A 15-Year Follow-up Study of Ventilatory Function in Adults with Asthma

Copenhagen City Heart Study, Epidemiologic Research Unit, Bispebjerg University Hospital, Denmark.
New England Journal of Medicine (Impact Factor: 55.87). 11/1998; 339(17):1194-200. DOI: 10.1056/NEJM199810223391703
Source: PubMed

ABSTRACT Although the prevalence of asthma and morbidity related to asthma are increasing, little is known about the natural history of lung function in adults with this disease.
We used data from a longitudinal epidemiologic study of the general population in a Danish city, the Copenhagen City Heart Study, to analyze changes over time in the forced expiratory volume in one second (FEV1) in adults with self-reported asthma and adults without asthma. The study was conducted between 1976 and 1994; for each patient, three measurements of lung function were obtained over a 15-year period. The final data set consisted of measurements from 17,506 subjects (8136 men and 9370 women), of whom 1095 had asthma.
Among subjects who participated in all three evaluations, the unadjusted decline in FEV1 among subjects with asthma was 38 ml per year, as compared with 22 ml per year in those without asthma. The decline in FEV1 normalized for height (FEV1 divided by the square of the height in meters) was greater among the subjects with asthma than among those without the disease (P<0.001). Among both men and women, and among both smokers and nonsmokers, subjects with asthma had greater declines in FEV1 over time than those without asthma (P<0.001). At the age of 60 years, a 175-cm-tall nonsmoking man without asthma had an average FEV1 of 3.05 liters, as compared with 1.99 liters for a man of similar age and height who smoked and had asthma.
In a sample of the general population, people who identified themselves as having asthma had substantially greater declines in FEV1 over time than those who did not.

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    • "For example, 32% of COPD deaths among women and 47% among men in LMICs (WHO, 2009) and 90% of lung cancer deaths in men and 80% in women are attributable to smoking (WHO, 2012a). Morbidity outcomes are also affected, asthma is one example where, compared to non-smokers with asthma, smokers have more severe symptoms and accelerated decline in lung function (Hedman et al., 2011; Jindal and Gupta, 2004; Lange et al., 1998) and a reduced response to corticosteroid therapy (Tomlinson et al., 2005). There has been extensive integration of TB diagnosis and treatment within the health systems of high burden countries using the Directly Observed Treatment Short-course (DOTS) process (WHO, 2010). "
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    ABSTRACT: Smoking cessation services are rarely found within health services in low income countries. Given the interactions between Tuberculosis (TB) and tobacco, including cessation support within TB programs offers a promising cost-effective solution. We conducted secondary analysis of data from a cluster randomized controlled trial of smoking cessation in health centers in Pakistan to identify predictors of continuous and short-term abstinence in smokers suspected of TB using cigarettes or hookah. Predictor variables of those continuously abstinent at 5 and 25 weeks post quit-date (continuous abstinence) and those abstinent only at 5 weeks (short-term abstinence) were compared with those who continued smoking and with each other. Self-reported abstinence at both time points was confirmed biochemically. Data obtained from 1955 trial participants were analyzed. The factors that predicted continued smoking when compared to continuous abstinence were: being older RR 0.97 (0.95 to 0.98), smoking higher quantities of tobacco RR 0.975 (0.97 to 0.98) and sharing a workplace with other smokers RR 0.88 (0.77 to 0.99). Those with a confirmed TB diagnosis were more likely to remain continuously abstinent than those without RR 1.27 (1.10-1.47). Those diagnosed with TB are more likely to be abstinent than those diagnosed with other respiratory conditions. Beyond this, predictors of continued smoking in Pakistan are similar to those in high income contexts. Taking advantage of the 'teachable moment' that a TB diagnosis provides is an efficient means for resource-poor TB programs in low income settings to increase tobacco cessation and improve health outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 08/2015; DOI:10.1016/j.drugalcdep.2015.08.002 · 3.42 Impact Factor
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    • "First, aging has an effect on decreased lung function, as seen previously.5,25 Second, cigarette smoking in asthmatic patients can significantly accelerate the decline in lung function and increase the risk of COPD.21,29 Third, asthmatic patients can develop airway remodeling as a consequence of persistent airway inflammation which can lead to fixed airflow obstruction. "
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    ABSTRACT: Purpose In clinical practice, some patients with asthma show incompletely reversible airflow obstruction, resembling chronic obstructive pulmonary disease (COPD). The aim of this study was to analyze this overlap phenotype of asthma with COPD feature. Materials and Methods A total of 256 patients, over the age of 40 years or more with a diagnosis of asthma, based on either 1) positive response to bronchodilator: >200 mL forced expiratory volume in 1 s (FEV1) and >12% baseline or 2) positive methacholine or mannitol provocation test, were enrolled. Among the asthma patients, we defined the overlap group with incompletely reversible airflow obstruction [postbronchodilator FEV1/forced vital capacity (FVC) <70] at the initial time of admission and continuing airflow obstruction after at least 3 months follow up. We evaluated clinical features, serum eosinophil counts, serum total immunoglobulin (Ig) E with allergy skin prick test, spirometry, methacholine or mannitol provocation challenges and bronchodilator responses, based on their retrospective medical record data. All of the tests mentioned above were performed within one week. Results The study population was divided into two groups: asthma only (62%, n=159, postbronchodilator FEV1/FVC ≥70) and overlap group (38%, n=97, postbronchodilator FEV1/FVC <70). The overlap group was older, and contained more males and a higher percentage of current or ex-smokers than the asthma only group. Significantly lower FEV1 and higher total lung capacity, functional residual capacity, and residual volume were observed in the overlap group. Finally, significantly lower serum eosinophil count and higher IgE were seen in the overlap group. Conclusion Our results showed that the overlap phenotype was older, male asthmatic patients who have a higher lifetime smoking intensity, more atopy and generally worse lung function.
    Yonsei Medical Journal 07/2014; 55(4):980-6. DOI:10.3349/ymj.2014.55.4.980 · 1.29 Impact Factor
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    • "Furthermore, based on the about 2% prevalence with highly-elevated (>10 μM) serum γ-tocopherol in adults in CARDIA and the U.S. 2011 census of adults, we expect that the 350–570 milliliters lower FEV1 or FVC occurs in up to 4.5 million adults in the population. This is a clinically significant volume because it corresponds to 9 to 15 years of decline in lung function with aging [24]. "
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    ABSTRACT: Clinical studies of the associations of vitamin E with lung function have reported conflicting results. However, these reports primarily examine the alpha-tocopherol isoform of vitamin E and have not included the isoform gamma-tocopherol which we recently demonstrated in vitro opposes the function of alpha-tocopherol. We previously demonstrated, in vitro and in animal studies, that the vitamin E isoform alpha-tocopherol protects, but the isoform gamma-tocopherol promotes lung inflammation and airway hyperresponsiveness. To translate these findings to humans, we conducted analysis of 4526 adults in the Coronary Artery Risk Development in Young Adults (CARDIA) multi-center cohort with available spirometry and tocopherol data in blacks and whites. Spirometry was obtained at years 0, 5, 10, and 20 and serum tocopherol was from years 0, 7 and 15 of CARDIA. In cross-sectional regression analysis at year 0, higher gamma-tocopherol associated with lower FEV1 (p = 0.03 in blacks and p = 0.01 in all participants) and FVC (p = 0.01 in blacks, p = 0.05 in whites, and p = 0.005 in all participants), whereas higher alpha-tocopherol associated with higher FVC (p = 0.04 in blacks and whites and p = 0.01 in all participants). In the lowest quartile of alpha-tocopherol, higher gamma-tocopherol associated with a lower FEV1 (p = 0.05 in blacks and p = 0.02 in all participants). In contrast, in the lowest quartile of gamma-tocopherol, higher alpha-tocopherol associated with a higher FEV1 (p = 0.03) in blacks. Serum gamma-tocopherol >10 muM was associated with a 175-545 ml lower FEV1 and FVC at ages 21-55 years. Increasing serum concentrations of gamma-tocopherol were associated with lower FEV1 or FVC, whereas increasing serum concentrations of alpha-tocopherol was associated with higher FEV1 or FVC. Based on the prevalence of serum gamma-tocopherol >10 muM in adults in CARDIA and the adult U.S. population in the 2011 census, we expect that the lower FEV1 and FVC at these concentrations of serum gamma-tocopherol occur in up to 4.5 million adults in the population.
    Respiratory research 03/2014; 15(1):31. DOI:10.1186/1465-9921-15-31 · 3.09 Impact Factor
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