Prevalence Of Obstructive Lung Disease Research Articles

Obstructive Lung Disease Linked to Occupational Exposures in Malawian Tobacco Farmers

ABSTRACT Nicotine and pesticide exposure in agricultural settings have been linked to the development of chronic respiratory disease in workers. However, this has not been extensively studied in Africa. The aim of this study was therefore to determine the prevalence of obstructive lung disease and its relationship to concurrent nicotine and pesticide exposure among small-scale tobacco farmers in Malawi. For this purpose, sociodemographic characteristics, occupational and environmental exposures were evaluated in relation to work-related respiratory symptoms and lung function impairment. A cross-sectional study was conducted enrolling 279 workers in flue-cured tobacco farms in Zomba, Malawi. The study instruments used for assessing the health outcomes were a standardised European Community Respiratory Health Survey II (ECRHS) questionnaire and Spirometry testing. The questionnaires were aimed at collecting relevant data on sociodemographic factors and self-reported respiratory health outcomes. Data were also collected on potential pesticide and nicotine exposures. Spirometry was done to evaluate objective respiratory impairment in accordance with American Thoracic Society guidelines. The mean age of participants was 38 years with 68% being male. The prevalence of work-related ocular nasal symptoms, chronic bronchitis, and work-related chest symptoms was 20%, 17%, and 29%, respectively. Airflow limitation (FEV1/FVC <70%) was found in 8% of workers. Self-reported exposure to pesticides varied from 72%- to 83%, whilst the prevalence of recent green tobacco sickness was 26%. Tasks linked to nicotine exposure, such as sowing (OR: 2.5; CI 1.1–5.7) and harvesting (OR: 2.6; CI 1.4–5.1), were significantly associated with work-related chest symptoms. Pesticide application (OR:1.96; CI 1.0–3.7) was associated with an increased risk of work-related oculonasal symptoms. Duration of pesticide exposure was also associated with obstructive impairment FEV1/FVC<LLN (OR: 5.11; CI 1.6–16.7) and FEV1/FVC <70% (OR: 4.68; CI 1.2–18.0). This study demonstrated that tobacco farmers in Malawi had a high prevalence of respiratory symptoms and airflow limitation due to obstructive lung disease. This could be attributed to nicotine or pesticide exposure in small-scale tobacco farming. The implementation of occupational health and safety measures to mitigate these exposures may play an important role in modifying the risk of obstructive lung disease in this population.

Association between the prevalence of obstructive lung disease and the use of aspirin in a diabetic population

Many diabetic patients take a daily low-dose of aspirin because they are two to three times more likely to suffer from heart attacks and strokes, but its role in obstructive lung diseases is less clear.A total of 1,003 subjects in community practice settings were interviewed at home. Patients self-reported their personal and clinical characteristics, including any history of obstructive lung disease (including COPD or asthma). Current medications were obtained by the direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess for a possible association between obstructive lung disease history and the use of aspirin.In a multivariate logistic regression model, a history of obstructive lung disease was significantly associated with the use of aspirin even after correcting for potential confounders, including gender, low income (<USD 30,000/year), number of comorbidities, number of medications, cigarette smoking, and alcohol problems (adjusted odds ratio = 0.67, P = 0.03, 95% confidence interval = 0.47, 0.97). The opposite was found with aspirin and that for diabetic individuals that use insulin. A secondary analysis discovered a significant interaction between aspirin use and insulin: aspirin was associated with lower rates of lung disease except among those taking both drugs where the prevalence is significantly higher.These data suggest a negative correlation between the use of aspirin and obstructive lung disease prevalence in patients with diabetes but not for those that use insulin. Further studies are required to determine if this association is causal.

Potential enhanced association between obstructive lung disease and history of depression in patients with diabetes

Depression is one of the most common comorbidities of chronic diseases including diabetes and obstructive lung diseases (emphysema, chronic bronchitis, and asthma). Obstructive lung diseases and depression have few symptoms in common. However, they are both common in adults and associated with chronic inflammation. It is not clear if their coappearance in diabetic patients is coincidental or associated beyond that expected by chance.A total of 1,003 adults with diabetes in community practice settings were interviewed at home at the time of their enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory, and current medications were obtained by direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between the prevalence of obstructive lung disease and depression.In a multivariate logistic regression model, obstructive lung disease was significantly associated with depression even after correcting for gender, obesity (≥30 kg/m2), high comorbidities (>2), low annual income (<$30,000/ year), cigarette smoking, alcohol problems, and education level (odds ratio=1.83; 95% confidence interval 1.27, 2.62; P <0.01).These data suggest a potential enhanced association between obstructive lung disease and depression in patients with diabetes. Future studies are needed to identify if inflammation is implicated in this association as a common denominator.

Obstructive Lung Disease among Patients Performing Spirometry in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Obstructive lung disease is a leading cause of morbidity and mortality worldwide which causes economic and social burdens. Spirometry is a standard test for screening and evaluating patients with symptoms of chronic respiratory diseases and is the investigation of choice for identifying airflow obstruction. Chronic obstructive lung disease prevalence, mortality, and morbidity vary across different countries. The study aimed to find out the prevalence of obstructive lung disease among the patients performing spirometry in a tertiary care centre. A descriptive cross-sectional study was conducted in the pulmonary function test clinic of the Department of Internal Medicine of a tertiary care hospital between 1 October 2021 and 31 March 2022 from hospital records. Ethical approval was taken from the Institutional Review Committee (Reference number: 200320203). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 401 patients, obstructive lung disease was present in 173 (43.14%) (38.29-47.99, 95% Confidence Interval). The mean age was 55.78±18.54 years. The most common symptom for referral was dyspnea seen in 151 (87.30%). The prevalence of obstructive lung disease in our study was higher compared to other studies from the similar setting. Spirometry should be used more frequently for diagnosis and to stratify patients for appropriate treatment.

Spirometric surveillance of obstructive lung diseases

Obstructive Lung Disease (OLD) becomes global health issues that influencing the physical health and economic conditions of people. Chronic Respiratory Disease (CRD) is the disease of airways characterized by obstruction and influencing the structure of the lungs. It includes chronic bronchitis, COPD, emphysema and asthma. The most common disease is Chronic Obstructive Pulmonary Disease (COPD). The major causes of COPD involve exposure to an irritant that damage the lungs and airways that can cause such disease.1):Assess the prevalence of OLD among the patients admitted to general medical wards using spirometry; 2): Use a symptom questionnaire for screening patients with OLD and compare it with Spirometry; 3): Association of various medical co-morbidities with the diagnosis of OLD.The screening for OLDs and factors that are influencing it along with co morbidities were analyzed. This is a descriptive study conducted on patients admitted to general medical wards in hospital of South India for a period of 2 years. The study has involved the patients who are admitted in general wards and aged &amp;#62; 40 years.The physician diagnosis of OLD at admission was in 21 out of 144 patients. It was by symptom alone in 11% (16 of 144 patients) and based on spirometry in 3.48% (5 of 144) only. During the hospitalization the diagnosis of OLD increased by 2.08% (3 of 144) on the basis of symptom alone and 1.4% (2 of 144) by spirometry, cumulatively by 3.48% (5 of 144). Therefore, at admission about 14.48% were diagnosed to have OLD. An ROC curve was plotted and the area under the curve was 0.77 95% CI (0.688 — 0.865). By ROC coordinates a cut off of 15.5 for detecting OLDs showed a sensitivity and specificity of 71% and 78% respectively with a positive predictive value of 56% and negative predictive value of 87%.With the additional yield of Spirometry and association of medical comorbidities can help identify the conditions of patients earlier and pave way for offering appropriate holistic treatment.

Acute kidney injury after cardiac surgery: Sustained low efficiency compared to continuous renal replacement therapy

Study objectiveSustained low efficiency dialysis (SLED) has been introduced as a mode of renal replacement therapy (RRT) for treating severe cardiac surgery-associated acute kidney injury (CSA-AKI) at some hospitals; SLED is performed using intermittent hemodialysis (IHD) devices but differs from conventional IHD in its duration and intensity. However, there are limited data comparing SLED against more conventional continuous RRT methods. We conducted a retrospective cohort study to compare outcomes of patients with severe CSA-AKI after an institutional transition from continuous RRT to SLED. DesignFollowing research ethics approval, we conducted a retrospective cohort study of patients with severe CSA-AKI requiring RRT. SettingCardiac Intensive Care Unit at the Toronto General Hospital (Toronto, Ontario, Canada) from 1 January 1999 to 31 December 2011. Patients351 consecutive patients with severe CSA-AKI requiring RRT after cardiac surgery. InterventionsThe RRT mode was continuous RRT before 31 March 2008, and SLED after 1 April 2008. MeasurementsThe primary outcome was low-cardiac output syndrome (LCOS) and the main secondary outcome was associated costs. Propensity score matched-pairs analyses were used to compare the outcomes of patients in the continuous RRT period versus the SLED period. Main resultsThere were 268 patients treated with continuous RRT and 83 patients treated with SLED. The SLED group had a higher weight, higher baseline hemoglobin concentration, and higher prevalence of obstructive lung disease. In propensity score match-pairs analysis (n = 148), the SLED group experienced similar odds of low cardiac output syndrome (odds ratio [OR] 1.06, 95% CI 0.68 to 1.67), death (OR 1.09, 0.94 to 1.28), acute stroke (OR 0.97, 0.83 to 1.13), myocardial infarction (OR 0.92, 0.84 to 1.01). The use of SLED was associated with a reduced cost compared to continuous RRT. The cost differential for 83 treated patients was CAD$130,974 (CAD$178,159.50 vs CAD$309,133.50) in favor of SLED. ConclusionsAn institutional transition from continuous RRT to SLED, was associated with a significant lower cost with the use of SLED, while maintaining comparable postoperative outcomes in CSA-AKI patients.

Lung Health in the Solomon Islands: A Mixed Methods Study.

Background and ObjectivesDespite a population of 600,000 people from 900 islands, there is little published data on the prevalence of lung disease in the Solomon Islands. We sought to 1) estimate the prevalence of obstructive lung disease (OLD) in Gizo, Solomon Islands, 2) identify risk factors for respiratory disease in this population and 3) review current management practices for respiratory disease through an audit of local emergency department (ED) presentations.MethodsA two-part mixed methods study was performed between March and May 2019; the first was a population-based, cross-sectional study conducted in Gizo, Solomon Islands, with a random sample undergoing questionnaires and spirometry. The second was an audit of Gizo Hospital ED records to assess presentation numbers, diagnoses and outcomes.ResultsA total of 104 patients were randomly selected for spirometry. The mean age was 46.9 years. Current smoking rates were high (24.0% overall, 43.3% age < 40, 16.2% age ≥ 40) as was regular (>10h/week) exposure to indoor/enclosed wood fire ovens (51.5%). The prevalence of COPD was 3.2% overall. A further 9.7% of participants demonstrated significant bronchodilator responsiveness suggestive of possible asthma. Most patients seen in ED presented with a respiratory condition or fever/viral illness, but spirometry was not available. Only four outpatients were prescribed salbutamol and two patients inhaled corticosteroid.ConclusionThere appears to be a high burden of obstructive lung disease in the Solomon Islands with high smoking rates, indoor smoke exposure and bronchodilator responsiveness. Respiratory symptoms are common amongst hospital ED presentations; however, inhaled asthma treatments are infrequently prescribed to outpatients.

Pulmonary function parameters among marble industry workers in Lahore, Pakistan

Background: Occupational contact with dust particles is a well-known phenomenon, particularly in developing countries of the world. Crystalline silica present in marble dust is the main etiology of a rising prevalence of obstructive lung diseases in marble stone workers, who are in direct contact with marble dust in the surrounding environment during their regular work. The purpose of this study was to compare the pulmonary function parameters of workers in marble workshops and age matched healthy individuals in the Lahore District of Pakistan. Methods: The study included 164 male individuals, 82 individuals working in marble workshops and 82 healthy individuals from the same community. Data were collected through in-person interviews using a structured questionnaire after obtaining written consent. A Spiro Lab spirometry for pulmonary function tests was used to identify any change in the lung function parameters. FVC% (forced vital capacity), FEV 1 (forced expiratory volume in first second) and FEV1 / FVC ratio were evaluated. Results: Mean age in the exposed group (marble workers) and non-exposed group (healthy individuals) were 29.92 ± 6.19 and 30.58 ± 6.37 years, respectively. The mean years of work experience of the exposed group was 11.92 ± 5.67 years. A statistically insignificant difference was observed between marble exposed workers & healthy individuals from the demographic variables. Lung function parameters in marble workers exhibited a highly significant (P < 0.001) decrease in FVC%, FEV 1 & FEV 1 / FVC ratio when compared to healthy individuals. Seventy-one percent of marble workers had abnormal pulmonary parameters whereas 34% of workers had restrictive pulmonary impairment. Marble workers who had worked for more than 15 years had a highly significant risk of developing abnormal pulmonary function (P < 0.001). Conclusion: Continuous exposure to marble dust deteriorates the lung function of marble workers.

Pulmonary function parameters among marble industry workers in Lahore, Pakistan.

Background: Occupational contact with dust particles is a well-known phenomenon, particularly in developing countries of the world. Crystalline silica present in marble dust is the main etiology of a rising prevalence of obstructive lung diseases in marble stone workers, who are in direct contact with marble dust in the surrounding environment during their regular work. The purpose of this study was to compare the pulmonary function parameters of workers in marble workshops and age matched healthy individuals in the Lahore District of Pakistan. Methods: The study included 164 male individuals, 82 individuals working in marble workshops and 82 healthy individuals from the same community. Data were collected through in-person interviews using a structured questionnaire after obtaining written consent. A Spiro Lab spirometry for pulmonary function tests was used to identify any change in the lung function parameters. FVC% (forced vital capacity), FEV 1 (forced expiratory volume in first second) and FEV1 / FVC ratio were evaluated. Results: Mean age in the exposed group (marble workers) and non-exposed group (healthy individuals) were 29.92 ± 6.19 and 30.58 ± 6.37 years, respectively. The mean years of work experience of the exposed group was 11.92 ± 5.67 years. A statistically insignificant difference was observed between marble exposed workers & healthy individuals from the demographic variables. Lung function parameters in marble workers exhibited a highly significant (P < 0.001) decrease in FVC%, FEV 1 & FEV 1 / FVC ratio when compared to healthy individuals. Seventy-one percent of marble workers had abnormal pulmonary parameters whereas 34% of workers had restrictive pulmonary impairment. Marble workers who had worked for more than 15 years had a highly significant risk of developing abnormal pulmonary function (P < 0.001). Conclusion: Continuous exposure to marble dust deteriorates the lung function of marble workers.

Pretreatment Lung Function and Checkpoint Inhibitor Pneumonitis in NSCLC

IntroductionCheckpoint inhibitor pneumonitis (CIP) is a serious toxicity of anti–programmed death-(ligand) 1 immunotherapy. Whether pretreatment differences in pulmonary function exist in patients who develop CIP is unknown. We analyzed the pulmonary function tests (PFTs) of patients with NSCLC treated with immune checkpoint inhibitors (ICIs) to evaluate whether pretreatment lung function was associated with CIP development. MethodsPatients were included if they completed greater than or equal to 1 PFT within 2 years preceding ICI initiation. CIP status (CIP+: developed CIP, CIP−: did not develop CIP) was determined clinically. Generalized estimating equation–based linear regression was used to evaluate the effects of time and CIP on lung function. Primary outcomes included the following: percent-predicted forced expiratory volume in 1 second (FEV1pp), percent-predicted forced vital capacity (FVCpp), and FEV1/FVC. ResultsA total of 43 patients (34 CIP−, 9 CIP+) with 79 PFTs (59 CIP−, 20 CIP+) were included. CIP+ patients had a 21.7% lower pretreatment FEV1pp compared with the CIP− group (95% confidence interval: −38.6 to −4.7). No statistically significant differences in FVCpp or FEV1/FVC were observed. The prevalence of obstructive lung disease was similar in both groups at 67% and 62% for the CIP+ and CIP− cohorts, as was the prevalence of current/former smoking at 100% and 93%, respectively. ConclusionsPretherapy differences in lung function were evident between patients who did and did not develop CIP, though the prevalence of obstructive lung disease was similar. Prospective studies are needed to validate these findings, inform potential risk factors for CIP, and investigate the effects of ICI treatment and CIP on pulmonary function in patients with NSCLC.

High-Density Lipoprotein Cholesterol: A Component of the Metabolic Syndrome with a New Role in Lung Function.

Background A considerable uncertainty exists about the relationship between adult metabolic syndrome (MS) and obstructive lung disease (OLD), perhaps owing to systemic inflammation. Therefore, this study aimed to investigate the relationship between MS (with its components) and the patterns of lung function impairment. Methods The participants in this study were 3978 adults aged 30-78 years from the baseline cohort of the Ningxia Cohort Study. The participants underwent pulmonary function tests, questionnaire surveys, physical examinations, and analysis of blood specimens. Results No significant difference in the prevalence of OLD was observed between male (15.9%) and female (14.2%) participants. After adjusting for possible confounding factors (e.g., age and family income), impaired lung function was found to be related to some MS components, such as abdominal obesity, high blood pressure, and low levels of high-density lipoprotein cholesterol (HDL-C) (all P < 0.05). Conclusions As an important component of MS, abdominal obesity is related to impaired lung function. Surprisingly, this study found that increased HDL-C levels could accelerate the decline of lung function; it also suggests that in the presence of different metabolic health conditions, especially abdominal obesity and low levels of HDL-C, various metabolic indicators should be comprehensively considered to prevent the decline of lung function. This partly explains the increase in the incidence of two or more chronic diseases. Therefore, the prevention of chronic diseases should shift from single-disease prevention to a comprehensive consideration of multi-disease prevention in the future. Therefore, a more sensitive evaluation of the role of HDL-C in lung function is warranted.

Association between prevalence of obstructive lung disease and obesity: results from The Vermont Diabetes Information System

BackgroundThe association of obesity with the development of obstructive lung disease, namely asthma and/or chronic obstructive pulmonary disease, has been found to be significant in general population studies, and weight loss in the obese has proven beneficial in disease control. Obese patients seem to present with a specific obstructive lung disease phenotype including a reduced response to corticosteroids. Obesity is increasingly recognized as an important factor to document in obstructive lung disease patients and a critical comorbidity to report in diabetic patients, as it may influence disease management. This report presents data that contributes to establishing the relationship between obstructive lung disease in a diabetic cohort, a population highly susceptible to obesity.MethodsA total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any history of obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory, and current medications were obtained by direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between obstructive lung disease history and obesity.ResultsIn a multivariate logistic regression model, a history of obstructive lung disease was significantly associated with obesity (body mass index ≥30) even after correcting for potential confounders including gender, low income (<$30,000/year), number of comorbidities, number of prescription medications, cigarette smoking, and alcohol problems (adjusted odds ratio (OR) = 1.58, P = 0.03, 95% confidence interval (CI) = 1.05, 2.37). This association was particularly strong and significant among female patients (OR = 2.18, P = < 0.01, CI = 1.27, 3.72) but not in male patients (OR = 0.97, P = 0.93, CI = 0.51, 1.83).ConclusionThese data suggest an association between obesity and obstructive lung disease prevalence in patients with diabetes, with women exhibiting a stronger association. Future studies are needed to identify the mechanism by which women disproportionately develop obstructive lung disease in this population.

Incident obstructive lung disease and mortality among people with HIV and a history of injecting drugs.

People with HIV (PWH) experience increased prevalence of obstructive lung disease (OLD), regardless of greater observed smoking behaviors. We investigated whether the effect of incident OLD on mortality differed by HIV and HIV viral suppression among persons who inject drugs (PWID) and report smoking history. ALIVE is a longitudinal, observational cohort study of HIV-positive and seronegative PWID. This analysis included participants who had at least one spirometry measure to assess OLD between 2007 and 2016, excluding those who never smoked (5%, n = 62) or had baseline OLD (17%, n = 269). Incident OLD occurred when the first prebronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) less than 0.70 during follow-up. The effect of incident OLD on all-cause mortality was estimated in PWH and seronegative participants using inverse-probability-of-treatment-weighted marginal structural models controlling for baseline (age, race, sex, calendar year, smoking pack-years) and time-varying (smoking intensity, viral suppression, and calendar time) confounders. Among 1204 participants, 269 (22.3%) and 157 (13.0%) experienced incident OLD and death, respectively, over a median of five person-years of follow-up. There was no effect of OLD on mortality among seronegative participants [hazard ratio = 0.84, 95% confidence interval (CI): 0.47-1.48]; however, PWH diagnosed with OLD experienced an increased mortality risk (hazard ratio = 1.71, 95% CI: 1.04-2.80) during follow-up. HIV viral suppression did not confound or modify the effect of OLD on mortality among PWH. There was an apparent effect of OLD on all-cause mortality irrespective of viral suppression among PWH but not among seronegative persons, after accounting for baseline and time-varying confounders. These results highlight the need for enhanced screening and management of OLD among PWH.

Prevalence and burden of obstructive lung disease in the urban poor population of Ottawa, Canada: a community-based mixed-method, observational study

BackgroundGlobally the burden of Obstructive Lung Diseases (OLD) is growing, however its effect on urban poor populations with the high prevalence of tobacco dependence is virtually unknown. The purpose of this project is to estimate the prevalence and burden of OLD in the urban, low-income populations of Ottawa, Canada.MethodsThe study presented in this paper was part of the PROMPT (Management and Point-of-Care for Tobacco Dependence) project; a prospective cohort study in a community-based setting (n = 80) with meaningful Patient Engagement from design to dissemination. Spirometry data, standardized questionnaires and semi-structured interviews from PROMPT were interpreted to understand the lung function, disease burden and social determinants (respectively) in this population.ResultsThe prevalence of OLD among those who completed spirometry (N = 64) was 45–59%. Generic and disease-specific quality of life was generally poor in all PROMPT participants, even those without OLD, highlighting the higher disease burden this vulnerable population faces. Quality of life was impacted by two major themes, including i) socioeconomic status and stress and ii) social networks and related experiences of trauma.ConclusionThe prevalence and disease burden of OLD is significantly higher in Ottawa’s urban poor population than what is observed in the general Canadian population who smoke, suggesting an etiological role of the social determinants of health. This urges the need for comprehensive care programs addressing up-stream factors leading to OLDs, including poor access and utilization of preventive healthcare addressing the social determinants of health.Trial registrationClinicalTrails.gov - NCT03626064, Retrospective registered: August 2018.

Healthcare Service Usage and Costs for Elderly Patients with Obstructive Lung Disease.

BackgroundThe worldwide prevalence of obstructive lung disease (OLD) is increasing, especially among people >65 years old, and nearly three in four adults with OLD have two or more comorbid conditions. This study describes the impact of such comorbidities on the healthcare service usage and related costs in a country with universal health coverage, basing on a large cohort of elderly patients with OLD and employing real-world data.MethodsWe carried out a retrospective cohort study on a large population of elderly (age >64 years) patients with OLD served by a Local Health Unit in northern Italy. Their comorbidities were assessed using the clinical diagnoses assigned by the Adjusted Clinical Group (ACG) system to individual patients by combining different information flows. Correlations between number of comorbidities and total annual healthcare service usage and costs were examined with Spearman’s test. Regression models were applied to analyze the associations between the above-mentioned variables, adjusting for age and sex.ResultsAll types of healthcare service usage (access to emergency care; number of outpatient visits; number of hospital admissions) and pharmacy costs increased significantly with the number of comorbidities. Average total annual costs increased steadily with the number of comorbidities, ranging from € 1158.84 with no comorbidities up to € 9666.60 with 6 comorbidities or more. Poisson regression analyses showed an independent association between the number of comorbidities and the use of every type of healthcare service.ConclusionThese results based on real-world data provide evidence that the burden of care for OLD patients related to their comorbidities is independent of and in addition to the burden related to OLD alone and is strongly dependent on the number of comorbidities, suggesting a holistic approach to multimorbid patients with OLD is the most sound public health strategy.

Prevalence and correlates of obstructive lung disease among people who inject drugs, San Diego, California

BackgroundPulmonary tissue damage leading to obstructive lung disease (OLD) could result from intravenous administration of insoluble particles found in illicit drugs. This study described the prevalence and identified correlates of OLD among people who inject drugs (PWID). MethodsIn 2012–2016, a community-based cohort of PWID who had injected within the past month were enrolled in a study to assess HIV, hepatitis C virus (HCV) andMycobacterium tuberculosis (Mtb) infections and their related risk factors. Data were obtained through face-to-face interviews, serological testing and spirometry. Baseline data were used for a cross-sectional analysis of the prevalence and correlates of OLD, defined as FEV1/FVC < 0.7. Univariate and multivariable logistic regression were used to identify factors associated with OLD. ResultsAmong 516 participants who had complete spirometry and interview results, the mean age was 43.3 years, 73.6 % were male, 9.5 % were Black, 91.1 % smoked cigarettes and 18.2 % had OLD. Few (9.6 %) PWID with OLD reported a previous diagnosis of COPD although many (44.7 %) reported related symptoms. Black race (AOR = 2.66, 95 %CI: 1.37, 5.17), pack-years smoked (AOR = 1.06/5 years, 95 %CI: 1.01, 1.12), and duration of injection drug use (AOR = 1.13, 95 %CI: 1.01, 1.27) were independently associated with OLD after controlling for age. ConclusionsThe prevalence of OLD was high in this cohort and associated with Black race and cigarette smoking—known risk factors. In addition, OLD prevalence increased with greater duration of injection drug use, suggesting a link between cumulative exposure to injected insoluble particles and OLD. Further examination of these adulterants and lung pathology are needed.

Prevalence of Obstructive Lung Disease in Asymptomatic Gas Field Workers.

IntroductionObstructive lung disease, if not managed appropriately and in a timely manner, increases morbidity and mortality. The aim of this study was to see an obstruction on spirometry reports of clinically asymptomatic oil and gas field workers.MethodsIn this retrospective observational study, spirometry reports performed at the pulmonary function laboratory of Ziauddin Hospital and University, Karachi, were reviewed. All reports were of the clinically asymptomatic employees of an oil and gas company in Pakistan, who presented for their routine assessment. Obstructive impairment was defined as a forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7.ResultsOf the total of 199 spirometry reports, 197 (99%) were of male employees. The mean age of the employees was 30.52 ± 8.24 years and 46 (23.1%) employee were smokers. Obstruction was observed in 48 (24.1%) of the reports of the employees with 13 (27.1%) smokers and 35 (72.9%) non-smokers. No statistically significant association between obstruction and gender, age, and smoking was observed.ConclusionIn this study, we observed obstructive impairment in around one-fourth of the otherwise clinically asymptomatic oil and gas field workers with no apparent impact of baseline smoking behavior.

Asthma/COPD Disparities in Diagnosis and Basic Care Utilization Among Low-Income Primary Care Patients.

Obstructive pulmonary disease outcomes in the United States differ between Latinos and non-Hispanic whites. There is little objective data about diagnosis prevalence and primary care visit frequency in these disease processes. We used electronic health record data to perform a retrospective cohort analysis of 34,849 low-income patients seen at Oregon community health centers between 2009 and 2013 to assess joint racial/ethnic and insurance disparities in diagnosis and visit rates between Latino and non-Hispanic white patients. The overall study prevalence of obstructive lung disease was 18%. Latinos had lower odds of obstructive lung disease diagnosis (OR 0.37, 95% CI 0.30-0.44). Among those diagnosed prior to 2009, the uninsured (regardless of race/ethnicity) had lower visit rates during 2009-2013 than the insured. This study identified racial/ethnic disparities in the diagnosis of obstructive pulmonary disease between Latinos and non-Hispanic Whites, confirming trends observed in survey research but controlling for important confounders. Health insurance was associated with basic care utilization, suggesting that lack of health insurance could lessen the quality of care for obstructive pulmonary disease in Latino and non-Hispanic white patients.

Airway inflammation in sickle cell disease-A translational perspective.

Asthma and sickle cell disease (SCD) are common chronic conditions in children of African ancestry that are characterized by cough, wheeze, and obstructive patterns on pulmonary function. Pulmonary function testing in children with SCD has estimated a prevalence of obstructive lung disease ranging from 13% to 57%, and airway hyper-responsiveness of up to 77%, independent of a diagnosis of asthma. Asthma co-existing with SCD is associated with increased risk of acute chest syndrome (ACS), respiratory symptoms, pain episodes, and death. However, there are inherent differences in the pathophysiology of SCD and asthma. While classic allergic asthma in the general population is associated with a T-helper 2 cell (Th-2 cells) pattern of cell inflammation, increased IgE levels and often positive allergy testing, inflammation in SCD is associated with different inflammatory pathways, involving neutrophilic and monocytic pathways, which have been explored to a limited extent in mouse models and with a dearth of human studies. The current review summarizes the existent literature on sickle cell related airway inflammation and its cross roads with allergic asthma-related inflammation, and discusses the importance of further elucidating and understanding these common and divergent inflammatory pathways in human studies to facilitate development of targeted therapy for children with SCD and pulmonary morbidity.

Aspergillus spp. in Patients with Chronic Lung Disease in Colombia : Prevalence of Increased Serum IgE, Aspergillus Sensitization and Colonization Chronic Obstructive Lung Disease COPD

Aspergillus spp. in Patients with Chronic Lung Disease in Colombia : Prevalence of Increased Serum IgE, Aspergillus Sensitization and Colonization Chronic Obstructive Lung Disease COPD