Self-reported Chronic Obstructive Pulmonary Disease Research Articles

Prevalence, mortality and risk factors for self-reported COPD among smokers and never smokers, NHANES 1999-2018.

Cigarette smoke is the main risk factor for chronic obstructive pulmonary disease (COPD), but 25% to 50% of cases occur in non-smokers. In the US, limited recent national data compare COPD prevalence between smokers and never smokers. Furthermore, our study seeks to explore the prevalence and mortality of self-reported COPD among smokers (including current smokers and ex-smokers) and never smokers in the US from 1999 to 2018, and to identify the risk factors and differences. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Age-standardized prevalence of self-reported COPD among current smokers, ex-smokers, and never smokers was calculated using sample weights and 2010 US Census estimates. Risk factors were evaluated through weighted logistic regression models. Subsequently, participants who enrolled in the study cohort were followed until 31 December 2019, to determine all-cause mortality rates. Between 1999 and 2018, the weighted prevalence of COPD among current smokers, ex-smokers, and never smokers in the U.S. was 12.6%, 9.6%, and 4.1%, respectively. The mortality rates observed were 21.1% among current smokers with COPD, 29% among ex-smokers with COPD, and 12% among never smokers with COPD. Over this period, among the general population in the U.S., the proportion of current smokers has declined, the proportion of never smokers has increased, and the proportion of ex-smokers has remained relatively stable. From 1999 to 2018, COPD prevalence rose from 13.7% to 21.9% among current smokers, stayed at 10.1% among ex-smokers, and dropped from 4.9% to 3.3% among never smokers. Independent risk factors for COPD across all groups included being female, older, and lower income. In particular, US citizens and non-Hispanic Whites (among ex-smokers and never smokers) were at higher risk compared to their counterparts. The prevalence and all-cause mortality of COPD among current smokers and ex-smokers remain elevated. Although the prevalence of COPD among never smokers is gradually declining, it continues to be significant, thereby maintaining a substantial burden of disease. Furthermore, common independent risk factors for COPD across current smokers, ex-smokers, and never smokers include female gender, advanced age, lower income, and deviations from normal body weight whether overweight or underweight.

Development and validation of reference equations for dual-energy X-ray absorptiometry-derived measures of fat-free mass in adults aged 45-85 years: results from the Canadian Longitudinal Study on Aging.

Reference equations for fat-free mass (FFM) and lean soft tissue mass (LM) measures obtained from dual-energy X-ray absorptiometry (DEXA) are important for the interpretation of body composition. This study developed and validated reference equations for FFM and LM using DEXA from the Canadian Longitudinal Study on Aging. Reference equations were developed using data from a random population-based sample of ostensibly healthy and functionally independent adults aged 45-85 years. Reference equations for absolute (accounting for age, sex, height, and body mass) and height-adjusted aka index (accounting for age, sex, and body mass index) measures of FFM and LM were developed using quantile regression. Reference equations were respectively developed and validated in derivation (80%) and validation cohorts (20%). Reference equations were applied to symptomatic adults with self-reported chronic obstructive pulmonary disease (COPD) or heart disease to assess discriminant validity; and compared with other published equations to assess performance. Bland-Altman analyses and Lin's concordance correlation coefficients were utilised to assess agreement. Reference equations for 5th, 10th, 50th, 90th, and 95th percentiles were developed for DEXA-derived estimates of FFM and LM based on 1881 healthy participants (57% male) aged 55 [IQR: 50-61] years. Reference equations performed comparably in the validation cohort and discriminated reference values between ostensibly healthy adults and people with symptomatic COPD or heart disease. Previously published reference equations tended to over- or under-predict estimates of LM compared with the current reference equations. This study provides a comprehensive and validated set of reference equations for estimating and interpreting FFM and LM from DEXA in Canadian adults aged 45-85 years, although additional validation may be required for those>75 years.

Associations of long-term exposure to air pollution and greenness with incidence of chronic obstructive pulmonary disease in Northern Europe: The Life-GAP project

BackgroundProlonged exposure to air pollution has been linked to adverse respiratory health, yet the evidence concerning its association with chronic obstructive pulmonary disease (COPD) is inconsistent. The evidence of a greenness effect on chronic respiratory diseases is limited. ObjectiveThis study aimed to investigate the association between long-term exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3) and greenness (as measured by the normalized difference vegetation index - NDVI) and incidence of self-reported chronic bronchitis or COPD (CB/COPD). MethodsWe analyzed data from 5355 adults from 7 centers participating in the Respiratory Health in Northern Europe (RHINE) study. Mean exposures to air pollution and greenness were assessed at available residential addresses in 1990, 2000 and 2010 using air dispersion models and satellite data, respectively. Poisson regression with log person-time as an offset was employed to analyze the association between air pollution, greenness, and CB/COPD incidence, adjusting for confounders. ResultsOverall, there were 328 incident cases of CB/COPD during 2010–2023. Despite wide statistical uncertainty, we found a trend for a positive association between NO2 exposure and CB/COPD incidence, with incidence rate ratios (IRRs) per 10 μg/m³ difference ranging between 1.13 (95% CI: 0.90–1.41) in 1990 and 1.18 (95% CI: 0.96–1.45) in 2000. O3 showed a tendency for inverse association with CB/COPD incidence (IRR from 0.84 (95% CI: 0.66–1.07) in 2000 to 0.88 (95% CI: 0.69–1.14) in 2010. No consistent association was found between PM, BC and greenness with CB/COPD incidence across different exposure time windows. ConclusionConsistent with prior research, our study suggests that individuals exposed to higher concentrations of NO2 may face an elevated risk of developing COPD, although evidence remains inconclusive. Greenness was not associated with CB/COPD incidence, while O3 showed a tendency for an inverse association with the outcome.

Bisoprolol in Patients With Chronic Obstructive Pulmonary Disease at High Risk of Exacerbation

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Observational studies report that β-blocker use may be associated with reduced risk of COPD exacerbations. However, a recent trial reported that metoprolol did not reduce COPD exacerbations and increased COPD exacerbations requiring hospital admission. To test whether bisoprolol decreased COPD exacerbations in people with COPD at high risk of exacerbations. The Bisoprolol in COPD Study (BICS) was a double-blind placebo-controlled randomized clinical trial conducted in 76 UK sites (45 primary care clinics and 31 secondary clinics). Patients with COPD who had at least moderate airflow obstruction on spirometry (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity <0.7; FEV1 <80% predicted) and at least 2 COPD exacerbations treated with oral corticosteroids, antibiotics, or both in the prior 12 months were enrolled from October 17, 2018, to May 31, 2022. Follow-up concluded on April 18, 2023. Patients were randomly assigned to bisoprolol (n = 261) or placebo (n = 258). Bisoprolol was started at 1.25 mg orally daily and was titrated as tolerated during 4 sessions to a maximum dose of 5 mg/d, using a standardized protocol. The primary clinical outcome was the number of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both during the 1-year treatment period. Safety outcomes included serious adverse events and adverse reactions. Although the trial planned to enroll 1574 patients, recruitment was suspended from March 16, 2020, to July 31, 2021, due to the COVID-19 pandemic. Two patients in each group were excluded postrandomization. Among the 515 patients (mean [SD] age, 68 [7.9] years; 274 men [53%]; mean FEV1, 50.1%), primary outcome data were available for 514 patients (99.8%) and 371 (72.0%) continued taking the study drug. The primary outcome of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both was 526 in the bisoprolol group, with a mean exacerbation rate of 2.03/y, vs 513 exacerbations in the placebo group, with a mean exacerbation rate of 2.01/y. The adjusted incidence rate ratio was 0.97 (95% CI, 0.84-1.13; P = .72). Serious adverse events occurred in 37 of 255 patients in the bisoprolol group (14.5%) vs 36 of 251 in the placebo group (14.3%; relative risk, 1.01; 95% CI, 0.62-1.66; P = .96). Among people with COPD at high risk of exacerbation, treatment with bisoprolol did not reduce the number of self-reported COPD exacerbations requiring treatment with oral corticosteroids, antibiotics, or both. isrctn.org Identifier: ISRCTN10497306.

Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years - United States, 2011-2021.

Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States. Overall COPD prevalence declined during 1999-2011. Trends in COPD prevalence during the previous decade have not been reported. CDC analyzed 2011-2021 Behavioral Risk Factor Surveillance System data to assess trends and differences in self-reported physician-diagnosed COPD prevalence among U.S. adults aged ≥18 years. Age-standardized prevalence of COPD did not change significantly from 2011 (6.1%) to 2021 (6.0%). Prevalence was stable for most states and subgroups; however, it decreased significantly among adults aged 18-44 years (average annual percent change [AAPC]=-2.0%) and increased significantly among those aged ≥75 years (AAPC=1.3%), those living in micropolitan counties (0.8%), and among current (1.5%) or former (1.2%) smokers. COPD prevalence remained elevated in the following groups: women, adults aged ≥65 years, those with a lower education level, unable to work, living in rural areas, and who ever smoked. Evidence-based strategies, especially those tailored for adults disproportionately affected, can reduce COPD prevalence, and address the continued need for prevention, early diagnosis, treatment, and management.

Association of cigarette smoking with increased use of heated tobacco products in middle-aged and older adults with self-reported chronic obstructive pulmonary disease, asthma, and asthma-COPD overlap in Japan, 2022: the JASTIS study

BackgroundSmoking cessation is the most important intervention in chronic obstructive pulmonary disease (COPD), asthma, and asthma-COPD overlap (ACO); however, high rates of current cigarette smoking are observed in adults with these respiratory diseases. Meanwhile, rapidly increasing use of heated tobacco products (HTPs) is observed in Japan; however, the status of HTPs use has not been fully understood in adults with COPD, asthma, and ACO. This study aimed to reveal the association between COPD, asthma, and ACO and HTPs use in adults.MethodsData on Japanese individuals ≥ 40 years old obtained from the Japan Society and New Tobacco Internet Survey were analyzed. The prevalence of HTPs use in adults with COPD, asthma, and ACO, among individuals categorized into three groups according to cigarette smoking (never, former, and current), was calculated and the relationship between each disease and HTPs use were evaluated. The clinical diagnosis of these diseases was based on the self-reported diagnosis, as obtained from questionnaires.ResultsA total of 19,308 individuals were included. The proportions of never, past, and current cigarettes smokers were 10,900 (56.5%), 4,903 (25.4%), and 3,505 (18.2%), respectively, and that of HTPs use was 1,813 (9.4%). In current cigarettes smokers, the adjusted odds ratios (ORs) of HTPs use was 2.88 (95% CI [confidence interval], 1.86–4.47), 1.23 (95% CI, 0.99–1.52), and 5.81 (95% CI, 3.12–10.82) in adults with COPD, asthma, and ACO compared to those without these respiratory diseases, respectively. Meanwhile, in past cigarettes smokers, the adjusted ORs of HTPs use was 0.51 (95% CI, 0.24–1.08), 0.69 (95% CI, 0.53–0.88), and 0.25 (95% CI, 0.06–1.07) in adults with COPD, asthma, and ACO, respectively.ConclusionsHTPs use is more prevalent among current cigarettes smokers with COPD, asthma, and ACO compared to those without these respiratory diseases. Complete cessation of smoking both cigarettes and HTPs is the only way to achieve complete smoking cessation, therefore, adults with COPD, asthma, and ACO need to make greater efforts to quit smoking.

Respiratory and population effects of e-cigarettes: A Chinese perspective.

Respiratory and population effects of e-cigarettes: A Chinese perspective.

Factors Related to Fatigue and Physical Function in COPD: A Secondary Analysis Using National Survey Data.

Fatigue in chronic obstructive pulmonary disease (COPD) is debilitating and associated with considerable morbidity. The aim of this study is to present a model based on the Theory of Unpleasant Symptoms of physiologic, psychologic, and situational factors with COPD-related fatigue and the relationship with physical functioning. This study used data collected from Wave 2 (2010-2011) of the National Social, Health, and Aging Project (NSHAP). A total of 518 adults with self-reported COPD were included in this study. Path analysis was used for hypothesis testing. Depression was the only psychologic factor found to have a direct relation to both fatigue (β = 0.158, p < .001) and physical function (β = -0.131, p = .001). Factors related to physical function included fatigue, depression, sleep, loneliness, and pain. Additionally, fatigue was indirectly associated with physical function via depression (β = -0.064, p = .012). These findings suggest avenues for future research on predictors of COPD-related fatigue in relation to physical functioning.

Association between abdominal and general obesity and respiratory symptoms, asthma and COPD. Results from the RHINE study

IntroductionPrevious studies on the association between abdominal and general obesity and respiratory disease have provided conflicting results. Aims and objectivesWe aimed to explore the associations of abdominal obesity with respiratory symptoms, asthma, and chronic obstructive pulmonary disease independently from general obesity in women and men. MethodsThis cross-sectional study was based on the Respiratory Health in Northern Europe (RHINE) III questionnaire (n = 12 290) conducted in 2010–2012. Abdominal obesity was self-measured waist circumference using a sex-specific standard cut-off point: ≥102 cm in males and ≥88 cm in females. General obesity was defined as self-reported BMI ≥30.0 kg/m2. ResultsThere were 4261 subjects (63% women) with abdominal obesity and 1837 subjects (50% women) with general obesity. Both abdominal and general obesity was independent of each other and associated with respiratory symptoms (odds ratio (OR) from 1.25 to 2.00)). Asthma was significantly associated with abdominal and general obesity in women, OR (95% CI) 1.56 (1.30–1.87) and 1.95 (1.56–2.43), respectively, but not in men, OR 1.22 (0.97–3.17) and 1.28 (0.97–1.68) respectively. A similar sex difference was found for self-reported chronic obstructive pulmonary disease. ConclusionsGeneral and abdominal obesity were independent factors associated with respiratory symptoms in adults. Asthma and chronic obstructive pulmonary disease were independently linked to abdominal and general obesity in women but not men.

Cigarettes, ENDS Use, and Chronic Obstructive Pulmonary Disease Incidence: A Prospective Longitudinal Study

Understanding the relationship between ENDS use and chronic obstructive pulmonary disease (COPD) and other respiratory conditions is critical. However, most previous studies have not fully adjusted for cigarette smoking history. Using Waves 1-5 of the U.S. Population Assessment of Tobacco and Health study, the association between ENDS use and self-reported incident COPD was examined among adults aged 40+ years using discrete-time survival models. Current ENDS use was measured as a time-varying covariate, lagged by 1 wave, defined as established daily or some days of use. Multivariable models were adjusted for baseline demographics (age, sex, race/ethnicity, education), health characteristics (asthma, obesity, exposure to second-hand smoke), and smoking history (smoking status and cigarette pack years). Data were collected between 2013 and 2019, and the analysis was conducted in 2021-2022. Incident COPD was self-reported by 925 respondents during the 5-year follow-up. Before adjusting for other covariates, time-varying ENDS use appeared to double COPD incidence risk (hazard ratio=1.98, 95% CI=1.44, 2.74). However, ENDS use was no longer associated with COPD (adjusted hazard ratio=1.10, 95% CI=0.78, 1.57) after adjusting for current cigarette smoking and cigarette pack years. ENDS use did not significantly increase the risk of self-reported incident COPD over a 5-year period once current smoking status and cigarette pack years were included. Cigarette pack years, by contrast, remained associated with a net increase in COPD incidence risk. These findings highlight the importance of using prospective longitudinal data and adequately controlling for cigarette smoking history to assess the independent health effects of ENDS.

Prevalence of abnormal spirometry in individuals with a smoking history and no known obstructive lung disease

IntroductionRecent evidence suggests a high prevalence of undiagnosed chronic obstructive pulmonary disease (COPD). These individuals are at risk of exacerbations and delayed treatment. We analyzed an at-risk population for the prevalence of abnormal spirometry to provide clarity into who should undergo early spirometry. MethodsWe analyzed data from the COPDGene study. Participants with ≥10 pack-years of smoking were included. Individuals with self-reported or physician-diagnosed COPD, asthma, chronic bronchitis, emphysema and/or were on inhalers were excluded. Parsimonious multivariable logistic regression models identified factors associated with abnormal spirometry, defined as either airflow obstruction (AFO) or preserved ratio impaired spirometry. Variables were selected for the final model using a stepwise backward variable elimination process which minimized Akaike information criterion (AIC). Similarly, during the 5-year follow-up period, we assessed factors associated with incident diagnosis of COPD. ResultsOf 5055 individuals, 1064 (21%) had undiagnosed AFO. Age, pack-years, current smoking and a history of acute bronchitis were associated with AFO while body mass index, female sex, and Black race were inversely associated. Among 2800 participants with 5-year follow-up, 532 (19%) had an incident diagnosis of COPD. Associated risk factors included mMRC ≥2, chronic productive cough, respiratory exacerbations during the follow-up period, and abnormal spirometry. Age was inversely associated. ConclusionsThe prevalence of undiagnosed COPD is high in at-risk populations. We found multiple factors associated with undiagnosed COPD and incident diagnosis of COPD at follow up. These results can be used to identify those at risk for undiagnosed COPD to facilitate earlier diagnosis and treatment.

The Association Between Systemic Arterial Hypertension and Chronic Obstructive Pulmonary Disease. Results from the U.S. National Health and Nutrition Examination Survey 1999-2018: A Cross-sectional Study.

Systemic arterial hypertension (HTN) is one of the common comorbidities among patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association between HTN and COPD. A total of 46,804 eligible non-pregnant participants aged ≥ 20 years examined in the Mobile Examination Center of the National Health and Nutrition Examination Survey (NHANES) 1999-2018 were included in this cross-sectional study. Participants with invalid data on covariates, HTN, and COPD were excluded. The association between HTN and COPD was studied using logistic regression upon adjusting the potential covariates. Among the participants, 46.1% (95% confidence interval [CI], 45.3-46.9) had HTN, and 6.8% (95% CI, 6.4-7.2) had self-reported COPD. COPD was associated with HTN (OR [odds ratio]=1.18, 95% CI [1.05-1.31], P<0.01) after adjusting for demographics, socioeconomic factors, smoking, diabetes, body mass index, and medication use, including inhaled corticosteroids and methylxanthines. The association between HTN and COPD was significant among adults younger than 60 years (P<0.01). Stratified by smoking status, there was a significant association between HTN and COPD in current heavy smokers (1.25, 95% CI [1.01-1.58]; P=0.04). In this nationwide survey, COPD was associated with HTN. The association was more robust among adults younger than 60 years and current heavy smokers. Future prospective studies are needed to examine the relationship between HTN and COPD.

Determinants of depressive symptom trajectories in self-reported chronic obstructive pulmonary disease patients

BackgroundThe depressive symptom trajectories of COPD individuals and its’ predictors remain to be established. Therefore, this study aimed to explore the trajectories of depressive symptoms and predictors thereof in COPD patients.MethodsA total of 1286 individuals over 45 years of age with self-reported COPD were assessed. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale short form, with depressive symptom trajectories being identified via latent class growth analysis. The predictors of depressive symptom trajectories were then identified through multinomial logistic regression.ResultsFinally, three depressive symptom trajectories were identified: “steadily high”, “consistently moderate”, and “consistently low”. Old age, longer night-time sleep duration, and high BMI were found to be associated with individuals being classified under the “consistently moderate” trajectory. Moreover, participants exhibiting more than two chronic conditions were more likely to be classified under the “consistently moderate” trajectory. Higher education and lower hand grip strength were important predictors of individuals classified in the “steadily high” trajectory.ConclusionsTo conclude, three depressive symptom trajectories were identified in self-reported COPD individuals. To ensure timely intervention aimed at preventing the worsening of depressive symptom progression among COPD individuals, health-care workers should regular analyze depressive symptoms and provide appropriate interventions when possible.

BMI moderates the association between adverse childhood experiences and COPD

ObjectivesCigarette smoking and obesity are leading risk factors for chronic obstructive pulmonary disease (COPD). Although studies have established an association between adverse childhood experiences (ACEs) and COPD, few studies have examined whether this association is moderated by cigarette smoking or body mass index (BMI). This cross-sectional study examined the association between ACEs and COPD, and whether cigarette smoking or BMI moderates this association. MethodsData for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,700 adults aged 18–79 years (50.7% female) were analyzed using binary logistic regression. The outcome variable investigated was self-reported physician-diagnosed COPD, and the main explanatory variable was ACEs. ResultsOf the 75,700 respondents examined, 8.1% had COPD. About one in three (33.6%) respondents had no ACEs, 23.1% had one ACE, and about one in five (20.2%) had four or more ACEs. In the multivariable binary logistic regression, we found that the association between ACEs and COPD differs by BMI status. Controlling for the effects of other factors, the association between ACEs and COPD is strongest for respondents who are obese (AOR = 1.41, 95% CI = 1.04–1.91). ConclusionsThe findings of this study demonstrate that ACEs are associated with COPD later in adulthood, and BMI moderated this association. The findings of this study add to the number of studies demonstrating the adverse impact of ACEs on chronic health outcomes among adults.

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

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

Early-Life Exposure to Malnutrition From the Chinese Famine on Risk of Asthma and Chronic Obstructive Pulmonary Disease in Adulthood.

ObjectivesIntrauterine malnutrition has a long-term effect on respiratory and lung function. However, few studies have explored the association between early-life exposure to famine with asthma and chronic obstructive pulmonary disease (COPD) in adulthood. Therefore, we aimed to investigate the association of early-life exposure to the Chinese famine of 1959–1962 with asthma and COPD later in life.MethodsThis national population-based study included 6,771 participants from the baseline survey of the China Health and Retirement Longitudinal Study (CHARLS) who were born around the time of the Chinese famine. The famine exposure groups were determined according to the participants' birth year as non-exposed (1964–1967), fetal-exposed (1959–1962), preschool-exposed (1954–1957), and school-age exposed (1950–1953). Information about the demographic characteristics, self-reported doctor-diagnosed asthma and COPD, behavior and lifestyles, and indoor pollution were collected using validated questionnaires. In addition, peak expiratory flow (PEF) was measured to assess pulmonary function. Multivariable logistic regression and generalized linear mixed models were performed to explore the risk of adult asthma and COPD, PEF changes during various famine exposure periods compared with the non-exposed group. Stratified and sensitivity analyses were conducted to examine the modification and robustness of the association.ResultsThe prevalence of doctor-diagnosed asthma and COPD was 2.8 and 8.1%, respectively. Compared with the non-exposed group, the risk was significantly higher in the fetal-exposed group for asthma [adjusted odds ratio, (aOR) = 1.87, 95% confidence interval (CI):1.14–3.07] and the school-age exposed group [1.30 (1.00–1.69)] for COPD after controlling for confounders. Furthermore, we observed that fetal exposure to famine was significantly associated with a decrement of PEF in adulthood [β = −11.38 (−22.75 to −0.02)] compared with the non-exposed group. Stratified analyses showed that the association of asthma was stronger in men, who resided in severely famine-affected areas, smoked, and used solid fuels for cooking. No clearly consistent association was observed for subsequent COPD.ConclusionsOur results suggest that fetal exposure to the Chinese famine is significantly associated with the increased risk of asthma in adulthood. Future prospective studies are warranted to examine the association and mechanisms.

Perceptions of Environmental Influence and Environmental Information-Seeking Behavior Among People With Asthma and COPD.

Environmental exposures and socioeconomic status (SES) are associated with asthma and chronic obstructive pulmonary disease (COPD) morbidity and mortality. Despite efforts to reduce the impact of environmental exposures through regulation and education, knowledge gaps remain. We sought to understand how adults with asthma and COPD perceive and seek information about environmental factors, and how these responses varied by disease or socioeconomic characteristics. Participants with self-reported asthma or COPD enrolled in a digital platform for respiratory disease self-management, consisting of sensors to track medication use and a companion smartphone app, completed an electronic survey exploring perceptions of environmental factors. Using mixed-method analyses, we evaluated differences in responses by disease (asthma vs. COPD), education (≤ vs. > some college), annual household income (< vs. ≥ $50,000), and mean annual residential air pollutant exposure (> vs. ≤80th percentile). Survey responses from 698 participants [500 asthma (72%) and 198 COPD (28%)] were analyzed. A high percentage of participants perceived that environmental factors could influence their symptoms, including: pollen (93% for asthma vs. 86% for COPD), mold (89 vs. 85%), second-hand smoke (89 vs. 83%), and air pollution (84% for both). Participants reported seeking environmental information daily from an average of three sources, preferring mobile apps and television (TV) programs. Significant differences were identified by disease.ConclusionParticipants with asthma and COPD perceive a relationship between their respiratory symptoms and their environment and regularly seek out environmental information. This information can help inform digital health development for respiratory education and self-management.

Associations Between Physical Activity, Smoking Status, and Airflow Obstruction and Self-Reported COPD: A Population-Based Study.

BackgroundChronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with an increased mortality rate in recent years, mainly caused by exposure to tobacco smoke. Regular physical activity is thought to diminish the risk of COPD exacerbation, while very few studies investigate the interaction between smoking and physical activity on COPD development. This study aims to investigate the association between smoking status, physical activity and prevalent COPD.MethodsThis study analyzed data of adults 20 to 79 years old from the National Health and Nutrition Examination Survey (NHANES) 2007–2012.ResultsA total of 6404 participants aged 20–79 were included and divided into four groups by their physical activity levels and smoking status. Amongst, 2819 (43.7%) were physically active non-smokers, 957 (14.8%) were physically inactive non-smokers, 1952 (30.3%) were physically active smokers, and 717 (11.1%) were physically inactive smokers. Prevalence of airflow obstruction were 5.7%, 7.1%, 17.7% and 18.6%, respectively. After adjustment, physically active smokers (aOR=2.71, 95% CI=1.94–3.80) and physically inactive smokers (aOR=2.70, 95% CI=1.78–4.09) but not physically active non-smokers were more likely to have airflow obstruction than physically active non-smokers. These associations were similar among most subgroups by age, sex, or BMI. Among smokers, being physically inactive was not significantly associated with a greater chance for prevalent airflow obstruction than being physically active.ConclusionSmokers, regardless of their physical activity level, are more likely to have airflow obstruction as compared with physically active non-smokers. Within smokers, being physically inactive poses no excess chance to be airflow obstructed. The findings indicate that physical activity level seem not altering the relationship between smoking and airflow obstruction.

Impact of Comorbidities on Lung Cancer Screening Evaluation

Objectives: We used data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial to examine the impact of self-reported chronic obstructive pulmonary disease, coronary artery disease, stroke, and diabetes mellitus on diagnostic complications in lung cancer screening evaluation. Methods: In our analysis, we included individuals from the usual care and intervention (annual chest x-ray) of the lung cancer screening trial with equal or greater than 55 years of age with a 20 pack-year smoking history who had undergone an invasive procedure. We performed multivariate logistic regression analysis to estimate the association of comorbidity on procedure complication. Our primary outcome was the incidence of major or moderate complications. Results: Features associated with high-risk complication included older age (OR = 1.03 per year, P = .001), history of coronary artery disease (OR = 1.40, P = .03), history of diabetes mellitus (OR = 0.41, P < .001, current smoking status (OR = 1.46, P ≤ .001), surgical biopsy (OR = 7.39, P < .001), needle biopsy (OR = 1.94, P < .001), and other invasive procedure (OR = 1.58, P < .001). We did not find an associated with complication and history of stroke (OR = 0.84, P = .53) or chronic obstructive pulmonary disease (OR = 1.27, P = .06). Conclusion: Patient and procedure-level factors may alter the benefits of lung cancer screening. Data concerning individual risk factors and high-risk complications should therefore be incorporated into diagnostic algorithms to optimize clinical benefit and minimize harm. Further study and validation of the risk factors identified herein are warranted.

Bronchiectasis in Low-Dose CT Screening for Lung Cancer.

Background Bronchiectasis is associated with loss of lung function, substantial use of health care resources, and increased morbidity and mortality in people with cardiopulmonary diseases. Purpose To assess the frequency and severity of bronchiectasis and related clinical findings of participants in a low-dose CT (LDCT) screening program. Materials and Methods The Early Lung and Cardiac Action Program (ELCAP) bronchiectasis score (range, 0-42; higher values indicate more severe bronchiectasis) was developed to facilitate bronchiectasis assessment. This quantitative scoring system screened participants based on accumulated knowledge and improved CT imaging capabilities. Secondary review of LDCT studies from smokers aged 40-90 years was performed when they were initially enrolled in the prospective Mount Sinai ELCAP screening study between 2010 and 2019. Medical records were reviewed to identify associated respiratory symptoms and acute respiratory events during the 2 years after LDCT. Logistic regression analysis was performed to examine factors associated with bronchiectasis. Results LDCT studies of 2191 screening participants (mean age, 65 years ± 9; 1140 [52%] women) were obtained, and bronchiectasis was identified in 504 (23%) participants. Median ELCAP bronchiectasis score was 12 (interquartile range, 9-16). Bronchiectasis was most common in the lower lobes for all participants, and lower lobe prevalence was greater with higher ELCAP score (eg, 91% prevalence with an ELCAP score of 16-42). In the fourth quartile, however, midlung involvement was higher compared with lower lung involvement (128 of 131 participants [98%] vs 122 of 131 participants [93%]). Bronchiectasis was more frequent with greater age (odds ratio [OR] = 2.0 per decade; 95% CI: 1.7, 2.4); being a former smoker (OR = 1.33; 95% CI: 1.01, 1.73); and having self-reported chronic obstructive pulmonary disease (OR = 1.38; 95% CI: 1.02, 1.88), an elevated hemidiaphragm (OR = 4; 95% CI: 2, 11), or consolidation (OR = 5; 95% CI: 3, 11). It was less frequent in overweight (OR = 0.7; 95% CI: 0.5, 0.9) or obese (OR = 0.6; 95% CI: 0.4, 0.8) participants. Two years after baseline LDCT, respiratory symptoms, acute respiratory events, and respiratory events that required hospitalization were more frequent with increasing severity of the ELCAP bronchiectasis score (P < .005 for all trends). Conclusion Prevalence of bronchiectasis in smokers undergoing low-dose CT screening was high, and respiratory symptoms and acute events were more frequent with increasing severity of the Early Lung and Cardiac Action Program Bronchiectasis score. © RSNA, 2022 See also the editorial by Verschakelen in this issue.