Association between Cohort Characteristics, Pneumonia, HIV and Absolute FEV1 (mL).

<p>*Model adjusted for other predictors in the table.</p>†<p>Defined as lowest quartile compared with remaining population.</p>‡<p>Occurring anytime in the past.</p><p>Abbreviations: BMI, Body Mass Index; CI, Confidence Interval; FEV1, Forced Expiratory Volume in 1 second; HIV, Human Immunodeficiency Virus.</p

Health Outcomes of the Lung Health Study Participants According to Quintiles of Myeloperoxidase Levels in Serum at Year 5.

<p>Abbreviations: FEV1, forced expiratory volume in 1 second.</p>*<p>adjusted for age and sex and race and body mass index.</p

A Cross Sectional Analysis of the Role of the Antimicrobial Peptide Cathelicidin in Lung Function Impairment within the ALIVE Cohort

<div><p>Background</p><p>Vitamin D deficiency is associated with reduced lung function. Cathelicidin, an antimicrobial peptide regulated by vitamin D, plays a role within the innate immune system. The association of cathelicidin with lung function decrement and respiratory infection is undefined.</p><p>We determined the independent relationship of cathelicidin with lung function.</p><p>Methods</p><p>In a cross-sectional analysis of 650 participants in an urban observational cohort with high smoking prevalence, plasma 25(OH)-vitamin D and cathelicidin levels were measured from stored samples obtained within 6 months of spirometry study visits. Multivariable linear regression was used to determine the independent association between low cathelicidin (defined as the lowest quartile of the cohort) and absolute forced expiratory volume in 1 second (FEV1).</p><p>Results</p><p>The mean age of the cohort was 49 years; 91% were black, 35% female and 41% HIV-infected. Participants with low cathelicidin had a 183 mL lower FEV1 compared to higher cathelicidin (p = 0.009); this relationship was maintained (115 ml lower; p = 0.035) after adjusting for demographics, BMI, and smoking. Neither HIV serostatus, heavy smoking history, nor 25(OH)-vitamin D levels were associated with cathelicidin levels. Participants with low cathelicidin had a greater prevalence of prior bacterial pneumonia (21% versus 14%; p = 0.047). Inclusion of pneumonia in adjusted models did not substantially reduce the FEV1 decrement observed with low cathelicidin (104 mL lower FEV1; p = 0.05). Lung function decrements associated with low cathelicidin were greatest among individuals with lower 25(OH)-vitamin D levels.</p><p>Conclusions</p><p>In a cohort at risk for airflow obstruction, low cathelicidin was independently associated with lower FEV1. These clinical data support a mechanistic link between 25(OH)-vitamin D deficiency and lung function impairment, independent of pneumonia risk.</p></div

Implementation of a COPD Screening Questionnaire in an Outpatient HIV Clinic

<p>Human immunodeficiency virus (HIV) is associated with increased risk for chronic obstructive pulmonary disease (COPD); yet substantial under-recognition of COPD exists. We administered a patient-completed, physician-reviewed COPD screening tool in an outpatient HIV clinic to determine whether screening is feasible or possible. Patients attending nonacute, routine HIV care visits were provided a brief COPD screening tool, which included three questions focused on age, respiratory symptoms, and smoking history. Providers were given completed forms for review and ordered spirometry at their discretion. Forms and medical records were subsequently reviewed to determine completion and results of spirometry testing. Of the 1,510 patients screened during the study period, 968 (64%) forms were completed. After excluding 79 incomplete forms, 889 (92%) unique patient forms were included in this analysis. Among these, 204 (23%) met criteria for spirometry referral, among whom physicians ordered spirometry in 64 (31%). At 6 months following study completion, 19 (30%) of the patients referred for spirometry had the test completed, with 5 (26%) demonstrating airflow obstruction. Nearly one out of four HIV patients met indication for screening spirometry and roughly one out of four undergoing spirometry had COPD. Critical drop-offs in the screening and diagnostic process occurred at questionnaire completion and spirometry ordering. Interventions tailored to these critical steps could improve the yield from COPD screening and help to optimize the identification of COPD in high-risk HIV-infected populations. COPD screening in a clinic focused on longitudinal HIV care can effectively identify COPD among those completing the screening continuum.</p

Association between Cohort Characteristics and Absolute FEV1 (mL).

<p>*Model adjusted for other predictors in the table.</p>†<p>Defined as lowest quartile compared with remaining population.</p><p>Abbreviations: BMI, Body Mass Index; CI, Confidence Interval; FEV1, Forced Expiratory Volume in 1 second.</p

The Risk of Cardiovascular Mortality According to Quintiles of Myeloperoxidase Levels and Smoking Status.

<p>Data presented as % of quintile column total (hazard ratio relative to quintile 1 adjusted for age, sex, race and body mass index).</p>*<p>adjusted for age and sex and race and body mass index.</p

The Rate of Decline in FEV1 According to Serum Myeloperoxidase LevelsOver 11 Years in LHS.

<p>A positive number denotes faster decline in FEV1.</p>*<p>adjusted for age, sex, race, baseline FEV1, and smoking status at visit 5.</p

The Baseline Characteristics of the Lung Health Study Participants According to Quintiles of Myeloperoxidase Levels in Serum at Year 5.

<p>Abbreviations: FEV1, forced expiratory volume in 1 second; BMI, body mass index. Study participants were divided into 5 identical groups based on myeloperoxidase levels. Data are presented as mean ± SD.</p>*<p>p<.05 versus quintile 1.</p>†<p>p<.05 versus quintile 2.</p>‡<p>p<.05 versus each other.</p

Cumulative cardiovascular mortality stratified to according to quintiles of myeloperoxidase levels.

<p>P value was derived from multivariable Cox proportional hazards model. The risk of cardiovascular mortality over the follow up period significantly increased along the increased quintiles of myeloperoxidase, after adjustments for age, sex, race and body mass index (p = 0.036).</p

Urbanization and Daily Exposure to Biomass Fuel Smoke Both Contribute to Chronic Bronchitis Risk in a Population with Low Prevalence of Daily Tobacco Smoking

<p><b><i>Objective</i></b>: Risk factors beyond tobacco smoking associated with chronic bronchitis are not well understood. We sought to describe the prevalence and risk factors of chronic bronchitis across four distinct settings in Peru with overall low prevalence of tobacco smoking yet varying degrees of urbanization, daily exposure to biomass fuel smoke and living at high altitude. <b><i>Methods</i></b>: We analyzed data of 2,947 participants from rural and urban Puno, Lima and Tumbes including spirometry, blood samples, anthropometry and administered questionnaires about respiratory symptoms. We used multivariable Poisson regression to assess biologic, socioeconomic and environmental risk factors associated with chronic bronchitis. <b><i>Results</i></b>: Overall prevalence of chronic bronchitis was 5.9% (95%CI 5.1%–6.9%) with variation by setting: prevalence was lower in semi-urban Tumbes (1.3%) vs. highly urbanized Lima (8.9%), urban Puno (7.0%) and rural Puno (7.8%; p < 0.001). Chronic bronchitis was more common among participants with vs. without COPD based on FEV₁/FVC< LLN (12.1% vs 5.6%, p < 0.01) and it was associated with increased reporting of dyspnea on exertion (p < 0.001), hospitalization (p = 0.003) and workdays missed due to respiratory symptoms (p < 0.001). Older age (Prevalence ratio [PR] = 1.23 for each 10-years of age, 95%CI 1.09–1.40) past history of asthma (PR = 2.87, 95%CI 1.80–4.56), urbanization (PR = 3.34, 95%CI 2.18–5.11) and daily exposure to biomass fuel smoke (PR = 2.00, 95%CI 1.30–3.07) were all associated with chronic bronchitis. <b><i>Conclusions</i></b>: We found important variations in the prevalence of chronic bronchitis across settings. Prevalence increased with both urbanization and with daily exposure to biomass fuel smoke. Having chronic bronchitis was also associated with worse patient-centered outcomes including dyspnea, hospitalization and missed workdays.</p