Respiratory symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scores) and GOLD-ABCD COPD classification: the LASSYC study

Chronic obstructive pulmonary disease; Symptoms; COPDEnfermedad pulmonar obstructiva crónica; Síntomas; EPOCMalaltia pulmonar obstructiva crònica; Símptomes; MPOCObjective To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points. Methods In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores. Results Among the 734 patients with COPD, 61% were male, age 69.6±8.7 years, FEV1% post-BD 49.1±17.5%, mMRC 1.8±1.0 and CAT 15.3±.8.1. By mMRC 33.7% were group-A, 29.2% group-B, 10.2% group-C and 26.9% group-D. By CAT 22.3% were group-A, 41% group-B, 4.8% group-C and 31.9% group-D. Using the mMRC the severity of E-RS, NiSCI and EMSCI scores increased from group A to D. Using the CAT, the groups B and D had the higher scores. Agreement between mMRC and CAT was 89.5% (Kappa statistics=75.7%). For mMRC score of 2, CAT score of ≥11 showed the maximum Youden’s index (1.34). For mMRC score of 1, CAT score of ≥9 and ≥10 showed the maximum Youden’s index (1.48). Conclusion GOLD COPD classification by CAT seems to better discriminate 24-hour symptoms. Results do not support the equivalent use of CAT≥10 and mMRC≥2 for assessing symptoms.This observational study was funded by AstraZeneca Latin America. The funder had no input into the study design, analysis, or interpretation of the results

Respiratory medication use in primary care of four latin american countries: the puma study

Universidade Federal de Sao Paulo, Sao Paulo, BrazilFac Med Sci Santa Casa Sao Paulo, Sao Pablo, BrazilCent Univ Venezuela, Fac Med, Caracas, VenezuelaUniv Comahue, Fac Ciencias Med, Cipolletti, Rio Negro, ArgentinaUniv Republica, Hosp Maciel, Montevideo, UruguayHosp Univ Caracas, Caracas, VenezuelaUniversidade Federal de Sao Paulo, Sao Paulo, BrazilWeb of Scienc

Asthma–COPD overlap syndrome (ACOS) in primary care of four Latin America countries: the PUMA study

Abstract Background Asthma–COPD overlap syndrome (ACOS) prevalence varies depending on the studied population and definition criteria. The prevalence and clinical characteristics of ACOS in an at-risk COPD primary care population from Latin America was assessed. Methods Patients ≥40 years, current/ex-smokers and/or exposed to biomass, attending routine primary care visits completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) < 0.70; asthma was defined as either prior asthma diagnosis or wheezing in the last 12 months plus reversibility (increase in post-bronchodilator FEV1 or FVC ≥200 mL and ≥12%); ACOS was defined using a combination of COPD with the two asthma definitions. Exacerbations in the past year among the subgroups were evaluated. Results One thousand seven hundred forty three individuals completed the questionnaire, 1540 performed acceptable spirometry, 309 had COPD, 231 had prior asthma diagnosis, and 78 asthma by wheezing + reversibility. ACOS prevalence in the total population (by post-bronchodilator FEV1/FVC < 0.70 plus asthma diagnosis) was 5.3 and 2.3% by post-bronchodilator FEV1/FVC < 0.70 plus wheezing + reversibility. In the obstructive population (asthma or COPD), prevalence rises to 17.9 and 9.9% by each definition, and to 26.5 and 11.3% in the COPD population. ACOS patients defined by post-bronchodilator FEV1/FVC < 0.7 plus wheezing + reversibility had the lowest lung function measurements. Exacerbations for ACOS showed a prevalence ratio of 2.68 and 2.20 (crude and adjusted, p < 0.05, respectively) (reference COPD). Conclusions ACOS prevalence in primary care varied according to definition used. ACOS by post-bronchodilator FEV1/FVC < 0.7 plus wheezing + reversibility represents a clinical phenotype with more frequent exacerbations, which is probably associated with a different management approach

Respiratory medication used in COPD patients from seven Latin American countries : The lassyc study

Background: Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region. Methods: This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries. Adherence to inhaled therapy was assessed using the Test of Adherence to Inhalers (TAI) questionnaire. The type of medication was assessed as: short-acting β-agonist (SABA) or short-acting muscarinic antagonist (SAMA) only, long-acting muscarinic antagonist (LAMA), long-acting β-agonist (LABA), LABA/LAMA, inhaled corticosteroid (ICS), ICS/LABA, ICS/LAMA/LABA, or other. Results: In total, 795 patients were included (59.6% male), with a mean age of 69.5±8.7 years and post-bronchodilator FEV1of 50.0%±18.6%. The ICS/LAMA/LABA (32.9%) and ICS/LABA (27.7%) combinations were the most common medications used, followed by LABA/LAMA (11.3%), SABA or SAMA (7.9%), LABA (6.4%), LAMA (5.8%), and ICS (4.3%). The types of medication most commonly used in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 category were ICS/LABA (A: 32.7%; B: 19.8%; C: 25.7%; D: 28.2%) and ICS/LAMA/LABA (A: 17.3%; B: 30.2%; C: 33%; D: 41.1%). The use of long-acting bronchodilators showed the highest adherence (good or high adherence &gt;50%) according to the TAI questionnaire. Conclusion: COPD management in specialist practice in Latin America does not follow the current guideline recommendations and there is an overuse of ICSs in patients with COPD from this region. Treatment regimens including the use of long-acting bronchodilators are associated with the highest adherence. © 2018 Casas et al

Respiratory medication used in COPD patients from seven Latin American countries : The lassyc study

Background: Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region. Methods: This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries. Adherence to inhaled therapy was assessed using the Test of Adherence to Inhalers (TAI) questionnaire. The type of medication was assessed as: short-acting β-agonist (SABA) or short-acting muscarinic antagonist (SAMA) only, long-acting muscarinic antagonist (LAMA), long-acting β-agonist (LABA), LABA/LAMA, inhaled corticosteroid (ICS), ICS/LABA, ICS/LAMA/LABA, or other. Results: In total, 795 patients were included (59.6% male), with a mean age of 69.5±8.7 years and post-bronchodilator FEV1of 50.0%±18.6%. The ICS/LAMA/LABA (32.9%) and ICS/LABA (27.7%) combinations were the most common medications used, followed by LABA/LAMA (11.3%), SABA or SAMA (7.9%), LABA (6.4%), LAMA (5.8%), and ICS (4.3%). The types of medication most commonly used in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 category were ICS/LABA (A: 32.7%; B: 19.8%; C: 25.7%; D: 28.2%) and ICS/LAMA/LABA (A: 17.3%; B: 30.2%; C: 33%; D: 41.1%). The use of long-acting bronchodilators showed the highest adherence (good or high adherence &gt;50%) according to the TAI questionnaire. Conclusion: COPD management in specialist practice in Latin America does not follow the current guideline recommendations and there is an overuse of ICSs in patients with COPD from this region. Treatment regimens including the use of long-acting bronchodilators are associated with the highest adherence. © 2018 Casas et al

Airflow Obstruction in Never Smokers in Five Latin American Cities: the PLATINO Study

Background. Although chronic obstructive pulmonary disease (COPD) is mostly related to tobacco smoking, a variable proportion of COPD occurs in never smokers. We investigated differences between COPD in never smokers compared with smokers and subjects without COPD.Methods. PLATINO is a cross-sectional population-based study of five Latin American cities. COPD was defined as postbronchodilator FEV1/FVC <0.70 and FEV1 <80% of predicted values.Results. Among 5,315 subjects studied, 2278 were never smokers and 3036 were ever smokers. COPD was observed in 3.5% of never smokers and in 7.5% of ever smokers. Never smokers with COPD were most likely older and reported a medical diagnosis of asthma or previous tuberculosis. Underdiagnosis was as common in obstructed patients who never smoked as in ever smokers.Conclusions. Never smokers comprised 26% of all individuals with airflow obstruction. Obstruction was associated with female gender, older age and a diagnosis of asthma or tuberculosis. (C) 2012 IMSS. Published by Elsevier Inc.Asociacion Latinoamericana de Torax (ALAT)Inst Nacl Enfermedades Resp, Mexico City 14080, DF, MexicoUniv Republica, Fac Med, Montevideo, UruguayCent Univ Venezuela, Fac Med, Caracas, VenezuelaUniversidade Federal de São Paulo, São Paulo, BrazilPontificia Univ Catolica Chile, Santiago, ChileUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Lung function decline in subjects with and without COPD in a population-based cohort in Latin-America

<div><p>Background</p><p>Lung-function decline is one of the possible mechanisms leading to Chronic Obstructive Pulmonary Disease (COPD).</p><p>Methods</p><p>We analyzed data obtained from two population-based surveys of adults (n = 2026) conducted in the same individuals 5–9 years (y) after their baseline examination in three Latin-American cities. Post BronchoDilator (postBD) FEV₁ decline in mL/y, as %predicted/y (%P/y) and % of baseline/y (%B/y) was calculated and the influence of age, gender, BMI, baseline lung function, BD response, exacerbations rate evaluated using multivariate models.</p><p>Results</p><p>Expressed in ml/y, the mean annual postBD FEV₁ decline was 27 mL (0.22%P, 1.32%B) in patients with baseline COPD and 36 (0.14%P, 1.36%B) in those without. Faster decline (in mL/y) was associated with higher baseline lung function, with significant response to bronchodilators, older age and smoking at baseline, also in women with chronic cough and phlegm, or ≥2 respiratory exacerbations in the previous year, and in men with asthma.</p><p>Conclusions</p><p>Lung function decline in a population-based cohort did not differ in obstructed and non-obstructed individuals, it was proportional to baseline FEV₁, and was higher in smokers, elderly, and women with respiratory symptoms.</p></div

Increased Risk of Exacerbation and Hospitalization in Subjects With an Overlap Phenotype COPD-Asthma

Background: Several COPD phenotypes have been described; the COPD-asthma overlap is one of the most recognized. the aim of this study was to evaluate the prevalence of three subgroups (asthma, COPD, and COPD-asthma overlap) in the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) study population, to describe their main characteristics, and to determine the association of the COPD-asthma overlap group with exacerbations, hospitalizations, limitations due to physical health, and perception of general health status (GHS).Methods: the PLATINO study is a multicenter population-based survey carried out in five Latin American cities. Outcomes were self-reported exacerbations (defined by deterioration of breathing symptoms that affected usual daily activities or caused missed work), hospitalizations due to exacerbations, physical health limitations, and patients' perception of their GHS obtained by questionnaire. Subjects were classified in three specific groups: COPD-a postbronchodilator (post-BD) FEV1/FVC ratio of < 0.70; asthma-presence of wheezing in the last year and a minimum post-BD increase in FEV1 or FVC of 12% and 200 mL; and overlap COPD-asthma-the combination of the two.Results: Out of 5,044 subjects, 767 were classified as having COPD (12%), asthma (1.7%), and COPD-asthma overlap (1.8%). Subjects with COPD-asthma overlap had more respiratory symptoms, had worse lung function, used more respiratory medication, had more hospitalization and exacerbations, and had worse GHS. After adjusting for confounders, the COPD-asthma overlap was associated with higher risks for exacerbations (prevalence ratio [PR], 2.11; 95% CI, 1.08-4.12), hospitalizations (PR, 4.11; 95% CI, 1.45-11.67), and worse GHS (PR, 1.47; 95% CI, 1.18-1.85) compared with those with COPD.Conclusions: the coexisting COPD-asthma phenotype is possibly associated with increased disease severity.Boehringer Ingelheim GmbHGlaxoSmithKlineUniv Fed Pelotas, Postgrad Program Epidemiol, BR-96020220 Pelotas, RS, BrazilCent Univ Venezuela, Fac Med, Caracas, VenezuelaNatl Inst Resp Dis, Sleep Clin & Pulm Physiol, Mexico City, DF, MexicoGlaxoSmithKline, London, EnglandUniv Republica, Fac Med, Montevideo, UruguayCtr Hosp Pereira Rossell, Montevideo, UruguayUniversidade Federal de São Paulo, São Paulo, BrazilPontificia Univ Catolica Chile, Santiago, ChileUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc