantly lower in this group (p < 0.05). Postcardiotomy (44 vs. 31%) and fulminant myocarditis (13 vs. 2%) were more frequent etiologies in females than in males (p = 0.01), whereas acute myocardial infarction was less common among females (13 vs. 33%). Regarding management, the use of temporary mechanical circulatory support, mechanical ventilation, or renal replacement therapy was frequent and no different between the groups (88, 87, and 49%, respectively, in females vs. 42, 91, and 41% in males, p > 0.05). In-hospital survival in the overall cohort was 53%, without differences between groups (52% in females vs. 55% in males, p = 0.76). Most of the patients (60.7%) were in SCAIE at presentation without differences between sexes. The SCAI classification showed a moderate ability for predicting in-hospital mortality (overall, AUC: 0.653, 95% CI 0.582–0.725). The AUC was 0.636 for women (95% CI 0.491–0.780) and 0.658 for men (95% CI 0.575–0.740).ConclusionsOnly one in four of patients treated at a dedicated CS team were female. This may reflect differences in prevalence of severe heart disease at young (<65) ages, although a patient-selection bias cannot be ruled out. In this very high-risk CS population of multiple etiologies, overall, in-hospital survival was slightly above 50% and showed no differences between sexes. Treatment approaches, procedures, and SCAI risk stratification performance did not show gender disparities among treated patients.

The Dietary Inflammatory Index and Early COPD: Results from the National Health and Nutrition Examination Survey.

We examined 3962 people aged 20 to 49 years who had information on spirometry testing and underwent a 24 h dietary recall interview from the 2007–2012 National Health and Nutrition Examination Survey (NHANES) and used multivariable logistic regression to evaluate associations between Dietary Inflammatory Index (DII, a pro-inflammatory diet) and early COPD and lung function. The overall prevalence of early COPD was 5.05%. Higher DII was associated with increased odds of early COPD (quartile 4 vs. 1, the OR = 1.657, 95% CI = 1.100–2.496, p = 0.0156). In a full-adjusted model, each unit of increase in DII score was associated with a 90.3% increase in the risk of early COPD. Higher DII is significantly associated with lower FEV1 and FVC among individuals with early COPD, each unit increment in the DII was significantly associated with 0.43 L–0.58 L decrements in FEV1 (β = –0.43, 95% CI = −0.74, −0.12) and FVC (β = −0.58, 95% CI = −1.01, −0.16). These findings demonstrate that higher consumption of a pro-inflammatory diet may contribute to an increased risk of early COPD and lower lung function, and further support dietary interventions as part of a healthy lifestyle in order to preserve lung function and prevent or improve COPD.

STUDY OF SOCIODEMOGRAPHIC AND CLINICAL PROFILE OF SMOKER AND NON-SMOKER COPD PATIENTS ATTENDING A TERTIARY CARE CENTRE IN NORTH INDIA

COPD is the third leading cause of death worldwide and the second leading cause of death in India. There are so many factors that contribute to the development of COPD and determine its progression and severity. This study was done to know the Sociodemographic and clinical proles of smoker and non-smoker COPD patients attending a tertiary care centre in North India. This was a hospital-based prospective andMaterial and Method: observational study conducted in the Department of TB and Respiratory Diseases, S.N. Medical College, Agra. Patients were recruited for the study based on GOLD criteria (Post Bronchodilator FEV1/FVC &lt; 0.7). Patients were evaluated based on demographic characteristics and clinical features. Results: Among the total eligible patient's prevalence of smoker COPD patients was 62.96% and the prevalence of non-smoker patients was 37.04%. Among the eligible 108 cohort patients, 70 (64.81%) were males and 38 (35.18%) were females. Female patients were higher in the non-smoker group (75%). The higher number of patients enrolled were from a rural background (60.18%). Mean age of the population was 48.8 years with a majority of patients lying in the younger age group and were malnourished (BMI&lt;18.5). Breathlessness was the most common symptom reported (49%) and smoker COPD patients were having severe dyspnoea (46.29%). 37.04% prevalence of non-smoker COPD was noted. Early detectionConclusion: with the help of spirometry will be helpful in not only modifying the disease course but also delaying and preventing fatal complications. Hence, patients may be treated earliest by various measures like lifestyle modication, smoking cessation, etc.

Epidemiology, Healthcare Resource Utilization, and Mortality of Asthma and COPD in COVID-19: A Systematic Literature Review and Meta-Analyses

PurposeThere has been concern that asthma and chronic obstructive pulmonary disease [COPD] increase the risk of developing and exacerbating COVID-19. The effect of medications such as inhaled corticosteroids (ICS) and biologics on COVID-19 is unclear. This systematic literature review analyzed the published evidence on epidemiology and the burden of illness of asthma and COPD, and the use of baseline medicines among COVID-19 populations.Patients and MethodsUsing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE® and Cochrane were searched (January 2019–August 2021). The prevalence of asthma or COPD among COVID-19 populations was compared to the country-specific populations. Odds ratios (ORs) were estimated to compare healthcare resource utilization (HCRU) rates, and meta-analyses of outcomes were estimated from age-adjusted ORs (aORs) or hazard ratios (aHRs). Meta-analyses of COVID-19 outcomes were conducted using random effects models for binary outcomes.ResultsGiven the number and heterogeneity of studies, only 183 high-quality studies were analyzed, which reported hospitalization, intensive care unit (ICU) admissions, ventilation/intubation, or mortality. Asthma patients were not at increased risk for COVID-19–related hospitalization (OR = 1.05, 95% CI: 0.92 to 1.20), ICU admission (OR = 1.21, 95% CI: 0.99 to 1.1.48), ventilation/intubation (OR = 1.24, 95% CI: 0.95 to 1.62), or mortality (OR = 0.85, 95% CI: 0.75 to 0.96). Accounting for confounding variables, COPD patients were at higher risk of hospitalization (aOR = 1.45, 95% CI: 1.30 to 1.61), ICU admission (aOR = 1.28, 95% CI: 1.08 to 1.51), and mortality (aOR = 1.41, 95% CI: 1.37 to 1.65). Sixty-five studies reported outcomes associated with ICS or biologic use. There was limited evidence that ICS or biologics significantly impacted the risk of SARS-CoV-2 infection, HCRU, or mortality in asthma or COPD patients.ConclusionIn high-quality studies included, patients with asthma were not at significantly higher odds for adverse COVID-19–related outcomes, while patients with COPD were at higher odds. There was no clear evidence that baseline medication affected outcomes.RegistrationPROSPERO (CRD42021233963).

0074 Neighborhood-Level Sleep Health and Childhood Opportunity Index at the Census Tract Level: Comparison to Other Health Indicators

Abstract Introduction Promoting sleep health at the neighborhood level may be an efficient way to promote overall health and well-being. This study examined the relative contribution of sleep health, versus other regional health metrics. Methods Neighborhood sleep health values were obtained from the “500 Cities” data collected by the CDC, which includes census tract and proportion that report values associated with health. Data include the population of each census tract as well as census-estimated proportion of the population in each census tract that report obtaining at least 7 hours of sleep. Other health indicators evaluated included access to health insurance, past-year routine medical or dental checkup, older adult preventive care, leisure-time activity, mammography, pap testing, and prevalence of arthritis, binge drinking, hypertension, antihypertensive use, cancer, asthma, coronary disease, cholesterol screening, colon screening, COPD, smoking, diabetes, hypercholesterolemia, kidney disease, poor mental and physical health, obesity, stroke, and teeth lost. The Child Opportunity Index (COI) is a publicly-available index (DiversityDataKids.org) reported at the census tract level. It provides indices for “Education,” “Health and Environment,” and “Social and Economic” domains, as well as a global score. The present analysis merged the 500 Cities data with the COI data, using census tract as the matching variable. When data were merged, 27,130 census tracts were included. Results In stepwise analyses adjusted for population size, with global COI as the dependent variable, sleep health emerged as the strongest predictor, accounting for 57.2% of the variance of global COI (p&amp;lt;0.0001). When all other health predictors were included in the model, the next largest contributors were teeth lost (additional 15.5%), health insurance (additional 3.0%), and asthma (additional 1.4%). Similarly, when stepwise analyses examined each component of COI as dependent variable, sleep health consistently emerged as the most substantial predictor, accounting for 41.2%, 24.3%, and 56.4% of the variance of “Education,” “Health and Environment,” and “Social and Economic” scores, respectively (all p&amp;lt;0.0001). Conclusion Sleep health is more strongly associated with overall COI (and all its components) than any other regional health metric. Public health efforts targeting sleep health may have disproportionately beneficial impact on factors that support family health and well-being. Support (If Any)

Nonadherence to health promotion depending on chronic obstructive pulmonary disease severity

BackgroundNonadherence to recommended health behaviors reportedly correlates with the prevalence and health outcomes of COPD, but the factors contributing to multiple health promotions are not well understood. ObjectiveTo examine the factors associated with nonadherence to health behaviors, specifically focusing on COPD severity. MethodsWe conducted a secondary data analysis with data from the 2016–2019 Korea National Health and Nutrition Examination Survey. The analyzed data were from 1,627 individuals aged over 40 years who had a FEV1/FVC ratio < 70% measured via spirometer. In this study, nonadherence to health behaviors is the sum of seven health-promoting behaviors in terms of smoking cessation, alcohol abstinence, regular exercise, weight control, recommended sleep time, influenza vaccination, and medical check-up. ResultsCOPD patients’ nonadherence to health behaviors was significantly associated with comorbidity (p=0.017), stress (p=0.002), and COPD severity (moderate, severe; p=0.010, p=0.039, respectively). In addition, the moderate and severe COPD groups showed a higher nonadherence rate than the mild COPD group. Specifically, nonadherence to weight control was the most significantly different behavior according to COPD severity levels, based on the GOLD classification of airflow limitation. ConclusionOur study findings support that those with higher levels of stress, comorbidities, and severe disease conditions are less likely to adhere to health behaviors. Thus, healthcare providers and policymakers should provide tailored approaches according to COPD severity to educate and support appropriate health behaviors for individuals with COPD.

Let Us Pump The Brakes On The Heart: Optimal AV-nodal Agent For Atrial Fibrillation In Heart Failure With Preserved Ejection Fraction

Introduction Current AHA/ACC/HRS guidelines recommend either non-dihydropyridine calcium channel blockers (ND-CCB) or beta-blockers (BB) for rate control in atrial fibrillation/flutter (AF) as first line therapy among patients with compensated heart failure and preserved ejection fraction (HFpEF, LVEF≥50%). However, comparing differences if any, in clinical outcomes among patients with HFpEF and AF who are treated with either class of drugs remains unclear. Methods We compared long-term survival among all patients seen at University of Wisconsin Hospitals and Clinics with AF and HFpEF from 2009-2019 (n=2820) who received treatment with a BB (n=2643) or ND-CCB (n=177), patients on combinations of these drugs were excluded. Kaplan Meier curves and Cox regression models were constructed to evaluate mortality and all-cause hospitalizations with length of stay in each group were analyzed. Results Compared to BB group, patients receiving ND-CCB were older (73.9±11.5 vs. 71.5±12.5 years), had a higher prevalence of COPD (38% vs 20%), but lower prevalence of coronary disease (32% vs 55%), hyperlipidemia (56% vs 71%), and diabetes (39% vs 50%), p-value for all <0.05. Upon follow up, (mean 3.3 years) 985 patients died. Kaplan Meier curve (Figure) demonstrated better survival of those on BB therapy (log rank p <0.01) compared to ND-CCB. Multivariable Cox analysis showed that patients on BB had a 26% lower risk of death (95% confidence interval 0.584-0.937) compared to ND-CCB group on long-term follow up. The BB cohort had similar hospitalization rates but longer length of stay (15.1 vs 11.2 days; p=0.04) compared to the CCB group. Conclusions Despite higher prevalence of cardiovascular risk factors, patients treated with BB for AF and HFpEF had better survival than those treated with ND-CCB. Future randomized controlled studies are needed to confirm or refute these findings. Current AHA/ACC/HRS guidelines recommend either non-dihydropyridine calcium channel blockers (ND-CCB) or beta-blockers (BB) for rate control in atrial fibrillation/flutter (AF) as first line therapy among patients with compensated heart failure and preserved ejection fraction (HFpEF, LVEF≥50%). However, comparing differences if any, in clinical outcomes among patients with HFpEF and AF who are treated with either class of drugs remains unclear. We compared long-term survival among all patients seen at University of Wisconsin Hospitals and Clinics with AF and HFpEF from 2009-2019 (n=2820) who received treatment with a BB (n=2643) or ND-CCB (n=177), patients on combinations of these drugs were excluded. Kaplan Meier curves and Cox regression models were constructed to evaluate mortality and all-cause hospitalizations with length of stay in each group were analyzed. Compared to BB group, patients receiving ND-CCB were older (73.9±11.5 vs. 71.5±12.5 years), had a higher prevalence of COPD (38% vs 20%), but lower prevalence of coronary disease (32% vs 55%), hyperlipidemia (56% vs 71%), and diabetes (39% vs 50%), p-value for all <0.05. Upon follow up, (mean 3.3 years) 985 patients died. Kaplan Meier curve (Figure) demonstrated better survival of those on BB therapy (log rank p <0.01) compared to ND-CCB. Multivariable Cox analysis showed that patients on BB had a 26% lower risk of death (95% confidence interval 0.584-0.937) compared to ND-CCB group on long-term follow up. The BB cohort had similar hospitalization rates but longer length of stay (15.1 vs 11.2 days; p=0.04) compared to the CCB group. Despite higher prevalence of cardiovascular risk factors, patients treated with BB for AF and HFpEF had better survival than those treated with ND-CCB. Future randomized controlled studies are needed to confirm or refute these findings.