Lung Age Research Articles

“Lung age” - a motivational smoking cessation tool in smokers with chronic obstructive pulmonary disease

“Lung age” - a motivational smoking cessation tool in smokers with chronic obstructive pulmonary disease

Prognostic Value of Thyroid Transcription Factor-1 Expression in Patients with Advanced Lung Adenocarcinoma.

The prognostic role of thyroid transcription factor-1 (TTF1) in advanced lung cancer is not clearly established. The present study aimed to evaluate the associations between clinicopathological characteristics, TTF1 expression, and overall survival (OS) of patients with advanced lung adenocarcinoma. One hundred and seventy-two patients were enrolled in this retrospective study. OS was assessed according to immunohistochemical TTF1 expression in lung adenocarcinoma tissue, age, gender, performance status (PS), smoking history and status, disease stage, tumor differentiation, epidermal growth factor receptor (EGFR) mutation and EGFR tyrosine kinase inhibitor (TKI) treatment status. The OS time was longer (p<0.001) for patients with TTF1 expression than for patients without TTF1 expression (13.0 vs. 5.0 months, respectively). A multivariate analysis confirmed that worse PS [hazard ratio (HR)=2.13, p<0.001], poor histological differentiation (HR=2.02, p=0.001), wild-type EGFR status (HR=3.08, p<0.001) and negative TTF1 expression (HR=1.97, p=0.001) were independent predictors of worse prognosis. TTF1 expression is an independent predictor of survival of patients with advanced lung adenocarcinoma.

Comparing the impairment in lung age due to various etiologies among bus rapid transit system traffic wardens of Indore city

Comparing the impairment in lung age due to various etiologies among bus rapid transit system traffic wardens of Indore city

Impact of a Pharmacist-driven Spirometry Clinic Service within a Community Family Health Center: A 5-year Retrospective Review.

Objective:This study was designed to describe the impact of a trained pharmacist in performing quality spirometry testing within a community family health center.Methods:This was a retrospective, cohort study of 150 physician-referred patients who attended their scheduled spirometry office appointment between November 2008 and December 2013. Information obtained included type of the disease (patients with obstructive or restrictive pulmonary disease), calculated lung age decline due to smoking history, quality of spirometry testing, and percentage of patients requiring pulmonary drug regimen alterations due to spirometry results. Pearson correlation and descriptive statistics were used to address study objectives.Findings:Spirometry testing performed by a pharmacist resulted in 87% of tests meeting guidelines for quality. Testing identified patients with reversible airway disease (39%), chronic obstructive pulmonary disease (21%), restrictive (11%), and mixed obstructive/restrictive (11%) lung defect. Patients with abnormal spirometry demonstrated a greater smoking pack-year history and calculated lung age than patients with normal spirometry (29.1 pack-years vs. 17 pack-years; P = 0.024 and 76.3 years vs. 54.6 years; P < 0.001, respectively). A weak correlation was found between a 29.1 smoking pack-year history and forced vital capacity (r = −0.3593, P = 0.018). The pharmacist assisted in modifying pulmonary drug regimens in 69% of patients based on evidence-based guidelines.Conclusion:A pharmacist-driven spirometry service was associated with quality testing results, identified respiratory disease abnormalities, and helped modifications of pulmonary drug regimens based on evidence-based guidelines. Future direction of this service may include collaborative practice agreements with physicians to expand services of pharmacists to include spirometry testing.

Healthcare experience among older cancer survivors: Analysis of the SEER-CAHPS dataset.

Little is known about factors affecting medical care experiences of cancer survivors. This study examined experience of care among cancer survivors and assessed associations of survivors' characteristics with their experience. We used a newly-developed, unique data resource, SEER-CAHPS (NCI's Surveillance Epidemiology and End Results [SEER] data linked to Medicare Consumer Assessment of Healthcare Providers and Systems [CAHPS] survey responses), to examine experiences of care among breast, colorectal, lung, and prostate cancer survivors age >66years who completed CAHPS >1year after cancer diagnosis and survived ≥1year after survey completion. Experience of care was assessed by survivor-provided scores for overall care, health plan, physicians, customer service, doctor communication, and aspects of care. Multivariable logistic regression models assessed associations of survivors' sociodemographic and clinical characteristics with care experience. Among 19,455 cancer survivors with SEER-CAHPS data, higher self-reported general-health status was significantly associated with better care experiences for breast, colorectal, and prostate cancer survivors. In contrast, better mental-health status was associated with better care experience for lung cancer survivors. College-educated and Asian survivors were less likely to indicate high scores for care experiences. Few differences in survivors' experiences were observed by sex or years since diagnosis. The SEER-CAHPS data resources allows assessment of factors influencing experience of cancer among U.S. cancer survivors. Higher self-reported health status was associated with better experiences of care; other survivors' characteristics also predicted care experience. Interventions to improve cancer survivors' health status, such as increased access to supportive care services, may improve experience of care.

Carbonaceous particulate matter on the lung surface from adults living in São Paulo, Brazil.

Accumulation of carbonaceous particulate matter (PM) in the lung is associated with chronic disease. The amount of carbonaceous PM in airway macrophages is reported to be associated with exposure to both fossil fuel PM and cigarette smoke. However, the contribution of these exposures to carbonaceous PM at the lung surface is unclear.ObjectivesWe therefore sought to identify the exposures associated with lung surface in long-term residents of São Paulo, Brazil.MethodsLung surface carbon were analyzed in 72 autopsy specimens by image analysis. Smoking history, measured PM10 nearest to the home, distance to main road, and distance-weighted traffic density were used as exposure variables. Data are summarized as median (IQR), and compared by Mann Whitney Test, with correlations done by Spearman’s correlation.ResultsThere was no association between lung surface and age or gender. There was no statistically significant association in lung surface between smokers and non-smokers 6.74 cm2 (3.47 to 10.02) versus 5.20cm2 (2.29 to 7.54), and there was no significant association between lung surface carbon and exposure to environmental PM and markers of traffic exposure.ConclusionWe did not find a statistically significant association between lung surface and smokers and non-smokers, and no statistically significant association between lung surface carbon and environmental exposure variables. These results suggest that lung surface carbon in long-term residents of São Paulo may predominately be from environmental PM, but the most appropriate environmental exposure marker remains unclear.

Prevalence of occupational exposure to asbestos and crystalline silica according to phenotypes of lung cancer from the CaProMat study: A case-only study.

The objective of the study was to compare the prevalence of occupational exposure to asbestos and crystalline silica according to histological types of lung cancer and age at diagnosis. CaProMat study is a pooled case-only study conducted between 1996 and 2011. The current study consisted of 6521 lung cancer cases. Occupational exposure to asbestos and crystalline silica was assessed by two Job-Exposure Matrices. A weighted prevalence of exposure was derived and compared according to histological types and age at diagnosis. There was no difference of weighted prevalence of exposure to asbestos and crystalline silica according to histological types of lung cancer. There was a statistically significant difference of weighted prevalence of exposure to asbestos and crystalline silica according to age at diagnosis. Due to the limited clinical importance of the difference, neither the histological type, nor the age at diagnosis can be used as an indicator for the occupational exposure to asbestos or crystalline silica.

P223 Reslizumab improves spirometric lung age in patients with severe eosinophilic asthma

P223 Reslizumab improves spirometric lung age in patients with severe eosinophilic asthma

The Efficacy and Safety of a Novel, Nebulized Glycopyrrolate for the Treatment of COPD in Phase 3 Placebo-Controlled Studies: Effect of Baseline Lung Function and Age

The Efficacy and Safety of a Novel, Nebulized Glycopyrrolate for the Treatment of COPD in Phase 3 Placebo-Controlled Studies: Effect of Baseline Lung Function and Age

The Prevalence of CYP2D6 Gene Polymorphisms among Filipinos and their use as Biomarkers for Lung Cancer Risk

Objectives. The highly polymorphic nature of the CYP2D6 gene and its central role in the metabolism of commonly used drugs make it an ideal candidate for pharmacogenetic screening. This study aims to determine the prevalence of CYP2D6 polymorphisms among Filipinos and their association to lung cancer. Method. Forty seven single nucleotide polymorphisms (SNPs) of the CYP2D6 gene were genotyped from DNA samples of 115 cases with lung cancer and age- and sex-matched 115 controls. Results. Results show that 18 out of 47 polymorphisms have significant genotypic variability (&gt;1% for at least 2 genotypes). No variant is associated with lung cancer. However, rs1135840, rs16947 and rs28360521, were found to be highly variable among Filipinos. Conclusion. This study demonstrated that CYP2D6 polymorphisms are present among Filipinos, which, although not found to be associated with lung cancer, can be useful biomarkers for future pharmacogenetic studies. The SNP rs16947 is found to be associated with cancer and timolol-induced bradycardia; the SNP rs1135840, on the other hand, is only shown to be linked with cancer. The genetic variant rs28360521 is known to be associated with low-dose aspirin-induced lower gastrointestinal bleeding.

A propensity matched analysis of outcomes and long term survival in stented versus stentless valves

BackgroundTo compare the perioperative and long term survival after aortic valve replacement using stentless versus stented valves in a large cohort of patients grouped using propensity score matching.MethodsFrom 1991 to 2012, 4,563 patients underwent aortic valve replacement with stentless and stented valves at our institution. Propensity score matching identified 444 pairs using 13 independent variables: incidence of operation, smoking status, renal failure, hypertension, diabetes, peripheral vascular disease, cerebrovascular disease, chronic lung disease, ejection fraction, gender, age, valve status, and use of coronary artery bypass graft. Data were collected from our Society of Thoracic Surgeons database and the Social Security Death Index. Groups were compared using univariate and Kaplan-Meier analysis.ResultsThe two groups demonstrated no significant differences for the 13 matching variables and the majority of 30-day outcomes (p > 0.05). The stented valve group showed a higher incidence of postoperative bleeding (3.6% vs 1.1%, p = 0.015), but a lower incidence of stroke (0.9% vs. 2.9%, p = 0.028). One, five, and 10-year survival was 95.0, 80.7, and 52.8% for stented and 93.2, 80.5, and 51.3% for stentless valves. Overall survival did not differ significantly between the two groups (p = 0.641).ConclusionsStentless and stented valves had identical 30-day outcomes except for a higher postoperative incidence of bleeding and a lower incidence of stroke in the stented group. There was no significant difference in long term survival between valve types. Both valves may be used for aortic valve replacement with low morbidity and excellent long term survival.

Pulmonary artery to aorta ratio is associated with cardiac structure and functional changes in mild-to-moderate COPD.

BackgroundThe ratio of the diameter of the pulmonary artery (PA) to the diameter of the aorta (PA:A) on computed tomography (CT) imaging is associated with both COPD exacerbation and pulmonary hypertension. The mechanisms of PA enlargement in COPD are poorly understood.MethodsIn this retrospective, single center study we evaluated pulmonary function, CT scans, right heart catheterizations, and echocardiography in 88 subjects with mild-to-moderately severe COPD. A sensitivity analysis was performed in 43 subjects in whom CT scan and echocardiogram were performed within 50 days of each other. To evaluate the association between PA:A ratio and echocardiographic parameters and hemodynamics, we performed simple correlations and multivariable linear regression analysis adjusting for lung function, age, sex, race, and diastolic function.ResultsAll subjects had preserved left ventricular (LV) systolic function (LV ejection fraction 62.7%±5.5%). Among them, 56.8% had evidence of diastolic dysfunction. There was no association between PA:A ratio and the presence of diastolic dysfunction. In a multivariable model, PA:A ratio was associated with right ventricular (RV) chamber size (β=0.015; P<0.003), RV wall thickness (β=0.56; P<0.002), and RV function (−0.49; P=0.05). In the subgroup of subjects with testing within 50 days, the association with RV chamber size persisted (β=0.017; P=0.04), as did the lack of association with diastolic function. PA:A ratio was also associated with elevated PA systolic pressures (r=0.62; P=0.006) and pulmonary vascular resistance (r=0.46; P=0.05), but not pulmonary arterial wedge pressure (r=0.17; P=0.5) in a subset of patients undergoing right heart catheterization.ConclusionIn patients with mild-to-moderately severe COPD and preserved LV function, increased PA:A ratio occurs independent of LV diastolic dysfunction. Furthermore, the PA:A ratio is associated with right heart structure and function changes, as well as pulmonary hemodynamics. These findings indicate that PA:A ratio is a marker of intrinsic pulmonary vascular changes rather than impaired LV filling.

Relationship between lung function and grip strength in older hospitalized patients: a pilot study.

ObjectiveOlder people with reduced respiratory muscle strength may be misclassified as having COPD on the basis of spirometric results. We aimed to evaluate the relationship between lung function and grip strength in older hospitalized patients without known airways disease.MethodsPatients in acute medical wards were recruited who were aged ≥70 years; no history, symptoms, or signs of respiratory disease; Mini Mental State Examination ≥24; willing and able to consent to participate; and able to perform hand grip and forced spirometry. Data including lung function (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, peak expiratory flow rate [PEFR], and slow vital capacity [SVC]), grip strength, age, weight, and height were recorded. Data were analyzed using descriptive statistics and linear regression unadjusted and adjusted (for age, height, and weight).ResultsA total of 50 patients (20 men) were recruited. Stronger grip strength in men was significantly associated with greater FEV1, but this was attenuated by adjustment for age, height, and weight. Significant positive associations were found in women between grip strength and both PEFR and SVC, both of which remained robust to adjustment.ConclusionThe association between grip strength and PEFR and SVC may reflect stronger patients generating higher intrathoracic pressure at the start of spirometry and pushing harder against thoracic cage recoil at end-expiration. Conversely, patients with weaker grip strength had lower PEFR and SVC. These patients may be misclassified as having COPD on the basis of spirometric results.

Role of stereotactic body radiation therapy for lung metastases from radio-resistant primary tumours.

A retrospective analysis was performed on patients treated for lung oligo-metastatic disease from radio-resistant histology groups. The primary end point was local control (LC), secondary end points were overall survival (OS) and progression free survival (PFS). Toxicity was scored according to CTCAE 4.03. 200 patients were analyzed: 49.5% of the cases derived from colorectal primary tumors, 20.5% from sarcomas, 12.0% from renal cell carcinoma and the rest from other mixed origin. The mean follow-up was 24.2months. LC at 1 and 2years was 91, 84.9%. Primary histology and the presence of extra-pulmonary disease had a significant impact on LC. OS at 1 and 2years was 88.7, 65.4%. Primary histology, disease free interval, presence of extra-pulmonary disease, number of irradiated lung lesions and age showed a correlation with prognosis at univariate analysis. PFS at 1 and 2years was 84, 57.7%. The presence of extra-pulmonary disease and the number of irradiated lung lesions correlated with prognosis. Treatment was well tolerated with no G3-4 acute or late toxicity recorded. Colorectal metastases showed a higher rate of local relapse. However, the factors mostly influencing prognosis were the presence of extra-pulmonary disease and the number of lung lesions.

Intérêt de la spirométrie en médecine générale pour la motivation au sevrage tabagique. Étude pilote de faisabilité et intérêt de l’« âge pulmonaire »

Our aim was to investigate whether spirometry, performed in general practitioners' offices would change non-motivated smokers' attitudes toward smoking cessation. We performed an interventional, prospective, before-after single-center study, approved by a research ethics committee. We included 74 smokers older than 18years old, who reported no intention to quit smoking, whatever they were visiting general practitioners for. We performed spirometry and gave them their results, FEV1/FVC and lung age together with a comment on it. Nine months later, we called them for another assessment. Fifty-six percent were women with an average-age of 46.5, who smoked 26.3 pack-years. Eighty-two percent of them had normal FEV1/FVC but lung age was pathological among 38% of them. Nine months later, 61.1% reported an increased motivation to quit smoking. They smoked 10.9 cigarettes per day versus 13,3 at baseline (P=0.0254). Increase in motivation was not statistically related to age, gender, previous smoking cessations, daily smoking, nicotine dependence or an abnormal FEV1/VC ratio (P>0.75) but was significantly related to the presence of an abnormal lung age status (P<0.03). This study suggests that spirometry in general practice, combined with the determination of the lung age, may increase motivation towards smoking cessation in smokers who lack motivation.

Lung cancer: 1 year experience at tertiary care centre with reference to cytodiagnostic approach

Background: Lung cancer is the most common cancer incidence wise as well as leading cause of cancer related death in worldwide as well as in India. Cytological diagnosis plays an important role in patients having lung cancer. This study was conducted to evaluate sensitivity of various cytological methods in diagnosis of lung cancer, to study typing of lung cancer, age and gender wise distribution of lung cancer and its association with smoking.Methods: This study includes patients having clinical and radiological diagnosis of lung cancer. Total 150 cases of entire January 2015 to December 2015 are included. Methods obtaining samples includes, abrasive cytology by bronchoscope guided: bronchoalveolar lavage (BAL); brush cytology and bronchial washing, CT/USG guided transthoracic fine needle aspiration, trans- bronchial needle aspiration. Samples have been processed as per standard protocols and cytomorphology of samples are studied, along with these patient age, gender, and smoking habit have been recorded.Results: Sensitivity of various method: abrasive cytology by bronchoscope guided bronchoalveolar lavage (BAL); brush cytology and bronchial washing, trance bronchial needle aspiration, CT/USG guided transthoracic fine needle aspiration is 70%, 66%, 90% respectively. Adenocarcinoma is most common carcinoma followed by squamous carcinoma, having incident of 41%, 31.39% respectively. In male patient peak age is 5th decade, and in female peak age is 6th decade. Male:female ratio is 5.1:1. Adenocarcinoma is most common carcinoma is 10 times more common in non-smokers as compare to squamous cell carcinoma .But association of squamous cell carcinoma with smoking is 97%.Conclusions: CT/USG guided transthoracic fine needle aspiration method has highest sensitivity. In male patients peak age of presentation of lung carcinoma is 5th decade, and in female patient’s peak age is 6th decade. Lung carcinoma found to be more common in males than in females. Adenocarcinoma is most common carcinoma. It is 10 times more common in non-smokers as compare to squamous cell carcinoma. Association of squamous cell carcinoma with smoking is 97%.

OA01.05 The Impact of Lung Age on Postoperative Complications in Patients with Lung Cancer Combined with Pulmonary Fibrosis and Emphysema

Postoperative complications after pulmonary resection may cause morbidities such as prolonged hospitalization. Recently, combined pulmonary fibrosis and emphysema (CPFE) have reportedly been linked to a high risk for postoperative complications following lung cancer surgery. Moreover, some studies have claimed that lung age (LA) is associated with postoperative complications. Here we clarify the relationship between LA and postoperative complications in lung cancer patients with CPFE. Among a total of 1166 consecutive patients who underwent curative resection for lung cancer from January 2004 to April 2016 at the Kitasato University Hospital, Japan, a dataset of 36 patients with CPFE was retrospectively analyzed. Lungs with CPFE were defined based on preoperative chest computed tomography (CT) findings. LA was determined using the methods advocated by the Japanese Respiratory Society. The difference between “real age” (RA) and LA was calculated as “RA−LA,” and patients were classified into three groups: group A, RA−LA > 0 (n = 10); group B, −15 ≤ RA−LA ≤ 0 (n = 13); group C, RA−LA < −15 (n = 13). The average age was 70 (males, 69.1; females, 73.2) years. Thirty two patients were male and four were female. Almost all patients were ex- or current smokers. The average postoperative hospital stay was 16 (range, 7–56) days. There were no significant differences in age, gender, smoking history, and postoperative hospital stay among the three groups. The surgical procedures were lobectomy (n = 29), segmentectomy (n = 2), and wedge resection (n = 5). Histologically, the tumors were squamous cell carcinoma (n = 22), adenocarcinoma (n = 9), and other types (n = 4). Postoperative complications were arrhythmia (4 cases), hypertension (4 cases), air leakage (3 cases), pneumonia (5 cases), hypoxemia (3 cases), and others (5 cases). There were no significant differences in postoperative complications among the groups (p = 0.69). However, cardiovascular complications in group C were significantly higher than those in the other groups (p = 0.008). There were 26 patients with postoperative acute exacerbation, but there were no significant differences among the groups. LA accurately predicted postoperative cardiovascular complications in lung cancer patients with CPFE.

Influence of Central Obesity Assessed by Conicity Index on Lung Age in Young Adults.

Central obesity is an emerging public health problem in young adults which compromises lung mechanics. Conicity Index (CI) is a simple anthropometric measure to assess central adiposity. The concept of lung age relates to a person's current lung function at which his/her lung function would be considered abnormal in relation to the present actual age. To determine the effect of central obesity by CI on lung age in young adults. A total of 319 young adults in the age group 18-25 years were recruited for this cross-sectional observational study. Written informed consent and Institutional Ethical Clearance (IEC) approval were obtained. Anthropometric parameters were measured and CI was calculated using the following formula: CI = Waist Circumference (WC) (m)/ [0.109 X√ {Bodyweight (kg)/ Height (m)}] where 0.109 is a constant. Spirometry was performed and all the lung volumes and capacities were obtained. There was a significant increase in mean values of CI in obese young adults compared to non obese (1.36±0.15 and 1.16±0.08, p<0.001). The effect of central obesity on lung age in young adults was compared using an independent t-test. Mean of lung age was significantly higher in centrally obese young adults compared to non obese 23.87±3.03 and 21.30±2.6, p<0.001) which was statistically significant. Lung age is significantly increased in centrally obese young adults compared to non obese. Hence, lung age can be used as a potential psychological tool to show an individual with central obesity that there is premature aging of their lungs.

日本総合健診医学会 第45回大会・シンポジウム6 COPDの早期発見を目指して&lt;br&gt;COPDの早期発見のための肺年齢 とくに非喫煙者に焦点をあてて

日本総合健診医学会 第45回大会・シンポジウム6 COPDの早期発見を目指して&lt;br&gt;COPDの早期発見のための肺年齢 とくに非喫煙者に焦点をあてて

P2.03b-087 PD-L1 Expression in Adenosquamous Lung Carcinoma and the Comparison with the Other Common Variants of Non-Small Cell Lung Cancer: Topic: Biomarkers

Adenosquamous lung carcinoma (ASC) is a hybrid tumor made of adenocarcinoma and squamous cell carcinoma in one tumor. It is a rare disease with poorer prognosis comparing with the other common variants of non-small cell lung cancer (NSCLC). There is a persisting need for identifying more effective targeted therapy methods. Immune check point therapy targeted PD-1 or PD-L1 has achieved promising results in advanced stage NSCLC. PD-L1 expression has been suggested as a potential biomarker to enrich patients who will benefit from these treatments. There is limited data regarding the expression of PD-L1 in lung ASC and its correlation with the driver oncogene changes. Protein expression of PD-L1 was examined by immunohistochemistry method using the VENTANA PD-L1 (SP263) Rabbit Monoclonal Antibody. Messenger RNA level of PD-L1 was evaluated by in situ hybridization method. EGFR, K-ras, and B-raf mutation were detected by real time PCR method. Tissue microarrays (TMAs) containing formalin fixed paraffin embedded (FFPE) NSCLC cases were used in this study. This study included 51 cases of lung ASC, 133 cases of lung adenocarcinoma (AD), and 83 cases of lung squamous cell carcinoma (SCC), totally. PD-L1 expression rate in lung ASC at the mRNA level and the protein level is highly correlated, which the kappa coefficient of the two examination methods is 0.856 (P=0.000). For the 46 cases of lung ASC, which the glandular and squamous components were analyzed separately, PD-L1 expression were divergent and mainly occurred in the SCC component of lung ASC. PD-L1 expression rate in the SCC component of ASC is similar with the result of lung SCC (39% vs 29%, P=0.327); its expression rate in AD component of ASC is the same with the result of lung AD (13.7% vs 13.5%, P=1.000). There is no association between PD-L1 expression and clinicopathological characteristics in lung ASC, for example, sex, age, smoking status, clinical stage, prognosis, EGFR mutation, K-ras mutation, or B-raf mutation, et al. PD-L1 expression in the two components of lung ASC is divergent and more prone to be expressed in the SCC component. Lung ASC may be not suitable for the PD-L1 targeted therapy because of this divergent expression status.