Decline in FEV1 in relation to incident chronic obstructive pulmonary disease in a cohort with respiratory symptoms.
ABSTRACT Data on the relationship between decline in lung function and development of COPD are sparse. We assessed the decline in FEV1 during 10 years among subjects with respiratory symptoms by two different methods and evaluated risk factors for decline and its relation to incident Chronic Obstructive Pulmonary Disease, COPD. A cross-sectional postal questionnaire was in 1986 sent to 6610 subjects of three age strata. All subjects reporting respiratory symptoms were invited to a structured interview and spirometry. A follow-up survey was performed 10 years later, and totally 1109 subjects performed spirometry in both 1986 and 1996. COPD was defined according to the ATS/ERS standards (FEV1/FVC < or =0.70). The decline in FEV1 was 39 ml/year in men vs. 28 ml/year in women, p = < 0.001 (-1.53 vs. -0.12 change in percent of predicted normal value over 10 years (pp), p = 0.023), among smokers 39 vs. non-smokers 28 ml/year, p < 0.001 (-3.30 vs. 0.69 pp, p < 0.001), in subjects with chronic productive cough 36 vs. not 32 ml/year, p = 0.044 (-2.00 vs. -0.02 pp, p = 0.002). Incident cases of moderate COPD (n = 83) had a decline of 62 ml/year (-12.6 pp) and 22.9% of them had a decline > 90 ml/year (-27.8 pp over 10 years). Gender-specific analysis revealed that smoking was a stronger risk factor in women than in men, while higher age was a significant risk factor in men only. In conclusion, decline in FEV1 was associated with age, smoking, and chronic productive cough, but the risk factor pattern was gender-dependent. Among incident cases of COPD the decline was steeper and close to a quarter had a rapid decline.
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a progressive disease that begins many years before a diagnosis is usually made. The need for an early and confirmed diagnosis of COPD is increasingly appreciated by primary care physicians in whose hands the ability to make improvements in early diagnosis largely rests. Case-finding of patients with symptoms of lifestyle limitation is probably the most practical way to achieve early diagnosis. Evidence suggests a burden of early COPD on afflicted people and their families. Early encouragement of smoking cessation, in conjunction with management of symptoms and treating activity limitation and exacerbations by appropriate non-pharmacologic and pharmacologic management at the earliest possible stage, could positively affect the impact and progression of the disease.Primary care respiratory journal: journal of the General Practice Airways Group 03/2011; 20(1):15-22.
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ABSTRACT: A relationship between local and systemic inflammation and different co-morbidities, such as cardiovascular, has been discussed in relation to disease process and prognosis in COPD. To evaluate if conditions as cardiovascular diseases, diabetes, chronic rhinitis and gastroesophageal reflux are overrepresented in COPD. All subjects with COPD according to GOLD, FEV(1)/FVC<0.70, were identified (n = 993) from the clinical follow-up in 2002-04 of the OLIN (Obstructive Lung Disease in Northern Sweden) studies' cohorts together with 993 gender- and age-matched reference subjects without COPD (non-COPD, further divided into normal and restrictive lung function). Interview data on co-morbidity and symptoms were used. Cardiovascular co-morbidity, taken together heart disease, hypertension, stroke and intermittent claudication, was the most common and higher in COPD compared to in normal lung function (Nlf) 50.1% vs 41.0% (p<0.001). The prevalence of chronic rhinitis and gastroesophageal reflux (GERD) was higher in COPD compared to in Nlf (43.1% vs 32.3%, p<0.001 and 16.7% vs 12.0%, p = 0.011). In restrictive lung function the prevalence of chronic rhinitis, cardiovascular disease, hyperlipemia and diabetes was higher compared to in Nlf (41.0% vs 32.3%, p = 0.017, 59.0% vs 41.0%, p<0.001, 29.2% vs.12.9%, p = 0.033, 20.9% vs 8.6%, p <0.001). In COPD and heart disease, 62.5% had chronic rhinitis and/or GERD, while in Nlf the corresponding proportion was 42.5%. Co-morbid conditions such as cardiovascular disease, chronic rhinitis and gastroesophageal reflux were common in COPD. The overlap between heart disease, chronic rhinitis and GERD was large in COPD. Restrictive lung function did also identify a population with increased disease burden.COPD Journal of Chronic Obstructive Pulmonary Disease 12/2011; 8(6):421-8. · 2.31 Impact Factor
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ABSTRACT: In recent years, some epidemiological surveys of risk factors for chronic obstructive pulmonary disease (COPD) have been done in some regions of China, but the relevance is shown different in these surveys. A meta-analysis was undertaken to assess the relationship between smoking and COPD in Chinese population. 24 papers were included in our study. Total number of ever smokers and never smokers were 34 191 and 58 854, the number of COPD cases in each group were 5 843 and 4 874 respectively. We used meta-analysis method to analyze the selected papers quantitatively, and stratified by type of study, gender and smoking index. Risk of COPD for ever smokers is higher than never smokers (OR 2.90, 95%CI 2.22∼3.80); after stratifying by gender and smoking index, risks of COPD for male and female ever smokers are higher than male and female never smokers (OR 1.93, 95%CI 1.35∼2.77; OR 2.67, 95%CI 2.01∼3.56, respectively); risks of COPD for ever smokers who belong to different smoking index group(1∼200, 200∼400, >400, <300, ≥300 cigarettes per day*year) are all higher than never smokers (OR 2.49, 95%CI 1.66∼3.74; OR 2.91, 95%CI 2.19∼3.87; OR 4.07, 95%CI 3.17∼5.23; OR 2.39, 95%CI 1.42∼4.02; OR 3.31, 95%CI 2.99∼3.66, respectively). The risk of COPD is higher for ever smokers than never smokers in Chinese population. The risk of COPD is higher for female smokers than male smokers. The risk of COPD is higher with greater smoking index.The Clinical Respiratory Journal 02/2014; · 1.66 Impact Factor