Measure and effect of diet in chronic obstructive pulmonary disease

Background and objectives: Recent research has shown an association between a healthy diet and reduced chronic obstructive pulmonary disease (COPD) incidence. However, the potential role of diet in COPD prognosis is unknown. This thesis aimed to describe the characteristics of diet in COPD patients and to estimate its association with the disease evolution, in terms of pathophysiological impairment and hospitalizations. A secondary objective was to study the role of diet in asthma, as a COPDrelated phenotype. Methods: A dietary ancillary protocol was included in a well phenotyped cohort of 342 COPD patients recruited during their first admission for a COPD exacerbation in Spain. Dietary data of the last 2 years was assessed using a validated food frequency questionnaire (122 items). Levels of oxidative stress and inflammatory markers were measured in serum. Hospital admissions during follow-up were obtained from national datasets. Additionally, data from the International Study of Asthma and Allergies in Childhood (ISAAC) in Mexico was used to assess the effect of diet in childhood asthma. Results: (i) COPD patients report an adequate intake of the main food groups and macro- and micro-nutrients according to local recommendations, excepting vitamin D; (ii) vitamin E and olive oil intakes are associated with reduced oxidative stress in COPD active smokers; (iii) intake of _3 and _6 fatty acids is related to the levels of serum inflammatory markers; (iv) cured meat intake increases the risk of COPD admission during follow-up; and (v) children adherence to a Mediterranean dietary pattern relates to reduced childhood asthma prevalence. Conclusions: Dietary habits may modify COPD prognosis and childhood asthma. Therefore, advice on healthy diet should be considered in chronic respiratory diseases guidelines.Antecedents i objectius: Estudis recents mostren associacions entre una dieta sana i reduccions en la incidència de malaltia pulmonar obstructiva crònica (MPOC). Tanmateix, el possible rol de la dieta en l'evolució de l'MPOC és desconegut. L'objectiu d'aquesta tesi és descriure les característiques de la dieta en pacients amb MPOC i estimar-ne l’associació amb l'evolució de la malaltia en termes d’alteracions fisiopatològiques i hospitalitzacions. Com a objectiu secundari, també es vol estudiar el paper de la dieta en l'asma, com a malaltia estretament relacionada amb l'MPOC. Mètodes: Es va aniuar un protocol d’epidemiologia nutricional en una cohort de 342 malalts d’MPOC, ben fenotipats, reclutats a Espanya durant la seva primera hospitalització per agudització de l'MPOC. Es va administrar un qüestionari de freqüència de consum d'aliments (122 ítems) preguntant per la dieta dels darrers 2 anys. Es van mesurar en sèrum els nivells de marcadors d'estrès oxidatiu i d'inflamació. Les hospitalitzacions durant el temps de seguiment s’obtingueren a partir de registres nacionals. Per últim, s'utilitzaren dades de l'International Study of Asthma and Allergy in Childhood (ISAAC) a Mèxic per a estimar l'efecte de la dieta en l'asma infantil. Resultats: (i) El consum d'aliments i macro- i micro-nutrients fou considerat adient respecte a les recomanacions locals, exceptuant la vitamina D; (ii) la ingesta de vitamina E i oli d’oliva s’associà a menors nivells d’estrès oxidatiu en pacients fumadors actius; (iii) els nivells de ingesta d'àcids grassos _3 i _6 es va relacionar amb els nivells d’inflamació sistèmica; (iv) la ingesta d’embotits i carns curades va incrementar el risc d'hospitalització per MPOC durant el seguiment; i (v) l’adherència a un patró mediterrani d'alimentació s’associà a menor prevalença d'asma infantil. Conclusions: Els hàbits alimentaris poden modificar l'evolució de l'MPOC i el desenvolupament d'asma infantil. Per tant, s’hauria de considerar l’inclusió de consells alimentaris en les guies clíniques per a malalties respiratòries cròniques

Lifetime occupational exposure to dusts, gases and fumes is associated with bronchitis symptoms and higher diffusion capacity in COPD patients

Background: Occupational exposure to dusts, gases and fumes has been associated with reduced FEV1 and sputum production in COPD patients. The effect of occupational exposure on other characteristics of COPD, especially those reflecting emphysema, has not been studied in these patients. Methods: We studied 338 patients hospitalized for a first exacerbation of COPD in 9 Spanish hospitals, obtaining full occupational history in a face-to-face interview; job codes were linked to a job exposure matrix for semi-quantitative estimation of exposure to mineral/biological dust, and gases/fumes for each job held. Patients underwent spirometry, diffusing capacity testing and analysis of gases in stable conditions. Quality of life, dyspnea and chronic bronchitis symptoms were determined with a questionnaire interview. A high- resolution CT scan was available in 133 patients. Results: 94% of the patients included were men, with a mean age of 68(8.5) years and a mean FEV1% predicted 52 (16). High exposure to gases or fumes was associated with chronic bronchitis, and exposure to mineral dust and gases/fumes was associated with higher scores for symptom perception in the St. George’s questionnaire. No occupational agent was associated with a lower FEV1. High exposure to all occupational agents was associated with better lung diffusion capacity, in long-term quitters. In the subgroup with CT data, patients with emphysema had 18% lower DLCO compared to those without emphysema. Conclusions: In our cohort of COPD patients, high exposure to gases or fumes was associated with chronic bronchitis, and high exposure to all occupational agents was consistently associated with better diffusion capacity in long-term quitters.The PAC-COPD Study is funded by grants from the Fondo de Investigación Sanitaria (FIS PI020541), Ministry of Health, Spain; Agència d’Avaluació de Tecnologia i Recerca Mèdiques (AATRM 035/20/02), Catalan Government; Spanish Society of Pulmonology and Thoracic Surgery (SEPAR 2002/137); Catalan Pulmonology Foundation (FUCAP 2003 Beca Maria Ravà); Red RESPIRA (RTIC C03/11); Red RCESP (RTIC C03/09); Fondo de Investigación Sanitaria (PI052486); Fondo de Investigación Sanitaria (PI052302); Fondo de Investigación Sanitaria (PI060684); Fundació La Marató de TV3 (num. 041110); and Novartis Farmacèutica, Spain. CIBERESP and CIBERES are funded by Instituto de Salud Carlos III, Ministry of Health, Spain. Judith Garcia-Aymerich has a researcher contract from Instituto de Salud Carlos III (CP05/00118), Ministry of Health, Spai

Factors affecting the relationship between psychological status and quality of life in COPD patients

Background: This study aims to (i) evaluate the association between anxiety and depressive symptoms and health-related quality of life (HRQoL); and (ii) identify the effect modifiers of this relationship in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 337 clinically stable COPD patients answered the St. George's Respiratory Questionnaire (SGRQ) (assessing HRQoL) and the Hospital Anxiety and Depression Scale (HADS). Socio-demographic information, lung function, and other clinical data were collected. Results: Most patients (93%) were male; they had a mean (SD) age of 68 (9) years and mild to very severe COPD (post-bronchodilator FEV1 52 (16)% predicted). Multivariate analyses showed that anxiety, depression, or both conditions were associated with poor HRQoL (for all SGRQ domains). The association between anxiety and total HRQoL score was 6.7 points higher (indicating a worse HRQoL) in current workers than in retired individuals. Estimates for patients with "both anxiety and depression" were 5.8 points lower in stage I-II than in stage III-IV COPD, and 10.2 points higher in patients with other comorbidities than in those with only COPD. Conclusions: This study shows a significant association between anxiety, depression, or both conditions and impaired HRQoL. Clinically relevant factors affecting the magnitude of this association include work status, COPD severity, and the presence of comorbidities.This study was supported by grants from Fondo de Investigación Sanitaria (FIS PI020541), Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca Mèdiques (AATRM 035/20/02), Catalonia Government; Spanish Society of Pneumology and Thoracic Surgery (SEPAR 2002/137); Catalan Foundation of Pneumology (FUCAP 2003 Beca Marià Ravà); Red RESPIRA (RTIC C03/11); Red RCESP (RTIC C03/09), Fondo de Investigación Sanitaria (PI052486); Fondo de Investigación Sanitaria (PI052302); Fundació La Marató de TV3 (num. 041110); DURSI (2005SGR00392); Novartis Farmacèutica, Spain. CIBERESP and CIBERES are funded by the Instituto de Salud Carlos III, Ministry of Health, Spain. Judith Garcia-Aymerich has a researcher contract from the Instituto de Salud Carlos III (CP05/00118), Ministry of Health, Spain

Determinants and outcomes of physical activity in patients with COPD: a systematic review

BACKGROUND: The relationship between physical activity, disease severity, health status and prognosis in patients with COPD has not been systematically assessed. Our aim was to identify and summarise studies assessing associations between physical activity and its determinants and/or outcomes in patients with COPD and to develop a conceptual model for physical activity in COPD. METHODS: We conducted a systematic search of four databases (Medline, Embase, CINAHL and Psychinfo) prior to November 2012. Teams of two reviewers independently selected articles, extracted data and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess quality of evidence. RESULTS: 86 studies were included: 59 were focused on determinants, 23 on outcomes and 4 on both. Hyperinflation, exercise capacity, dyspnoea, previous exacerbations, gas exchange, systemic inflammation, quality of life and self-efficacy were consistently related to physical activity, but often based on cross-sectional studies and low-quality evidence. Results from studies of pharmacological and non-pharmacological treatments were inconsistent and the quality of evidence was low to very low. As outcomes, COPD exacerbations and mortality were consistently associated with low levels of physical activity based on moderate quality evidence. Physical activity was associated with other outcomes such as dyspnoea, health-related quality of life, exercise capacity and FEV1 but based on cross-sectional studies and low to very low quality evidence. CONCLUSIONS: Physical activity level in COPD is consistently associated with mortality and exacerbations, but there is poor evidence about determinants of physical activity, including the impact of treatment.The PROactive project is funded by the European Commission Innovative Medicines Initiative Joint Undertaking (IMI JU # 115011

Protocol for regional implementation of community-based collaborative management of complex chronic patients

Supported by CONNECARE (H2020-PHC-2015, Grant no. 689802), PITES (FIS-PI15/00576), SELFIE (H2020, Grant no. 634288), and NEXTCARE (RIS3CAT), Generalitat de Catalunya (2014SGR661), and CERCA Programme / Generalitat de Cataluny