GOLD Criteria Research Articles

COPD prevalence in a north-eastern Italian general population

COPD prevalence estimates vary mostly depending on different study methodologies. We evaluated the prevalence and clinical features of COPD, as defined by GOLD and ERS/ATS recommendations in a representative sample of Northern Italy general population. A randomized cross-sectional study was performed. The study participants completed a questionnaire covering: key indicators for considering a diagnosis of COPD, self-reported physician diagnoses of respiratory disease, pharmacological treatment for respiratory disease, indirect costs, occupational and environmental exposures. They also underwent spirometry and physician assessment. We evaluated 1236 subjects. Daily respiratory symptoms were experienced by 26.7%. Of this group, only 30.7% had previously performed a spirometry. The overall COPD prevalence was: 11.7% according to GOLD criterion; 9.1% according to LLN criterion; 6.8% according to self-reported physician diagnosis. Of note, 48,8% of subjects with a reported diagnosis of COPD had never undergone a spirometry before the study. Our study provides an estimation of COPD prevalence in a representative sample of Northern Italy general population relying on both clinical symptoms and spirometry outcomes, and describes the different prevalence rates depending on the adopted diagnostic criterion. Spirometry underuse may account for under-diagnosis and misdiagnosis of COPD. It may result in a major impact on quality of life as well as in economic burden.

Behavior of Quality of Life (SGRQ) in COPD Patients According to BODE Scores

IntroductionTo evaluate if the association between the BODE index and deterioration in health-related quality of life is linear. To determine possible associations between the BODE index and health status evaluated by the Saint George's Respiratory Questionnaire (SGRQ) at all levels of disease severity in COPD. MethodsA cross-sectional study was carried out on 253 patients from two Latin American respiratory centers (Brazil and Chile) with a clinical diagnosis of COPD, based on GOLD criteria. Assessment included the BODE index and the SGRQ questionnaire. ResultsPatients had a BODE index of 3.1±2.0; FEV1 (%) of 49±19.2; BMI (kg/m2) of 24.7±5.1; 6MWT distance (meters) of 444±96. Significant correlations were found between the BODE index and SGRQ total scores (r=0.5; <0.001), impact (r=0.45; <0.001) and activity (r=0.5; <0.001). From BODE score zero, HRQOL was already compromised in all SGRQ domains. SGRQ scores (total and domain) increased progressively for individual components of the BODE index, with the decrease in airflow limitation (<0.05), BMI (<0.002) and 6MWT (<0.05), and with the increase in the Modified Medical Research Council (MMRC) score (<0.05). ConclusionThere is an association between health-related quality of life, as assessed by the SGRQ and the BODE index within the entire spectrum of COPD severity. Even in early disease stages and BODE index zero, health-related quality of life is already impaired.

PRS22 - Out-of-Pocket Expenses for Copd Patients In A Third Level Hospital

Chronic Obstructive Pulmonary Disease (COPD) is a main worldwide cause of morbidity and mortality. COPD prevalence in 40 years or older people is 7.8% in Mexico City. However, there is no information about direct cost of COPD patients in Mexico. This study estimated direct costs of COPD from patient perspective in a third level hospital. We conducted an interview at each visit by patients from august 2013 to July 2014 in a third level hospital. The diagnosis was carried out by a pulmonologist according to GOLD criteria. Information about direct and indirect costs was collected. Mean (SD) of annual total cost, medical consultation, clinical test, drugs, oxygen, transportation, gasoline and food were estimated for outpatients with at least one year of diagnosis and stratifying by severity. Costs were transformed in US Dollars of 2014. We interviewed 482 outpatients. Patients were classified as: mild (n=36), moderate (n=137), severe (n=76) and very severe (n=233). Mean (SD) of age and diagnostic time were 72.4 (9.1) and 5.8 (4.2) years, respectively; and 257 (53.2%) were men. Annual total costs for mild, moderate, severe and very severe were $915.3, $1214.3, $1382.6 and $1595.1, respectively. Drugs (74.0%), oxygen (19.5%) and transportation (1.8%) were the main categories of total costs. Less than 9% of patients can afford oxygen. According to total cost, severity is positively correlated with the amount of out-of-pocket expenses. Oxygen is accessible to few patients.

THE FORECASTING SYSTEM OF GOLD MINERALIZATION IN PRECAMBRIAN COMPLEXES OF UKRAINIAN SHIELDD

Purpose. The goal of this paper is to characterize and evaluate the components of the forecasting system of gold mineralization in Precambrian complexes of the Ukrainian shield based on the systemic and the model approach.Methodology. This paper is based on the materials of the previous forecast studies, including the work of the author, and the results of analysis, interpretation and quantification of the main factors, signs and criteria for gold mineralization.Finding. As the basis of an optimal system of forecasting industrial of gold mineralization in the Precambrian Ukrainian Shield “factors”, “signs” and “criteria” are proposed as the basic categories of the forecast of ore-bearing geological structures. The middle-scale level of prognosis is offered for this purpose, ie at the level of ore districts and fields.To decipher the formation of gold objects we propose a method of geological-genetic interpretation of geological information on these ones. At first it involves the construction of simple geological and genetic models, and then their superposition to form complex models of gold-ore systems as a basis for forecasting real gold objects.The prognosis system involves first creation of middle-scale maps displaying paleolithologic, regional-metamorphic and magmatogenic-ultrametamorphogenical geological factors. Then on the basis of forecast maps performed retrieval evaluation with an analysis of prognosis criteria and search features with distinguishing perspective areas.Results. On the basis of the system and the characteristic of the model approach and evaluation components of the prognosis industrial gold mineralization system in Precambrian complexes of the Ukrainian Shield, which are displayed in the form of two pieces of information – mapping and prognosis-search.

Relationships between body mass index (BMI) and the health status in elderly Mongolian subjects with COPD

BackgroundWe previously reported that the health status of overweight Chinese COPD patients were significantly better than those in normal weight patients, but not in Japanese patient. In this study, we examined the relationships between the health status and BMI in Mongolia, compared with those in China and Japan. &#x0D; [Method] We examined factors affecting the health status of Mongolians from 2012 to 2013. Participants were local residents of 50‐79 years old (n=521). Health status was measured using COOP/WONCA charts, and information such as symptoms and medical history were reported by participants. Pulmonary function was measured by spirometer, and physician evaluated airflow limitation by GOLD criteria. Data of 782 subjects (399 Chinese, 383 Japanese) in the previous study were compared with those of Mongolian.&#x0D; [Result] Healthy Mongolian subjects showed significantly higher BMI than those of healthy Japanese and Chinese. COPD patients in Mongolia and Japan, but not in China, showed significantly lower BMI than healthy subjects. BMI was inversely‐correlated with COPD GOLD stage health status only in Chinese male patients. There was no significant effect of BMI on health status and prevalence of respiratory symptoms among Mongolian and Japanese patients.&#x0D;ConclusionThere was no difference in health status between healthy and COPD subjects in Mongolia and Japan. Despite of the difference of medical environment between Mongolia and Japan, the health statuses of patients were not correlated with BMI in Mongolia and Japan. There is limitation that the differences of proportion of severity of COPD between these three countries. Since Chinese COPD patients contained those with more advanced stage, it became a limitation for accurately compare patients across three countries.

Prevalence and predictors of chronic obstructive pulmonary disease among high-risk Egyptians

Abstract Background Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. COPD prevalence, morbidity, and mortality vary across countries and across different groups within countries. In Egypt, COPD is a rising significant health problem; however, information on its prevalence, morbidity, and mortality is still lacking. Aim of the study The first aim was to detect the prevalence of COPD among high-risk Egyptians Global using Initiative for Chronic Obstructive Lung Disease (GOLD) and FEV1/FVC &lt; lower limit of normal (LLN) definitions. The second goal was to identify the factors predictive for diagnosis of COPD. Patients and methods This study included 363 randomly selected individuals with a high risk for COPD; 176 were smokers (group I), 107 were construction and brick manufacturer workers (group II), and 80 were women exposed to biomass fuel (group III). All individuals filled out a respiratory questionnaire, were clinically examined, and subjected to spirometric evaluation. Results The prevalence of COPD among high-risk individuals was 9.6 and 17.4% on the basis of GOLD and LLN, respectively. The sensitivity and specificity of prebronchodilator values of FEV1/FVC &lt; LLN were 94.3 and 90.8%, respectively, for the diagnosis of COPD. However, our findings support that the postbronchodilator LLN definition is superior in ruling out the presence of COPD, as it has a good negative test specificity of 99.7%. Chest wheezes were the only symptom that was an independent predictor of COPD (odds ratio 4.80, 95% confidence interval 1.57–14.74, P = 0.02). Increasing age, smoking, and mean pack-years were also factors predictive for COPD. Conclusion The prevalence of COPD among high-risk individuals in Egypt was estimated to be about 10% as per GOLD. Prebronchodilator LLN is a reliable method for the diagnosis of COPD and it yields comparable results to the GOLD criteria. The main predictors for COPD diagnosis are old age, smoking history, and presence of chest wheezes.

Validation of the chronic respiratory questionnaire in the Colombian population with chronic obstructive pulmonary disease.

To assess the validity and reliability of the chronic respiratory questionnaire (CRQ) in the measurement of HRQL in the Colombian population with COPD. A cross-sectional study was conducted with a sample of 200 patients diagnosed with COPD according to GOLD criteria. Convergence validity was evaluated by correlating the questionnaire results with other clinical variables such as exercise tolerance, forced expiratory volume at the first second (FEV1), and depression levels. HRQL measured through the CRQ correlated significantly with the 6-min walk test (r = 0.34), just as the dimensions fatigue (r = 0.37) and dyspnoea correlated with the FEV1 test (r = 0.21) and the dimensions emotional function and disease management with depression levels (r = -0.79). The Generalized Structured Component Analysis (GSCA) with the prespecified model is showed, and the total variance explained by the items in the model was 61.5 % (FIT = 0.615), unweighted least squares (GFI = 0.998), and standardised root mean square (SRMR = 0.084), indicating that the model fits adequately. The CRQ presents evidence of adequate validity and reliability in the Colombian population. Its use is recommended to measure HRQL in patients with COPD, although future validations will be needed to identify the property of sensitivity to change.

Comportamiento de la calidad de vida (SGRQ) en pacientes con EPOC según las puntuaciones BODE

IntroductionTo evaluate if the association between the BODE index and deterioration in health-related quality of life is linear. To determine possible associations between the BODE index and health status evaluated by the Saint George's Respiratory Questionnaire (SGRQ) at all levels of disease severity in COPD. MethodsA cross-sectional study was carried out on 253 patients from two Latin American respiratory centers (Brazil and Chile) with a clinical diagnosis of COPD, based on GOLD criteria. Assessment included the BODE index and the SGRQ questionnaire. ResultsPatients had a BODE index of 3.1±2.0; FEV1 (%) of 49±19.2; BMI (kg/m2) of 24.7±5.1; 6MWT distance (meters) of 444±96. Significant correlations were found between the BODE index and SGRQ total scores (r=0.5; <0.001), impact (r=0.45; <0.001) and activity (r=0.5; <0.001). From BODE score zero, HRQOL was already compromised in all SGRQ domains. SGRQ scores (total and domain) increased progressively for individual components of the BODE index, with the decrease in airflow limitation (<0.05), BMI (<0.002) and 6MWT (<0.05), and with the increase in the Modified Medical Research Council (MMRC) score (<0.05). ConclusionThere is an association between health-related quality of life, as assessed by the SGRQ and the BODE index within the entire spectrum of COPD severity. Even in early disease stages and BODE index zero, health-related quality of life is already impaired.

S19 Imaging Derived Regional Lung Function Using Hyperpolarised Xenon Mri (xe-mri) And Quantitative Computed Tomography (qct) In Chronic Obstructive Pulmonary Disease (copd)

Introduction and objectives To derive quantitative regional imaging lung function parameters using hyperpolarised xenon MRI (Xe-MRI) and computed tomography (QCT), and compare these to pulmonary function tests (PFTs) in subjects with chronic pulmonary obstructive disease (COPD). Methods Twenty patients with COPD (stage II – IV GOLD criteria classification) underwent Xe-MRI at 1.5T, QCT, and PFTs. Whole lung and lobar percentage ventilated volumes were obtained using automated segmentation of multi-slice Xe-MRI ventilation images acquired at a breath hold of FRC + 1L using in-house software. Average whole lung apparent diffusion coefficients (ADCs) were calculated from multi-slice Xe-MRI diffusion-weighted images ( b =20.855 sec/cm 2 ). Percentage predicted PFT results were established for each participant. Whole lung and lobar QCT-derived metrics for emphysema and bronchial wall thickness were calculated from percentage of lung tissue with density of Pearson’s correlation coefficients were used to evaluate the relationship between whole lung and lobar imaging measures and PFTs. Results Xe-MRI whole lung average ADC showed significant correlation with: whole lung QCT percentage emphysema ( r = 0 .79, p = 0.001), whole lung Pi10 ( r = 0 .68, p r = 0 .635, p r = -0.81, p r = -0.80, p r = -0.51, p r = 0 .75, p r = 0 .29, p Conclusion This study demonstrates excellent correlation between Xe-MRI, QCT-derived metrics and PFTs in COPD. New quantitative whole lung and lobar functional imaging parameters have been derived that may be of value when assessing patients with COPD for regional treatment and in trialling new therapies. Although further investigation is required, this may represent the first integrated regional lung imaging technique linked to pulmonary functional outcomes.

Frequency of Lower Urinary Tract Symptoms and Effects on Quality of Life in Women with Rheumatoid Arthritis

Objective: To investigate the frequency of lower urinary tract symptoms (LUTS) in women with rheumatoid arthritis (RA) and to evaluate its possible effects on quality of life (QoL). Material and Methods: A total of 104 women diagnosed with RA, who were aged between 30 and 60 years, and 82 healthy women were included in this study. We used the American Urological Association symptom index as the gold criteria in the evaluation of LUTS and QoL. Hospital Anxiety and Depression Scale was used to evaluate anxiety/depression levels, whereas disease activity scale (DAS-28) and Health Assessment Questionnaire (HAQ) were used to determine the disease activity levels. Results: There was no statistical difference between the two groups by means of age range. There was a prominent difference in LUTS frequency between the groups and moderate to severe symptoms were higher in women with RA. QoL measurements were also significantly lower in this group (p<0.01). There was a positive relationship between anxiety and LUTS and significantly positive relationship between depression and LUTS measurement (p<0.01). There was a positive relationship between depression and QoL; however, there was no relationship between anxiety and QoL measurements. Although there was no relationship between LUTS and DAS-28, significant relationship was found between LUTS and HAQ. There was no relationship between QoL and DAS-28; however, there was a significant relationship between QoL and HAQ (p<0.01). Conclusion: LUTS were more frequent in women with RA; furthermore, QoL was low. Furthermore, these symptoms can be related with anxiety and depression. Moderate and severe symptoms observed in women with RA are frequently related with HAQ.

Can early introduction of specialized palliative care limit intensive care, emergency and hospital admissions in patients with severe and very severe COPD? a randomized study.

BackgroundCOPD is a progressive lung disorder with rates of mortality between 36–50%, within 2 years after admission for an acute exacerbation. While treatment with inhaled bronchodilators and steroids may partially relieve symptoms and oxygen therapy may prolong life, for many patients the course of the disease is one of inexorable decline. Very few palliative care intervention studies are available for this population. This trial seeks to determine the effectiveness of the introduction of specialized palliative care on hospital, intensive care unit and emergency admissions of patients with severe and very severe COPD.Methods/DesignThe study is a three year single centre, randomized controlled trial using a 2 arms parallel groups design conducted in a tertiary center (University Hospitals; Geneva). For the intervention group, an early palliative care consultation is added to standard care; the control group benefits from standard care only. Patients with COPD defined according to GOLD criteria with a stage III or IV disease and/or long term treatment with domiciliary oxygen and/or home mechanical ventilation and/or one or more hospital admissions in the previous year for an acute exacerbation are eligible to participate. Allocation concealment is achieved using randomisation by sealed envelopes. Our sample size of 90 patients/group gives the study a 80% power to detect a 20% decrease in intensive care unit and emergency admissions – the primary endpoint. All data regarding participants will be analysed by a researcher blinded to treatment allocation, according to the "Intention to treat" principle.DiscussionGiven the trends toward aggressive and costly care near end-of-life among patients with COPD, a timely introduction of palliative care may limit unnecessary and burdensome personal and societal costs, and invasive approaches. The results of this study may provide directions for future palliative care interventions in this particular population.Trial registrationThis trial has been registered at clinicaltrials.gov under NCT02223780

Study of serum Granzyme B in heavy cigarette smokers with and without chronic obstructive pulmonary disease

BackgroundInflammation of the airways is present in COPD with increased number of inflammatory cells including killer cells that lyse their target cells by two mechanisms; membranolysis in which secreted molecules such as granzymes form pores in the membrane of target cells; and apoptosis. Granzyme B has the strongest apoptotic activity of all granzymes. Aim of this workAim of this work was to study the relation between Granzyme B, tobacco smoking and chronic obstructive pulmonary disease. MethodsThe study included 40 clinically stable COPD patients classified according to GOLD (2013) criteria into two groups; moderate (GOLD II) and severe (GOLD III) plus 40 apparently healthy control subjects (20 smokers and 20 nonsmokers). Pulmonary function results and serum levels of Granzyme B (measured by ELISA) were recorded. ResultsGranzyme B levels are elevated in COPD. Cigarette smoking appears to be a direct stimulus to Granzyme B production. Granzyme B could play a role in the pathogenesis of COPD. Aging seems to be a risk factor for Granzyme B production and pathogenesis of COPD. ConclusionGranzyme B levels are elevated in COPD. Cigarette smoking appears to be a direct stimulus to Granzyme B production. Granzyme B could play a role in the pathogenesis of COPD. Aging seems to be a risk factor for Granzyme B production and pathogenesis of COPD.

Facial wrinkling: A possible mirror of COPD severity.....

Background and objectiveThe objective of our study was to test the hypothesis that facial wrinkling is a reflection to the severity of COPD disease and whether there is an association between facial wrinkling score and the severity of COPD as assessed by different parameters retrieved from GOLD criteria as well as clinical based parameters. Therefore we aimed to investigate whether extensive facial wrinkling should promote the screening of affected individuals for airflow obstruction. Subjects and methodsThe study included 100 patients diagnosed with COPD. Demographic data, smoking exposure as well as spirometric measures were obtained from all patients. Each patient was given a score based on combined assessment of COPD system. The extent of facial wrinkling in the “crows’ feet area” was determined using the scoring system described by Daniell. ResultsThe results of our study demonstrated that wrinkling score was statistically significantly higher in COPD patients with high risk based on combined assessment system compared to those with low risk with p<0.001. Also, a statistically significantly higher score of wrinkling was found in COPD patients with more symptoms based on mMRC breathlessness scale compared to those with low symptoms with p<0.001. We also found that wrinkling was statistically significantly higher in COPD patients with concomitant comorbidities compared to those without comorbidities with p<0.00. Positive correlations existed between wrinkling score and: age of the patients (r=0.738, p<0.001), smoking severity of the patients (r=0.326, p<0.001), and severity of COPD based on post bronchodilator FEV1 (r=0.547, p<0.001). There were also positive correlations between wrinkling score and: risk of exacerbations (r=0.333, p<0.001), modified medical research council breathlessness scale (r=0.602, p<0.001) and Combined COPD assessment (r=0.573, p<0.001). There was a negative correlation between wrinkling score and post bronchodilator FEV1% of predicted values (r=−0.673, p<0.001). We demonstrated in Multivariate Linear regression model of predictive factors that age and concomitant COPD comorbidities were the main predictive factors for wrinkling in patients with COPD with t=6.968, at p<0.001 and t=3.473, at p<0.002, respectively. ConclusionFacial wrinkling is strongly associated with the risk of airflow obstruction. Extensive facial wrinkling may be a marker of susceptibility to the effects of cigarette smoking and should promote the screening of affected individuals for airflow obstruction.

Prevalence of Chronic Obstructive Pulmonary Disease in the Canary Islands

IntroductionThe prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9–10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. Materials and methodsA random group of 1353 subjects aged between 40 and 70years was selected from a sample population of 596478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. ResultsThe prevalence of COPD was 7.3% (95%CI: 5.5–9.5) and was higher in males than in females (8.7% vs 6.3%, P=.134). The incidence of smoking was 29.4% (95%CI: 25.4–33.1) and was also higher in males than in females (35.1% vs 25.4%, P<.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in group I, 69.9% in group II, 10.4% in group III and 3.3% in group IV. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. ConclusionsDespite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.

Prevalence of COPD by Disease Severity in Men and Women in Northern Vietnam

The prevalence of COPD and its risk factor pattern varies between different areas of the world. The aim of this study was to investigate the prevalence of COPD by disease severity in men and women and risk factors for COPD in northern Vietnam. From all 5782 responders to a questionnaire survey, a randomly selected sample of 1500 subjects was invited to a clinical follow-up study. The methods included a structured interview using a modified GA2LEN study questionnaire for registration of symptoms and possible determinants of disease. Spirometry was performed before and after bronchodilation. The age distribution of the sample was 23–72 years. Of 684 subjects attending, 565 completed acceptable spirometric measurements. The prevalence of COPD defined by the GOLD criteria was 7.1%; in men 10.9% and in women 3.9% (p = 0.002). Of those 3.4% had a mild disease, 2.8% a moderate and 0.9% a severe disease. In ages >50 years, 23.5% of men and 6.8% of women had COPD. Among smokers aged >60 years (all men), 47.8% had COPD. None of the women with COPD had been smokers. Increasing age, smoking and male sex were the dominating risk factors, although male sex lost its significance in a multivariate setting. The prevalence of COPD among adults in northern Vietnam was 7.1% and was considerably higher among men than women. The prevalence increased considerably with age. Increasing age and smoking, the latter among men only, were the most important determinants of COPD.

Postoperative complications do not influence the pattern of early lung function recovery after lung resection for lung cancer in patients at risk.

BackgroundThe pattern and factors influencing the lung function recovery in the first postoperative days are still not fully elucidated, especially in patients at increased risk.MethodsProspective study on 60 patients at increased risk, who underwent a lung resection for primary lung cancer. Inclusion criteria: complete resection and one or more known risk factors in form of COPD, cardiovascular disorders, advanced age or other comorbidities. Previous myocardial infarction, myocardial revascularization or stenting, cardiac rhythm disorders, arterial hypertension and myocardiopathy determined the increased cardiac risk. The severity of COPD was graded according to GOLD criteria. The trend of the postoperative lung function recovery was assessed by performing spirometry with a portable spirometer.ResultsCardiac comorbidity existed in 55%, mild and moderate COPD in 20% and 35% of patients respectively. Measured values of FVC% and FEV1% on postoperative days one, three and seven, showed continuous improvement, with significant difference between the days of measurement, especially between days three and seven. There was no difference in the trend of the lung function recovery between patients with and without postoperative complications. Whilst pO2 was decreasing during the first three days in a roughly parallel fashion in patients with respiratory, surgical complications and in patients without complications, a slight hypercapnia registered on the first postoperative day was gradually abolished in all groups except in patients with cardiac complications.ConclusionExtent of the lung resection and postoperative complications do not significantly influence the trend of the lung function recovery after lung resection for lung cancer.

Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias

IntroductionThe prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. Materials and methodsA random group of 1,353 subjects aged between 40 and 70years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. ResultsThe prevalence of COPD was 7.3% (95%CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P=.134). The incidence of smoking was 29.4% (95%CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P<.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in groupi, 69.9% in groupii, 10.4% in groupiii and 3.3% in groupiv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. ConclusionsDespite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.

CARDIOVASCULAR RISKS IN OBSTRUCTIVE SLEEP APNEA SYNDROME WITH IMPROVED SASD07 COMPARE TO STARDUST II

Background : Sleep Apnea Syndrome (SAS) is a cause of hypertension, increasingcardiovascular risk and cardiovascular disease such as stroke, coronary artery disease, myocardial infarction, arrhythmias, heart failure, increasing the risk of death in patients with heart disease, independent of other causative factors. So far, in Vietnam there are very few studies on Obstructive Sleep Apnea Syndrome (OSAS) and cardiovascular risk factors . Self-making SASD07 is trustly for detecting OSAS with statistical significiant in comparision with StarDustII (gold criteria). Subjects and Methods: Cross sectional study, comparision with control group: 136 peoples (68 in disease group and 68 in control group). Patients were parallelly measured with StarDustII and SASD07 to detect OSAS and find the corellation with cardiovascular risk factors. Results: There is a positive correlation between SBP with the severity of OSAS (r = 0.459, p &lt; 0.001), positive correlation between DBP with the severity of OSAS (r = 0.352, p &lt; 0.003). No statistically significant differences between severe OSAS and fasting blood glucose, cholesterol, HDL Cholesterol, Non - HDL Cholesterol, LDL Cholesterol and TG median (p &gt; 0.05). There is a positive correlation between AHI and neck circumference (r = 0.511, p &lt; 0.001), waist circumference (r = 0.585, p &lt; 0.001), BMI (r = 0.380, p &lt; 0.01). SASD07 diagnostic value of detecting OSAS compared with StarDustII have Kappa = 0.72, (standard error 0.06, p &lt;0.001). Conclusion: The risk factors related to OSAS in our study is neck circumference, waist circumference, systolic blood pressure, diastolic blood pressure. SASD07 have a good value in diagnosing of OSAS compared with polysomnography StarDustII. Key words: Sleep Apnea Syndrome, cardiovascular risk factor, SASD07.

Twenty-four Months Longitudinal Study of Acute Exacerbations in a Cohort of Chronic Obstructive Pulmonary Disease Patients

Background: This study aims to follow a cohort of COPD patients so as to measure the frequency of acute exacerbation and annually correlate it with the BODE index and with the cellularity of induced sputum (IS) at admission. Methods: The longitudinal study followed 44 COPD patients for 30 months. COPD severity was determined according to the GOLD criteria and the cellularity of induced sputum was quantified. For two years, COPD patients were assessed for acute exacerbation, characterized by an intensification of COPD symptoms that required additional antibiotics or/and systemic corticosteroids. All patients were smokers and returned for regular clinical visits. IS was collected from all patients when admitted to the study and cellularity was quantified. BODE index was measured in the 1st and 2nd years. Results: Data showed that the GOLD criteria did not correlate with acute exacerbation, but the BODE index did (r = 0.587). Neutrophils and macrophages from induced sputum had good correlation with FEV₁ and there is a phenotypic profile for which acute exacerbation is more recurrent, which is chronic bronchitis (p<0.038). Conclusions: The frequency of acute exacerbation is similar to that of world medical literature, approximately 2 episodes per annum. The results suggest that BODE index could be used to identification of subgroup of COPD patients which has more acute exacerbation.

Comorbidities and Health Status in Individuals With and Without COPD in Five Latin American Cities: The PLATINO Study

IntroductionComorbidities are common in patients with chronic obstructive pulmonary disease (COPD), and have a significant impact on health status and prognosis. The PLATINO study provides data on self-reported comorbidities and perceived health status in COPD subjects. MethodsPLATINO is a population-based study on COPD prevalence in five Latin American cities. COPD diagnosis was defined by GOLD criteria (FEV1/FVC<.70 post-bronchodilator). Information was collected on the following comorbidities: heart disease, hypertension, diabetes, cerebrovascular disease, peptic ulcer and asthma. Health status was evaluated using the SF-12 questionnaire, derived from the question: “In general, would you say your health is excellent, very good, good, fair or poor?” A simple comorbidity score was calculated by adding the total number of comorbid conditions. ResultsOf a total population of 5314 individuals, 759 had COPD. Reported comorbidities by decreasing frequency were: any cardiovascular disease, hypertension, peptic ulcer, heart disease, diabetes, cerebrovascular disease, asthma and lung cancer. COPD patients had a higher comorbidity score and prevalence of lung cancer (P<.0001) and asthma (P<.0001), as well as a higher tendency to have hypertension (P=.0652) and cerebrovascular disease (P=.0750). Factors associated with comorbidities were age, body mass index (BMI) and female gender. The number of comorbidities increased as the health status deteriorated. ConclusionsIn the PLATINO population-based study, COPD individuals had an increased number of comorbidities. Age, female gender and higher BMI were the factors associated with comorbidity in these patients. Comorbid conditions were associated with impaired health status, independently of the COPD status.