80 research outputs found
EPOC en la mujer
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing
worldwide, mainly due to the increase in women. In developed countries, COPD in
women is mainly a result of exposure to tobacco smoke and in developing countries
to inhalation of biomass combustion products. Underdiagnosis of COPD is more
common in women since this disease has classically been associated with men.
Moreover, COPD in women shows certain differential features, such as a greater
expression of aspects related to perception (dyspnea and health-related quality
of life), a high prevalence of malnutrition, anxiety and depression, and a
distinct distribution of emphysema from that in men. Better phenotypical
characterization of COPD in women would allow its impact on the health system to
be more accurately evaluated and more individualized therapeutic strategies to be
designe
Radiologic features of small pulmonary nodules detected in initially negative screening CT examinations: a step towards personalized screening strategies?
Results of the National Lung Screening Trial (NLST)
have invigorated the discussion around performing lung
cancer screening using low-dose computed tomography
(LDCT) of the chest. The NLST trial demonstrated a
clear benefit of LDCT screening in reducing lung cancer
and all-cause mortality, by showing reduced lung cancer
mortality in high-risk individuals by about 20%, and allcause mortality by 6.7%, compared to a control group of
subjects receiving chest radiographs
Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a Bronchus sign on CT imaging: results from a prospective study
Electromagnetic navigation bronchoscopy (ENB) has been developed as a
novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules.
Despite successful navigation in 90% of patients, ENB diagnostic yield does not
generally exceed 70%. We sought to determine whether the presence of a bronchus
sign on CT imaging conditions diagnostic yield of ENB and might account for the
discrepancy between successful navigation and diagnostic yield. METHODS: We
conducted a prospective, single-center study of ENB in 51 consecutive patients
with pulmonary nodules. ENB was chosen as the least invasive diagnostic technique
in patients with a high surgical risk, suspected metastatic disease, or
advanced-stage disease, or in those who demanded a preoperative diagnosis prior
to undergoing curative resection. We studied patient and technical variables that
might condition diagnostic yield, including size, cause, location, distance to
the pleural surface, and fluorodeoxyglucose uptake of a given nodule; the
presence of a bronchus sign on CT imaging; registration point divergence; and the
minimum distance from the tip of the locatable guide to the nodule measured
during the procedure. RESULTS: The diagnostic yield of ENB was 67% (34/51). The
sensitivity and specificity of ENB for malignancy in this study were 71% and
100%, respectively. ENB was diagnostic in 79% (30/38) patients with a bronchus
sign on CT imaging but only in 4/13 (31%) with no discernible bronchus sign.
Univariate analysis identified the bronchus sign (P = .005) and nodule size (P =
.04) as statistically significant variables conditioning yield, but on
multivariate analysis, only the bronchus sign remained significant (OR, 7.6; 95%
CI, 1.8-31.7). No procedure-related complications were observed. CONCLUSIONS: ENB
diagnostic yield is highly dependent on the presence of a bronchus sign on CT
imaging
Emphysema presence, severity, and distribution has little impact on the clinical presentation of a cohort of patients with mild to moderate COPD
Phenotypic characterization of patients with COPD may have potential
prognostic and therapeutic implications. Available information on the
relationship between emphysema and the clinical presentation in patients with
COPD is limited to advanced stages of the disease. The objective of this study
was to describe emphysema presence, severity, and distribution and its impact on
clinical presentation of patients with mild to moderate COPD. METHODS: One
hundred fifteen patients with COPD underwent clinical and chest CT scan
evaluation for the presence, severity, and distribution of emphysema. Patients
with and without emphysema and with different forms of emphysema distribution
(upper/lower/core/peel) were compared. The impact of emphysema severity and
distribution on clinical presentation was determined. RESULTS: Fifty percent of
the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%).
Upper and core zones had the more severe degree of emphysema. Patients with
emphysema were older, more frequently men, and had lower FEV(1)%, higher total
lung capacity percentage, and lower diffusing capacity of the lung for carbon
monoxide. No differences were found between the clinical or physiologic
parameters of the different emphysema distributions. CONCLUSIONS: In patients
with mild to moderate COPD, although the presence of emphysema has an impact on
physiologic presentation, its severity and distribution seem to have little
impact on clinical presentation
Trabecular bone score in active or former smokers with and without COPD
Background Smoking is a recognized risk factor for osteoporosis. Trabecular bone score (TBS) is a novel texture parameter to evaluate bone microarchitecture. TBS and their main determinants are unknown in active and former smokers. Objective To assess TBS in a population of active or former smokers with and without Chronic Obstructive Pulmonary Disease (COPD) and to determine its predictive factors. Methods Active and former smokers from a pulmonary clinic were invited to participate. Clinical features were recorded and bone turnover markers (BTMs) measured. Lung function, low dose chest Computed Tomography scans (LDCT), dual energy absorptiometry (DXA) scans were performed and TBS measured. Logistic regression analysis explored the relationship between measured parameters and TBS. Results One hundred and forty five patients were included in the analysis, 97 (67.8%) with COPD. TBS was lower in COPD patients (median 1.323; IQR: 0.13 vs 1.48; IQR: 0.16, p = 0.003). Regression analysis showed that a higher body mass index (BMI), younger age, less number of exacerbations and a higher forced expiratory volume-one second (FEV1%) was associated with better TBS (β = 0.005, 95% CI:0.000–0.011, p = 0.032; β = -0.003, 95% CI:-0.007(-)-0.000, p = 0.008; β = -0.019, 95% CI:-0.034(-)-0.004, p = 0.015; β = 0.001, 95% CI:0.000–0.002, p = 0.012 respectively). The same factors with similar results were found in COPD patients. Conclusions A significant proportion of active and former smokers with and without COPD have an affected TBS. BMI, age, number of exacerbations and the degree of airway obstruction predicts TBS values in smokers with and without COPD. This important information should be considered when evaluating smokers at risk of osteoporosis
Sex differences in mortality in patients with COPD
Little is known about survival and clinical prognostic factors in females with chronic
obstructive pulmonary disease (COPD). The aim of the present study was to determine the
survival difference between males and females with COPD and to compare the value of the
different prognostic factors for the disease.
In total, 265 females and 272 males with COPD matched at baseline by BODE (body mass index,
airflow obstruction, dyspnoea, exercise capacity) and American Thoracic Society/European
Respiratory Society/Global Initiative of Chronic Obstructive Lung Disease criteria were
prospectively followed. Demographics, lung function, St George’s Respiratory Questionnaire,
BODE index, the components of the BODE index and comorbidity were determined. Survival was
documented and sex differences were determined using Kaplan–Meier analysis. The strength of
the association of the studied variables with mortality was determined using multivariate and
receiver operating curves analysis.
All-cause (40 versus 18%) and respiratory mortality (24 versus 10%) were higher in males than
females. Multivariate analysis identified the BODE index in females and the BODE index and
Charlson comorbidity score in males as the best predictors of mortality. The area under the curve
of the BODE index was a better predictor of mortality than the forced expiratory volume in one
second for both sexes.
At similar chronic obstructive pulmonary disease severity by BODE index and forced expiratory
volume in one second, females have significantly better survival than males. For both sexes the
BODE index is a better predictor of survival than the forced expiratory volume in one second
Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest.
Identification of risk factors for lung cancer can help in selecting
patients who may benefit the most from smoking cessation interventions, early
detection, or chemoprevention. OBJECTIVE: To evaluate whether the presence of
emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk
factor for lung cancer. METHODS: The study used data from a prospective cohort of
1,166 former and current smokers participating in a lung cancer screening study.
All individuals underwent a baseline LDCT and spirometry followed by yearly
repeat LDCT studies. The incidence density of lung cancer among patients with and
without emphysema on LDCT was estimated. Stratified and multiple regression
analyses were used to assess whether emphysema is an independent risk factor for
lung cancer after adjusting for age, gender, smoking history, and the presence of
airway obstruction on spirometry. RESULTS: On univariate analysis, the incidence
density of lung cancer among individuals with and without emphysema on LDCT was
25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk
ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also
associated with increased risk of lung cancer when the analysis was limited to
individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to
18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51;
95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79
to 5.58) was associated with increased risk of lung cancer after adjusting for
potential cofounders. CONCLUSIONS: Results suggest that the presence of emphysema
on LDCT is an independent risk factor for lung cancer
Chronic obstructive pulmonary disease (COPD) as a disease of early aging: evidence from the epiChron cohort
Background: Aging is an important risk factor for most chronic diseases. Patients with COPD develop more comorbidities than non-COPD subjects. We hypothesized that the development of comorbidities characteristically affecting the elderly occur at an earlier age in subjects with the diagnosis of COPD.
Methods and findings: We included all subjects carrying the diagnosis of COPD (n = 27,617), and a similar number of age and sex matched individuals without the diagnosis, extracted from the 727,241 records of individuals 40 years and older included in the EpiChron Cohort (Aragon, Spain). We compared the cumulative number of comorbidities, their prevalence and the mortality risk between both groups. Using network analysis, we explored the connectivity between comorbidities and the most influential comorbidities in both groups. We divided the groups into 5 incremental age categories and compared their comorbidity networks. We then selected those comorbidities known to affect primarily the elderly and compared their prevalence across the 5 age groups. In addition, we replicated the analysis in the smokers' subgroup to correct for the confounding effect of cigarette smoking. Subjects with COPD had more comorbidities and died at a younger age compared to controls. Comparison of both cohorts across 5 incremental age groups showed that the number of comorbidities, the prevalence of diseases characteristic of aging and network's density for the COPD group aged 56-65 were similar to those of non-COPD 15 to 20 years older. The findings persisted after adjusting for smoking.
Conclusion: Multimorbidity increases with age but in patients carrying the diagnosis of COPD, these comorbidities are seen at an earlier age
B cell–adaptive immune profile in emphysema-predominant chronic obstructive pulmonary disease
Cigarette smoke, the major risk factor for COPD in developed countries, causes pulmonary inflammation that persists long after smoking cessation, suggesting self-perpetuating adaptive immune responses similar to those that occur in autoimmune diseases. Increases in the number and size of B cell–rich lymphoid follicles (LFs) have been shown in patients in severe stages of COPD (4), and increased B-cell products (autoantibodies) have been observed in the blood and lungs of patients with COPD (5, 6). Oligoclonal rearrangement of the immunoglobulin genes has been observed in B cells isolated from COPD LFs, suggesting that a specific antigenic stimulation drives B-cell proliferation. Consistently, we have shown that in the COPD lung, there is an overexpression of BAFF (B-cell activation factor of the TNF family), which is a key regulator of B-cell homeostasis in several autoimmune diseases (7) and is involved in the growth of LFs in COPD. However, a network analysis of lung transcriptomics showed that a prominent B-cell molecular signature characterized emphysema preferentially but was absent in AD independently of the degree of airflow limitation (8). In the current study, we investigated the correlation between B-cell responses in lung tissue from patients with COPD and healthy smokers, and the extent of emphysema versus airflow limitation
Finding the best thresholds of FEV1 and dyspnea to predict 5-year survival in COPD patients: the COCOMICS study
BACKGROUND:
FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence.
OBJECTIVES:
We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients.
DESIGN AND METHODS:
We conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival.
RESULTS:
A total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4 ± 9.7, and predicted FEV1 of 53.8% (± 19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥ 70%, moderate 56-69%, severe 36-55%, and very severe ≤ 35%. Survival at 5 years was 0.89 for patients with FEV1 ≥ 70 vs. 0.46 in patients with FEV1 ≤ 35% (H.R: 6; 95% C.I.: 4.69-7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear.
CONCLUSIONS:
The best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥ 70%, 56-69%, 36-55%, and ≤ 35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs
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