Nasal neutrophil activity and mucinous secretory responsiveness in COPD.

Patients with chronic obstructive pulmonary disease (COPD) frequently report nasal symptoms. In the present study, we have examined whether or not COPD is associated with any nasal inflammation. Plasma exudation evoked by histamine challenges has been employed to improve the recovery of inflammatory indices in nasal lavage fluids. In 23 COPD-patients and 26 healthy subjects, all without history or signs of allergic rhinitis, nasal polyposis, or chronic rhinosinusitis, nasal saline-lavages were performed with and without histamine. alpha2-Macroglobulin, fucose, eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were determined as indices of plasma exudation, mucinous secretion, eosinophil activity and neutrophil activity, respectively. The difference in MPO-levels between the histamine and the saline lavage was greater in COPD patients compared with healthy subjects (P<0·05). Also, COPD patients reporting nasal symptoms presented an increase in MPO at histamine challenge (P<0·05, cf. saline) and greater differences in MPO and fucose, respectively, between the histamine and the saline lavage (P<0·05, cf. patients without symptoms). We conclude that COPD is not associated with any marked nasal inflammation. However, our observation on increased MPO-levels at histamine challenge suggests some degree of increased neutrophil activity in this condition. Furthermore, when associated with nasal symptoms, COPD may be associated with an increased nasal secretory responsiveness

Allergic Rhinitis and its Associated Co-Morbidities at Bugando Medical Centre in Northwestern Tanzania; A Prospective Review of 190 Cases.

Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (χ2 = 28.691, P = 0.000). Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P < 0.05). Strong perfume odors affect female than males (χ2 = 4.583, P = 0.032). In this study family history of allergic rhinitis was not a significant risk factor (P =0.423). The majority of patients (68.8%) were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 - 28 days). Most patients (98.4%) had satisfactory results at discharge. The study shows that allergic rhinitis is common in our settings representing 14.7% of all otorhinolaryngology and commonly affecting children and adolescent. Sufferers seek medical services due to co-morbidities of which combination of surgical and medical treatment was needed. High index of suspicions in diagnosing allergic rhinitis and early treatment is recommended

Luftvägssjukdomar - enkät från år 1992

The prevalence of various respiratory diseases are increasing in Scandinavia and also in other parts of the world. In this study, an extensive questionnaire on issues related to respiratory diseases, was sent out to residents in the municipality of Malmö and the surrounding area. The questionnaire was 1992 sent to 12 079 individuals, i.e. 1.5% of the formerly population in the municipality of Malmö and the county of Malmöhus. The individuals were selected from the population registry from four age groups (20-29, 30-39, 40-49 and 50-59) with comparable numbers of men and women in each group. After two reminders 8468 (70.1%) individuals had responded to the survey. The questionnaire contained questions such as self-reported asthma, chronic bronchitis, emphysema or allergies, a doctor’s diagnosis of these diseases. It also contained questions regarding if the individual often were bothered by coughing or having trouble with the lungs and nose, such as squeaky breathing and nasal congestion. The questionnaire also included questions about smoking, medication, and if you live near a busy road. A follow-up study was done 2000 and a similar survey was sent out again to 4933 of the individuals who responded to the survey in 1992. The questionnaire was supplemented with issues related to chronic obstructive pulmonary disease. This survey was also sent out to 7000 new individuals in the Malmö area, randomly selected from the population register. In total, 11 933 questionnaires were distributed to individuals aged 18-77 years. Of these individuals 9316 (78.1%) subjects responded to the survey, of which 4280 (86.8%) responded to both the 1992- and 2000-survey. For the individuals who responded to the survey in year 2000, additional data on traffic and air pollution have been added using the geographic coordinates of the registered address, data from the Swedish Transport Administration as well as data from an emission database for nitrogen oxides. Purpose: To investigate the prevalence of and risk factors for respiratory diseases in adults in southern Sweden. 8568 individuals responded in year 1992 on a comprehensive questionnaire concerning respiratory diseases.Prevalensen av olika luftvägssjukdomar ökar i Skandinavien och även i andra delar av världen. I denna studie har en omfattande enkät med frågor som rör luftvägssjukdomar skickats ut till invånare i Malmö kommun med omgivning. Det första utskicket gjordes 1992 till 12 079 individer, dvs. 1.5% av den dåvarande populationen i Malmö kommun och Malmöhus län. Individerna valdes ut från populationsregistret från fyra åldersgrupper (20-29, 30-39, 40-49 samt 50-59) med jämförbart antal kvinnor och män i varje grupp. Efter två påminnelser så hade 8468 (70.1%) individer svarat på enkäten. Enkäten innehöll frågor som självrapporterad astma, kronisk bronkit, emfysem eller allergi, om man har fått en diagnos på dessa sjukdomar av en läkare, samt frågor om man ofta besväras av hosta eller har problem med lungorna och näsan som t.ex. pipig andning och nästäppa. Enkäten innehöll även frågor om rökning, medicinering och om man bor nära en trafikerad väg. År 2000 gjordes en uppföljning och en liknande enkät skickades åter ut till 4933 av de individer som svarade på enkäten 1992. Enkäten som skickades ut år 2000 hade kompletterats med frågor som rör kronisk obstruktiv lungsjukdom. Denna enkät skickades även ut till 7000 nya individer i Malmöområdet som slumpmässigt valts ut från populationsregistret. Totalt skickades 11 933 enkäter ut år 2000 till individer i åldrarna 18-77 år. Av dessa individer svarade 9316 (78.1%) på enkäten, varav 4280 (86.8%) individer svarade på både 1992- och 2000-enkäten. Till individerna som svarade på enkäten år 2000 har ytterligare data om trafik och luftföroreningar lagts till med hjälp av geografiska koordinater för folkbokföringsadress, data från vägverket samt data från en emissionsdatabas för kväveoxider. Syfte: Att undersöka förekomst av och riskfaktorer för olika luftvägssjukdomar i den vuxna befolkningen i södra Sverige. 8568 individer svarade år 1992 på en omfattande enkät med frågor rörande luftvägssjukdomar

Prevalence of airway obstruction in the elderly: results from a cross-sectional spirometric study of nine age cohorts between the ages of 60 and 93 years.

AIMS: To study the prevalence of airway obstruction according to age, gender and smoking habits using spirometry, and to compare the results using different definitions, classifications and spirometric reference values in an elderly population. METHODS: A random sample of 2046 men and women in nine age cohorts (aged 60, 66, 72, 78, 81, 84, 87, 90 and 93 years) were drawn from the Swedish municipality registers. 1092 subjects performed spirometry of which 574 met ATS spirometric criteria. RESULTS: According to GOLD criteria (FEV1/FVC <0.7) the prevalence of obstruction was 22.5% regardless of which one of three different spirometric reference values were used. Using the recently-changed Swedish National Guideline (SNG) recommendations - an FEV1/(F)VC ratio<0.7 in subjects younger than 65 years but an FEV1/(F)VC ratio<0.65 in subjects 65 years or older in order to define airway obstruction - the prevalence was 14.1% regardless of the applied spirometric reference values. Using the criterion FEV1/(F)VC < expected for age and gender (i.e. lower limit of normal, LLN) yielded the lowest prevalence of 10.1%. CONCLUSIONS: The prevalence of pulmonary obstruction depends on the criteria used for defining airway obstruction and on which spirometric normal values are applied. Using an age-adjusted FEV1/(F)VC LLN quotient to define pulmonary obstruction can be recommended on the basis of our results

Luftvägssjukdomar - enkät från år 2000

The prevalence of various respiratory diseases are increasing in Scandinavia and also in other parts of the world. In this study, an extensive questionnaire on issues related to respiratory diseases, was sent out to residents in the municipality of Malmö and the surrounding area. The questionnaire was 1992 sent to 12 079 individuals, i.e. 1.5% of the formerly population in the municipality of Malmö and the county of Malmöhus. The individuals were selected from the population registry from four age groups (20-29, 30-39, 40-49 and 50-59) with comparable numbers of men and women in each group. After two reminders 8468 (70.1%) individuals had responded to the survey. The questionnaire contained questions such as self-reported asthma, chronic bronchitis, emphysema or allergies, a doctor’s diagnosis of these diseases. It also contained questions regarding if the individual often were bothered by coughing or having trouble with the lungs and nose, such as squeaky breathing and nasal congestion. The questionnaire also included questions about smoking, medication, and if you live near a busy road. A follow-up study was done 2000 and a similar survey was sent out again to 4933 of the individuals who responded to the survey in 1992. The questionnaire was supplemented with issues related to chronic obstructive pulmonary disease. This survey was also sent out to 7000 new individuals in the Malmö area, randomly selected from the population register. In total, 11 933 questionnaires were distributed to individuals aged 18-77 years. Of these individuals 9316 (78.1%) subjects responded to the survey, of which 4280 (86.8%) responded to both the 1992- and 2000-survey. For the individuals who responded to the survey in year 2000, additional data on traffic and air pollution have been added using the geographic coordinates of the registered address, data from the Swedish Transport Administration as well as data from an emission database for nitrogen oxides. Purpose: To investigate the prevalence of and risk factors for respiratory diseases in adults in southern Sweden. 9316 individuals responded in year 2000 to the same questionnaire which was sent out in 1972, supplemented with issues related to chronic obstructive pulmonary disease. Additional data on traffic and air pollution are also collected.Prevalensen av olika luftvägssjukdomar ökar i Skandinavien och även i andra delar av världen. I denna studie har en omfattande enkät med frågor som rör luftvägssjukdomar skickats ut till invånare i Malmö kommun med omgivning. Det första utskicket gjordes 1992 till 12 079 individer, dvs. 1.5% av den dåvarande populationen i Malmö kommun och Malmöhus län. Individerna valdes ut från populationsregistret från fyra åldersgrupper (20-29, 30-39, 40-49 samt 50-59) med jämförbart antal kvinnor och män i varje grupp. Efter två påminnelser så hade 8468 (70.1%) individer svarat på enkäten. Enkäten innehöll frågor som självrapporterad astma, kronisk bronkit, emfysem eller allergi, om man har fått en diagnos på dessa sjukdomar av en läkare, samt frågor om man ofta besväras av hosta eller har problem med lungorna och näsan som t.ex. pipig andning och nästäppa. Enkäten innehöll även frågor om rökning, medicinering och om man bor nära en trafikerad väg. År 2000 gjordes en uppföljning och en liknande enkät skickades åter ut till 4933 av de individer som svarade på enkäten 1992. Enkäten som skickades ut år 2000 hade kompletterats med frågor som rör kronisk obstruktiv lungsjukdom. Denna enkät skickades även ut till 7000 nya individer i Malmöområdet som slumpmässigt valts ut från populationsregistret. Totalt skickades 11 933 enkäter ut år 2000 till individer i åldrarna 18-77 år. Av dessa individer svarade 9316 (78.1%) på enkäten, varav 4280 (86.8%) individer svarade på både 1992- och 2000-enkäten. Till individerna som svarade på enkäten år 2000 har ytterligare data om trafik och luftföroreningar lagts till med hjälp av geografiska koordinater för folkbokföringsadress, data från vägverket samt data från en emissionsdatabas för kväveoxider. Syfte: Att undersöka förekomst av och riskfaktorer för olika luftvägssjukdomar i den vuxna befolkningen i södra Sverige. 9316 individer svarade år 2000 på samma enkät som skickades ut 1972, kompletterad med frågor som rör kronisk obstruktiv lungsjukdom. Till dessa individer finns även ytterligare data om trafik och luftföroreningar

Influence of family history and smoking habits on the incidence of self-reported physician's diagnosis of COPD.

AbstractBackground: The incidence of chronic obstructive pulmonary disease (COPD) is little investigated. This study assessed the incidence of a self-reported physician's diagnosis of chronic bronchitis and/or emphysema (CBE) and/or COPD (CBE/COPD), and investigated the effects of a family history of CBE in 1992 and change in smoking habits (assessed in 1992 and 2000) on this incidence.Methods: A follow-up study in 2000 of 4933 subjects who responded to a respiratory questionnaire study in 1992 was performed. Response rate was 86.8%. Odds ratios (ORs) for incident cases of CBE/COPD were calculated by multiple logistic regression.Results: The cumulative incidence of a physician's diagnosis of CBE/COPD was 2.9%. A family history of CBE predicted incident cases of CBE/COPD, OR 2.7 (95% CI 1.5–5.1). Also continuous smoking, relapse into smoking, or having stopped smoking between 1992 and 2000 had elevated ORs for incident cases of CBE/COPD, 2.6 (1.4–4.7), 7.2 (2.7–18.7), and 2.6 (1.3–5.3), while the OR for ex-smoking in 1992 as well as 2000 was 0.9 (0.4–1.8).Conclusions: A family history of CBE increases the risk for development of CBE/COPD. Sustained smoking cessation over many years may be required to significantly reduce the risk of developing CBE/COPD

Increased serum levels of carbohydrate-deficient transferrin in patients with chronic obstructive pulmonary disease

OBJECTIVE: The reason that only a minority of smokers develop chronic obstructive pulmonary disease (COPD) is still largely unknown. Glycosylation defects are involved in the pathological mechanisms in cystic fibrosis (CF), where chronic progressive obstructive lung disease dominates the clinical picture. Whether defects of protein glycosylation occur in COPD has not previously been examined. Increase in carbohydrate-deficient transferrin (CDT) in serum seems to function as an indicator of general defects of N-glycosylation. Recently, one study observed high serum CDT concentrations in CF patients. We examined whether subjects with COPD also have increased serum CDT levels. METHOD AND RESULTS: A total of 131 randomly selected individuals, 45-64 years of age, underwent a medical examination, spirometry and blood tests. Serum CDT was determined using high performance liquid chromatography. In subjects diagnosed as having COPD (n = 15), multiple logistic regression analyses demonstrated a significant relationship between the diagnosis of COPD and CDT, even after all efforts were made to take the influence of age and smoking into account (odds ratio 3.16, 95% CI 1.11-8.95). Also, in subjects with COPD there was an inverse partial correlation between forced expiratory volume in 1 s (FEV1) and serum CDT (r = -0.81, p = 0.001). CONCLUSION: These results suggest that protein glycosylation defects occur in COPD and, in addition, might be involved in the pathogenetic mechanisms of the disease. It seems that further investigation of the protein glycosylation in COPD is warranted

Detection of chronic obstructive pulmonary disease (COPD) in primary health care: role of spirometry and respiratory symptoms

Objective - To evaluate the role of spirometry and respiratory symptoms in the detection of chronic obstructive pulmonary disease (COPD) in primary health care. Design - A cross-sectional study. Setting - A primary health centre in Landskrona, southern Sweden. Subjects - 164 subjects who in 1992 had answered a postal questionnaire concerning obstructive pulmonary diseases and respiratory symptoms. They were aged 45-64 years, with a mean of 55 years. Main outcome measures - In 1997, the subjects were invited to perform a spirometry and a medical examination and to answer the same questionnaire as in 1992. Subjects with a forced expiratory volume in 1 second (FEV1) <85% of the predicted normal value performed reversibility tests. Results - 131 subjects participated in the examinations. 15 subjects (11.5%) were diagnosed as having COPD. Only three of them had been previously diagnosed as having a respiratory disease. Many commonly occurring respiratory symptoms were associated with a reduction in FEV1. Conclusions - Spirometry examinations in primary health care improve the probability of detecting COPD. A spirometry examination should be considered for patients with respiratory symptoms. It should also be considered for middle-aged smokers, even if they are symptom-free