Prevalence Of COPD Research Articles

The link between chronic obstructive pulmonary disease phenotypes and histological subtypes of lung cancer: a case-control study.

BackgroundCOPD is considered an independent risk factor for lung cancer. COPD and lung cancer are both very heterogeneous diseases, and the study herein investigates the link between COPD phenotypes and specific histological subtypes of lung cancer.MethodsThis case–control study comprised 2,283 patients with newly diagnosed pathological lung cancer and 2,323 non-lung cancer controls. All participants underwent pulmonary function tests. The diagnosis of COPD was based on Global Initiative for Chronic Obstructive Lung Disease criteria. Subtypes of the two diseases were categorized according to 2015 World Health Organization classification of lung cancer and computer quantification of airway collapse on maximum expiratory flow volume. ORs were estimated using logistic regression analysis.ResultsThe prevalence of COPD was higher (32.8%) in lung cancer patients compared to controls (16.0%). After adjustment for age, sex, body-mass index, and smoking status, the presence of COPD significantly increased the risk of lung cancer (OR 2.88, 95% CI 2.48–3.34) and all common histological subtypes (ORs 2.04–5.26). Both emphysema-predominant and non-emphysema-predominant phenotypes of COPD significantly increased the risk of lung cancer (OR 4.43, 95% CI 2.85–6.88; OR 2.82, 95% CI 2.40–3.31). Higher risk of squamous-cell carcinoma and small-cell lung cancer was observed in patients with the emphysema-predominant than the non-emphysema-predominant phenotype (OR 1.73, 95% CI 1.03–2.89; OR 3.74, 95% CI 1.64–8.53).ConclusionCOPD was an independent risk factor for lung cancer and all common histological subtypes. Both emphysema-predominant and non-emphysema-predominant phenotypes of COPD significantly increased the risk of lung cancer. Relative to non-emphysema-predominant phenotype of COPD, emphysema-predominant phenotype had a higher risk of squamous-cell carcinoma and small-cell lung cancer.

Letter from Taiwan

Letter from Taiwan

Prevalence and trend of COPD from 1995-1997 to 2006-2008: The HUNT study, Norway.

COPD is a major cause of morbidity and mortality across the world and new estimates of prevalence and trend are of great importance. We aimed to estimate the prevalence and trend of COPD from 1995-1997 to 2006-2008 in Norwegian adults ≥40 years from the Nord-Trøndelag Health Study. COPD was assessed using a fixed-ratio and lower limit of normal (LLN) criteria. Pre-bronchodilator spirometry was performed during 1995-1997 (n = 7158) and 2006-2008 (n = 8788). The prevalence of COPD was weighted using the inverse probability of selection and predicted probability of response. The prevalence of pre-bronchodilator COPD was 16.7% in 1995-1997 and 14.8% in 2006-2008 using fixed-ratio criteria, and 10.4% in 1995-1997 and 7.3% in 2006-2008 using LLN criteria. The prevalence of LLN COPD was higher among men (13.0% in 1995-1997, 7.7% in 2006-2008) than women (8.0% in 1995-1997, 6.9% in 2006-2008). From 1995-1997 to 2006-2008, the prevalence decreased among men but remained relatively stable among women. Over the 11-year period, the cumulative incidence of pre-bronchodilator COPD using LLN criteria was 3.3% and 2.7% among men and women respectively. The prevalence of self-reported asthma and respiratory symptoms increased. The prevalence declined in men but not in women from 1995-1997 to 2006-2008, and was consistently higher among men than women.

Prevalencia de enfermedad pulmonar obstructiva crónica no diagnosticada en una población con factores de riesgo cardiovascular

Background and objectiveThe magnitude of undiagnosed COPD in our population with cardiovascular risk factors (CVRF) is unknown. The objective of this study was to estimate the prevalence of undiagnosed COPD and its specific characteristics in a population with CVRF. Materials and methodsStudy the prevalence of COPD in patients with CVRF. Spirometry was performed between 01/01/2015 and 12/31/2016 and the percentage of patients with COPD, who had not previously been diagnosed, was determined. Each patient's variables of interest were recorded; the records of patients who had spirometry showing COPD were checked to confirm whether a diagnosis had been recorded or not. The association of undiagnosed COPD with different independent variables was determined with adjusted odds ratio (aOR) by non conditional logistic regression models. Results2,295 patients with CVRF were studied. The overall prevalence of COPD was 14.5%. An underdiagnosis of 73.3% was observed. Newly diagnosed COPD vs. undiagnosed COPD showed to be higher in women (74.1% vs. 36.0%; P=.081), non-smokers (21.3% vs. 12.4%; P=.577), mild cases (GOLD1) (42.6% vs. 32.4%, P=.008) and cases with lower than average HbA1c (5.5% vs. 5.6%; P=.008) and uric acid (5.1mg/dL vs. 5.6mg/dL; P=.011). The variables associated with undiagnosed COPD were: women (aOR=1.27; 95%CI: 0.74-2.17; P=.383); age (aOR=0.94; 95%CI: 0.87-0.99; P=.018); smokers (smoker/non-smoker) (aOR=0.47; 95%CI: 0.22-1.01; P=.054) and HbA1c (%) (aOR=0.45; 95%CI: 0.23-0.88; P=.019). ConclusionsThe under-diagnosis of COPD is very high. The contact patients aged between 50 and 65 years-old who have CVRF with their health system should be reassessed, and they need to ask for a spirometry.

Sarcopenia and Its Clinical Correlates in the General Population: The Rotterdam Study.

Sarcopenia, a complex multifactorial condition, is characterized by loss of muscle mass and function, which increases progressively with age. The existence of different definitions has contributed to the large variation in the prevalence estimates of sarcopenia. We aimed to estimate the prevalence of sarcopenia in the general population using the European Working Group on Sarcopenia in Older People (EWGSOP) proposed definition and compared baseline demographic and clinical characteristics between the nonsarcopenia, presarcopenia, and sarcopenia individuals, with particular emphasis on the overlap with osteoporosis and fracture risk. We studied 5911 subjects at a mean age of 69.2 years (55.8% female) with data on sarcopenia participating in the Rotterdam Study, a prospective population-based cohort study in Rotterdam, the Netherlands. Presarcopenia was defined as having only low muscle mass, whereas sarcopenia was defined based on the presence of low muscle mass, plus either low muscle strength or low physical performance. The prevalence of presarcopenia and sarcopenia was 5.9% and 4.4%, respectively. Individuals with sarcopenia were older, more often males, smokers, with less optimal dietary intake, and more often disabled with lower physical activity. Although the prevalence of fractures was higher in individuals with low lean mass (presarcopenic [16.6%] and sarcopenic [23.5%]) compared with the no sarcopenic group (15.5%), the differences were not present after correcting for age and sex. There were no statistical differences in the prevalence of chronic diseases, with the exception of a higher prevalence of COPD in presarcopenic (29.1%) and sarcopenic (26.9%) individuals compared with nonsarcopenic (13.4%) individuals. Osteoporotic individuals with (odds ratio [OR] = 2.59, 95% confidence interval [CI] 1.41-4.45) and without sarcopenia (OR = 2.75, 95% CI 2.01-3.75) had similar elevated risk of nonvertebral fractures. The presence of sarcopenia appears to be independent of chronic diseases with the exception of COPD and more related to lifestyle factors and disabilities. Sarcopenic individuals in the general population are at no greater risk of fracture than what is determined by their low bone mineral density. © 2018 American Society for Bone and Mineral Research.

Prevalence and Risk Factors of COPD in Karachi, Pakistan: Findings from the Adult Asthma Study-Karachi

Background/Aim: Limited data is available regarding burden and risk factors of COPD from developing countries through community based epidemiological assessment comprising spirometry. So to determine the prevalence and risk factors of COPD among adult population of Karachi, Pakistan. Methods: A multi-stage, community-based cross-sectional survey was conducted from May 2014-August 2015 comprising of 1630 adult (≥ 18 years) participants from 75 randomly selected (out of 9400) clusters in Karachi. From each cluster, 25 households were selected randomly and all eligible participants were recruited. Data was collected through questionnaire-based interviews in Urdu, consisting of respiratory health related questions (American Thoracic Society questionnaire; ATS-DLD 78A), socio-demographic characteristics and risk factors for asthma. Pre and post-bronchodilator spirometry was performed according to the ATS criteria. COPD was defined as a post-bronchodilator FEV1/FVC ratio < 0.70 according to the GOLD criteria. Results: Among 930 participants with acceptable spirometry we found the overall prevalence of COPD to be 10.9% (n=101; 95%CI: 8.9-12.8). Among them, the prevalence was 19.4% (n=78; 95%CI: 15.5-23.2) among adults aged 40 and above. Out of 101 participants having COPD, 20.8% have mild, 59.4% have moderate, 18.8% have severe and 1% have very severe disease according to the GOLD criteria of airflow limitation severity in COPD. Risk of COPD was increased with increasing age (AOR: 5.2, 95%CI: 3.1-8.5), increase in pack years of smoking (AOR: 3.3, 95%CI: 1.8-5.9) and among participants reporting history of allergies (AOR: 2.2, 95% CI: 1.4-3.4). Risk of COPD was decreased among those categorized as white collar employees compared to those not working or unemployed (AOR: 0.5, 95% CI: 0.3-0.9). Conclusions: This study provides evidence through robust epidemiological assessment regarding the actual burden of COPD among adults in Pakistan. Targeted preventive measures should be taken to reduce smoking habit and promote better environmental conditions at work places.

Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist.

BackgroundThe diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program.MethodsA study was conducted in 10 primary health care centers of Central Greece during a 7-month period. Eligible participants were aged ≥40 years and were either current smokers or exsmokers.ResultsA total of 186 subjects were included (68% males, mean age 62.3±12.6 years, mean life-time tobacco exposure 50 pack-years). COPD prevalence was 17.8%, identified to be higher in elderly males. Forty-two percent of the COPD group were newly diagnosed patients, who were of younger age, current smokers, presented with less dyspnea and better health status, and mainly appeared with mild-to-moderate disease. Interestingly, 61.4% of non-COPD and 85.7% of newly diagnosed COPD individuals had been using inhaled medication under primary care provider’s prescription without ever undergoing spirometry or further evaluation by a pulmonologist; thus, the phenomena of COPD overdiagnosis and missed diagnosis came into the spotlight. Moreover, only 26.3% of known COPD patients were properly medicated according to GOLD guidelines, while half of them were inappropriately treated with triple inhaled therapy.ConclusionWe reported a significant prevalence of COPD in smoking population attending this spirometry program. A remarkable proportion of COPD patients were undiagnosed and made case finding worthwhile. Underutilization of spirometry in the diagnosis and management of COPD as well as general practitioners’ nonadherence to the GOLD treatment guidelines was confirmed by our data. These findings highlight the need for a major overhaul and culture change in primary care settings of Central Greece.

Burden of COPD in Nepal.

BackgroundCOPD is a globally significant public health problem and is the second leading cause of mortality. This study presents the health burden of COPD in Nepal using the Global Burden of Disease (GBD) study 2016 dataset.MethodsThis study used the data from the GBD repository presenting morbidity and mortality attributed to COPD, by sex and age. In GBD 2016, due to a lack of the primary source of data in Nepal, estimations on morbidity and mortality of COPD were based on its predictive covariates. Years of life lost (YLLs) were calculated based on the cause of death estimations, applying GBD’s Cause of Death Ensemble modeling. Likewise, years lived with disability (YLDs) were calculated by multiplying the prevalence of each sequela by the disability weight. Disability-adjusted life years (DALYs) were derived as the sum of YLLs and YLDs.ResultsBetween 1990 and 2016, the estimated age-standardized mortality rate due to COPD was decreasing for both genders, but the decline was much higher among males. Unlike the high rate of incidence among males, the age-standardized DALYs were found to be high among females (2,274.9 [95% UI: 1,702.0–2,881.5] per 100,000). YLLs contributed around 80% of DALYs due to COPD in 2016. Age-standardized YLLs rate was higher among females, with a value of 1,860 (95% uncertainty interval (UI): 1,282.8–2,472.8) vs 1,547.6 (95% UI: 992.1–2,018.5) among the males per 100,000 population.ConclusionThe prevalence and incidence of COPD remained almost stationary over the years, but still very high. Though the incidence and prevalence of disease were high among males, the death rate and DALYs were more significant among females throughout the years. If the current situation prevails, the burden of COPD will continue to increase in the country. Hence, comprehensive social, environmental, and behavioral approaches to curtail the risk factors along with early identification, treatment, and management of COPD is of utmost importance.

Association of thrombocytosis with COPD morbidity: the SPIROMICS and COPDGene cohorts

BackgroundThrombocytosis has been associated with COPD prevalence and increased all-cause mortality in patients with acute exacerbation of COPD (AECOPD); but whether it is associated with morbidity in stable COPD is unknown. This study aims to determine the association of thrombocytosis with COPD morbidity including reported AECOPD, respiratory symptoms and exercise capacity.MethodsParticipants with COPD were included from two multi-center observational studies (SPIROMICS and COPDGene). Cross-sectional associations of thrombocytosis (platelet count ≥350 × 109/L) with AECOPD during prior year (none vs. any), exertional dyspnea (modified Medical Research Council (mMRC) score ≥ 2), COPD Assessment Test (CAT) score ≥ 10, six-minute-walk distance (6MWD), and St. George Respiratory questionnaire (SGRQ) were modeled using multivariable logistic or linear regression. A pooled effect estimate for thrombocytosis was produced using meta-analysis of data from both studies.ResultsThrombocytosis was present in 124/1820 (6.8%) SPIROMICS participants and 111/2185 (5.1%) COPDGene participants. In meta-analysis thrombocytosis was associated with any AECOPD (adjusted odds ratio [aOR] 1.5; 95% confidence interval [95% CI]: 1.1–2.0), severe AECOPD (aOR 1.5; 95% CI: 1.1–2.2), dyspnea (mMRC ≥ 2 aOR 1.4; 95% CI: 1.0–1.9), respiratory symptoms (CAT ≥ 10 aOR 1.6; 95% CI: 1.1–2.4), and higher SGRQ score (β 2.7; 95% CI: 0.5, 5). Thrombocytosis was also associated with classification into Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D (aOR 1.7 95% CI: 1.2–2.4).ConclusionsThrombocytosis was associated with higher likelihood of prior exacerbation and worse symptoms. Platelet count, a commonly measured clinical assay, may be a biomarker for moderate-severe COPD symptoms, guide disease classification and intensity of treatment. Future longitudinal studies investigating the role of platelets in COPD progression may be warranted.Trial registrationClinicalTrials.gov: NCT01969344 (SPIROMICS) and NCT00608764 (COPDGene).

Russian guidelines for the management of COPD: algorithm of pharmacologic treatment.

The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs) in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD. The proposed algorithm had to comply with the requirements of the Russian Ministry of Health to be included into the unified electronic rubricator, which required a balance between the level of information and the simplicity of the graphic design. This was achieved by: exclusion of the initial diagnostic process, grouping together the common pharmacologic and nonpharmacologic measures for all patients, and the decision not to use the letters A–D for simplicity and clarity. At all stages of the treatment algorithm, efficacy and safety have to be carefully assessed. Escalation and de-escalation is possible in the case of lack of or insufficient efficacy or safety issues. Bronchodilators should not be discontinued except in the case of significant side effects. At the same time, inhaled corticosteroid (ICS) withdrawal is not represented in the algorithm, because it was agreed that there is insufficient evidence to establish clear criteria for ICSs discontinuation. Finally, based on the Global Initiative for Obstructive Lung Disease statement, the proposed algorithm reflects and summarizes different approaches to the pharmacological treatment of COPD taking into account the reality of health care in the Russian Federation.

The relation of state resident neuroticism levels to state cancer incidence in the USA

The present research was conducted to determine state-level relations of resident neuroticism to age-adjusted cancer incidence, overall health status, the prevalence of four other major illnesses, the incidence of 25 invasive cancer sites, all-cause mortality, and 10 main cause-of-death categories. Responses of 619,397 residents to the Big Five Inventory between 1999 and 2005 produced state neuroticism scores for each of the 50 states. State socioeconomic status, White population percent, urban population percent, heavy drinking, smoking, obesity, exercise, and consumption of fruits and vegetables served as control variables. For each of the 44 criteria, statistical control was attained in sequential multiple regression equations by entering the eight variables first as block, and then first stepwise, followed by the forced entry of neuroticism. For the 2000–2010 period, Study 1 established that state resident neuroticism accounted for an additional 11.2 to 31.7% of the variance in total, male, and female cancer incidence. With the same analytic procedures, Study 2 provided evidence for convergent and discriminant validity. Neuroticism accounted for significant variance in the incidence of a majority of the top 25 invasive cancer sites between 2000 and 2010, and cancer as a cause of death in 2011. In contrast, neuroticism was not a significant positive predictor of overall health in 2011, all-cause mortality in 2011, the prevalence of diabetes, COPD, and kidney disease in 2011, or, death in 2011 from digestive, nervous system, endocrine, nutritional, and metabolic diseases, as well as from mental and behavioral disorders and certain infectious and parasitic diseases.

Estimating prevalence of chronic obstructive pulmonary disease in the Southern Cone of Latin America: how different spirometric criteria may affect disease burden and health policies

BackgroundChronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. The study aimed to determine and compare the prevalence of COPD in the general population aged 45-74 years old according to fixed ratio and lower limit of normal (LLN) thresholds in four cities in the Southern Cone of Latin America.MethodsThe Pulmonary Risk in South America (PRISA) study used a 4-stage stratified sampling method to select 5814 participants from 4 cities in the Southern Cone of Latin America (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Data on demographic information, medical history, risk factors, pre-bronchodilator and post-bronchodilator spirometry were obtained using a standard protocol. According to GOLD, COPD was defined as a post-bronchodilator ratio of forced expiratory volume in one second (FEV1) over forced vital capacity (FVC) less than 70%. The LLN threshold was defined as the lower fifth percentile for predicted FEV1/FVC, and was evaluated as an alternative COPD definition.ResultsOverall COPD prevalence was 9.3% (95% CI 8.4, 10.2%), and men had a higher prevalence [11.8% (95% CI 10.3, 13.3%)] than women [7.3% (95% CI 6.2, 8.3%)] with the fixed ratio. Overall COPD prevalence using LLN was 4.7% (95% CI 4.1, 5.3%), higher in men: 5.8% (95% CI 4.7, 6.8%) than women: 3.9% (95% CI 3.1, 4.7%). COPD prevalence was significantly higher among those who were older, had <high-school education and lower body-mass index, were cigarette smokers, and had self-reported history of asthma and tuberculosis.ConclusionsFirst, COPD and its risk factors are highly prevalent in the general population of Argentina, Chile, and Uruguay. Second, the prevalence of COPD by LLN criterion was significantly lower with lesser degrees of severity compared to fixed ratio of FEV1/FVC. Implementing LLN criterion instead of fixed ratio of FEV1/FVC may reduce the risk of over-diagnosis of COPD, although further prognostic studies of COPD adverse outcomes should be conducted using both definitions. Third, these data suggest that national efforts on the prevention, treatment, and control of COPD should be a public health priority in the Southern Cone of Latin America.

Geographical distribution of COPD prevalence in Europe, estimated by an inverse distance weighting interpolation technique.

Existing data on COPD prevalence are limited or totally lacking in many regions of Europe. The geographic information system inverse distance weighted (IDW) interpolation technique has proved to be an effective tool in spatial distribution estimation of epidemiological variables, when real data are few and widely separated. Therefore, in order to represent cartographically the prevalence of COPD in Europe, an IDW interpolation mapping was performed. The point prevalence data provided by 62 studies from 19 countries (21 from 5 Northern European countries, 11 from 3 Western European countries, 14 from 5 Central European countries, and 16 from 6 Southern European countries) were identified using validated spirometric criteria. Despite the lack of data in many areas (including all regions of the eastern part of the continent), the IDW mapping predicted the COPD prevalence in the whole territory, even in extensive areas lacking real data. Although the quality of the data obtained from some studies may have some limitations related to different confounding factors, this methodology may be a suitable tool for obtaining epidemiological estimates that can enable us to better address this major public health problem.

Use of telemedicine in the assessment of patients referred for pulmonary rehabilitation

ABSTRACTRATIONALE: Due to the high global prevalence and economic burden of COPD, there is growing interest in new approaches to reduce the time from referral to assessment for rehabilitation, especially among those in remote communities.OBJECTIVES: To describe the structure of a pilot teleconsultation (TC) service for people referred for inpatient pulmonary rehabilitation (PR) and the characteristics of patients seen over four years.METHODS: Patient and clinic visit information since inception of the TC service in 2012 was retrieved from the electronic record of the respiratory medicine service at West Park Healthcare Centre. Descriptive statistics were calculated for patient characteristics and TC data.MAIN RESULTS: From January 2012 to December 2015, 112 patients were booked for TC with the majority (n = 90, 80%) attending at least once. Of the 90 attendees, 78 (86%) were seen for assessment for inpatient PR and 61 of them (78%) were subsequently enrolled. Of these 78 patients, the majority (n = 61, 78%) had chronic obstructive pulmonary disease (COPD) as their primary lung condition and they resided in 46 locations across Ontario as well as in Newfoundland, Alberta and New Brunswick. The patients located in Ontario were saved a total of 70,070 km in travel which translates to a travel-only cost savings of $28,028.CONCLUSIONS: TC is an alternative to in-person visits for the assessment of patients referred for PR. It results in meaningful cost savings and increased convenience for the patient and will assist clinicians in identifying those for whom PR would be a valuable intervention.RÉSUMÉJUSTIFICATION: En raison du fardeau économique et de la prévalence mondiale élevés de la MPOC, il y a un intérêt croissant pour les nouvelles approches afin de réduire le délai entre le moment où le patient est référé et son évaluation pour la réadaptation, en particulier chez les résidents des collectivités éloignées.OBJECTIF: Décrire la structure d'un service pilote de téléconsultation destiné aux personnes référées à la réadaptation pulmonaire en milieu hospitalier, de même que les caractéristiques des patients rencontrés au cours d'une période de quatre ans.MÉTHODES: Les renseignements sur les patients et sur les visites à la clinique depuis le début du service de téléconsultation en 2012 ont été récupérés des archives électroniques du service de médecine respiratoire du West Park Healthcare Centre. Des statistiques descriptives ont été calculées pour les données concernant les caractéristiques des patients et la téléconsultation.PRINCIPAUX RÉSULTATS: De janvier 2012 à décembre 2015, 112 patients ont été inscrits à la téléconsultation et la majorité d'entre eux (90,8 %) y ont assisté au moins une fois. Parmi les 90 personnes qui y ont assisté, 78 (86 %) ont été rencontrés pour une évaluation en vue d'une réadaptation pulmonaire et 61 d'entre eux (78 %) y ont subséquemment été inscrits. La majorité de ces 78 patients (n = 61, 78 %) étaient atteints de maladie pulmonaire obstructive chronique (MPOC) en tant que première affection pulmonaire et vivaient dans 46 lieux situés en Ontario, à Terre-Neuve, en Alberta et au Nouveau-Brunswick. Les patients vivant en Ontario ont ainsi évité de parcourir 70 070 km, ce qui se traduit par des épargnes de 28 026 $ uniquement en coûts de transport.CONCLUSIONS: La téléconsultation est une bonne option de rechange aux visites en personne pour l’évaluation des patients référés à la réadaptation pulmonaire. Elle donne lieu à une réduction significative des coûts, tout en étant plus pratique pour le patient. Elle aidera les cliniciens à déterminer les personnes pour qui la réadaptation pulmonaire serait une intervention utile.

Validation of St. George's Respiratory Questionnaire (SGRQ) in Chronic Obstructive Pulmonary Disease (COPD) at Respira Lung Hospital Yogyakarta

The prevalence of COPD in Indonesia is increasing. Over the world, COPD is predicted to be the third cause of death in 2020. As the chronic disease, quality of life became one of the outcome treatments of COPD. This research was aimed to validate Indonesian version of St. George's Respiratory Questionnaire (SGRQ) Indonesia. This study used cross sectional design approach from June to July 2016, conducted at Respira Lung Hospital, Yogyakarta. Data was collected from medical record and direct interviews to patients using SGRQ. An inclusion criterion was adult patients with COPD. Some statistical tests were performed to analyze construct validity, known group validity and reliability of Indonesian version of SGRQ. We recruited 41 respondents. The SGRQ meet reliability criteria with the value of Cronbach alpha are &gt; 0.7 for symptom, activity and impact domains. There are 17 questions and 10 questions in symptom, activity and impact domains which do not meet convergent and discriminant validity. The significant difference is found in symptom domain for the 17-48 and 49-80 year age. The SGRQ Indonesian version is not valid enough to be used in clinical practice but still reliable.

Abstract 21155: Outcomes of Transcatheter Aortic Valve Replacement in High or Extreme Risk Patients With Severe Bicuspid Aortic Valve Stenosis

Introduction: Although TAVR has been performed in patients with bicuspid aortic valves (BAV), these patients were excluded from all the US pivotal trials and therefore their postoperative outcomes are not clearly defined. Hypothesis: Patients with BAV undergoing TAVR may achieve similar outcomes when compared with trileaflet aortic valve (TAV) stenosis. Methods: We retrospectively evaluated the outcomes of high or extreme risk patients with BAV stenosis at our institution between April 2011 and November 2016, and compared them with those of patients with TAV stenosis. Chi-square and the Mann-Whitney U tests were used to compared the groups, and a Kaplan-Meier analysis was performed to estimate long-term survival. The study was approved by the Duke University Hospital Institutional Review Board. Results: TAVR was performed in a total of 567 eligible patients, from which 50 (8.8%) had BAV and 517 (91.2%) TAV disease. Patients with BAV were younger (median age 70 years [64-74] vs. 81 [75-86], p&lt;0.001), had higher prevalence of COPD (52.0% vs. 30.8, p=0.002), lower prevalence of coronary artery disease (64.0% vs 76.8, p=0.036), higher BMI (median 28 kg/m 2 [25-35] vs. 27 [24-31], p=0.046) and lower STS PROM score (median 4.6% [3.0-7.7] vs. 6.7 [4.4-9.9], p=0.004) when compared with those with TAV. Overall, self-expanding and balloon-expandable TAVR devices were used in 58.4% and 41.3% of the cases, and transfemoral access was used in 86.8%. Patients with BAV had a higher mean aortic valve gradient postoperatively (median 12 mmHg [10-15] vs. 10 [7-13], p&lt;0.001). There were no differences in the procedural characteristics or in the incidence of any of the postoperative adverse outcomes between the groups, including moderate to severe paravalvular regurgitation (4.0% vs. 3.5, p=0.541), stroke (2.0% vs. 1.5, p=0.567), and 30-day all-cause mortality (6.0% vs. 1.5, p=0.064). The 2-year survival (82.0% vs. 83.4, p=0.476) was similar between the groups. Conclusions: This initial experience suggests that TAVR can be performed in patients with severe BAV stenosis at high or extreme risk for traditional surgical aortic valve replacement achieving similar short-term clinical outcomes and mid-term survival compared with patients with TAV.

Characteristics of patients with exacerbation of COPD hospitalised in the pulmonology department of a hospital (Yaroslavl study)

Background: The increase in the prevalence of COPD has created serious problems for health in many countries. A feature of COPD is the worsening course of the disease in the presence of exacerbations. We aimed to analyse the epidemiological features of patients hospitalised with an exacerbation of COPD. Methods: This is a retrospective cohort study using a database of patients in the pulmonology department of a city hospital from 2002 to 2016. Findings: On average about 230 people with COPD exacerbation were hospitalised every year in the pulmonology department. Patients with COPD exacerbations averaged 17.9% of the patients admitted to the department. In 2002, patients with exacerbation of COPD comprised 15.2% of all hospitalised patients in the department, which increased to 20.1% in 2016. Most patients were men (85.9%). The average age of patients was 63.7 years, with the average age increasing over the observation period (from 61.4 years to 66.3 years). The average length of hospitalisation for exacerbation of COPD was 14.0 days, with a decrease over the observation period (from 16.7 days to 11.8 days). On admission to hospital, FEV1 averaged 43.1%, while at discharge from hospital the average volume was 49.6%. The combination of COPD and asthma in different years ranged from 3.7% to 17.1% of patients (average 9.6%). Cancer of the respiratory system was noted on average in 3.1% patients hospitalised with exacerbation of COPD (with increase over time from 1.6% to 4.0%). Cardiovascular pathology was the most common concomitant disease, including arterial hypertension (54.7%) and ischaemic heart disease (23.8%). The level of respiratory function disorders was distributed as follows: 4.7% of patients were stage 1; 32.6% were stage 2; 40.9% were stage 3; and 20.3% were stage 4. More than half of patients (53.2%) were disabled and 19.9% worked. Hospital mortality of patients with exacerbation of COPD increased from 0% in 2002 to 3.0% in 2016. Interpretation: It is necessary to pay attention to the features of patients with exacerbation of COPD. In our sample, there was preponderance of men older than 60 years old and of serious cardiovascular diseases and risk factors for unfavourable outcomes grew over time. Epidemiological monitoring of these patients could help to unify approaches to manage patients and better understand characteristics of this patient group. Conflicts of interest: We declare that we have no conflicts of interest.

Characteristics of COPD patients according to GOLD classification and clinical phenotypes in the Russian Federation: the SUPPORT trial.

BackgroundThe high prevalence of COPD in the Russian Federation has been demonstrated in several epidemiological studies. However, there are still no data on the clinical characteristics of these patients according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups and phenotypes, which could provide additional understanding of the burden of COPD, routine clinical practice, and ways to improve the treatment of patients with COPD in Russia.Patients and methodsSUPPORT was an observational multicenter study designed to obtain data about the distribution of patients with previously diagnosed COPD according to the severity of bronchial obstruction, symptom severity, risk of exacerbation, COPD phenotypes, and treatment of COPD. We included patients with a previous diagnosis of COPD who visited one of 33 primary-care centers for any reason in 23 cities in Russia.ResultsAmong the 1,505 patients with a previous diagnosis of COPD who attended the primary-care centers and were screened for the study, 1,111 had a spirometry-confirmed diagnosis and were included in the analysis. Up to 53% of the patients had severe or very severe COPD (GOLD stages III–IV), and 74.3% belonged to the GOLD D group. The majority of patients were frequent exacerbators (exacerbators with chronic bronchitis [37.3%], exacerbators without chronic bronchitis [14%]), while 35.8% were nonexacerbators and 12.9% had asthma–COPD overlap. Among the GOLD D group patients, >20% were treated with only short-acting bronchodilators.ConclusionCOPD is still misdiagnosed in primary care in Russia. COPD patients in primary care are usually GOLD D with frequent exacerbations and are often treated with only short-acting bronchodilators.

Chronic obstructive pulmonary disease and β-blocker treatment in Asian patients with heart failure.

AimsChronic obstructive pulmonary disease (COPD) and heart failure (HF) are increasingly frequent in Asia and commonly coexist in patients. However, the prevalence of COPD among Asian patients with HF and its impact on HF treatment are unclear.Methods and resultsWe compared clinical characteristics and treatment approaches between patients with or without a history of COPD, before and after 1:2 propensity matching (for age, sex, geographical region, income level, and ethnic group) in 5232 prospectively recruited patients with HF and reduced ejection fraction (HFrEF, <40%) from 11 Asian regions (Northeast Asia: South Korea, Japan, Taiwan, Hong Kong, and China; South Asia: India; Southeast Asia: Thailand, Malaysia, Philippines, Indonesia, and Singapore). Among the 5232 patients with HFrEF, a history of COPD was present in 8.3% (n = 434), with significant variation in geography (11.0% in Northeast Asia vs. 4.7% in South Asia), regional income level (9.7% in high income vs. 5.8% in low income), and ethnicity (17.0% in Filipinos vs. 5.2% in Indians) (all P < 0.05). Use of mineralocorticoid receptor antagonists and diuretics was similar between groups, while usage of all β‐blockers was lower in the COPD group than in the non‐COPD group in the overall (66.3% vs. 79.9%) and propensity‐matched cohorts (66.3% vs. 81.7%) (all P < 0.05). A striking exception was the Japanese cohort in which β‐blocker use was high in COPD and non‐COPD patients (95.2% vs. 91.2%).ConclusionsThe prevalence of COPD in HFrEF varied across Asia and was related to underuse of β‐blockers, except in Japan.

Preoperative Toxoplasma gondii serostatus does not affect long-term survival of cardiac transplant recipients. Analysis of the Spanish Heart Transplantation Registry.

It's unclear whether pre-transplant T. gondii seropositivity is associated with impaired survival in heart transplant recipients. To test the above-mentioned hypothesis in the Spanish Heart Transplantation Registry. Post-transplant outcomes of 4048 patients aged >16years who underwent first, single-organ heart transplantation in 17 Spanish institutions from 1984 to 2014 were studied. Long-term post-transplant survival and survival free of cardiac death or retransplantation of 2434 (60%) T. gondii seropositive recipients and 1614 (40%) T. gondii seronegative recipients were compared. T. gondii seropositive recipients were older, had higher body mass index, and presented higher prevalence of hypertension, hypercholesterolemia, COPD and Cytomegalovirus seropositivity than T. gondii seronegative recipients. In univariable analysis, pre-transplant T. gondii seropositivity was associated with increased post-transplant all-cause mortality (non-adjusted HR 1.15; 95% CI 1.04-1.26). However, this effect was no longer statistically significant after multivariable adjustment by recipient's age and sex (adjusted HR 1.01, 95% CI 0.92-1.11). Extended multivariable adjustment by other potential confounders showed similar results (adjusted HR 0.99, 95% CI 0.89-1.11). T. gondii seropositivity had no significant effect on the composite outcome cardiac death or retransplantation (non-adjusted HR 1.08, 95% CI 0.95-1.24, p=0.235). The distribution of the causes of death was comparable in T. gondii seropositive and T. gondii seronegative recipients. No statistically significant impact of donor's T. gondii serostatus or donor-recipient T. gondii serostatus matching on post-transplant survival was observed. Our analysis did not show a significant independent effect of preoperative T. gondii serostatus on long-term outcomes after heart transplantation.