Lung function, forced expiratory volume in 1 s decline and COPD hospitalisations over 44 years of follow-up

BackgroundThe European Community Respiratory Health Survey is a major international study designed to assess lung health in adults. This Australian follow-up investigated changes in symptoms between sexes and the roles of asthma, smoking, age, sex, height, and change in body mass index (ΔBMI) on lung function decline (LFD), which is a major risk factor for chronic obstructive pulmonary disease (COPD).MethodsLFD was measured as the rate of decline over time in FEV1 (mL/year) (ΔFEV1) and FVC (ΔFVC) between 1993 and 2013. Multiple linear regression was used to estimate associations between risk factors and LFD, separately for males and females. Multiple logistic regression was used to assess sex differences and changes in respiratory symptoms over time.ResultsIn Melbourne, 318 subjects (53.8% females) participated. The prevalence of most respiratory symptoms had either remained relatively stable over 20 years or decreased (significantly so for wheeze). The exception was shortness of breath after activity, which had increased. Among the 262 subjects who completed spirometry, current smoking declined from 20.2% to 7.3%. Overall mean (± standard deviation) FEV1 declined by 23.1 (±17.1) and FVC by 22.9 (±20.2) mL/year. Predictors of ΔFEV1 in males were age, maternal smoking, and baseline FEV1; and in females they were age, ΔBMI, baseline FEV1, and pack-years in current smokers. Decline in FVC was predicted by baseline FVC, age, and ΔBMI in both sexes; however, baseline FVC predicted steeper decline in females than males.ConclusionMost respiratory symptoms remained stable or decreased over time in both sexes. Age, baseline lung function, and change in BMI were associated with the rate of decline in both sexes. However, obesity and personal smoking appear to put females at higher risk of LFD than males. Health promotion campaigns should particularly target females to prevent COPD.

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“…Excessively rapid LFD is a well-established precursor of COPD, 11 airway and systemic inflammation, 19 hospitalization, and death from COPD. 20 …”

Section: Introductionmentioning

confidence: 99%

Symptoms and lung function decline in a middle-aged cohort of males and females in Australia

Abramson¹,

Kaushik²,

Benke³

et al. 2016

COPD

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“… 15 Another recent study found that airflow obstruction at the age of 55 years was an important risk factor for future COPD hospitalizations. 16 Poor lung function has been associated with an increased risk of exacerbations. Previous studies had shown that exacerbations became more frequent and more severe as the severity of COPD increased.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong – computerized data collection and analysis

Chan¹,

Ko²,

Chan³

et al. 2018

COPD

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BackgroundCOPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK).Patients and methodsIt was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed.ResultsIn total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies.ConclusionPatients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.

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“…Low spirometry results are associated with an increased risk of COPD morbidity (16,17) and exacerbations (5,(18)(19)(20)(21). An important reason why low spirometry values, notably low FEV 1 , have a predictive value is that a low value may represent a pathologic decline from a higher normal value and therefore indicates COPD, provided other diseases are excluded.…”

Section: Discussionmentioning

confidence: 99%

Prediction of COPD and Related Events Improves by Combining Spirometry and the Single Breath Nitrogen Test

Olofson

Bake

Bergman

et al. 2018

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Chronic obstructive pulmonary disease (COPD) develops in small airways. Severity of small airway pathology relates to progression and mortality. The present study evaluated the prediction of COPD of a validated test for small airway disease, i.e. a slope of the alveolar plateau of the single breath nitrogen test (N 2-slope). The N 2-slope, spirometry, age, smoking habits, and anthropometric variables at baseline were obtained in a population-based sample (n ¼ 592). The cohort was followed for first COPD events (first hospital admission of COPD or related conditions or death from COPD) during 38 years. During follow-up, 52 subjects (8.8%) had a first COPD event, of which 18 (3.0%) died with a first COPD diagnosis. In the proportional hazard regression analysis adjusted for age and smoking habits, the cumulative COPD event incidence increased from 5% among those with high forced expired volume in one second (FEV 1) to 25% among those with low FEV 1 , while increasing from 4% among those with the lowest N 2-slope to 26% among those with the highest. However, combining the N 2-slope and FEV 1 resulted in considerable synergy in the prediction of first COPD event and even more so when taking account of smoking habits. The cumulative COPD event incidence rate was 75% among heavy smokers with the highest N 2-slope and lowest FEV 1 , and less than 1% among never smokers with the lowest N 2-slope and highest FEV 1. Thus, combining the results of the single breath N 2-slope and FEV 1 considerably improved the prediction of COPD events as compared to either test alone.

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Lung function, forced expiratory volume in 1 s decline and COPD hospitalisations over 44 years of follow-up

Cited by 13 publications

References 41 publications

Symptoms and lung function decline in a middle-aged cohort of males and females in Australia

Symptoms and lung function decline in a middle-aged cohort of males and females in Australia

Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong – computerized data collection and analysis

Prediction of COPD and Related Events Improves by Combining Spirometry and the Single Breath Nitrogen Test

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Lung function, forced expiratory volume in 1 s decline and COPD hospitalisations over 44 years of follow-up

Cited by 13 publications

References 41 publications

Symptoms and lung function decline in a middle-aged cohort of males and females in Australia

Symptoms and lung function decline in a middle-aged cohort of males and females in Australia

Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong &ndash; computerized data collection and analysis

Prediction of COPD and Related Events Improves by Combining Spirometry and the Single Breath Nitrogen Test

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Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong – computerized data collection and analysis