COPD Deaths Research Articles

Ambient particulate matter and chronic obstructive pulmonary disease mortality: a nationwide, individual-level, case-crossover study in China

Short-term exposure to particulate matter air pollution has been associated with the exacerbations of COPD, but its association with COPD mortality was not fully elucidated. We aimed to assess the association between short-term particulate matter exposure and the risk of COPD mortality in China using individual-level data. We derived 2.26 million COPD deaths from a national death registry database in Chinese mainland between 2013 and 2019. Exposures to fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) were assessed by satellite-based models of a 1×1km resolution and assigned to each individual based on residential address. The associations of PM2.5 and PM2.5-10 with COPD mortality were examined using a time-stratified case-crossover design and conditional logistic regressions with distributed lag models. We further conducted stratified analyses by age, sex, education level, and season. Short-term exposures to both PM2.5 and PM2.5-10 were associated with increased risks of COPD mortality. These associations appeared and peaked on the concurrent day, attenuated and became nonsignificant after 5 or 7 days, respectively. The exposure-response curves were approximately linear without discernible thresholds. An interquartile range increase in PM2.5 and PM2.5-10 concentrations was associated with 4.23% (95% CI: 3.75%, 4.72%) and 2.67% (95% CI: 2.18%, 3.16%) higher risks of COPD mortality over lag 0-7d, respectively. The associations of PM2.5 andPM2.5-10 attenuated slightly but were still significant in the mutual-adjustment models. A larger association of PM2.5-10 was observed in the warm season. This individual-level, nationwide, case-crossover study suggests that short-term exposure to PM2.5 and PM2.5-10 might act as one of the environmental risk factors for COPD mortality. This study is supported by the National Key Research and Development Program of China (2023YFC3708304 and 2022YFC3702701), the National Natural Science Foundation of China (82304090 and 82030103), the 3-year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.2-YQ31), and the Science and Technology Commission of Shanghai Municipality (21TQ015).

Timing of follow-up visits after hospital discharge for COPD: Application of a new method.

A common strategy to reduce COPD readmissions is to encourage patient follow-up with a physician within 1 to 2 weeks of discharge, yet evidence confirming its benefit is lacking. We used a new study design called target randomized trial emulation to determine the impact of follow-up visit timing on patient outcomes. All Ontario residents aged 35 or older discharged from a COPD hospitalization were identified using health administrative data and randomly assigned to those who received and did not receive physician visit follow-up by within seven days. They were followed to all-cause emergency department visits, readmissions or death. Targeted randomized trial emulation was used to adjust for differences between the groups. COPD emergency department visits, readmissions or death was also considered. There were 94,034 patients hospitalized with COPD, of whom 73.5% had a physician visit within 30 days of discharge. Adjusted hazard ratio for all-cause readmission, emergency department visits or death for people with a visit within seven days post discharge was 1.03 (95% Confidence Interval [CI]: 1.01-1.05) and remained around 1 for subsequent days; adjusted hazard ratio for the composite COPD events was 0.97 (95% CI 0.95-1.00) and remained significantly lower than 1 for subsequent days. While a physician visit after discharge was found to reduce COPD events, a specific time period when a physician visit was most beneficial was not found. This suggests that follow-up visits should not occur at a predetermined time but be based on factors such as anticipated medical need.

Effects of ambient temperature and humidity on COPD mortality in Ganzhou city, China.

This study used the time series data of Ganzhou city to explore the individual and interaction effects of temperature and humidity on COPD death, and identify vulnerable subgroups of the population. We collected daily COPD mortality and meteorological data in Ganzhou from 2016 to 2019. The nonlinear distribution lag model was used to examine the associations and interaction between daily mean temperature and humidity and COPD mortality. For the total population, male and 65 years old or above, the relative risk (RR) for COPD mortality could be significant at extremely low temperature (3.3 ℃), reaching 1.799 (95% confidence interval [CI]: 1.216, 2.662), 1.894 (95% CI: 1.164, 3.084) and 1.779 (95% CI:1.185, 2.670). Also, at extremely low humidity (47.8%), the risk reached 1.888 (95% CI: 1.217, 2.930), 1.837 (95% CI: 1.066, 3.165) and 2.166 (95% CI: 1.375, 3.414). The cumulative COPD death risk for females was 3.524 (95% CI: 1.340, 9.267) at high temperature (30.7 ℃), 1.953(95% CI: 1.036, 3.683) at low humidity (47.8%) and 1.726 (95% CI: 1.048, 2.845) at high humidity (96.7%). For the total COPD deaths and subgroups, the interaction effects between daily temperature and humidity were not significant (p > 0.05). Both extremely low temperature and low humidity increased the risk of COPD death in Ganzhou city, especially for males and people over 65 years old. Females were more sensitive to extremely high temperature and humidity. Patients with COPD should pay attention to self-protection under extreme temperature and humidity weather conditions.

Relationship Between Systemic Immune-Inflammation Index and Risk of Respiratory Failure and Death in COPD: A Retrospective Cohort Study Based on the MIMIC-IV Database.

Chronic obstructive pulmonary disease (COPD) concurrent with respiratory failure (RF) is devastating, and may result in death and disability. Systemic immune-inflammation index (SII) is a new prognostic biomarker linked to unfavorable outcomes of acute coronary syndrome, ischemic stroke, and heart failure. Nonetheless, its role in COPD is rarely investigated. Consequently, this study intends to assess the accuracy of SII in predicting the prognosis of COPD. The clinical information was retrospectively acquired from the Medical Information Mart for Intensive Care-IV database. The outcomes encompassed the incidence of RF and mortality. The relationship between different SII and outcomes was examined utilizing the Cox proportional-hazards model and restricted cubic splines. Kaplan-Meier analysis was employed for all-cause mortality. The present study incorporated 1653 patients. During hospitalization, 697 patients (42.2%) developed RF, and 169 patients (10.2%) died. And 637 patients (38.5%) died during long-term follow-up. Higher SII increased the risk of RF (RF: HR: 1.19, 95% CI 1.12-1.28, P<0.001), in-hospital mortality (HR: 1.22, 95% CI 1.07-1.39, P=0.003), and long-term follow-up mortality (HR: 1.12, 95% CI 1.05-1.19, P<0.001). Kaplan-Meier analysis suggested a significantly elevated risk of all-cause death (log-rank P<0.001) in patients with higher SII, especially during the short-term follow-up period of 21 days. SII is closely linked to an elevated risk of RF and death in COPD patients. It appears to be a potential predictor of the prognosis of COPD patients, which is helpful for the risk stratification of this population. However, more prospective studies are warranted to consolidate our conclusion.

Cardiovascular Events According to Inhaler Therapy and Comorbidities in Chronic Obstructive Pulmonary Disease.

COPD coexists with many concurrent comorbidities. Cardiovascular complications are deemed to be major causes of death in COPD. Although inhaler therapy is the main therapeutic intervention in COPD, cardiovascular events accompanying inhaler therapy require further investigation. Therefore, this study aimed to investigate new development of cardiovascular events according to each inhaler therapy and comorbidities. This study analyzed COPD patients (age ≥ 40 years, N = 199,772) from the Health Insurance Review and Assessment Service (HIRA) database in Korea. The development of cardiovascular events, from the index date to December 31, 2020, was investigated. The cohort was eventually divided into three arms: the LAMA/LABA group (N = 28,322), the ICS/LABA group (N = 11,812), and the triple group (LAMA/ICS/LABA therapy, N = 6174). Multivariable Cox analyses demonstrated that, compared to ICS/LABA therapy, triple therapy was independently associated with the development of ischemic heart disease (HR: 1.22, 95% CI: 1.04-1.43), heart failure (HR: 1.45, 95% CI: 1.14-1.84), arrhythmia (HR: 1.72, 95% CI: 1.41-2.09), and atrial fibrillation/flutter (HR: 2.31, 95% CI: 1.64-3.25), whereas the LAMA/LABA therapy did not show a significant association. Furthermore, emergency room visit during covariate assessment window was independently associated with the development of ischemic heart disease, heart failure, arrhythmia, and atrial fibrillation/flutter (p < 0.05). Our data suggest that cardiovascular risk should be considered in COPD patients receiving triple therapy, despite the confounding bias resulting from disparities in each group.

Effects of air temperature on the risk of death from COPD in major microregions in Brazil: a time series study.

To evaluate the association between the risk of death from COPD and air temperature events in ten major Brazilian microregions. This was a time series analysis of daily COPD deaths and daily mean air temperatures between 1996 and 2017. Using distributed nonlinear lag models, we estimated the cumulative relative risks of COPD mortality for four temperature percentiles (representing moderate and extreme cold and heat events) in relation to a minimum mortality temperature, with a lag of 21 days, in each microregion. Significant associations were found between extreme air temperature events and the risk of death from COPD in the southern and southeastern microregions in Brazil. There was an association of extreme cold and an increased mortality risk in the following microregions: 36% (95% CI, 1.12-1.65), in Porto Alegre; 27% (95% CI, 1.03-1.58), in Curitiba; and 34% (95% CI, 1.19-1.52), in São Paulo; whereas moderate cold was associated with an increased risk of 20% (95% CI, 1.01-1.41), 33% (95% CI, 1.09-1.62), and 24% (95% CI, 1.12-1.38) in the same microregions, respectively. There was an increased COPD mortality risk in the São Paulo and Rio de Janeiro microregions: 17% (95% CI, 1.05-1.31) and 12% (95% CI, 1,02-1,23), respectively, due to moderate heat, and 23% (95% CI, 1,09-1,38) and 32% (95% CI, 1,15-1,50) due to extreme heat. Non-optimal air temperature events were associated with an increased risk of death from COPD in tropical and subtropical areas of Brazil.

Application of the RE-AIM framework to evaluate the implementation of telehealth pulmonary rehabilitation in a randomized controlled trial among African-American and Hispanic patients with advanced stage Chronic Obstructive Pulmonary Disease

BackgroundPulmonary rehabilitation (PR) decreases rehospitalization for people with COPD. However, less than 2% receive PR, partly due to lack of referral and sparsity of PR facilities. This disparity is particularly pronounced in African American and Hispanic persons with COPD. Telehealth-provided PR could increase access and improve health outcomes.MethodsWe applied the RE-AIM framework in a post-hoc analysis of our mixed methods RCT comparing referral to Telehealth-delivered PR (TelePR) versus standard PR (SPR) for African American and Hispanic COPD patients hospitalized for COPD exacerbation. Both arms received a referral to PR for 8 weeks, social worker follow-up, and surveys administered at baseline, 8 weeks, 6, and 12 months. PR sessions were conducted twice a week for 90 min each (16 sessions total). Quantitative data were analyzed using 2-sample t tests or nonparametric Wilcoxon tests for continuous data and χ2/Fisher exact tests for categorical data. Logistic regression–estimated odds ratios (ORs) were used for the intention-to-treat primary outcome. Qualitative interviews were conducted at the end of the study to assess adherence and satisfaction and were analyzed using inductive and deductive methods. The goal was to understand Reach (whether the target population was able to be enrolled), Effectiveness (primary outcome was a composite of 6-month COPD rehospitalization and death), Adoption (proportion of people willing to initiate the program), Implementation (whether the program was able to be executed as intended, and Maintenance (whether the program was continued).ResultsTwo hundred nine people enrolled out of a 276-recruitment goal. Only 85 completed at least one PR session 57/111 (51%) TelePR; 28/98 (28%) SPR. Referral to TelePR compared to SPR did not decrease the composite outcome of 6-month COPD-readmission rate/death (OR1.35;95%CI 0.69,2.66). There was significant reduction in fatigue (PROMIS® scale) from baseline to 8-weeks in TelePR compared to SPR (MD-1.34; ± SD4.22; p = 0.02). Participants who received TelePR experienced improvements from baseline in several outcomes (ie, before and after 8 weeks of PR) in the following: COPD symptoms, knowledge about COPD management, fatigue, and functional capacity. Among the patients who had 1 initial visit, adherence rates were similar (TelePR arm, 59% of sessions; SPR arm, 63%). No intervention-related adverse events occurred. Barriers to PR adoption included difficulty or reluctance to complete medical clearances and beliefs about PR efficacy. Notably, only 9 participants sustained exercise after program completion. Maintenance of the program was not possible due to low insurance reimbursement and sparsity of Respiratory Therapists.ConclusionsTelePR can reach COPD patients with health disparities and can be successfully implemented. The small sample size and large confidence intervals prevent conclusion about the relative effectiveness of participating in TelePR compared to SPR. However, improved outcomes were seen for those in TelePR as well as in SPR. Increasing adoption of PR and TelePR requires consideration of comorbidity burden, and perception of PR utility, and must facilitate medical clearances. Given the sparsity of SPR locations, TelePR can overcome at least the barrier of access. However, given the challenges to the uptake and completion of PR - many of the additional barriers in PR (both in TelePR and SPR) need to be addressed. Awareness of these real-world challenges will not only inform implementation of TelePR for clinicians seeking to adopt this platform but will also inform study designers and reviewers regarding the feasibility of approaches to patient recruitment and retention.

A Study to Assess the Effectiveness of STP Regarding Knowledge of Preventive Measures on COPD Among Old Age People in Selected Village Rohtas Bihar

INTRODUCTION: COPD is a chronic airway limited disease as characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The more familiar terms ‘chronic bronchitis’ and ‘emphysema’ are no longer used, but are now included within the COPD diagnosis. COPD is not simply a “smoker’s cough” but an under-diagnosed, life-threatening lung disease. According to WHO report that the 3.29 million of people suffer with the COPD death, in nearly 90% of COPD death in those under 70 years of age occur in developing countries. The most cause of COPD the including environmental exposure to tobacco, smoke, indoor air pollution and occupational dusts, fumes, and chemicals are important risk. The early is most common treatment of COPD economic preventable management is quite smoking, and is needed to slow the progression of symptoms. AIM: To assess the effectiveness of STP on knowledge of preventive measures on COPD among old age people. METHODOLOGY: The pre-experimental one group pre-test and post-test design was conducted at Takiya, Sasaram, Rohtas, Bihar from 6/2/23 to 10/2/23. The conceptual framework utilized in this study was based on General System theory of “Ludwig von Bertalanffy”. A self-structured questionnaire method was used to assess the pre-test level of knowledge of preventive measures on COPD among old age people in selected village Rohtas Bihar by adopting probability random sampling technique. Immediately after pre-test STP was implemented just after the implementation post-test was conducted by using same questionnaire method. The result was analyzed. RESULTS: Before implementation of STP the knowledge level of old age people, (32) had poor knowledge, (28) had average knowledge and none of them had good knowledge of preventive measures on COPD among old age people in selected village Rohtas Bihar and the pre-test mean knowledge score was. After implementation of STP the knowledge level of old age people, none of them had poor knowledge, (31) had average level of knowledge and (29) had good knowledge of preventive measures on COPD among old age people in selected village Rohtas Bihar. The post-test mean score (14.72) of knowledge of preventive measures on COPD among old age people were comparatively more than their pre-test mean knowledge score (7.98). It confirms that, there was increase in knowledge of preventive measures on COPD among old age people after the administration of STP. CONCLUSION: At last, as a researchers, we concluded that there is increase in knowledge of preventive measures on COPD among old age people after implementation of STP and there is no association between variable and sociodemographic variables.

Predicting Early Versus Late In-Hospital Mortality in the Trauma Population.

This study aimed to evaluate non-survivors who were admitted to a level I trauma center but later died, in terms of predicting who would expire early vs late. This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. Trauma patients who may experience an earlier death were those with increasing injury severity scores, activation of massive transfusion protocol, comorbid advanced directive limiting care, COPD, personality disorder, and ED death location. Patients were more likely to experience later in-hospital mortality, including those with increasing ICU stays, and comorbid dementia.

Outdoor air pollution impacts chronic obstructive pulmonary disease deaths in South Asia and China: a systematic review and meta-analysis

Background: Chronic obstructive lung disease is among leading causes of death globally. Exposure to outdoor pollution is an important cause for increased mortality and morbidity. Objective: To present a systemic synthesis evidence regarding impact of outdoor pollution on COPD mortality in south asia and china. Methods: A systematic search on studies with statistical power has been conducted from 1990 - June 30th 2021, in English electronic databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from MEDLINE and PUBMED databases with terms: Chronic Obstructive Pulmonary disease OR 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 AND Outdoor pollution, ambient pollution was conducted. Results: Out of 1899 papers screened only 16 found eligible to be included in the study. Subjects with COPD exposed to higher levels of outdoor air pollution had a 49 % higher risk of death as compared to COPD subjects exposed to lower levels of outdoor air pollution. When taken individual pollutants into consideration, common air pollutants like PM10 had an OR of 1.06 at CI 95%, where as SO2 had OR of 0.66 at 95% CI , and NO2 with 1.01 OR at 95% CI. These values suggest that there is an effect of outdoor pollution on COPD but not to a significant level. Conclusion: Despite heterogeneity across selected studies, exposure to outdoor pollutants found to have risk of COPD mortality. Though it appears to have risk, COPD mortality was not significantly associated with outdoor pollutants. Controlling air pollution can substantially decrease the risk of COPD in South Asia and China. Further research including more prospective and longitudinal studies are urgently needed in COPD sub-groups.

CORRELATION OF 6MWD WITH FEV1% &amp; DLCO% IN COPD PATIENTS

BACKGROUND: Chronic obstructive pulmonary disease is the third leading cause of death worldwide, causing 3.23 million deaths in 2019 according to WHO. Nearly 90% of COPD deaths in those under 70 years of age occur in low and middle income countries (LMIC). There may be a considerable nancial burden due to limitation of workplace and home productivity, and costs of medical treatment. Spirometry is used not only for conforming the diagnosis but also for grading the severity of COPD. 6MWD test has gained importance's in the assessments of functional exercise capacity in patients with COPD and other Respiratory diseases. Diffusion Capacity of the Lung for Carbon Monoxide (DLCO) has been employed as an additional investigation to aid in assessing the properties of gas transfer in many respiratory diseases. It is a hospital based cross sectional and analytic MATERIALS AND METHODS: al study performed over a period of 12 months (June 2021-june 2022) in the department of Respiratory medicine, Narayana medical college and hospital, Nellore, in 30 patients diagnosed with COPD and patients were subjected to 6MWD, spirometry and DLCO. RESULTS: Correlation between FEV1% &amp; DLCO%, FEV1% &amp; 6MWD and DLCO% &amp; 6MWD were done respectively. Among the rst correlation(FEV1% &amp; DLCO%) there is a statistically signicant moderate and strong positive correlation observed in severe and very severe patients respectively. Among the second correlation (FEV1% &amp; 6MWD) only in the whole sample there is statistically signicant moderate positive correlation observed. Among the third correlation (DLCO% &amp; 6MWD) only in severe patients of COPD there is a statistically signicant moderate positive correlation observed. There is a slightly greater correlation for DLCO% &amp; 6MWD compared to FEV1%. In CONCLUSION: severe COPD patients decline in 6MWD can be used to monitor the disease progression where as the decline in DLCO% can be used to keep track of the severe and very severe stages of COPD. Incorporating of DLCO in grading COPD severity can help as a marker of exercise capacity limitation.

Associations and burdens of relative humidity with cause-specific mortality in three Chinese cities.

This study aimed to investigate the association between relative humidity (RH) and various cause of mortality, and then quantify the RH-related mortality fraction of low and high RH under the assumption that causal effects exist. Daily cause-specific mortality counts from 2008 to 2011, and contemporaneous meteorological data in three Chinese cities were collected. Distributed lag nonlinear models were adopted to quantify the nonlinear and delayed effects of RH on mortality risk. Low and high RH were defined as RH lower or higher than the minimum mortality risk RH (MMRH), respectively. Corresponding RH-related mortality fractions were calculated in the explanatory analysis. From the three cities, 736,301 deaths were collected. RH (mean ± standard deviation) were 50.9 ± 20.0 for Beijing, 75.5 ± 8.6 for Chengdu, and 70.8 ± 14.6 for Nanjing. We found that low RH in Beijing and high RH (about 80-90%) in Chengdu was associated with increased all-cause mortality risk. Both low and high RH may increase the CVD mortality risk in Beijing. Both low and high (about 80-85%) RH may increase the COPD mortality risk in Chengdu. Low RH (about < 45%) was associated with increased diabetes mortality risk in Nanjing. Effects of extreme low and extreme high RH were delayed in these cities, except that extreme low effects on COPD mortality appeared immediately in Chengdu. The effects of extreme low RH are higher than that of the extreme high RH in Beijing and Nanjing, while contrary in Chengdu. Finally, under the causal effect assumption, 6.80% (95% eCI: 2.90, 10.73) all-cause mortality and 12.48% (95% eCI: 7.17, 16.80) CVD deaths in Beijing, 9.59% (95% eCI: 1.38, 16.88) COPD deaths in Chengdu, and 23.79% (95% eCI: 0.92, 387.93) diabetes mortality in Nanjing were attributable to RH. Our study provided insights into RH-mortality risk, helped draw relative intervention policies, and is also significant for future predictions of climate change effects under different scenarios.

Spatial Association of Environmental and Dietary Factors with COPD Deaths.

IntroductionChronic obstructive pulmonary disease (COPD) remains a significant health concern globally and spatiotemporal investigations on the etiology and progression of COPD are needed to develop more effective and timely preventive measures. To address this continuing need, we explored the association of air-quality and meteorological markers, fruit and vegetable consumption and drinking water source trajectories with COPD death rate.MethodsFor 81 provinces of Turkey, we extracted and merged data in four dimensions: provincial COPD deaths, provincial annual meteorological and air-quality markers, drinking water source data covering rivers, dams, wells, and springs, and annual provincial fruits and vegetables consumption. To investigate the association of these markers with COPD deaths, we used a spatial modelling approach accounting for the spatial autocorrelation.ResultsControlling for household expenditure on cigarette and alcohol and elderly population size, our models suggest that provinces with higher consumption of lemon and higher temperature reported lower level of COPD deaths and provinces high in Nitrogen Dioxide concentration reported higher COPD deaths on average.ConclusionTherefore, provinces with such profiles need to develop closer screening and follow-up of patients with COPD and encourage healthier diets and lifestyles.

Gender differences in specific trends of COPD mortality in Croatia

ObjectivesChronic obstructive pulmonary disease (COPD) is one of the most common lower respiratory chronic diseases. The aim of this study was to analyze the COPD mortality trends in Croatia for the period 2010–2019 and to identify possible changes and differences by age group and gender. Study design and methodsIn data analysis were included COPD death cases for the period 2010–2019 defined as ICD-10 code J44.0 – J44.9. Mortality data were obtained from the Croatian Institute of Public Health based on death certificates. To model temporal changes in mortality rates joinpoint regression analysis was carried out. ResultsThe number of COPD deaths increased in men from 878 in 2010 to 1083 in 2019 and in women from 520 in 2010 to 737 in 2019. Over the 10-year period, there was a stable age-standardized COPD mortality rate among men and statistically significant increasing age-standardized COPD mortality rate among women at the national level. ConclusionsThe findings show a narrowing of the gender gap of COPD mortality. Observed higher COPD mortality rates with age in both men and women confirm previous data and imply that the number of COPD deaths will continue to increase in the future. The healthcare system should focus on the improvement of the quality of care and investment in health promotion and prevention programs aimed at reducing risk factors for COPD, especially tobacco smoking, as well as raising awareness and knowledge about COPD as a chronic disease.

Estimation of long-term and short-term health effects attributed to PM2.5 standard pollutants in the air of Ardabil (using Air Q + model).

Clean air is considered as a basic need for human health. However, air pollution is a significant threat to health in developed and developing countries. The aim of this study was to estimate the health effects attributed to PM2.5 pollutants in the air of Ardabil in 2018 (using Air Q + model). Raw data related to particles were collected from the Department of Environment and processed in Excel software and converted into an input file of the Air Q + model, and in the final stage, by considering appropriate epidemiological parameters and combining these data with air quality data, it was possible to estimate the health effects of air pollution. The results showed that the average annual concentrations of PM2.5 and PM10 were 15.47 and 30.94 in the study year, respectively. The total number of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths on average during the study period were estimated to be 73, 11, 7, 15, and 14 deaths, respectively, which include 14.62, 15.78, 4.9, 12.43, and 11.6% of deaths due to ALRI, COPD, lung cancer, IHD, and stroke deaths, respectively. In conditions of concentration above 5µg/m3, attributed proportion, total number of attributed cases and number of attributed cases per 100,000 population (with moderate relative risk and confidence interval of 95%) for cardiovascular diseases have been estimated to be 0.95% 103 people and 42.19 people. Also, the attributed proportion, the total number of attributable cases, and the number of attributable cases per 100,000 population (with moderate relative risk and confidence of 95%) for the admission of respiratory diseases have been estimated at 97.1%, 68 persons and 3 persons, respectively. Our results suggest that particle exposure even at low concentrations is associated with an increased risk of overall mortality and specific cause mortality and hospital admissions for respiratory and cardiovascular diseases.

PREVALENCE OF METABOLIC SYNDROME IN COPD CASES IN CENTRAL INDIA AND ITS CORRELATION WITH BMI

BACKGROUND: COPD is the third leading cause of death worldwide with more than 90% of COPD deaths occuring in low and middle income countries. While metabolic syndrome is a cluster of the most dangerous cardiovascular risk factors , dened to be associated with prothrombotic and proinammatory states. About 20%- 25% adult population of the world have Metabolic syndrome and are three times more likely to have coronary artery disease or stroke . Increasing evidence shows association between Metabolic Syndrome in COPD. However, the frequency of Metabolic Syndrome and its individual components are not still been clearly shown especially in Indian population in central India . METHODS: This was a cross sectional study conducted at Department of Respiratory Medicine, Gandhi Medical College &amp; Hamidia hospital, Bhopal. 100 spirometrically conrmed COPD cases were enrolled after permission from institutional ethics committee . Detailed history , clinical examination , laboratory parameters and anthropometric parameters were taken. RESULTS: Mean age of patients with COPD was 60.34±10.39 years .Mean weight, height and BMI of patients was 55.86±9.43 2. 2 kg, 160.47±7.58 m and 21.65±3.01kg/m .Majority - 57% patients had normal BMI (18.5 to 22.9 kg/m ). About 25% and 11% patients were overweight and underweight respectively. Metabolic syndrome was found to be present in 32% of the patients with COPD. BMI of patients with metabolic syndrome was signicantly higher as compared to COPD patients without metabolic syndrome (p&lt;0.01). CONCLUSION: The prevalence of metabolic syndrome in COPD was 32% and BMI in COPD patients with metabolic syndrome was signicantly higher than those without metabolic syndrome .

Global burden of COPD attributable to ambient PM2.5 in 204 countries and territories, 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019

The global spatiotemporal pattern of the COPD burden attributable to ambient PM2.5 is unknown in the context of the continuing increase in exposure to ambient PM2.5. Data on COPD burden attributable to ambient PM2.5 from 1990 to 2019 were retrieved from the Global Burden of Disease Study 2019. Cases and age-standardized rates of COPD mortality (ASMR) and disability-adjusted life years (ASDR) were estimated by age, sex, region, and country. The estimated annual percentage change (EAPC) was calculated to quantify the secular trends of ASMR and ASDR from 1990 to 2019. Globally, the number of COPD deaths and DALYs attributable to ambient PM2.5 both increased by over 90% from 1990 to 2019, but ASMR and ASDR both slightly decreased, with EAPC of −0.58 (95% CI: −0.72, −0.44) and −0.40 (95% CI: −0.51, −0.29), respectively. Most COPD deaths and DALYs attributable to PM2.5 occurred in the middle sociodemographic index (SDI) region, but the fastest growth of ASMR and ASDR occurred in the low SDI region, with EAPCs of 2.41 (95% CI: 2.23, 2.59) and 2.34 (95% CI: 2.16, 2.52), respectively. East Asia and South Asia were the high-risk areas of COPD deaths and DALYs attributable to PM2.5, among which China and India were the countries with the heaviest burden. COPD deaths and DALYs attributable to PM2.5 mainly occurred in individuals 70–89 years old and 60–84 years old, respectively. The age-specific rates of mortality and DALYs had a rapid increase in low and low-middle SDI regions from 1990 to 2019. The ASMR or ASDR had a reverse V-shaped relationship with SDI. In summary, the ambient PM2.5-attributable COPD burden is socioeconomic- and age-dependent, and it mediates the heterogeneity of spatial and temporal distribution. Low- and middle-income countries endure the highest ambient PM2.5-attributable COPD burden due to the high exposure to PM2.5 and poor availability and affordability of medicines and diagnostic tests.

Red blood cell distribution width and serum CA-125 level as prognostic markers in acute exacerbation of chronic obstructive pulmonary disease.

ObjectiveAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a primary cause of hospitalization and death in COPD. Serum CA-125 and red blood cell distribution width (RDW) are related to AECOPD. We investigated correlations between serum markers and AECOPD.MethodsIn total, 132 patients with AECOPD were included from January 2017 to December 2019. Participants were followed for 1 year. Patients were assigned to the poor prognosis (n = 40) or good prognosis (n = 92) group. We collected serum samples and general clinical information and conducted routine blood tests. We used logistic regression, receiver operating characteristic (ROC), and area under the ROC curve (AUC) analyses to assess differences between groups.ResultsWe found significant differences between groups (odds ratio, 95% confidence interval) for age (1.046, 1.005–1.09), RDW (2.012, 1.339–3.023), and cancer antigen 125 (CA-125; 1.022, 1.006–1.039); these remained risk factors for AECOPD prognosis in multivariate analyses. RDW and CA-125 in combination was significant in ROC curve analysis. The AUC of RDW, CA-125, and these combined were 0.691, 0.779, and 0.772, respectively. Patients with RDW >12.75% and CA-125 >15.65 U/mL were predicted to have poor prognosis.ConclusionsWe found that RDW and CA-125 are potential prognostic indicators for AECOPD.

Earlier palliative home care is associated with patient-centred medical resource utilisation and lower costs in the last 30 days before death in COPD: a population-level decedent cohort study

COPD patients often use many medical resources, such as hospital admissions and medical imaging, inappropriately close to death. Palliative home care (PHC) could beneficially affect this. The aim was to study the effect of use and timing of PHC on medical resource use and costs in the last 30 days before death (DBD) for COPD.We performed a retrospective study of all Belgian decedents in 2010-2015 with COPD and a primary cause of death being COPD or cardiovascular diseases. Odds ratios for medical resources were calculated between using and four PHC timing categories (>360, 360-181, 180-91 and 90-31 DBD) versus not using. Confounders were socio-demographic, care intensity and disease severity variables.Of the 58 527 decedents with COPD, 644 (1.1%) patients received PHC earlier than 30 DBD. Using PHC (versus not using) decreased the odds ratio for hospitalisation (0.35), intensive care unit admission (0.16), specialist contacts (0.58), invasive ventilation (0.13), medical imaging including chest radiograph (0.34), sedatives (0.48) and hospital death (0.14). It increased the odds ratio for home care (3.27), general practitioner contact (4.65), palliative care unit admission (2.61), noninvasive ventilation (2.65), gastric tube (2.15), oxygen (2.22) and opioids (4.04) (p<0.001). Mean total healthcare costs were €1569 lower for using PHC. All PHC timing categories showed a benefit in medical resource use and costs. However, we observed the largest benefit in the category PHC 90-31 DBD.Health policy and services should focus on increasing PHC access, while research should further explore early PHC initiation for COPD.

Association between adiposity measures and COPD risk in Chinese adults.

Bodyweight and fat distribution may be related to COPD risk. Limited prospective evidence linked COPD to abdominal adiposity. We investigated the association of body mass index (BMI) and measures of abdominal adiposity with COPD risk in a prospective cohort study.The China Kadoorie Biobank recruited participants aged 30–79 years from 10 areas across China. Anthropometric indexes were objectively measured at the baseline survey during 2004–2008. After exclusion of participants with prevalent COPD and major chronic diseases, 452 259 participants were included and followed-up until the end of 2016. We used Cox models to estimate adjusted hazard ratios relating adiposity to risk of COPD hospitalisation or death.Over an average of 10.1 years of follow-up, 10 739 COPD hospitalisation events and deaths were reported. Compared with subjects with normal BMI (18.5–<24.0 kg·m−2), underweight (BMI <18.5 kg·m−2) individuals had increased risk of COPD, with adjusted hazard ratio 1.78 (95% CI 1.66–1.89). Overweight (BMI 24.0–<28.0 kg·m−2) and obesity (BMI ≥28.0 kg·m−2) were not associated with an increased risk after adjustment for waist circumference. A higher waist circumference (≥85 cm for males and ≥80 cm for females) was positively associated with COPD risk after adjustment for BMI. Additionally, waist-to-hip ratio and waist-to-height ratio were positively related to COPD risk.Abdominal adiposity and underweight were risk factors for COPD in Chinese adults. Both BMI and measures of abdominal adiposity should be considered in the prevention of COPD.