Systematic review of the evidence relating FEV1 decline to giving up smoking

<p>Abstract</p> <p>Background</p> <p>The rate of forced expiratory volume in 1 second (FEV₁) decline ("beta") is a marker of chronic obstructive pulmonary disease risk. The reduction in beta after quitting smoking is an upper limit for the reduction achievable from switching to novel nicotine delivery products. We review available evidence to estimate this reduction and quantify the relationship of smoking to beta.</p> <p>Methods</p> <p>Studies were identified, in healthy individuals or patients with respiratory disease, that provided data on beta over at least 2 years of follow-up, separately for those who gave up smoking and other smoking groups. Publications to June 2010 were considered. Independent beta estimates were derived for four main smoking groups: never smokers, ex-smokers (before baseline), quitters (during follow-up) and continuing smokers. Unweighted and inverse variance-weighted regression analyses compared betas in the smoking groups, and in continuing smokers by amount smoked, and estimated whether beta or beta differences between smoking groups varied by age, sex and other factors.</p> <p>Results</p> <p>Forty-seven studies had relevant data, 28 for both sexes and 19 for males. Sixteen studies started before 1970. Mean follow-up was 11 years. On the basis of weighted analysis of 303 betas for the four smoking groups, never smokers had a beta 10.8 mL/yr (95% confidence interval (CI), 8.9 to 12.8) less than continuing smokers. Betas for ex-smokers were 12.4 mL/yr (95% CI, 10.1 to 14.7) less than for continuing smokers, and for quitters, 8.5 mL/yr (95% CI, 5.6 to 11.4) less. These betas were similar to that for never smokers. In continuing smokers, beta increased 0.33 mL/yr per cigarette/day. Beta differences between continuing smokers and those who gave up were greater in patients with respiratory disease or with reduced baseline lung function, but were not clearly related to age or sex.</p> <p>Conclusion</p> <p>The available data have numerous limitations, but clearly show that continuing smokers have a beta that is dose-related and over 10 mL/yr greater than in never smokers, ex-smokers or quitters. The greater decline in those with respiratory disease or reduced lung function is consistent with some smokers having a more rapid rate of FEV₁decline. These results help in designing studies comparing continuing smokers of conventional cigarettes and switchers to novel products.</p

Quality of spirometry – requirements, automation, practice

W pracy omówiono podstawy wykonywania badania spirometrycznego ze uwzględnieniem procedury pomiaru krzywej przepływ – objętość oraz kryteriów jakościowych oceny spirometrii na podstawie zaleceń standaryzacyjnych. Dokonano analizy jakości pomiaru krzywej przepływ objętość w trzech grupach: u dzieci, u osób w podeszłym wieku oraz uzyskanych w trakcie Światowego Dnia Spirometrii. Podkreślono rolę personelu wykonującego badania oraz sformułowano kilka postulatów dotyczących realizacji sprzętowo – programowych systemów spirometrycznych.The authors present description of the spirometry focusing on forced flow volume loop measurements and corresponding requirements according to ERS/ATS 2005 [2,3] and PTChP [4] 2006 statements. The introduction to actually applied solutions in supporting automatic assessment of quality assurance (QA)criteria is also presented. The quality analysis of spirometric measurements was performed for three different groups: children younger than 10 years, the group of elderly people and the spirometry obtained during the World Spirometry Day. All the three groups expressed different quality problems: the main problem in children group was too restrictive value of the demanded time of forced expiration (especially regarding significant correlation between the age and the forced expiratory time) – only 23.9% children fulfilled this re-quirements, in the group of elderly people lack of plateau on the expiratory end was the mostly registered error – 60,2%. In the spirometries obtained during the World Spirometry Day the significant number of non-repetitive measurements and the small number of properly performed measurements (only 28%) was the most interesting aspect. The authors concluded that competence and qualifications of the laboratory staff played the most important role in ensuring the quality of spirometry. However, some demands could be addressed to manufacturers of spirometry equipment

Does urinary peptide content differ between COPD patients with and without inherited alpha-1 antitrypsin deficiency?

Alfonso Carleo,1,2,* Joanna Chorostowska-Wynimko,3,* Thomas Koeck,4 Harald Mischak,4,5 Małgorzata Czajkowska-Malinowska,6 Adriana Rozy,3 Tobias Welte,1,2 Sabina Janciauskiene1,2 1Department of Respiratory Medicine, Hannover Medical School, 2Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), DZL Hannover, Germany; 3Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland; 4Mosaiques Diagnostics and Therapeutics AG, Hannover, Germany; 5Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; 6Department of Lung Diseases and Respiratory Failure, Regional Center of Pulmonology, Bydgoszcz, Poland *These authors contributed equally to this work Abstract: Differentiating between chronic obstructive pulmonary disease (COPD) patients with normal (PiMM) or deficient (PiZZ) genetic variants of alpha-1 antitrypsin (A1AT) is important not only for understanding the pathobiology of disease progression but also for improving personalized therapies. This pilot study aimed to investigate whether urinary peptides reflect the A1AT-related phenotypes of COPD. Urine samples from 19 clinically stable COPD cases (7 PiMM and 12 PiZZ A1AT) were analyzed by capillary electrophoresis coupled to mass spectrometry. We identified 66 peptides (corresponding to 36 unique proteins) that differed between PiZZ and PiMM COPD. Among these, peptides from the collagen family were the most abundant and divergent. A logistic regression model based on COL1A1 or COL5A3 peptides enabled differentiation between PiMM and PiZZ groups, with a sensitivity of 100% and specificity of 85.71% for COL1A1 and a sensitivity of 91.67% and specificity of 85.71% for COL5A3. Furthermore, patients with PiZZ presented low levels of urinary peptides involved in lipoproteins/lipids and retinoic acid metabolism, such as apolipoprotein A-I and C4, retinol-binding protein 4 and prostaglandin-H2 d-isomerase. However, peptides of MDS1 and EVII complex locus, gelsolin and hemoglobin alpha were found in the urine of COPD cases with PiZZ, but not with PiMM. These capillary electrophoresis coupled to mass spectrometry-based results provide the first evidence that urinary peptide content differs between PiMM and PiZZ patients with COPD. Keywords: alpha-1 antitrypsin, alpha-1 antitrypsin deficiency, COPD, urine, peptidomics, capillary electrophoresis coupled to mass spectrometry, phenotypes, peptides, biomarkers, collagen&nbsp

Distribution and characteristics of COPD phenotypes &ndash; results from the Polish sub-cohort of the POPE study

Aleksander Kania,1 Rafał Krenke,2 Krzysztof Kuziemski,3 Małgorzata Czajkowska-Malinowska,4 Natalia Celejewska-W&oacute;jcik,1 Barbara Kuźnar-Kamińska,5 Małgorzata Farnik,6 Juliusz Bokiej,7 Marta Miszczuk,2 Iwona Damps-Konstańska,3 Marcin Grabicki,5 Marzena Trzaska-Sobczak,6 Krzysztof Sładek,1 Halina Batura-Gabryel,5 Adam Barczyk6 1Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krak&oacute;w, Poland; 2Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland; 3Department of Allergology and Pneumonology, Medical University of Gdańsk, Gdańsk, Poland; 4Department of Lung Diseases and Respiratory Failure, Regional Center of Pulmonology, Bydgoszcz, Poland; 5Department of Pulmonology, Allergology and Respiratory Oncology, Poznań University of Medical Sciences, Poznań, Poland; 6Department of Pneumology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; 7Department of Lung Diseases, Regional Hospital Center Jelenia G&oacute;ra, Jelenia G&oacute;ra, Poland Background: This study aimed to examine the distribution of predefined phenotypes, demographic data, clinical outcomes, and treatment of patients who were included in the Polish cohort of the Phenotypes of COPD in Central and Eastern Europe (POPE) study. Patients and methods: This was a sub-analysis of the data from the Polish cohort of the POPE study, an international, multicenter, observational cross-sectional survey of COPD patients in Central and Eastern European countries. The study included patients aged .40 years, with a confirmed diagnosis of COPD, and absence of exacerbation for at least 4 weeks before study inclusion. A total of seven Polish centers participated in the study. Results: Among the 430 Polish COPD patients enrolled in the study, 61.6% were non-exacerbators (NON-AE), 25.3% were frequent exacerbators with chronic bronchitis (AE CB), 7.9% were frequent exacerbators without chronic bronchitis (AE NON-CB), and 5.1% met the definition of asthma-COPD overlap syndrome (ACOS). There were statistically significant differences among these phenotypes in terms of symptom load, lung function, comorbidities, and treatment. Patients with the AE CB phenotype were most symptomatic with worse lung function, and more frequently reported anxiety and depression. Patients with the ACOS phenotype were significantly younger and were diagnosed with COPD earlier than those with other COPD phenotypes; those with the ACOS phenotype were also more often atopic and obese. Conclusion: There is significant heterogeneity among COPD patients in the Polish population in terms of phenotype and clinical outcome. The non-exacerbator phenotype is observed most frequently in Poland, while the frequent exacerbator with chronic bronchitis phenotype is the most symptomatic. Keywords: chronic obstructive pulmonary disease, asthma-COPD overlap syndrome, phenotype

Atitudes dos pneumologistas brasileiros em face da dependência de nicotina: inquérito nacional Attitudes of Brazilian pulmonologists toward nicotine dependence: a national survey

O tabagismo é uma condição médica por haver dependência de droga, devendo ser abordado por todos os profissionais de saúde como uma doença crônica. Objetivando conhecer a conduta dos pneumologistas brasileiros perante fumantes, realizamos um inquérito nacional, por meio da aplicação de um questionário via internet, enviado para 2.800 desses profissionais, com um retorno de 587 questionários (21%). Observamos que 3,2% dos respondedores não entendem o tabagismo como uma condição médica. Somente 14,7% responderam tratar o tabagismo, e 32,4% disseram encaminhar o fumante para outro colega tratá-lo. Os resultados sugerem que os pneumologistas brasileiros não têm conhecimento suficiente sobre as terapias de cessação do tabagismo.<br>Smoking is a medical condition, since there is drug dependence, and health professionals should treat it as a chronic disease. In order to understand the attitudes of Brazilian pulmonologists toward smokers, we conducted a national survey, using a questionnaire posted on the Internet, of 2,800 pulmonologists, 587 (21%) of whom completed and returned the questionnaires. We found that 3.2% of the respondents did not believe that smoking is a medical condition. Only 14.7% treated smokers, and 32.4% stated that they would refer smokers to another professional for treatment. These results suggest that Brazilian pulmonologists have insufficient knowledge of smoking cessation therapies