40 results on '"de‐Torres, Juan P."'
Search Results
2. Dyspnea in COPD: New Mechanistic Insights and Management Implications
- Author
-
O’Donnell, Denis E., Milne, Kathryn M., James, Matthew D., de Torres, Juan Pablo, and Neder, J. Alberto
- Published
- 2020
- Full Text
- View/download PDF
3. Plasma metabolomics and clinical predictors of survival differences in COPD patients
- Author
-
Pinto-Plata, Victor, Casanova, Ciro, Divo, Miguel, Tesfaigzi, Yohannes, Calhoun, Vince, Sui, Jing, Polverino, Francesca, Priolo, Carmen, Petersen, Hans, de Torres, Juan Pablo, Marin, Jose Maria, Owen, Caroline A., Baz, Rebeca, Cordova, Elizabeth, and Celli, Bartolome
- Published
- 2019
- Full Text
- View/download PDF
4. Dynamic Ventilatory Reserve During Incremental Exercise: Reference Values and Clinical Validation in Chronic Obstructive Pulmonary Disease.
- Author
-
Berton, Danilo C., Plachi, Franciele, James, Matthew D., Vincent, Sandra G., Smyth, Reginald M., Domnik, Nicolle J., Phillips, Devin B., de-Torres, Juan P., Nery, Luiz E., O'Donnell, Denis E., and Neder, J. Alberto
- Subjects
EXERCISE tolerance ,VENTILATION ,CHRONIC obstructive pulmonary disease ,REFERENCE values ,OBSTRUCTIVE lung diseases ,EXERCISE tests - Abstract
Rationale: Ventilatory demand-capacity imbalance, as inferred based on a low ventilatory reserve, is currently assessed only at peak cardiopulmonary exercise testing (CPET). Peak ventilatory reserve, however, is poorly sensitive to the submaximal, dynamic mechanical ventilatory abnormalities that are key to dyspnea genesis and exercise intolerance. Objectives: After establishing sex- and age-corrected norms for dynamic ventilatory reserve at progressively higher work rates, we compared peak and dynamic ventilatory reserve for their ability to expose increased exertional dyspnea and poor exercise tolerance in mild to very severe chronic obstructive pulmonary disease (COPD). Methods: We analyzed resting functional and incremental CPET data from 275 controls (130 men, aged 19-85 yr) and 359 Global Initiative for Chronic Obstructive Lung Disease patients with stage 1-4 obstruction (203 men) who were prospectively recruited for previous ethically approved studies in three research centers. In addition to peak and dynamic ventilatory reserve (12[ventilation / estimated maximal voluntary ventilation]3100), operating lung volumes and dyspnea scores (0-10 on the Borg scale) were obtained. Results: Dynamic ventilatory reserve was asymmetrically distributed in controls; thus, we calculated its centile distribution at every 20 W. The lower limit of normal (lower than the fifth centile) was consistently lower in women and older subjects. Peak and dynamic ventilatory reserve disagreed significantly in indicating an abnormally low test result in patients: whereas approximately 50% of those with a normal peak ventilatory reserve showed a reduced dynamic ventilatory reserve, the opposite was found in approximately 15% (P,0.001). Irrespective of peak ventilatory reserve and COPD severity, patients who had a dynamic ventilatory reserve below the lower limit of normal at an isowork rate of 40W had greater ventilatory requirements, prompting earlier attainment of critically low inspiratory reserve. Consequently, they reported higher dyspnea scores, showing poorer exercise tolerance compared with those with preserved dynamic ventilatory reserve. Conversely, patients with preserved dynamic ventilatory reserve but reduced peak ventilatory reserve reported the lowest dyspnea scores, showing the best exercise tolerance. Conclusions: Reduced submaximal dynamic ventilatory reserve, even in the setting of preserved peak ventilatory reserve, is a powerful predictor of exertional dyspnea and exercise intolerance in COPD. This new parameter of ventilatory demand-capacity mismatch may enhance the yield of clinical CPET in the investigation of activity-related breathlessness in individual patients with COPD and other prevalent cardiopulmonary diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
5. Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease
- Author
-
Guerra, Beniamino, Haile, Sarah R., Lamprecht, Bernd, Ramírez, Ana S., Martinez-Camblor, Pablo, Kaiser, Bernhard, Alfageme, Inmaculada, Almagro, Pere, Casanova, Ciro, Esteban-González, Cristóbal, Soler-Cataluña, Juan J., de-Torres, Juan P., Miravitlles, Marc, Celli, Bartolome R., Marin, Jose M., ter Riet, Gerben, Sobradillo, Patricia, Lange, Peter, Garcia-Aymerich, Judith, Antó, Josep M., Turner, Alice M., Han, Meilan K., Langhammer, Arnulf, Leivseth, Linda, Bakke, Per, Johannessen, Ane, Oga, Toru, Cosio, Borja, Ancochea-Bermúdez, Julio, Echazarreta, Andres, Roche, Nicolas, Burgel, Pierre-Régis, Sin, Don D., Soriano, Joan B., Puhan, Milo A., and for the 3CIA collaboration
- Published
- 2018
- Full Text
- View/download PDF
6. Continuous Monitoring of Pulse Oximetry During the 6-MinuteWalk Test Improves Clinical Outcomes Prediction in COPD.
- Author
-
Batista, Kellen S., Cé;zar, Igor Dossin, Benedetto, Igor G., da Silva, Ravena M. C., Wagner, Litiele Evelin, Pereira da Silva, Danton, Sanches, Paulo R., Gazzana, Marcelo B., Knorst, Marli M., de-Torres, Juan P., Neder, J. Alberto, and Berton, Danilo C.
- Subjects
OBSTRUCTIVE lung disease diagnosis ,EXERCISE tests ,CAUSES of death ,KRUSKAL-Wallis Test ,PREDICTIVE tests ,CONFIDENCE intervals ,MULTIPLE regression analysis ,ONE-way analysis of variance ,PULSE oximetry ,EXERCISE physiology ,RETROSPECTIVE studies ,PATIENT monitoring ,SEVERITY of illness index ,HOSPITAL care ,OBSTRUCTIVE lung diseases ,PULMONARY function tests ,CHI-squared test ,KAPLAN-Meier estimator ,DESCRIPTIVE statistics ,RESEARCH funding ,DATA analysis software ,LOGISTIC regression analysis ,ODDS ratio ,LONGITUDINAL method ,COMORBIDITY - Abstract
BACKGROUND: Continuous monitoring of ... throughout the 6-min walk test (6MWT) unveiled that some patients with respiratory diseases may present values across the test lower than ... measured at the end of the test. Nevertheless, it remains unclear whether this approach improves the yield of walk-induced desaturation detection in predicting mortality and hospitalizations in patients with COPD. METHODS: Four hundred twenty-one subjects (51% males) with mild2very severe COPD underwent a 6MWT with continuous measurement of .... Exercise desaturation was defined as a fall in ... ≥ 4%. All-cause mortality was assessed up to 6 y of follow-up and the rate of hospitalizations in the year succeeding the 6MWT. RESULTS: One hundred forty-nine subjects (35.4%) died during a mean (interquartile) follow-up of 55.5 (30.2-64.1) months. Desaturation was observed in 299/421 (71.0%). ... along the test was < end ... (88 [82-92]% vs 90 [84293]%, P < .001). Desaturation detected only during (but not at the end of) the test was found in 81/421 (19.2%) participants. Multivariate Cox regression model adjusted for sex, body composition, FEV
1 , residual volume/total lung capacity ratio, walk distance, O2 supplementation during the test, and comorbidities retained the presence of desaturation either at the end (1.85 [95% CI 1.0-23.36]) or only along the test (2.08 [95% CI 1.09-4.01]) as significant predictors of mortality. The rate of hospitalizations was higher in those presenting with any kind of desaturation compared to those without exercise desaturation. Logistic regression analysis revealed that walking interruption and diffusing capacity of the lung for carbon monoxide predicted desaturation observed only during the test. CONCLUSIONS: O2 desaturation missed by end-exercise ... but exposed by measurements during the test was independently associated with all-cause mortality and hospitalizations in subjects with COPD. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF
7. Exertional dyspnoea in patients with mild‐to‐severe chronic obstructive pulmonary disease: neuromechanical mechanisms.
- Author
-
James, Matthew D., Phillips, Devin B., Vincent, Sandra G., Abdallah, Sara J., Donovan, Adamo A., de‐Torres, Juan P., Neder, J. Alberto, Smith, Benjamin M., Jensen, Dennis, and O'Donnell, Denis E.
- Subjects
CHRONIC obstructive pulmonary disease ,PULMONARY gas exchange ,DYSPNEA ,EXERCISE tests ,ORTHOSTATIC intolerance - Abstract
In patients with chronic obstructive pulmonary disease (COPD), exertional dyspnoea generally arises when there is imbalance between ventilatory demand and capacity, but the neurophysiological mechanisms are unclear. We therefore determined if disparity between elevated inspiratory neural drive (IND) and tidal volume (VT) responses (neuromechanical dissociation) impacted dyspnoea intensity and quality during exercise, across the COPD severity spectrum. In this two‐centre, cross‐sectional observational study, 89 participants with COPD divided into tertiles of FEV1 %predicted (Tertile 1 = FEV1 = 87 ± 9%, Tertile 2 = 60 ± 9%, Tertile 3 = 32 ± 8%) and 18 non‐smoking controls, completed a symptom‐limited cardiopulmonary exercise test (CPET) with measurement of IND by diaphragm electromyography (EMGdi (%max)). The association between increasing dyspnoea intensity and EMGdi (%max) during CPET was strong (r = 0.730, P < 0.001) and not different between the four groups who showed marked heterogeneity in pulmonary gas exchange and mechanical abnormalities. Significant inspiratory constraints (tidal volume/inspiratory capacity (VT/IC) ≥ 70%) and onset of neuromechanical dissociation (EMGdi (%max):VT/IC > 0.75) occurred at progressively lower minute ventilation (V̇E${\dot{V}}_{{\rm{E}}}$) from Control to Tertile 3. Lower resting IC meant earlier onset of neuromechanical dissociation, heightened dyspnoea intensity and greater propensity (93% in Tertile 3) to select qualitative descriptors of 'unsatisfied inspiration'. We concluded that, regardless of marked variation in mechanical and pulmonary gas exchange abnormalities in our study sample, exertional dyspnoea intensity was linked to the magnitude of EMGdi (%max). Moreover, onset of critical inspiratory constraints and attendant neuromechanical dissociation amplified dyspnoea intensity at higher exercise intensities. Simple measurements of IC and breathing pattern during CPET provide useful insights into mechanisms of dyspnoea and exercise intolerance in individuals with COPD. Key points: Dyspnoea during exercise is a common and troublesome symptom reported by patients with chronic obstructive pulmonary disease (COPD) and is linked to an elevated inspiratory neural drive (IND). The precise mechanisms of elevated IND and dyspnoea across the continuum of airflow obstruction severity in COPD remains unclear.The present study sought to determine the mechanisms of elevated IND (by diaphragm EMG, EMGdi (%max)) and dyspnoea during cardiopulmonary exercise testing (CPET) across the continuum of COPD severity.There was a strong association between increasing dyspnoea intensity and EMGdi (%max) during CPET across the COPD continuum despite significant heterogeneity in underlying pulmonary gas exchange and respiratory mechanical impairments.Critical inspiratory constraints occurred at progressively lower ventilation during exercise with worsening severity of COPD. This was associated with the progressively lower resting inspiratory capacity with worsening disease severity.Earlier critical inspiratory constraint was associated with earlier neuromechanical dissociation and greater likelihood of reporting the sensation of 'unsatisfied inspiration'. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
8. Physiological predictors of morbidity and mortality in COPD: the relative importance of reduced inspiratory capacity and inspiratory muscle strength.
- Author
-
Phillips, Devin B., James, Matthew D., O'Donnell, Conor D., Vincent, Sandra G., Webb, Katherine A., de-Torres, Juan P., Neder, J. Alberto, and O'Donnell, Denis E.
- Subjects
RESPIRATORY muscles ,MUSCLE strength ,CHRONIC obstructive pulmonary disease ,EXERCISE tests ,PULMONARY function tests ,RESPIRATORY obstructions - Abstract
Low resting inspiratory capacity (IC) and low maximal inspiratory pressure (MIP) have previously been linked to exertional dyspnea, exercise limitation, and poor survival in chronic obstructive pulmonary disease (COPD). The interaction and relative contributions of these two related variables to important clinical outcomes are unknown. The objective of the current study was to examine the interaction between resting IC and MIP (both % predicted), exertional dyspnea, exercise capacity, and long-term survival in patients with COPD. Two hundred and eighty-five patients with mild to advanced COPD completed standard lung function testing and a cycle cardiopulmonary exercise test. Multiple regression determined predictors of the exertional dyspnea-ventilation slope and peak oxygen uptake (...O
2peak ). Cox regression determined predictors of 10-year mortality. IC was associated with the dyspnea-ventilation slope (standardized β = -0.42, P < 0.001), whereas MIP was excluded from the regression model (P = 0.918). IC and MIP were included in the final model to predict VO2peak. However, the standardized β was greater for IC (0.43) than MIP (0.22). After adjusting for age, sex, body mass index, cardiovascular risk, airflow obstruction, and diffusing capacity, resting IC was independently associated with 10-year all-cause mortality (hazard ratio = 1.25, confidence interval5%_95% = 1.16-1.34, P < 0.001), whereas MIP was excluded from the final model (all P = 0.829). Low resting IC was consistently linked to heightened dyspnea intensity, low ...O2peak , and worse survival in COPD even after accounting for airway obstruction, inspiratory muscle strength, and diffusing capacity. These results support the use of resting IC as an important physiological biomarker closely linked to key clinical outcomes in COPD. NEW & NOTEWORTHY To our knowledge, this study is the first to show an independent association between low resting inspiratory capacity (IC) and, severe exertional dyspnea, exercise limitation, and increased mortality risk, after accounting for the severity of airway obstruction, inspiratory muscle strength, and diffusing capacity. These results support the use of resting IC as an important independent physiological biomarker closely linked to key clinical outcomes in COPD. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
9. Chest CT‐assessed comorbidities and all‐cause mortality risk in COPD patients in the BODE cohort.
- Author
-
Ezponda, Ana, Casanova, Ciro, Divo, Miguel, Marín‐Oto, Marta, Cabrera, Carlos, Marín, Jose M., Bastarrika, Gorka, Pinto‐Plata, Víctor, Martin‐Palmero, Ángela, Polverino, Francesca, Celli, Bartolome R., and de Torres, Juan P.
- Subjects
MORTALITY ,CORONARY artery calcification ,CHRONIC bronchitis ,BRONCHIECTASIS ,CHRONIC obstructive pulmonary disease ,COMORBIDITY ,PSOAS muscles - Abstract
Background and objective: The availability of chest computed tomography (CT) imaging can help diagnose comorbidities associated with chronic obstructive pulmonary disease (COPD). Their systematic identification and relationship with all‐cause mortality have not been explored. Furthermore, whether their CT‐detected prevalence differs from clinical diagnosis is unknown. Methods: The prevalence of 10 CT‐assessed comorbidities was retrospectively determined at baseline in 379 patients (71% men) with mild to severe COPD attending pulmonary clinics. Anthropometrics, smoking history, dyspnoea, lung function, exercise capacity, BODE (BMI, Obstruction, Dyspnoea and Exercise capacity) index and exacerbations rate were recorded. The prevalence of CT‐determined comorbidities was compared with that recorded clinically. Over a median of 78 months of observation, the independent association with all‐cause mortality was analysed. A 'CT‐comorbidome' graphically expressed the strength of their association with mortality risk. Results: Coronary artery calcification, emphysema and bronchiectasis were the most prevalent comorbidities (79.8%, 62.7% and 33.9%, respectively). All were underdiagnosed before CT. Coronary artery calcium (hazard ratio [HR] 2.09; 95% CI 1.03–4.26, p = 0.042), bronchiectasis (HR 2.12; 95% CI 1.05–4.26, p = 0.036) and low psoas muscle density (HR 2.61; 95% CI 1.23–5.57, p = 0.010) were independently associated with all‐cause mortality and helped define the 'CT‐comorbidome'. Conclusion: This study of COPD patients shows that systematic detection of 10 CT‐diagnosed comorbidities, most of which were not detected clinically, provides information of potential use to patients and clinicians caring for them. This multicentric study shows that chest computed tomography (CT) to evaluate the presence of 10 comorbidities detects important pathologies not diagnosed in the clinical management of those patients. While emphysema, coronary artery calcification (CAC) and bronchiectasis were the most prevalent CT‐detected comorbidities, CAC, bronchiectasis and low Psoas muscle density were independently associated with all‐cause mortality. See relatedEditorial [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
10. Mechanisms of Exertional Dyspnea in Patients with Mild COPD and a Low Resting DLCO.
- Author
-
James, Matthew D., Phillips, Devin B., Elbehairy, Amany F., Milne, Kathryn M., Vincent, Sandra G., Domnik, Nicolle J., de Torres, Juan P., Neder, J. Alberto, and O'Donnell, Denis E.
- Subjects
OBSTRUCTIVE lung diseases ,DYSPNEA ,RESPIRATORY mechanics ,LUNG volume ,LUNG volume measurements - Abstract
Patients with mild chronic obstructive pulmonary disease (COPD) and lower resting diffusing capacity for carbon monoxide (DL
CO ) often report troublesome dyspnea during exercise although the mechanisms are not clear. We postulated that in such individuals, exertional dyspnea is linked to relatively high inspiratory neural drive (IND) due, in part, to the effects of reduced ventilatory efficiency. This cross-sectional study included 28 patients with GOLD I COPD stratified into two groups with (n = 15) and without (n = 13) DLCO less than the lower limit of normal (2 (V̇ E /V̇CO2 ), and respiratory mechanics during incremental cycle exercise in the three groups. Spirometry and resting lung volumes were similar between COPD groups. During exercise, dyspnea, IND and V̇E /V̇CO2 were higher at equivalent work rates (WR) in the DLCO CO CO CO E/V̇CO 2 at a given work rate. Higher ventilatory requirements in the DLCO - Published
- 2021
- Full Text
- View/download PDF
11. Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD.
- Author
-
de-Torres, Juan P., O'Donnell, Denis E., Marín, Jose M., Cabrera, Carlos, Casanova, Ciro, Marín, Marta, Ezponda, Ana, Cosio, Borja G., Martinez, Cristina, Solanes, Ingrid, Fuster, Antonia, Neder, J. Alberto, Gonzalez-Gutierrez, Jessica, Celli, Bartolome R., O'Donnel, Denis E, Neder, Alberto, and Gutierrez, Jessica Gonzalez
- Subjects
- *
OBSTRUCTIVE lung diseases , *CARBON monoxide , *MORTALITY , *REFERENCE values , *MULTIPLE regression analysis - Abstract
Background: The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored.Research Question: Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients?Study Design and Methods: GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality.Results: A Dlco cutoff value of <60% predicted was associated with all-cause mortality (Dlco ≥ 60%: 9% vs Dlco < 60%: 23%, P = .01). At a same FEV1% predicted and Charlson score, patients with Dlco < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a Dlco < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
12. Psoas Muscle Density Evaluated by Chest CT and Long-Term Mortality in COPD Patients.
- Author
-
Ezponda, Ana, Casanova, Ciro, Cabrera, Carlos, Martin-Palmero, Ángela, Marin-Oto, Marta, Marín, Jose M., Pinto-Plata, Víctor, Divo, Miguel, Celli, Bartolome R., Zulueta, Javier J., Bastarrika, Gorka, and de-Torres, Juan P.
- Abstract
Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
- Full Text
- View/download PDF
13. Natural Course of the Diffusing Capacity of the Lungs for Carbon Monoxide in COPD: Importance of Sex.
- Author
-
Casanova, Ciro, Gonzalez-Dávila, Enrique, Martínez-Gonzalez, Cristina, Cosio, Borja G., Fuster, Antonia, Feu, Nuria, Solanes, Ingrid, Cabrera, Carlos, Marin, José M., Balcells, Eva, Peces-Barba, Germán, de Torres, Juan P., Marín-Oto, Marta, Calle, Myriam, Golpe, Rafael, Ojeda, Elena, Divo, Miguel, Pinto-Plata, Victor, Amado, Carlos, and López-Campos, José Luis
- Subjects
CARBON monoxide ,LUNG volume measurements ,OBSTRUCTIVE lung diseases ,RESEARCH ,RESEARCH methodology ,MEDICAL cooperation ,EVALUATION research ,SEX distribution ,COMPARATIVE studies ,PULMONARY function tests ,PULMONARY gas exchange ,PHENOTYPES - Abstract
Background: The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression.Research Question: What is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression?Study Design and Methods: We phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time.Results: The mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV1 % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039).Interpretation: Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function.Trial Registry: ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
14. Prognostic assessment in COPD without lung function: the B-AE-D indices
- Author
-
Boeck, Lucas, Soriano, Joan B., Brusse-Keizer, Marjolein, Blasi, Francesco, Kostikas, Konstantinos, Boersma, Wim, Milenkovic, Branislava, Louis, Renaud, Lacoma, Alicia, Djamin, Remco, Aerts, Joachim, Torres, Antoni, Rohde, Gernot, Welte, Tobias, Martinez-Camblor, Pablo, Rakic, Janko, Scherr, Andreas, Koller, Michael, van der Palen, Job, Marin, Jose M., Alfageme, Inmaculada, Almagro, Pere, Casanova, Ciro, Esteban, Cristobal, Soler-Cataluña, Juan J., de-Torres, Juan P., Miravitlles, Marc, Celli, Bartolome R., Tamm, Michael, Stolz, Daiana, Universitat Autònoma de Barcelona, Pulmonologie, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, MUMC+: MA Med Staf Spec Longziekten (9), and Faculty of Behavioural, Management and Social Sciences
- Subjects
Male ,Exacerbation ,Severity of Illness Index ,Body Mass Index ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Forced Expiratory Volume ,030212 general & internal medicine ,Longitudinal Studies ,Lung ,2. Zero hunger ,COPD ,medicine.diagnostic_test ,Glycopeptides ,Middle Aged ,Prognosis ,3. Good health ,Respiratory Function Tests ,Treatment Outcome ,Cardiology ,Female ,METIS-318027 ,Risk assessment ,Pulmonary and Respiratory Medicine ,Spirometry ,medicine.medical_specialty ,Risk Assessment ,External validity ,03 medical and health sciences ,Copeptin ,Internal medicine ,Severity of illness ,medicine ,Humans ,Mortality ,Exercise ,Aged ,Inflammation ,business.industry ,Reproducibility of Results ,medicine.disease ,respiratory tract diseases ,Oxygen ,Dyspnea ,030228 respiratory system ,Physical therapy ,IR-101435 ,business ,Body mass index - Abstract
Altres ajuts: A. Schötzau performed data management of PROMISE for which he received financial compensation.Thermo Scientific Biomarkers (Hennigsdorf, Germany) provided all the reagents for copeptin measurements. Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function. The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988). Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05). The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk. The B-AE-D indices allow a simple and accurate assessment of COPD-related risk in the absence of lung function
- Published
- 2016
15. Recent Advances in the Physiological Assessment of Dyspneic Patients with Mild COPD.
- Author
-
Neder, J. Alberto, de Torres, Juan P., and O'Donnell, Denis E.
- Subjects
- *
PULMONARY gas exchange , *OBSTRUCTIVE lung diseases , *PHYSICIANS , *VITAL capacity (Respiration) , *LUNG volume measurements - Abstract
There is growing recognition that a sizable fraction of COPD patients with forced expiratory volume in one second (FEV1)/forced vital capacity ratio below the lower limit of normal but preserved FEV 1 reports out-of-proportion dyspnea relative to the severity of airflow limitation. Most physicians, however, assume that patients' breathlessness is unlikely to reflect the negative physiological consequences of COPD vis-à-vis FEV1 normalcy. This concise review integrates the findings of recent studies which uncovered the key pathophysiological features shared by these patients: poor pulmonary gas exchange efficiency (increased "wasted" ventilation) and gas trapping. These abnormalities are associated with two well-known causes of exertional dyspnea: heightened ventilation relative to metabolic demand and critically low inspiratory reserves, respectively. From a clinical standpoint, a low diffusion capacity associated with increased residual volume (RV) and/or RV/total lung capacity ratio might uncover these disturbances, identifying the subset of patients in whom exertional dyspnea is causally related to "mild" COPD. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
16. COPD heterogeneity: Gender differences in the multidimensional BODE index
- Author
-
de Torres, Juan P, Casanova, Ciro, de Garcini, Angela Montejo, Jaime, Armando Aguirre, and Celli, Bartolomé R
- Subjects
Male ,Age Factors ,Gender ,Walking ,Middle Aged ,Severity of Illness Index ,humanities ,Body Mass Index ,Pulmonary Disease, Chronic Obstructive ,Cross-Sectional Studies ,Sex Factors ,BODE index ,Forced Expiratory Volume ,COPD ,Humans ,Female ,Original Research ,Aged - Abstract
Background: The BODE index was recently validated as a multidimensional tool for the evaluation of patients with COPD. The influence of gender on the BODE index has not been studied. Hypothesis: The contribution of each component of the disease to the BODE index may differ according to gender. Methods: We evaluated age, forced expiratory volume in one second (FEV1), Modified Medical Research Council (MMRC) score, 6-min walk distance (6MWD), and body mass index (BMI) in 52 men and 52 women with COPD and the same BODE index. We compared the studied parameters between men and women and then performed a multiple regression analysis by gender. Results: We found statistically significant differences between men and women in all parameters: FEV1 % (55 ± 17 vs 63 ± 18, p < 0.001), MMRC [1 (0–2) vs 1 (1–2) p = 0.03], BMI [28 (26–30) vs 25 (22–30), p = 0.05], and 6MWD [546 (451–592) vs 462 (419–520), p = 0.001]. Multiple regression analysis revealed that each component of the BODE index had different weight (β standardized coefficient) in men and women respectively: FEV1% (0.74 vs 0.62), MMRC (0.31 vs 0.48), BMI (−0.09 vs −0.17), and 6MWD (0.13 vs 0.10). Conclusions: The contribution of each component to the BODE index differs by gender in subjects with similar BODE scores. Long term longitudinal studies will help determine the significance of our findings.
- Published
- 2007
17. Prognostic Validation Using GesEPOC 2017 Severity Criteria.
- Author
-
Cabrera López, Carlos, Casanova Macario, Ciro, Marín Trigo, José María, de-Torres, Juan P., Sicilia Torres, Rebeca, González, Jesús María, Polverino, Francesca, Divo, Miguel, Pinto Plata, Víctor, Zulueta, Javier, Callejas, Francisco Javier, and Celli, Bartolomé
- Abstract
Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2019
- Full Text
- View/download PDF
18. External Validation and Recalculation of the CODEX Index in COPD Patients. A 3CIAplus Cohort Study.
- Author
-
Almagro, Pere, Martínez-Camblor, Pablo, Miravitlles, Marc, Rodríguez-Carballeira, Mónica, Navarro, Annie, Lamprecht, Bernd, Ramirez-Garcia Luna, Ana S, Kaiser, Bernhard, Alfageme, Inmaculada, Casanova, Ciro, Esteban, Cristobal, Soler-Cataluña, Juan J, de-Torres, Juan P, Celli, Bartolome R, Marin, Jose M, ter Riet, Gerben, Sobradillo, Patricia, Lange, Peter, Garcia-Aymerich, Judith, and Anto, Josep M
- Subjects
MANUSCRIPTS ,PROPORTIONAL hazards models ,COHORT analysis ,RECEIVER operating characteristic curves - Abstract
The CODEX index was developed and validated in patients hospitalized for COPD exacerbation to predict the risk of death and readmission within one year after discharge. Our study aimed to validate the CODEX index in a large external population of COPD patients with variable durations of follow-up. Additionally, we aimed to recalculate the thresholds of the CODEX index using the cutoffs of variables previously suggested in the 3CIA study (mCODEX). Individual data on 2,755 patients included in the COPD Cohorts Collaborative International Assessment Plus (3CIA+) were explored. A further two cohorts (ESMI AND EGARPOC-2) were added. To validate the CODEX index, the relationship between mortality and the CODEX index was assessed using cumulative/dynamic ROC curves at different follow-up periods, ranging from 3 months up to 10 years. Calibration was performed using univariate and multivariate Cox proportional hazard models and Hosmer-Lemeshow test. A total of 3,321 (87.8% males) patients were included with a mean ± SD age of 66.9 ± 10.5 years, and a median follow-up of 1,064 days (IQR 25–75% 426–1643), totaling 11,190 person-years. The CODEX index was statistically associated with mortality in the short- (≤3 months), medium- (≤1 year) and long-term (10 years), with an area under the curve of 0.72, 0.70 and 0.76, respectively. The mCODEX index performed better in the medium-term (<1 year) than the original CODEX, and similarly in the long-term. In conclusion, CODEX and mCODEX index are good predictors of mortality in patients with COPD, regardless of disease severity or duration of follow-up. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
19. Exercise Tolerance according to the Definition of Airflow Obstruction in Smokers.
- Author
-
Alberto Neder, J., Milne, Kathryn M., Berton, Danilo C., de-Torres, Juan P., Jensen, Dennis, Tan, Wan C., Bourbeau, Jean, O’Donnell, Denis E., Neder, J Alberto, O'Donnell, Denis E, Canadian Respiratory Research Network (CRRN) and the Canadian Cohort of Obstructive Lung Disease (CanCOLD) Collaborative Research Group, and CRRN (Canadian Respiratory Research Network) and the CanCOLD (Canadian Cohort of Obstructive Lung Disease) Collaborative Research Group
- Subjects
OBSTRUCTIVE lung diseases ,PATIENTS ,DIAGNOSIS ,RATIO analysis ,PERSONS - Abstract
The article describes how forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio discordance relates to functional outcomes relevant to subjects' daily functioning. Topics include the fixed FEV1/FVC ratio cutoff can result in over diagnosis of Chronic obstructive pulmonary disease (COPD) in older individuals; and a discordant FEV1/FVC ratio should be individually interpreted in light of clinical data.
- Published
- 2020
- Full Text
- View/download PDF
20. Changes and Clinical Consequences of Smoking Cessation in Patients With COPD: A Prospective Analysis From the CHAIN Cohort.
- Author
-
Martínez-González, Cristina, Casanova, Ciro, De-Torres, Juan P., Marín, José M., De Lucas, Pilar, Fuster, Antonia, Cosío, Borja G., Calle, Myriam, Peces-Barba, Germán, Solanes, Ingrid, Agüero, Ramón, Feu-Collado, Nuria, Alfageme, Inmaculada, Romero Plaza, Amparo, Balcells, Eva, De Diego, Alfredo, Marín Royo, Margarita, Moreno, Amalia, Llunell Casanovas, Antonia, and Galdiz, Juan B.
- Subjects
SMOKING cessation ,OBSTRUCTIVE lung diseases ,COHORT analysis ,DECISION trees ,ANXIETY - Abstract
Background: Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real life are still low among patients with COPD. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of patients with COPD.Methods: CHAIN (COPD History Assessment in Spain) is a Spanish multicenter study carried out at pulmonary clinics including active and former smokers with COPD. Smoking status was certified by clinical history and co-oximetry. Clinical presentation and disease impact were recorded via validated questionnaires, including the London Chest Activity of Daily Living (LCADL) and the Hospital Anxiety and Depression Scale (HADS). No specific smoking cessation intervention was carried out. Factors associated with and clinical consequences of smoking cessation were analyzed by multivariate regression and decision tree analyses.Results: One thousand and eighty-one patients with COPD were included (male, 80.8%; age, 65.2 [SD 8.9] years; FEV1, 60.2 [20.5]%). During the 2-year follow-up time (visit 2, 906 patients; visit 3, 791 patients), the majority of patients maintained the same smoking habit. Decision tree analysis detected chronic expectoration as the most relevant variable to identify persistent quitters in the future, followed by an LCADL questionnaire (cutoff 9 points). Total anxiety HADS score was the most relevant clinical impact associated with giving up tobacco, followed by the LCADL questionnaire with a cutoff value of 10 points.Conclusions: In this real-life prospective COPD cohort with no specific antismoking intervention, the majority of patients did not change their smoking status. Our study also identifies baseline expectoration, anxiety, and dyspnea with daily activities as the major determinants of smoking status in COPD.Trial Registry: ClinicalTrials.gov; No. NCT01122758; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]- Published
- 2018
- Full Text
- View/download PDF
21. Severe exacerbations and mortality in COPD: Importance of both body and mind.
- Author
-
de‐Torres, Juan P. and Divo, Miguel
- Subjects
- *
MIND & body , *CHRONIC obstructive pulmonary disease , *DISEASE exacerbation , *MORTALITY - Abstract
See relatedarticle [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
22. Prospective comparison of non-invasive risk markers of major cardiovascular events in COPD patients.
- Author
-
Zagaceta, Jorge, Bastarrika, Gorka, Zulueta, Javier J., Colina, Inmaculada, Alcaide, Ana B., Campo, Arantza, Divo, Miguel, Casanova, Ciro, Marin, José M., Pinto-Plata, Victor M., Celli, Bartolome R., and de-Torres, Juan P.
- Subjects
OBSTRUCTIVE lung diseases ,CARDIOVASCULAR diseases ,PATIENTS ,CORONARY arteries ,HYPERTENSION ,PROGNOSIS ,DISEASE risk factors ,CARDIOVASCULAR disease diagnosis ,OBSTRUCTIVE lung disease diagnosis ,COMPARATIVE studies ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,SMOKING ,SPIROMETRY ,EVALUATION research ,CALCINOSIS ,DIAGNOSIS - Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients.Methods: CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome.Results: During a median follow up of 65 months (ICR: 36-100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19-1.46, p < 001).Conclusions: In COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
23. Telomere shortening and accelerated aging in COPD: findings from the BODE cohort.
- Author
-
Elizabeth, Córdoba-Lanús, Sara, Cazorla-Rivero, Adriana, Espinoza-Jiménez, de-Torres, Juan P., María-José, Pajares, Armando, Aguirre-Jaime, Bartolomé, Celli, Ciro, Casanova, Córdoba-Lanús, Elizabeth, Cazorla-Rivero, Sara, Espinoza-Jiménez, Adriana, Pajares, María J, Aguirre-Jaime, Armando, Celli, Bartolomé, and Casanova, Ciro
- Subjects
OBSTRUCTIVE lung disease diagnosis ,OBSTRUCTIVE lung diseases patients ,TELOMERES ,CIGARETTE smokers ,AGING - Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) may be associated with accelerated aging. Telomere shortening is a biomarker of aging. Cross-sectional studies describe shorter telomeres in COPD compared with matched controls. No studies have described telomere length trajectory and its relationship with COPD progression. We investigated telomere shortening over time and its relationship to clinical and lung function parameters in a COPD cohort and smoker controls without COPD.Methods: At baseline leukocyte telomere length was measured by qPCR in 121 smokers with COPD and 121 without COPD matched by age (T/S0). The measurements were repeated in 70 of those patients with COPD and 73 non-COPD smokers after 3 years of follow up (T/S3).Results: At initial measurement, telomeres were shorter in COPD patients when compared to smoker controls (T/S = 0.68 ± 0.25 vs. 0.88 ± 0.52, p = 0.003) independent from age and sex. During the follow-up period, we observed an accelerated telomere shortening in individuals with COPD in contrast to smoker controls (T/S0 = 0.66 ± 0.21 vs. T/S3 = 0.46 ± 0.16, p < 0.001, for the patients with COPD and T/S0 = 0.83 ± 0.56 vs. T/S3 = 0.74 ± 0.52, p = 0.023 for controls; GLIM, p = 0.001). This shortening was inversely related to the baseline telomere length (r = -0.49, p < 0.001). No significant relationship was found between the rate of change in telomere length and change in lung function in the patients with COPD (p > 0.05).Conclusions: Compared with smokers, patients with COPD have accelerated telomere shortening and this rate of attrition depends on baseline telomere length. Furthermore, the telomere length and its rate of shortening did not relate to clinical and lung function parameters changes over 3 years of follow-up. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
24. Increased expression of A Proliferation-inducing Ligand (APRIL) in lung leukocytes and alveolar epithelial cells in COPD patients with non small cell lung cancer: a possible link between COPD and lung cancer?
- Author
-
Polverino, Francesca, Laucho-Contreras, Maria, Quintero, Joselyn Rojas, Divo, Miguel, Pinto-Plata, Victor, Sholl, Lynette, de-Torres, Juan P., Celli, Bartolome R., and Owen, Caroline A.
- Subjects
DELSARTE system ,CYTOPROTECTION ,EMBRYOLOGY ,OBSTRUCTIVE lung diseases ,LUNG cancer ,INCURABLE diseases - Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by an excessive activation of the adaptive immune system and, in particular, uncontrolled expansion of the B-cell pool. One of the key promoters of B cell expansion is A PRoliferation-Inducing Ligand (APRIL). APRIL has been strongly linked to non small cell lung cancer (NSCLC) onset and progression previously. However, little is known about the expression of APRIL in the lungs of COPD patients. Methods: Using immuno-fluorescence staining, the expression of APRIL was assessed in sections of lungs from 4 subjects with primary diagnosis of COPD (FEV
1 33 ± 20 % predicted), 4 subjects with primary diagnosis of NSCLC, 4 subjects diagnosed with both COPD and NSCLC, smokers without COPD or NSCLC and 3 healthy never-smokers. The percentage of B cells, alveolar macrophages (AMs) and polymorphonuclear neutrophils (PMNs) in the lung and alveolar epithelial cells (AECs) that stained positively for APRIL was quantified using epi-fluorescence microscopy and image analysis software. Results: The percentage of APRIL-expressing B cells, AMs, PMNs and alveolar epithelial cells (AECs) was higher in patients having both COPD and NSCLC than in patients with either COPD or NSCLC alone, SC or NSC (p < 0.03 for all comparisons). The percentage of APRIL-expressing AMs and AECs (but not in B cells) was higher in patients with NSCLC alone than in patients with COPD alone. The percentage of APRIL-expressing AECs (but not B cells or AMs) was higher in COPD patients than in SC and NSC (p < 0.05 for all comparisons). The percentage of APRIL-expressing B cells, AMs and AECs cells was similar in NSC and SC. Conclusion: The percentage of APRIL-expressing B cells, AMs and AECs is higher in the lungs of patients with both COPD and NSCLC than in patients with COPD or NSCLC alone or control subjects. These findings suggest that APRIL may contribute to the pathogenesis of both COPD and NSCLC, and possibly to the development of NSCLC in patients with established COPD. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
25. Defining the Asthma-COPD Overlap Syndrome in a COPD Cohort.
- Author
-
Cosio, Borja G., Soriano, Joan B., López-Campos, Jose Luis, Calle-Rubio, Myriam, Soler-Cataluna, Juan José, de-Torres, Juan P., Marín, Jose M., Martínez-Gonzalez, Cristina, de Lucas, Pilar, Mir, Isabel, Peces-Barba, Germán, Feu-Collado, Nuria, Solanes, Ingrid, Alfageme, Inmaculada, Casanova, Ciro, Calvo Bonachera, José, Lacárcel Bautista, Celia, Domenech, Adolfo, Guzmán, Rosirys, and Irigaray, Rosa
- Subjects
ASTHMA diagnosis ,OBSTRUCTIVE lung diseases patients ,OBSTRUCTIVE lung disease diagnosis ,ASTHMATICS ,PROGNOSIS ,FOLLOW-up studies (Medicine) ,DRUG therapy for asthma ,BRONCHODILATOR agents ,ASTHMA ,EOSINOPHILS ,LONGITUDINAL method ,OBSTRUCTIVE lung diseases ,QUESTIONNAIRES ,SYNDROMES ,VITAL capacity (Respiration) ,LEUKOCYTE count ,DISEASE complications ,THERAPEUTICS - Abstract
Background: Asthma-COPD overlap syndrome (ACOS) has been recently described by international guidelines. A stepwise approach to diagnosis using usual features of both diseases is recommended although its clinical application is difficult.Methods: To identify patients with ACOS, a cohort of well-characterized patients with COPD and up to 1 year of follow-up was analyzed. We evaluated the presence of specific characteristics associated with asthma in this COPD cohort, divided into major criteria (bronchodilator test > 400 mL and 15% and past medical history of asthma) and minor criteria (blood eosinophils > 5%, IgE > 100 IU/mL, or two separate bronchodilator tests > 200 mL and 12%). We defined ACOS by the presence of one major criterion or two minor criteria. Baseline characteristics, health status (COPD Assessment Test [CAT]), BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index, rate of exacerbations, and mortality up to 1 year of follow-up were compared between patients with and without criteria for ACOS.Results: Of 831 patients with COPD included,125 (15%) fulfilled the criteria for ACOS, and 98.4% of them sustained these criteria after 1 year. Patients with ACOS were predominantly male (81.6%), with symptomatic mild to moderate disease (67%), who were receiving inhaled corticosteroids (63.2%). There were no significant differences in baseline characteristics, and only survival was worse in patients with non-ACOS COPD after 1 year of follow-up (P < .05).Conclusions: The proposed ACOS criteria are present in 15% of a cohort of patients with COPD and these patients show better 1-year prognosis than clinically similar patients with COPD with no ACOS criteria.Trial Registry: ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
26. IL-8 Gene Variants are Associated with Lung Function Decline and Multidimensional BODE Index in COPD Patients But Not with Disease Susceptibility: A Validation Study.
- Author
-
Córdoba-Lanús, Elizabeth, Baz-Dávila, Rebeca, Espinoza-Jiménez, Adriana, Rodríguez-Pérez, María C., Varo, Nerea, de-Torres, Juan P., González-Almeida, Delia, Aguirre-Jaime, Armando, and Casanova, Ciro
- Subjects
INTERLEUKIN-8 ,OBSTRUCTIVE lung diseases ,CHEMOKINES ,SMOKING ,CYTOKINES ,SPIROMETRY ,GENETIC polymorphisms ,PULMONARY function tests - Abstract
Background and objective: COPD is a leading cause of dead worldwide and tobacco smoking is its major risk factor. IL8 is a proinflammatory chemokine mainly involved in the acute inflammatory reaction. The aim of this study was to test the association of IL-8, CXCR1 and CXCR2 gene variants and COPD susceptibility as part of a replication study and explore the effect of these variations in disease progression. Methods: 9 tagSNPs were genotyped in 728 Caucasian individuals (196 COPD patients, 80 smokers and 452 non-smoking controls). Pulmonary compromise was evaluated using spirometry and clinical parameters at baseline and annually over a 2 years period. We also determined plasma levels of TNF-α, IL-6, IL-8 and IL-16 in COPD patients. Results: There was a lack of association between gene variants or haplotypes with predisposition to COPD. No correlation was observed between the polymorphisms and cytokines levels. Interestingly, significant associations were found between carriers of the rs4073A (OR = 3.53, CI 1.34-9.35, p = 0.01), rs2227306C (OR = 5.65, CI 1.75-18.88, p = 0.004) and rs2227307T (OR = 4.52, CI = 1.49-12.82, p = 0.007) alleles in the IL-8 gene and patients who scored higher in the BODE index and showed an important decrease in their FEV
1 and FVC during the 2 years follow-up period ( p < 0.05). Conclusions: Despite no association was found between the studied genes and COPD susceptibility, three polymorphisms in the IL-8 gene appear to be involved in a worse progression of the disease, with an affectation beyond the pulmonary function and importantly, a reduction in lung function along the follow-up years. [ABSTRACT FROM AUTHOR]- Published
- 2015
- Full Text
- View/download PDF
27. Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease.
- Author
-
De-Torres, Juan P., Wilson, David O., Sanchez-Salcedo, Pablo, Weissfeld, Joel L., Berto, Juan, Campo, Arantzazu, Alcaide, Ana B., García-Granero, Marta, Celli, Bartolome R., and Zulueta, Javier J.
- Published
- 2015
- Full Text
- View/download PDF
28. Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients: A pilot study.
- Author
-
de-Torres, Juan P., Casanova, Ciro, Marín, Jose M., Zagaceta, Jorge, Alcaide, Ana B., Seijo, Luis M., Campo, Arantza, Carrizo, Santiago, Montes, Usua, Cordoba-Lanus, Elizabeth, Baz-Dávila, Rebeca, Aguirre-Jaime, Armando, Celli, Bartolome R., and Zulueta, Javier J.
- Abstract
Background: COPD is an independent risk factor for lung cancer, especially in patients with mild to moderate disease. Objective: To determine if performing lung cancer screening in GOLD 1 and 2 COPD patients, results in reduced lung cancer mortality. Methods: This study compared patients with mild to moderate COPD from 2 cohorts matched for age, gender, BMI, FEV
1 %, pack-yrs history and smoking status. The screening group (SG) had an annual low dose computed tomography (LDCT). The control group (CG) was prospectively followed with usual care. Lung cancer incidence and mortality densities were compared between groups. Results: From an initial sample of 410 (SG) and 735 (CG) patients we were able to match 333 patients from each group. At the same follow-up time lung cancer incidence density was 1.79/100 person-years in the SG and 4.14/100 person-years in the CG (p = 0.004). The most frequent histological type was adenocarcinoma in both SG and CG (65% and 46%, respectively), followed by squamous cell carcinoma (25% and 37%, respectively). Eighty percent of lung cancers in the SG (16/20) were diagnosed in stage I, and all of CG cancers (35/35) were in stage III or IV. Mortality incidence density from lung cancer (0.08 vs. 2.48/100 person-years, p < 0.001) was lower in the SG. Conclusions: This pilot study in patients with mild to moderate COPD suggests that screening with LDCT detects lung cancer in early stages, and could decrease lung cancer mortality in that high risk group. Appropriately designed studies should confirm these important findings. [ABSTRACT FROM AUTHOR]- Published
- 2013
- Full Text
- View/download PDF
29. Robust, standardized quantification of pulmonary emphysema in low dose CT exams.
- Author
-
Ceresa, Mario, Bastarrika, Gorka, de Torres, Juan P., Montuenga, Luis M., Zulueta, Javier J., Ortiz-de-Solorzano, Carlos, Muñoz-Barrutia, Arrate, and Muñoz-Barrutia, Arrate
- Abstract
Rationale and Objectives: The aim of this study was to present and evaluate a fully automated system for emphysema quantification on low-dose computed tomographic images. The platform standardizes emphysema measurements against changes in the reconstruction algorithm and slice thickness.Materials and Methods: Emphysema was quantified in 149 patients using a fully automatic, in-house developed software (the Robust Automatic On-Line Pulmonary Helper). The accuracy of the system was evaluated against commercial software, and its reproducibility was assessed using pairs of volume-corrected images taken 1 year apart. Furthermore, to standardize quantifications, the effect of changing the reconstruction parameters was modeled using a nonlinear fit, and the inverse of the model function was then applied to the data. The association between quantifications and pulmonary function testing was also evaluated. The accuracy of the in-house software compared to that of commercial software was measured using Spearman's rank correlation coefficient, the mean difference, and the intrasubject variability. Agreement between the methods was studied using Bland-Altman plots. To assess the reproducibility of the method, intraclass correlation coefficients and Bland-Altman plots were used. The statistical significance of the differences between the standardized data and the reference data (soft-tissue reconstruction algorithm B40f; slice thickness, 1 mm) was assessed using a paired two-sample t test.Results: The accuracy of the method, measured as intrasubject variability, was 3.86 mL for pulmonary volume, 0.01% for emphysema index, and 0.39 Hounsfield units for mean lung density. Reproducibility, assessed using the intraclass correlation coefficient, was >0.95 for all measurements. The standardization method applied to compensate for variations in the reconstruction algorithm and slice thickness increased the intraclass correlation coefficients from 0.87 to 0.97 and from 0.99 to 1.00, respectively. The correlation of the standardized measurements with pulmonary function testing parameters was similar to that of the reference (for the emphysema index and the obstructive subgroup: forced expiratory volume in 1 second, -0.647% vs -0.615%; forced expiratory volume in 1 second/forced vital capacity, -0.672% vs -0.654%; and diffusing capacity for carbon monoxide adjusted for hemoglobin concentration, -0.438% vs -0.523%).Conclusions: The new emphysema quantification method presented in this report is accurate and reproducible and, thanks to its standardization method, robust to changes in the reconstruction parameters. [ABSTRACT FROM AUTHOR]- Published
- 2011
- Full Text
- View/download PDF
30. Association of IL-6 gene polymorphisms and COPD in a Spanish Population.
- Author
-
Córdoba-Lanús, Elizabeth, de-Torres, Juan-Pablo, López-Aguilar, Celeste, Rodríguez-Pérez, María-Cristo, Maca-Meyer, Nicole, Montejo-de-Garcini, Angela, Aguirre-Jaime, Armando, Pérez-Méndez, Lina, and Casanova, Ciro
- Abstract
Summary: Interleukin-6 (IL-6) is a potential mediator of systemic effects of Chronic Obstructive Pulmonary Disease (COPD). In the present case–control study we investigated the association of promoter polymorphisms of this gene and COPD in a cohort of 191 patients, smokers without COPD (n =75) and a healthy control population (n =296). Besides spirometry, exercise capacity (6MWD, 6min walking distance) and body mass index (BMI) were measured in COPD patients. Genotyping of the IL-6 polymorphisms at positions −174, −572 and −597 was performed. The −597G/A and −174G/C polymorphisms were not associated with the disease. However, the −572G/C polymorphism was significantly associated with COPD susceptibility under a dominant model of inheritance. The frequency of the genotypes containing the C allele was significantly lower in the COPD cases (9.9%) compared with the healthy control group (16.9%) and smokers (23.1%), (OR=0.46, p =0.032 and OR=0.28, p =0.012, respectively). The GCG (−597/−572/−174) haplotype was significantly associated with the disease (OR=0.37, p =0.022, COPD cases vs. healthy subjects and OR=0.17, p =0.011, COPD cases vs. smokers). Moreover, a borderline association was also found for the −572G allele and hypoxemia (PaO
2 <60mmHg) (p =0.05). Our data suggest that the IL-6 −572C allele may confer a diminished risk of developing COPD. [Copyright &y& Elsevier]- Published
- 2008
- Full Text
- View/download PDF
31. Distance and Oxygen Desaturation During the 6-mm Walk Test as Predictors of Long-term Mortality in Patients With COPD.
- Author
-
Casanova, Ciro, Cote, Claudia, Marin, José M., Pinto-Plata, Victor, De Torres, Juan P., Aguirre-Jaíme, Armando, Vassaux, Carlos, and Celli, Bartolome R.
- Subjects
PHYSIOLOGICAL aspects of walking ,OBSTRUCTIVE lung disease treatment ,RESPIRATORY diseases ,PRIMARY health care ,MEDICAL care research ,PATIENTS - Abstract
The article presents a study on the health benefits of the 6-minute walk test (6MWT) on chronic obstructive pulmonary disease (COPD). The study involves the participation and observation of 576 stable COPD outpatients in Spain and U.S. for three years. During the 6MWT, body mass index, Charlson comorbidity score, and 6-minute walk distance (6MWD) were measured using pulse oximetry. The research shows that the test was a good predictor of all-cause and respiratory mortality of patients.
- Published
- 2008
- Full Text
- View/download PDF
32. Time to desaturation in the 6-min walking distance test predicts 24-hour oximetry in COPD patients with a PO2 between 60 and 70mmHg.
- Author
-
García-Talavera, Ignacio, García, Concepción Hernández, Macario, Ciro Casanova, de Torres, Juan Pablo, Celli, Bartolomé R., and Aguirre-Jaime, Armando
- Abstract
Summary: Background: The 6-min walking distance (6MWD) test is a useful tool for assessing patients with chronic obstructive pulmonary disease (COPD), but little is known about the changes in oxygen saturation that occur during the test. Objective: To predict the oximetry profile during daily living activities by the time to desaturation in the 6MWD test in COPD-affected patients. Patients and methods: We studied 67 COPD patients with moderate hypoxemia performing a 6MWD test and a 24-hour ambulatory pulse oximetry (24-hr PO). We determined the time to desaturation (SatO
2 ⩽90%) in the 6MWD test, in the daytime, nighttime and 24-hr PO. We then estimated the time to desaturation that better predicts desaturation in diurnal, nocturnal and 24-hour oximetries using the ROC type II analysis. Results: The patients who desaturated after 3′30min have a 100% probability not to desaturate during diurnal, nocturnal and 24-hr PO. Those patients who desaturated during the first minute of the 6MWD test have a 74% probability to desaturate in these oximetries. Conclusions: The time to desaturation in the 6MWD test can discriminate early desaturators who desaturate during their daily living activities and late desaturators who do not desaturate. Ambulatory oximetry would thus only be necessary in patients with a time to desaturation that ranges between 1 and 3′30″. [Copyright &y& Elsevier]- Published
- 2008
- Full Text
- View/download PDF
33. C-Reactive Protein Levels and Survival in Patients With Moderate to Very Severe COPD.
- Author
-
De Torres, Juan P., Pinto-Plata, Victor, Casanova, Ciro, Mullerova, Hanna, Córdoba-Lanús, Elizabeth, De Fuentes, Mercedes Muros, Aguirre-Jaime, Armando, and Celli, Bartolonw R.
- Subjects
- *
C-reactive protein , *OBSTRUCTIVE lung diseases , *ACUTE phase proteins , *LUNG diseases , *RESPIRATORY obstructions - Abstract
The article examines the correlation between serum levels of C-reactive protein (CRP) and survival in patients with moderate to severe chronic obstructive pulmonary disease (COPD) and compares this with other parameters for the prognosis of the disease. Research findings show that there is no association between CRP levels and survival compared to other prognostic clinical tools for COPD.
- Published
- 2008
- Full Text
- View/download PDF
34. Gender and COPD in Patients Attending a Pulmonary Clinic.
- Author
-
de Torres, Juan P., Casanova, Ciro, Hernández, Concepción, Abreu, Juan, Aguirre-Jaime, Armando, and Celli, Bartolome R.
- Subjects
- *
OBSTRUCTIVE lung diseases , *AIRWAY (Anatomy) , *SOCIAL indicators , *DISEASES in women , *MORTALITY ,SEX differences (Biology) - Abstract
This article presents information on a study which compares gender differences in the clinical expression of COPD patients attending a pulmonary clinic. The influence of gender on the expression of COPD has received limited attention. Gender differences in airway behavior and in the clinical manifestations of airway disease occur throughout life and are thought to be related to biological as well as sociocultural factors. The lack of information regarding gender and COPD is surprising because according to COPD disease surveillance in the United States, there was a fivefold increase in the mortality rate due to COPD in women between 1971 and 2000.
- Published
- 2005
- Full Text
- View/download PDF
35. Nocturnal Hypoxemia and CT Determined Pulmonary Artery Enlargement in Smokers.
- Author
-
Marin-Oto, Marta, Seijo, Luis M., Divo, Miguel, Bastarrika, Gorka, Ezponda, Ana, Calvo, Marta, Zulueta, Javier J., Gallardo, Guillermo, Cabezas, Elena, Peces-Barba, German, Pérez-Warnisher, Maria T., Marín, Jose M., Celli, Bartolomé R., Casanova, Ciro, De-Torres, Juan P., and López-Campos, José Luis
- Subjects
PULMONARY artery ,OBSTRUCTIVE lung diseases ,COMPUTED tomography ,HYPOXEMIA ,SLEEP apnea syndromes - Abstract
Background: Pulmonary artery enlargement (PAE) detected using chest computed tomography (CT) is associated with poor outcomes in chronic obstructive pulmonary disease (COPD). It is unknown whether nocturnal hypoxemia occurring in smokers, with or without COPD, obstructive sleep apnoea (OSA) or their overlap, may be associated with PAE assessed by chest CT. Methods: We analysed data from two prospective cohort studies that enrolled 284 smokers in lung cancer screening programs and completing baseline home sleep studies and chest CT scans. Main pulmonary artery diameter (PAD) and the ratio of the PAD to that of the aorta (PA:Ao ratio) were measured. PAE was defined as a PAD ≥ 29 mm in men and ≥27 mm in women or as a PA:Ao ratio > 0.9. We evaluated the association of PAE with baseline characteristics using multivariate logistic models. Results: PAE prevalence was 27% as defined by PAD measurements and 11.6% by the PA:Ao ratio. A body mass index ≥ 30 kg/m
2 (OR 2.01; 95%CI 1.06–3.78), lower % predicted of forced expiratory volume in one second (FEV1 ) (OR 1.03; 95%CI 1.02–1.05) and higher % of sleep time with O2 saturation < 90% (T90) (OR 1.02; 95%CI 1.00–1.03), were associated with PAE as determined by PAD. However, only T90 remained significantly associated with PAE as defined by the PA:Ao ratio (OR 1.02; 95%CI 1.01–1.03). In the subset group without OSA, only T90 remains associated with PAE, whether defined by PAD measurement (OR 1.02; 95%CI 1.01–1.03) or PA:Ao ratio (OR 1.04; 95%CI 1.01–1.07). Conclusions: In smokers with or without COPD, nocturnal hypoxemia was associated with PAE independently of OSA coexistence. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
36. Qualitative Components of Dyspnea during Incremental Exercise across the COPD Continuum.
- Author
-
PHILLIPS, DEVIN B., NEDER, J. ALBERTO, ELBEHAIRY, ANY F., MILNE, KATHRYN M., JAMES, TTHEW D., VINCENT, SANDRA G., DAY, ANDREW G., DE-TORRES, JUAN P., WEBB, KATHERINE A., and O'DONNELL, DENIS E.
- Subjects
- *
EXERCISE tests , *EXERCISE tolerance , *CONFIDENCE intervals , *CARDIOPULMONARY system , *CROSS-sectional method , *OXYGEN consumption , *EXERCISE physiology , *DYSPNEA , *OBSTRUCTIVE lung diseases , *FORCED expiratory volume , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *LOGISTIC regression analysis , *ODDS ratio , *SPIROMETRY , *RESPIRATORY mechanics - Abstract
Introduction: Evaluation of the intensity and quality of activity-related dyspnea is potentially useful in people with chronic obstructive pulmonary disease (COPD). The present study sought to examine associations between qualitative dyspnea descriptors, dyspnea intensity ratings, dynamic respiratory mechanics, and exercise capacity during cardiopulmonary exercise testing (CPET) in COPD and healthy controls. Methods : In this cross-sectional study, 261 patients with mild-to-very severe COPD (forced expiratory volume in 1 s, 62 +/- 25%pred) and 94 age-matched controls (forced expiratory volume in 1 s, 114 +/- 14%pred) completed an incremental cycle CPET to determine peak oxygen uptake (V[spacing dot above]O2peak). Throughout exercise, expired gases, operating lung volumes, and dyspnea intensity were assessed. At peak exercise, dyspnea quality was assessed using a modified 15-item questionnaire. Results : Logistic regression analysis revealed that among 15 dyspnea descriptors, only those alluding to the cluster "unsatisfied inspiration" were consistently associated with an increased likelihood for both critical inspiratory mechanical constraint (end-inspiratory lung volume/total lung capacity ratio >=0.9) during exercise and reduced exercise capacity (V[spacing dot above]O2peak < lower limit of normal) in COPD (odds ratio (95% confidence interval), 3.26 (1.40-7.60) and 3.04 (1.24-7.45), respectively; both, P < 0.05). Thus, patients reporting "unsatisfied inspiration" (n = 177 (68%)) had an increased relative frequency of critical inspiratory mechanical constraint and low exercise capacity compared with those who did not select this descriptor, regardless of COPD severity or peak dyspnea intensity scores. Conclusions : In patients with COPD, regardless of disease severity, reporting descriptors in the unsatisfied inspiration cluster complemented traditional assessments of dyspnea during CPET and helped identify patients with critical mechanical abnormalities germane to exercise intolerance. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
37. Mechanisms of Exertional Dyspnea in Patients with Mild COPD and a Low Resting DLCO.
- Author
-
James, Matthew D., Phillips, Devin B., Elbehairy, Amany F., Milne, Kathryn M., Vincent, Sandra G., Domnik, Nicolle J., de Torres, Juan P., Neder, J. Alberto, and O'Donnell, Denis E.
- Subjects
- *
OBSTRUCTIVE lung diseases , *DYSPNEA , *RESPIRATORY mechanics , *LUNG volume , *LUNG volume measurements - Abstract
Patients with mild chronic obstructive pulmonary disease (COPD) and lower resting diffusing capacity for carbon monoxide (DLCO) often report troublesome dyspnea during exercise although the mechanisms are not clear. We postulated that in such individuals, exertional dyspnea is linked to relatively high inspiratory neural drive (IND) due, in part, to the effects of reduced ventilatory efficiency. This cross-sectional study included 28 patients with GOLD I COPD stratified into two groups with (n = 15) and without (n = 13) DLCO less than the lower limit of normal (
- Published
- 2021
- Full Text
- View/download PDF
38. Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD
- Author
-
Ramón Agüero, Eva Balcells, Pilar de Lucas-Ramos, Celia Lacarcel, Inmaculada Alfageme, Jose M. Marin, Carlos Javier Gutiérrez Cabrera, Victor Pinto-Plata, Miguel Divo, Juan P. de-Torres, Alfredo de Diego, Rafael Golpe, Myriam Calle-Rubio, Amalia Moreno, Ingrid Solanes, Juan B. Galdiz, José Luis López-Campos, Joan B. Soriano, Nuria Feu-Collado, Bartolome R. Celli, Juan José Soler-Cataluña, Antonia Fuster, Amparo Romero, Antonia Llunell, Borja G. Cosío, Cristina Martínez-González, Ciro Casanova, Margarita Marín, Germán Peces-Barba, [Casanova, Ciro] Hosp Univ Ntra Sra La Candelaria, Pulmonol Dept, Tenerife, Spain, [Celli, Bartolome R.] Brigham & Womens Hosp, Pulm & Crit Care Dept, 75 Francis St, Boston, MA 02115 USA, [Divo, Miguel] Brigham & Womens Hosp, Pulm & Crit Care Dept, 75 Francis St, Boston, MA 02115 USA, [de-Torres, Juan P.] Clin Univ Navarra, Pulm Dept, Pamplona, Spain, [Martinez-Gonzalez, Cristina] Hosp Cent Asturias, Pulm Dept, Oviedo, Spain, [Cosio, Borja G.] Hosp Son Espases IdISPa, Pulm Dept, Palma de Mallorca, Spain, [Cosio, Borja G.] Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain, [Peces-Barba, German] Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain, [Luis Lopez-Campos, Jose] Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain, [Pinto-Plata, Victor] Baystate Med Ctr, Springfield, MA USA, [de Lucas-Ramos, Pilar] Hosp Gregorio Maranon, Pulm Dept 1, Madrid, Spain, [Fuster, Antonia] Hosp Son Llatzer, Pulm Dept, Mallorca, Spain, [Peces-Barba, German] Fdn Jimenez Diaz, Pulm Dept, Madrid, Spain, [Calle-Rubio, Myriam] Univ Complutense Madrid, Fac Med, Med Dept, Hosp Clin San Carlos,Pulm Dept, Madrid, Spain, [Solanes, Ingrid] Univ Autonoma Barcelona, Hosp Santa Creu & Sant Pau, Pulm Dept, Barcelona, Spain, [Aguero, Ramon] Hosp Marques Valdecilla, Pulm Dept, Santander, Spain, [Feu-Collado, Nuria] Hosp Univ Reina Sofia, IMIBIC, UCO, Pulm Dept, Cordoba, Spain, [Alfageme, Inmaculada] Hosp Univ Valme, Pulm Dept, Seville, Spain, [De Diego, Alfredo] Hosp Univ La Fe, Pulm Dept, Valencia, Spain, [Romero, Amparo] Hosp Manacor, Pulm Dept, Mallorca, Spain, [Balcells, Eva] Hosp Mar, Pulm Dept, Barcelona, Spain, [Llunell, Antonia] Hosp Tarrasa, Pulm Dept, Tarrasa, Spain, [Galdiz, Juan B.] Hosp Cruces, Pulm Dept, Bilbao, Spain, [Marin, Margarita] Hosp Gen Castellon, Pulm Dept, Castellon de La Plana, Spain, [Moreno, Amalia] Hosp Parc Tauli, Pulm Dept, Barcelona, Spain, [Cabrera, Carlos] Hosp Dr Negrin, Pulm Dept, Las Palmas Gran Canaria, Spain, [Golpe, Rafael] Hosp Univ Lucus Augusti, Pulm Dept, Lugo, Spain, [Lacarcel, Celia] Hosp Ciudad Jaen, Pulm Dept, Jaen, Spain, [Soriano, Joan B.] Hosp Univ La Princesa IISP, Inst Invest, Madrid, Spain, [Luis Lopez-Campos, Jose] Hosp Univ Virgen Rocio, Inst Biomed Sevilla IBiS, Unidad Med Quirrurg Enfermedades Resp, Seville, Spain, [Soler-Cataluna, Juan J.] Hosp Arnau Vilanova, Pulm Dept, Valencia, Spain, [Marin, Jose M.] Hosp Univ Miguel Servet, IISAragon, CIBERES, Pulm Dept, Zaragoza, Spain, and AstraZeneca (Madrid, Spain)
- Subjects
Male ,Cohort Studies ,Leukocyte Count ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Risk Factors ,Forced Expiratory Volume ,Prevalence ,Medicine ,Eosinophilia ,030212 general & internal medicine ,Obstructive pulmonary-disease ,COPD ,Inhaled corticosteroids ,respiratory system ,Middle Aged ,medicine.anatomical_structure ,Cohort ,Disease Progression ,Female ,medicine.symptom ,Cohort study ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Efficacy ,Guidelines ,Exacerbations ,03 medical and health sciences ,Internal medicine ,Humans ,In patient ,Risk factor ,Survival analysis ,Aged ,Clinical characteristics ,business.industry ,Biomarker ,Eosinophil ,medicine.disease ,Survival Analysis ,Asthma ,respiratory tract diseases ,Eosinophils ,Dyspnea ,030228 respiratory system ,Spain ,Immunology ,Fluticasone ,business - Abstract
The impact of blood eosinophilia in chronic obstructive pulmonary disease (COPD) remains controversial.To evaluate the prevalence and stability of a high level of blood eosinophils (>= 300 cells.mu L-1) and its relationship to outcomes, we determined blood eosinophils at baseline and over 2 years in 424 COPD patients (forced expiratory volume in 1 s (FEV1) 60% predicted) and 67 smokers without COPD from the CHAIN cohort, and in 308 COPD patients (FEV1 60% predicted) in the BODE cohort. We related eosinophil levels to exacerbations and survival using Cox hazard analysis.In COPD patients, 15.8% in the CHAIN cohort and 12.3% in the BODE cohort had persistently elevated blood eosinophils at all three visits. A significant proportion (43.8%) of patients had counts that oscillated above and below the cut-off points, while the rest had persistent eosinophil levels = 300 cells.mu L-1) and its relationship to outcomes, we determined blood eosinophils at baseline and over 2 years in 424 COPD patients (forced expiratory volume in 1 s (FEV1) 60% predicted) and 67 smokers without COPD from the CHAIN cohort, and in 308 COPD patients (FEV1 60% predicted) in the BODE cohort. We related eosinophil levels to exacerbations and survival using Cox hazard analysis.In COPD patients, 15.8% in the CHAIN cohort and 12.3% in the BODE cohort had persistently elevated blood eosinophils at all three visits. A significant proportion (43.8%) of patients had counts that oscillated above and below the cut-off points, while the rest had persistent eosinophil levels = 300 cells.mu L-1 persisting over 2 years was not a risk factor for COPD exacerbations. High eosinophil count was associated with better survival.
- Published
- 2017
39. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease
- Author
-
Masanori Yoshikawa, Daisy J.A. Janssen, Selina Dürr, Rudolf Joerres, Julia Billington, Nicholas Locantore, Florin Mihaltan, Sally Singh, Dimitar Sajkov, Thys van der Molen, Borja G. Cosío, Guilherme F. da Silva, Sarah Houben-Wilke, Ian Norman, Baykal Tulek, Jose M. Marin, David Miedinger, Samantha Coster, Janwillem W. H. Kocks, Sang Do Lee, Karel Hejduk, Juan P. de Torres, Maria Gonik, Mark Small, Samantha S.C. Kon, Nobuyuki Horita, Katherine A. Webb, Naseh Sigari, Ioanna Tsiligianni, Natya Raghavan, Yoshitaka Ogata, William D.-C. Man, Afroditi K. Boutou, Cristina Martínez, Marc Miravitlles, Lowie E.G.W. Vanfleteren, Miriam T.J. Groenen, Barbora Novotna, Isabel Mir, Miguel Guimaraes, Alvar Agusti, Nart Bedin Atalay, Dionne E. Smid, Trevor Murrells, Stefanie Brighenti-Zogg, Henrik Watz, Seigo Minami, José Luis López-Campos, Frits M.E. Franssen, Nicholas S Hopkinson, Pilar de Lucas-Ramos, Emiel F.M. Wouters, James Piercy, Melissa Jehn, Emma Chaplin, Vladimir Koblizek, Ciro Casanova, Nikolaos Tzanakis, Rebecca Tanner, Hiroshi Kimura, Lana Maricic, Nienke Nakken, David Price, Alberto Fernández-Villar, Denis E. O'Donnell, Annika Karch, Martijn A. Spruit, Yu-Il Kim, Joan B. Soriano, Ines Ladeira, Yu Nishijima, Namhee Kwon, Victoria Higgins, Laura Mendoza, Eanes Delgado Barros Pereira, Julia L. Kelly, Thomas Ringbaek, Guogang G. Xie, Chaicharn Pothirat, James W. Dodd, Joerg D. Leuppi, RS: NUTRIM - R3 - Respiratory & Age-related Health, Pulmonologie, Afdeling Onderwijs FHML, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, Promovendi NTM, MUMC+: MA Longziekten (3), [Smid, Dionne E.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Franssen, Frits M. E.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Groenen, Miriam T. J.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Houben-Wilke, Sarah] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Janssen, Daisy J. A.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Nakken, Nienke] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Vanfleteren, Lowie E. G. W.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Wouters, Emiel F. M.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Spruit, Martijn A.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Franssen, Frits M. E.] Maastricht Univ, Med Ctr, Dept Resp Med, Maastricht, Netherlands, [Vanfleteren, Lowie E. G. W.] Maastricht Univ, Med Ctr, Dept Resp Med, Maastricht, Netherlands, [Wouters, Emiel F. M.] Maastricht Univ, Med Ctr, Dept Resp Med, Maastricht, Netherlands, [Gonik, Maria] Biomax Informat AG, Planegg, Germany, [Miravitlles, Marc] Hosp Univ Hebron, CIBER Enfermedades Resp CIBERES, Pneumol Dept Hosp, Barcelona, Spain, [Casanova, Ciro] Hosp Univ NS Candelaria, Pulmonaty Dept, Santa Cruz de Tenerife, Spain, [Casanova, Ciro] Hosp Univ NS Candelaria, Res Unit, Santa Cruz de Tenerife, Spain, [Cosio, Borja G.] Hosp Son Espases IdISPa CIBERES, Dept Resp Med, Islas Baleares, Spain, [de Lucas-Ramos, Pilar] Hosp Gen Univ Gregorio Maranon, Pulm Dept, Madrid, Spain, [Marin, Jose M.] Hosp Univ Miguel Servet, IISAragon, CIBER Enfermedades Resp, Zaragoza, Spain, [Martinez, Cristina] Hosp Univ Cent Asturias, Inst Nacl Silicosis, Pneumol Serv, Oviedo, Spain, [Mir, Isabel] Hosp Gen Univ Gregorio Maranon, Pulm Dept, Madrid, Spain, [Soriano, Joan B.] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest, IISP, Madrid, Spain, [de Torres, Juan P.] Clin Univ Navarra, Pulm Dept, Pamplona, Spain, [Agusti, Alvar] Univ Barcelona, Hosp Clin, Resp Inst, Barcelona, Spain, [Agusti, Alvar] CIBERES, Madrid, Spain, [Atalay, Nart B.] TOBB Univ Econ & Technol, Dept Psychol, Ankara, Turkey, [Billington, Julia] Surbiton Hlth Ctr, Cent Surg, Surrey, England, [Boutou, Afroditi K.] G Gennimats Gen Hosp, Intens Care Unit, Thessaloniki, Greece, [Boutou, Afroditi K.] Aristotle Univ Thessaloniki, Resp Failure Unit, Thessaloniki, Greece, [Brighenti-Zogg, Stefanie] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Durr, Selina] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Leuppi, Joerg D.] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Miedinger, David] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Chaplin, Emma] Univ Hosp Leicester NHS Trust, NIHR Leicester Resp Biomed Res Unit, Ctr Exercise & Rehabil Sci, Leicester, Leics, England, [Singh, Sally] Univ Hosp Leicester NHS Trust, NIHR Leicester Resp Biomed Res Unit, Ctr Exercise & Rehabil Sci, Leicester, Leics, England, [Coster, Samantha] Kings Coll London, Florence Nightingale Fac Nursing & Midwifery, London, England, [Murrells, Trevor J.] Kings Coll London, Florence Nightingale Fac Nursing & Midwifery, London, England, [Norman, Ian J.] Kings Coll London, Florence Nightingale Fac Nursing & Midwifery, London, England, [Dodd, James W.] Univ Bristol, Southmead Hosp Bristol, North Bristol Lung Ctr, Acad Resp Unit, Bristol, Avon, England, [Fernandez-Villar, Alberto] Complexo Hosp Vigo, Inst Invest Biomed Vigo, Serv Neumol, Pontevedra, Spain, [Guimaraes, Miguel] Ctr Hosp Vila Nova Gaia Espinho, Pulmonol Dept, Vila Nova De Gaia, Portugal, [Ladeira, Ines] Ctr Hosp Vila Nova Gaia Espinho, Pulmonol Dept, Vila Nova De Gaia, Portugal, [Hejduk, Karel] Masaryk Univ, Fac Med, Inst Biostat & Analyses, Brno, Czech Republic, [Higgins, Victoria] Adelphi Real World, Bollington, England, [Piercy, James] Adelphi Real World, Bollington, England, [Small, Mark] Adelphi Real World, Bollington, England, [Hopkinson, Nicholas S.] Imperial Coll London, Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Tanner, Rebecca J.] Imperial Coll London, Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Horita, Nobuyuki] Yokohama City Univ, Grad Sch Med, Dept Pulmonol, Yokohama, Kanagawa, Japan, [Jehn, Melissa] Charite Univ Med Berlin, Arbeitsbereich Ambulante Pneumol, Berlin, Germany, [Joerres, Rudolf] Inst & Output Clin Occupat & Environm Med, Munich, Germany, [Karch, Annika] Hannover Med Sch, Inst Biostat, Hannover, Germany, [Kelly, Julia L.] Imperial Coll London, NIHR Resp Dis Biomed Res Unit Royal Brompton, Natl Heart & Lung Inst, Acad Unit Sleep & Ventilat, London, England, [Kelly, Julia L.] Harefield NHS Fdn Trust & Imperial Coll, London, England, [Kim, Yu-Il] Chonnam Natl Univ Hosp, Dept Internal Med, Div Pulmonol, Donggu, Gwangju, South Korea, [Kimura, Hiroshi] Nara Med Univ, Dept Internal Med 2, Nara, Japan, [Yoshikawa, Masanori] Nara Med Univ, Dept Internal Med 2, Nara, Japan, [Koblizek, Vladimir] Charles Univ Prague, Fac Med Hradec Kralove, Dept Pneumol, Hradec Kralove, Czech Republic, [Novotna, Barbora] Charles Univ Prague, Fac Med Hradec Kralove, Dept Pneumol, Hradec Kralove, Czech Republic, [Koblizek, Vladimir] Univ Hosp Hradec Kralove, Hradec Kralove, Czech Republic, [Novotna, Barbora] Univ Hosp Hradec Kralove, Hradec Kralove, Czech Republic, [Kocks, Janwillem H.] Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma, Dept Primary Care, Groningen, Netherlands, [van der Molen, Thys] Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma, Dept Primary Care, Groningen, Netherlands, [Tsiligianni, Ioanna G.] Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma, Dept Primary Care, Groningen, Netherlands, [Kocks, Janwillem H.] Univ Groningen, Univ Med Ctr Groningen, GRIAC, COPD, Groningen, Netherlands, [van der Molen, Thys] Univ Groningen, Univ Med Ctr Groningen, GRIAC, COPD, Groningen, Netherlands, [Tsiligianni, Ioanna G.] Univ Groningen, Univ Med Ctr Groningen, GRIAC, COPD, Groningen, Netherlands, [Kon, Samantha S. C.] Hillingdon Hosp NHS Fdn Trust, Uxbridge, Middx, England, [Kon, Samantha S. C.] Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Man, William D-C] Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Kon, Samantha S. C.] Imperial Coll, London, England, [Man, William D-C] Imperial Coll, London, England, [Kwon, Namhee] GlaxoSmithICline GSK, Resp Franchise Med, London, England, [Lee, Sang-Do] Univ Ulsan, Coll Med, Clin Res Ctr Chron Obstruct Airway Dis, Asan Med Ctr,Dept Pulm & Critical Care Med, Seoul, South Korea, [Locantore, Nicholas] GlaxoSmithICline, King Of Prussia, PA USA, [Lopez-Campos, Jose L.] Univ Seville, Hosp Univ Virgen Rocio, Inst Biomed Sevilla, Unidad MedQuirarg Enfermedades Resp, Seville, Spain, [Lopez-Campos, Jose L.] Inst Salud Carlos III, CIBERES, CIBER Enfermedades Resp, Madrid, Spain, [Maricic, Lana] Univ JJ Strossmayer Osijek, Fac Med, Dept Internal Med, Univ Hosp Osijek, Osijek, Croatia, [Mendoza, Laura] Hosp Clin Univ Chile, Independencia, Region Metropol, Chile, [Mihaltan, Florin] Inst Pneumol Marius Nasta, Bucharest, Romania, [Minami, Seigo] Osaka Police Hosp, Dept Resp Med, Osaka, Japan, [Nishijima, Yu] Osaka Police Hosp, Dept Resp Med, Osaka, Japan, [Ogata, Yoshitaka] Osaka Police Hosp, Dept Resp Med, Osaka, Japan, [Nishijima, Yu] Osaka Univ, Grad Sch Med, Dept Resp Med Allergy & Rheumat Dis, Suita, Osaka, Japan, [O'Donnell, Denis E.] Queens Univ & Kingston Gen Hosp, Dept Med, Kingston, ON, Canada, [Webb, Katherine A.] Queens Univ & Kingston Gen Hosp, Dept Med, Kingston, ON, Canada, [Pereira, Eanes D.] Fed Univ Ceara Brazil, Fortaleza, Ceara, Brazil, [Price, David] Observat & Pragmat Res Inst, Singapore, Singapore, [Price, David] Univ Aberdeen, Aberdeen, Scotland, [Pothirat, Chaicharn] Chiang Mai Univ, Fac Med, Dept Internal Med, Div Pulm Crit Care & Allergy, Chiang Mai, Thailand, [Raghavan, Natya] McMaster Univ, Dept Med, Hamilton, ON, Canada, [Ringbaek, Thomas] Univ Copenhagen, Hvidovre Hosp, Dept Resp Med, Copenhagen, Denmark, [Sajkov, Dimitar] Flinders Med Ctr, Australian Resp & Sleep Med Inst, Adelaide, SA, Australia, [Sigari, Naseh] Kurdistan Univ Med Sci, Med Fac, Internal Med Dept, Sanandaj, Iran, [da Silva, Guilherme F.] Univ Fortaleza, UNIFOR, Fortaleza, Ceara, Brazil, [Tsiligianni, Ioanna G.] Agia Barbara Hlth Care Ctr, Iraklion, Greece, [Tulek, Baykal] Selcuk Univ, Fac Med, Dept Chest Dis, Konya, Turkey, [Tulek, Baykal] Univ Crete, Med Sch, Univ Hosp Herakl, Dept Thorac Med, Iraklion, Greece, [Watz, Henrik] German Ctr Lung Res, Pulm Res Inst, Lung Clin Grosshansdorf, Grosshansdorf, Germany, [Xie, Guogang G.] Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Dept Resp Med, Shanghai, Peoples R China, [Spruit, Martijn A.] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, REVAL,Rehabil Res Ctr,BIOMED, Diepenbeek, Belgium, [Spruit, Martijn A.] Maastricht Univ, Med Ctr, NUTRIM Sch Nutr & Translat Res Metab, Dept Resp Med, Maastricht, Netherlands, MRC, National Institute for Health Research, Medical Research Council, Department of Health, Medical Research Council (MRC), EU/IMI Joint Undertaking, TOBB ETU, Faculty of Science and Literature, Department of Psychology, TOBB ETÜ, Fen Edebiyat Fakültesi, Psikoloji Bölümü, Atalay, Nart Bedin, and Groningen Research Institute for Asthma and COPD (GRIAC)
- Subjects
ASSESSMENT TEST SCORE ,Male ,clinical significance ,health status ,HISTORY ASSESSMENT ,Global Health ,Severity of Illness Index ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Assessment test score ,Quality of life ,CLINICAL CHARACTERISTICS ,QUALITY-OF-LIFE ,Sickness Impact Profile ,030212 general & internal medicine ,Prospective cohort study ,Copd assessment test ,General Nursing ,POPULATION ,COPD ,education.field_of_study ,HEALTH-STATUS ,COPD ASSESSMENT TEST ,Evidence-Based Medicine ,medicine.diagnostic_test ,Health Policy ,Age Factors ,Cat ,CAT ,General Medicine ,Middle Aged ,Obstructive lung disease ,Health-status ,3. Good health ,1117 Public Health And Health Services ,Practice Guidelines as Topic ,Disease Progression ,Female ,Symptom Assessment ,Research-council scale ,Spirometry ,medicine.medical_specialty ,Population ,Risk Assessment ,03 medical and health sciences ,Sex Factors ,Internal medicine ,Severity of illness ,medicine ,Humans ,GOLD ,education ,Aged ,Receiver operating characteristic ,Clinical characteristics ,business.industry ,1103 Clinical Sciences ,medicine.disease ,RESEARCH-COUNCIL SCALE ,History assessment ,PHYSICAL-ACTIVITY ,030228 respiratory system ,Geriatrics ,Physical therapy ,Physical-activity ,Quality-of-life ,Geriatrics and Gerontology ,business - Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
- Published
- 2017
40. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease.
- Author
-
Smid, Dionne E., Franssen, Frits M.E., Gonik, Maria, Miravitlles, Marc, Casanova, Ciro, Cosio, Borja G., de Lucas-Ramos, Pilar, Marin, Jose M., Martinez, Cristina, Mir, Isabel, Soriano, Joan B., de Torres, Juan P., Agusti, Alvar, Atalay, Nart B., Billington, Julia, Boutou, Afroditi K., Brighenti-Zogg, Stefanie, Chaplin, Emma, Coster, Samantha, and Dodd, James W.
- Subjects
- *
CALIBRATION , *COMPUTERS , *PSYCHOLOGICAL distress , *OBSTRUCTIVE lung diseases , *QUESTIONNAIRES , *STATISTICS , *DATA analysis , *SYMPTOMS , *RECEIVER operating characteristic curves , *RESEARCH methodology evaluation , *DESCRIPTIVE statistics - Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. Methods After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. Main outcomes Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. Findings A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. Conclusions The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.