Doctor-diagnosed Chronic Obstructive Pulmonary Disease Research Articles

Mendelian randomization analysis identifies druggable genes and drugs repurposing for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a prevalent condition that significantly impacts public health. Unfortunately, there are few effective treatment options available. Mendelian randomization (MR) has been utilized to repurpose existing drugs and identify new therapeutic targets. The objective of this study is to identify novel therapeutic targets for COPD. Cis-expression quantitative trait loci (cis-eQTL) were extracted for 4,317 identified druggable genes from genomics and proteomics data of whole blood (eQTLGen) and lung tissue (GTEx Consortium). Genome-wide association studies (GWAS) data for doctor-diagnosed COPD, spirometry-defined COPD (Forced Expiratory Volume in one second [FEV1]/Forced Vital Capacity [FVC] <0.7), and FEV1 were obtained from the cohort of FinnGen, UK Biobank and SpiroMeta consortium. We employed Summary-data-based Mendelian Randomization (SMR), HEIDI test, and colocalization analysis to assess the causal effects of druggable gene expression on COPD and lung function. The reliability of these druggable genes was confirmed by eQTL two-sample MR and protein quantitative trait loci (pQTL) SMR, respectively. The potential effects of druggable genes were assessed through the phenome-wide association study (PheWAS). Information on drug repurposing for COPD was collected from multiple databases. A total of 31 potential druggable genes associated with doctor-diagnosed COPD, spirometry-defined COPD, and FEV1 were identified through SMR, HEIDI test, and colocalization analysis. Among them, 22 genes (e.g., MMP15, PSMA4, ERBB3, and LMCD1) were further confirmed by eQTL two-sample MR and protein SMR analyses. Gene-level PheWAS revealed that ERBB3 expression might reduce inflammation, while GP9 and MRC2 were associated with other traits. The drugs Montelukast (targeting the MMP15 gene) and MARIZOMIB (targeting the PSMA4 gene) may reduce the risk of spirometry-defined COPD. Additionally, an existing small molecule inhibitor of the APH1A gene has the potential to increase FEV1. Our findings identified 22 potential drug targets for COPD and lung function. Prioritizing clinical trials that target these identified druggable genes with existing drugs or novel medications will be beneficial for the development of COPD treatments.

Prevalence of chronic obstructive pulmonary disease (COPD) in Albania

Aim: The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Albania. Methods: This was a cross-sectional study conducted in Albania in 2013-14. A nation-wide representative sample of 1200 adults aged ≥40 years was selected using multistage cluster sampling technique. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC ratio &lt;70% predicted. Results: Of the 1200 adults invited to participate, 939 adults or 78% (467 men and 472 women) were eligible for the study. The overall COPD prevalence (GOLD stage 1 or higher) was 12.4%; it was higher in men (17.4%) than in women (7.7%). Using Lower Limit of Normal (LLN), the prevalence of COPD was 9.9%, again higher in men (13.2%) than women (6.6%). The prevalence of doctor-diagnosed COPD was 1.3% (1.9% in men, 0.6 % in women). Male sex, smoking and increasing age were significantly associated with COPD diagnosis. Conclusion: The overall prevalence of COPD in Albania was 9.9% using BOLD standards. Smoking and increasing age were the main risk factors for COPD. The study highlights the importance of raising awareness of COPD among health professionals.

HIGH PREVALENCE OF COPD SYMTOMS IN THE TUNISIAN POPULATION CONTRASTING WITH LOW AWARENESS OF THE DISEASE

TYPE: Abstract TOPIC: Obstructive Lung Diseases PURPOSE: In Tunisia, the estimated prevalence of chronic obstructive pulmonary disease (COPD) was low compared with America and Europe and the disease is certainly under diagnosed. We have estimated the prevalence of COPD in the city of Sousse, following the Burden of Obstructive Lung Disease (BOLD) protocol. METHODS: We surveyed a representative random sample of 807 adults aged 40 years+ selected from the general population and have collected information on respiratory history and symptoms, risk factors for COPD and health status. Post-bronchodilator spirometry was performed for assessment of COPD. COPD and its stages were defined according to GOLD guidelines. Population weighted prevalence of COPD were computed allowing for survey design. RESULTS: The estimated population prevalence of GOLD Stage 1 and stage 2 or higher COPD were 7.8% and 4.2%, respectively (LLN modified stage 1 and stage 2 or higher COPD prevalence were 5.3% and 3.8%, respectively). COPD was far more common in men, increased with age and exposure to tobacco smoke. Prevalence of stage 1+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD. CONCLUSIONS: In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. CLINICAL IMPLICATIONS: The implications for disease diagnosis and management in clinical practices might have a public health impact. In subjects with COPD, age seems to be a much more powerful predictor of lung function than smoking. LLN _ Lower Limit of Normal; BOLD. DISCLOSURE: Nothing to declare. KEYWORD: Respiratory diseases

Associations of self-reported chronic obstructive pulmonary disease with indicators of economic instability and stress - 16 states, 2017.

To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.

Air pollution exposures from multiple point sources and risk of incident chronic obstructive pulmonary disease (COPD) and asthma

BackgroundExposure to environmental air pollutants exacerbates respiratory illness, but prospective studies of disease incidence are uncommon. Further, attempts to estimate effects from multiple point sources have rarely been undertaken. The current study examined risk of incident chronic obstructive pulmonary disease (COPD) and asthma in association with emissions of multiple air pollutants from point pollution sources in Australia. MethodsWe analyzed prospective cohort data from the Australian Longitudinal Study on Women's Health. Women from three age-cohorts (N = 35,755) were followed for up to 21 years for incident COPD and asthma. Exposures were measured from the National Pollutant Inventory and included carbon monoxide, nitrogen oxides, sulfur dioxide, and particulate matter (PM2.5 and PM10). We identified inverse-distance weighted emissions in kilograms that women experienced over time from point sources within 10 km of their residences.Cox proportional hazards regression models examined risk of self-reported doctor-diagnosed COPD and asthma in association with pollutant exposures and covariates. ResultsNew COPD cases numbered 3616 (11.5%) and new asthma cases numbered 2725 (9.4%). Participants were exposed to an average of 47–59 sites with air pollution emissions within 10 km of their residences. Fossil fuel electricity generation and mining made the largest contributions to air pollution but hundreds of other types of emissions also occurred. Controlling for covariates, all five air pollutants modeled individually were significantly associated with risk of COPD. Modeled jointly, only sulfur dioxide (SO2) remained significantly associated with COPD (HR = 1.038, 95% CI = 1.010–1.067), although the five pollutants were highly correlated (r = 0.89). None of the pollutants were significantly associated with adult onset asthma. Cohort-specific analyses indicated that COPD risk was significantly associated with SO2 exposure for younger (HR = 1.021, CI = 1.001–1.047), middle-age (HR = 1.019, CI = 1.004–1.034) and older cohorts (HR = 1.025, CI = 1.004–1.047). ConclusionsMultiple exposure sources and pollutants contributed to COPD risk, including electricity generation and mining but extending to many industrial processes. The results highlight the importance of policy efforts and technological improvements to reduce harmful air pollution emissions across the industrial landscape.

Misdiagnosis of asthma and COPD and underuse of spirometry in primary care unselected patients.

The diagnosis of both asthma and chronic obstructive pulmonary disease (COPD) consists of a combination of classical symptoms and signs, and the evidence of consistent lung function abnormalities. Spiromety has been reported to be underused, possibly for practical difficulties in accessing to a lung function lab. This may lead to misdiagnosis of both asthma and COPD. We aimed to evaluate the frequency of spirometry use and the concordance between doctor-diagnosed asthma and COPD and spirometric patterns, in an unselected cohort of patients sent by general practitioners to perform a spirometry. The first 300 patients consecutively enrolled patients performed spirometry and bronchodilator test with salbutamol 400 mcg. Demographic, clinical and lung function data have been collected. 128 patients (42.7%) declared a doctor-diagnosed asthma and 75 (25%) a doctor-diagnosis of COPD; the remaining subjects never had received any respiratory diagnosis. Only 112 patients with doctor-diagnosed asthma (55.2%) and 114 (56.2%) with doctor-diagnosed COPD have ever performed a spirometry in their entire life (average time since the last spirometry was about 47.0 months). Eighty-nine (69.5%) and 10 (13.3%) patients with respectively doctor-diagnosed asthma and COPD had concordant spirometric patterns with their known diseases. we described a worrying lack of use of spirometry and a high proportion of misdiagnosis, in patients with suspect chronic airway inflammatory diseases and cared by primary care physicians. Novel strategies to overcome this situation include should be implemented to give a better care to our patients.

Changes in prevalence of chronic obstructive pulmonary disease and asthma in the US population and associated risk factors.

Chronic lower airway diseases, including chronic obstructive pulmonary disease (COPD) and asthma, are currently the third leading cause of death in the United States. We aimed to evaluate changes in prevalence of and risk factors for COPD and asthma among the US adult population. We evaluated changes in prevalence of self-reported doctor-diagnosed COPD (i.e. chronic bronchitis and emphysema) and asthma and self-reported respiratory symptoms comparing data from the 1988-1994 and 2007-2010 National Health and Nutrition Examination Surveys. To investigate changes in the severity of each outcome over the two periods, we calculated changes in the proportions of spirometry-based airflow obstruction for each outcome. Prevalence of doctor-diagnosed chronic bronchitis and emphysema decreased significantly mainly among males, while asthma increased only among females. The self-reported disease and the respiratory symptoms were associated with increased prevalence of airflow obstruction for both periods. However, the prevalence of airflow obstruction decreased significantly in the second period among those with shortness of breath and doctor-diagnosed respiratory conditions (chronic bronchitis, emphysema, and asthma). COPD outcomes and asthma were associated with lower education, smoking, underweight and obesity, and occupational dusts and fumes exposure. Chronic lower airway diseases continue to be major public health problems. However, decreased prevalence of doctor-diagnosed chronic bronchitis and emphysema (in males) and decreased prevalence of airflow obstruction in those with respiratory symptoms and doctor-diagnosed respiratory diseases may indicate a declining trend and decrease in disease severity between the two periods. Continued focus on prevention of these diseases through public health interventions is prudent.

Prevalence of COPD and tobacco smoking in Tunisia--results from the BOLD study.

In Tunisia, there is a paucity of population-based data on Chronic Obstructive Pulmonary Disease (COPD) prevalence. To address this problem, we estimated the prevalence of COPD following the Burden of Lung Disease Initiative. We surveyed 807 adults aged 40+ years and have collected information on respiratory history and symptoms, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Six hundred and sixty one (661) subjects were included in the final analysis. The prevalence of GOLD Stage I and II or higher COPD were 7.8% and 4.2%, respectively (Lower Limit of Normal modified stage I and II or higher COPD prevalence were 5.3% and 3.8%, respectively). COPD was more common in subjects aged 70+ years and in those with a BMI < 20 kg/m2. Prevalence of stage I+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD. In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. In subjects with COPD, age is a much more powerful predictor of lung function than smoking.

PP60 Probable Airflow Obstruction in Adults: Data from the Health Survey for England 2010

BackgroundIn the UK, chronic obstructive pulmonary disease (COPD) causes approximately 25,000 deaths annually. Around three million people are estimated to have COPD, of whom fewer than one-third have been diagnosed....

Impact of active and passive smoking as risk factors for asthma and COPD in women presenting to primary care in Syria: first report by the WHO-GARD survey group

BackgroundThe burden of chronic respiratory disease (CRD) is alarming. International studies suggest that women with CRD are undersurveyed and underdiagnosed by physicians worldwide. It is unclear what the prevalence of CRD is in the general population of Syria, particularly among women, since there has never been a survey on CRD in this nation. The purpose of this study was to investigate the impact of different patterns of smoking on CRD in women.Materials and methodsWe extracted data on smoking patterns and outcome in women from the Global Alliance Against Chronic Respiratory Diseases survey. Using spirometric measurements before and after the use of inhaled bronchodilators, we tracked the frequency of CRD in females active and passive narghile or cigarette smokers presenting to primary care. We administered the questionnaire to 788 randomly selected females seen during 1 week in the fiscal year 2009–2010 in 22 primary care centers in six different regions of Syria. Inclusion criteria were age >6 years, presenting for any medical complaint. In this cross-sectional study, three groups of female subjects were evaluated: active smokers of cigarettes, active smokers of narghiles, and passive smokers of either cigarettes or narghiles. These three groups were compared to a control group of female subjects not exposed to active or passive smoking.ResultsExposure to active cigarette smoke but not narghile smoke was associated with doctor-diagnosed chronic obstructive pulmonary disease (COPD). However, neither cigarette nor narghile active smoking was associated with increased incidence of spirometrically diagnosed COPD. Paradoxically, exposure to passive smoking of either cigarettes or narghiles resulted in association with airway obstruction, defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 70% according to the Global initiative for chronic Obstructive Lung Disease criteria; association with FEV1 < 80% predicted, evidencing moderate to severe GOLD spirometric grade, and doctor-diagnosed COPD. Physicians tend to underdiagnose COPD in women who present to primary care clinics. Whereas around 15% of enrolled women had evidence of COPD with FEV1/FVC < 70% after bronchodilators, only 4.8% were physician-diagnosed. Asthma did not appear to be a significant spirometric finding in these female subjects, although around 11% had physician-diagnosed asthma. One limitation is FEV1/FVC < 70% could have also resulted from uncontrolled asthma. The same limitation has been reported by the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study.ConclusionContrary to popular belief in developing countries, women exposed to tobacco smoke, whether active or passive, and whether by cigarettes or narghiles, like men are at increased risk for the development of COPD, although cultural habits and taboos may decrease the risk of active smoking in some women.RecommendationsThese findings will be considered for country and region strategy for noncommunicable diseases, to overcome underdiagnosis of CRD in women, fight widespread female cigarette and narghile smoking, and promote behavioral research in this field.

The prevalence of chronic obstructive pulmonary disease in Maastricht, the Netherlands

Chronic obstructive pulmonary disease (COPD) is an increasing public health problem worldwide. Although epidemiologic data on COPD are important to raise awareness of the burden of disease, there are no actual spirometry-based data on the prevalence of COPD in the Netherlands. Using the Burden of Obstructive Lung Disease (BOLD) protocol and study design, a population-based sample of adults, aged ≥ 40 years, in the area of Maastricht, the Netherlands was surveyed. Post-bronchodilator spirometry and questionnaires with information on smoking history and reported respiratory disease were collected. COPD was defined as post-bronchodilator FEV(1)/FVC ratio < 0,7 (GOLD) or < the lower limit of normal (LLN) (95th percentile) of the population distribution for FEV(1)/FVC. Data were statistically weighted for the total number of people in the Maastricht population. Overall prevalence of COPD was 24%, and was higher for men (28.5%) than for women (195%). (unweighted p = 0.002) The prevalence of GOLD stage 2 or higher COPD was 10%. The prevalence of LLN-defined COPD was 19% and 10% for stage 2 or higher. Overall prevalence of current smoking was 23%. The prevalence of COPD increased with age and amount of pack-years, although 14% of never smokers fulfilled spirometric criteria for COPD. The prevalence of doctor-diagnosed COPD was only 8.8%. Almost one quarter of the Maastricht population aged ≥ 40 years had COPD. Considering the ageing population and still an important smoking prevalence, this burden is bound to increase and imposes great demands to public health care and society in the Netherlands.

Is adult height related to the risk of having chronic obstructive pulmonary disease?

BackgroundA number of historical studies have suggested that early life deprivation increases the risk of developing chronic obstructive pulmonary disease (COPD) in adult life, but whether this is still true...

Epidemiologic analysis of COPD in Guangdong province

To survey the prevalence of chronic obstructive pulmonary disease (COPD) in urban and rural areas in Guangdong Province and relevant risk factors. Using the same protocol including Burden of Obstructive Lung Disease (BOLD) questionnaire, a questionnaire survey was conducted among 3449 respondents, 1370 males and 1916 females, aged over 40 with an average age of 56.8, by random disproportional cluster sampling in Liwang District of Guangzhou City and Yunyan Town, Lechang City, northern Guangdong Province. Spirometry was performed in all subjects. Lung function indices were regarded as gold criteria of diagnosis of COPD. There were 3286 cases with full data and good quality spirometry test, 1370 males and 1916 females, aged 56.8. The total prevalence of COPD was 9.4%. The prevalence of COPD in the males was 15.9%, significantly higher than that in the females (4.8%, P < 0.01). The prevalence in the rural area was 12.0%, significantly higher than that in the urban area (7.4%, chi(2) = 20.3, P < 0.01). 67.7% of the patients with COPD presented symptoms such as cough, expectoration and/or dyspnoea. 58.7% of the COPD patients (78.9% of the male patients and 10.9% of the female patients) smoked. The odd ratio (OR) for COPD in the smokers was 2.59 (95% CI 1.87 - 3.59). Only 15.1% of the smokers (17.9% of the male smokers and 4.1% of the female smokers) developed COPD. No significant relationship was found between pack years of cigarette smoking and COPD prevalence. The risk of COPD was increased when biomass fuels were used in house cooking (OR = 1.54 95% CI 1.08 - 2.20). Furthermore, the combination of biomass fuels and cigarette smoking further increased the risk with the OR of 4.41 (95% CI 3.22 - 6.04), indicating a synergetic impact of smoking and biomass burning on the prevalence of COPD. The Prevalence of doctor-diagnosed COPD based on the clinical manifestation was significant lower than the actual prevalence (only 31.0%). COPD is a very common disease in Guangdong. The prevalence of COPD is higher in the rural area than in the urban area, which may be attributed to the synergic effect of smoking and biomass burning. Lung function test is of great importance in COPD diagnosis, especially in the earlier stage of COPD and those asymptomatic COPD patients.

The health impact of undiagnosed airflow obstruction in a national sample of United States adults.

To determine the health and functional impact of undiagnosed airflow obstruction for subjects in the general population, we used data obtained as part of the Third National Health and Nutrition Examination Survey (NHANES III). Categories of diagnosed and undiagnosed airflow obstruction were defined using questionnaire responses and spirometric results. Health and functional impact of airflow obstruction was assessed from responses to questions about general health status, walking 1/4 mile, lifting or carrying something as heavy as 10 lb, or needing help with personal care. Undiagnosed airflow obstruction (12.0%) was more common than doctor-diagnosed chronic obstructive pulmonary disease (COPD) (3.1%) or asthma (2.7%). Although undiagnosed airflow obstruction was usually very mild, approximately 5% of the entire sample had an FEV(1) less than 75% predicted. After adjusting for smoking, obesity, and comorbid conditions, the risk of impaired health and functional status with undiagnosed airflow obstruction was independently associated with severity of FEV(1) impairment. For males and females, ever smoking was strongly associated with all types of airflow obstruction, diagnosed or not. However, among females with airflow obstruction, 12.2% to 35.2% never smoked. Undiagnosed airflow obstruction is common in the general population of the United States and is associated with impaired health and functional status. airflow obstruction; spirometry; health impact; screening