体重指数与慢性阻塞性肺疾病及生活质量的关系

目的在2002至2004年中国7个地区（北京、上海、广东、辽宁、天津、重庆和陕西）慢性阻塞性肺疾病（COPD）现况调查的基础上，探讨体重指数（BMI）与COPD的关系。方法现况调查采用多阶段分层整群随机抽样方法，对40岁及以上的居民进行问卷调查、身高和体重的测量及肺功能检测。调查有效人数为20245名，男8705名，女11540名，以支气管扩张试验后第一秒用力呼气容积／用力肺活量（FEV1／FVC）〈70％作为COPD的诊断标准，并排除其他已知的气流受限的疾病，共筛查出1668例COPD和18577例非COPD进行BMI与COPD的关系分析。结果COPD患者的BMI[（22．7±3．5）kg／m^2]较非COPD患者[（24．1±3．4）kg／m^2]低，吸烟者BMI为[（23．6±3．4）kg／m^2]较不吸烟者[（24．2±3．5）ks／m^2]低，差异均有统计学意义（F分别为158．31、49．10，P均〈0．01），且COPD与吸烟存在对BMI的交互作用（F=6．03，P〈0．05）。COPD病情程度分级越高BMI越低（F=45．46，P〈0．01），COPD病情程度分级与BMl分级存在负相关（r=-0．08，P〈0．01）。BMI越低COPD的患病率越高（趋势x^2=102．68，P〈0．01），多因素logistic回归分析显示，与正常BMI（18．5～23．9kg／m^2）比较，1级BMI（〈18．5kg／m^2）、3级BMI（24．0～27．9kg／m^2）和4级BMI（≥28．0ks／m^2）患COPD的D尺值分别为[2．12（1．73～2．59）、0．67（0．59～0．76）、0．60（0．49～0．73），P均〈0．05]；且BMl分级与吸烟存在对COPD的交互作用（x^2=4．73，P〈O．05）。与2级BMI的COPD患者比较，1级BMI的COPD患者生活质量差（心理指数评分：55±8、57±6，F=2．96，P〈0．05；躯体指数评分：42±10、46±9，F=4．21，P〈0．01）；气促分数高（1．4±1．5、1．1±1．3，x^2=14．32，P〈0．01）。结论1级BMI与COPD关系密切，其可能是COPD患病的独立于吸烟的危险因素，而低BMI也可能是COPD病情严重程度的一个重要指标。     

Ten-year cumulative incidence of COPD and risk factors for incident disease in a symptomatic cohort

STUDY OBJECTIVES: To determine the 10-year cumulative incidence of COPD in a cohort of subjects with respiratory symptoms (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 0) using the British Thoracic Society (BTS) and GOLD spirometric criteria. Furthermore, we sought to evaluate risk and gender factors for incident COPD. DESIGN AND SETTING: A postal questionnaire was administered in 1986 to all 6,610 subjects in eight areas of northern Sweden who had been born in 1919 to 1920 (group 1), 1934 to 1935 (group 2), and 1949 to 1950 (group 3). The response rate was 86%. All of the subjects reporting respiratory symptoms were invited to participate in a structured interview and pulmonary function test (PFT), and 1,506 (91%) participated. In 1996, 90% could be traced for follow-up, of whom 1,165 (86%) of the invited subjects participated and 1,109 subjects (534 women) were able to perform technically adequate PFTs in both 1986 and 1996. RESULTS: The 10-year cumulative incidence of COPD was estimated at 8.2% (using BTS criteria) and 13.5% (using GOLD criteria). Significant risk factors for incident COPD (using BTS and GOLD criteria) in a multivariate analysis were higher age (group 1 odds ratio [OR]: BTS criteria, 3.49; GOLD criteria, 3.37; group 2 OR: BTS criteria, 4.50; GOLD criteria, 5.70) and smoking (OR: BTS criteria, 5.37; GOLD criteria, 4.56), but not gender or heredity. Respiratory symptoms were significantly associated with incident COPD when added to the same model. In analogous analyses that were conducted separately for men and women, smoking yielded an OR of 8.52 among women (95% confidence interval [CI], 3.43 to 21.2) compared with 3.14 among men (95% CI, 1.26 to 7.84). The symptoms cough, sputum production, and chronic productive cough reached statistical significance in women, while dyspnea and wheeze did so in men. CONCLUSION: In this cohort, the 10-year cumulative incidence of COPD was 8.2% (using BTS criteria) and 13.5% (using GOLD criteria). Increasing age, smoking, and bronchitic symptoms, but not gender, were risk factors for incident COPD. GOLD stage 0 therefore appears to identify subjects who are at risk of COPD, but men and women presented different risk profiles.     

Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study

SETTING: Five Latin American cities: S?o Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; Caracas, Venezuela. OBJECTIVE: To describe the burden of chronic obstructive pulmonary disease (COPD) in Latin America. DESIGN: This is a multicentre study. Post-bronchodilator spirometry was used and the main outcome measure was FEV(1)/FVC < 0.7 (fixed ratio criterion). Global Obstructive Lung Disease (GOLD) stages were also analysed. RESULTS: The combined population aged > or =40 years in the five countries included in the study was approximately 85.3 million. Of these, it was estimated that 12.2 million have airflow obstruction, which corresponds to our prevalence estimate of 14.3%. The proportion of subjects in Stages II-IV of the GOLD classification was 5.6%. Risk factors presenting the highest aetiological fractions for COPD were age, current smoking, indoor exposure to coal and exposure to dust in the workplace. Smoking, the modifiable factor with the strongest aetiological fraction for COPD, affects 29.2% of adults aged > or =40 years in these cities, corresponding to approximately 25 million smokers in this age group. CONCLUSION: Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD in Latin America. The information obtained by a collaborative study has been vast and encouraging for other similar studies.     

Relationship between body mass index and different domains of disability in older persons: the 3C study

OBJECTIVE: To study the relationships between body mass index (BMI) and different domains of disability in elderly subjects from the French 3C study. SETTING: Three cities in France: Bordeaux (South-West), Dijon (North-East) and Montpellier (South-East). DESIGN: Cross-sectional study. SUBJECTS: A sample of 8966 elderly community dwellers (age: 65-101 y). MEASUREMENTS: Main outcome measures: BMI, continence, basic and Instrumental Activities of Daily Living (ADL and IADL) and mobility. Adjustment variables: age, educational level, lifestyle, cognitive functioning, smoking and drinking history, depression, dyspnea, diabetes and indicator of cardiovascular disease. RESULTS: Obesity (BMI> or =30 kg/m2) was significantly associated with disability in each domain for women. The relationship tended to be linear for ADL and for continence; whereas for IADL, underweight women (BMI <21 kg/m2) were also at higher risk of disability. In men, relationships were weaker since BMI was only associated with mobility restriction, with a higher risk for both underweight and obese subjects. CONCLUSION: These results are in favor of a strong association between obesity and the three domains of disability and incontinence. Weaker relationships between underweight and disability were observed. Results suggest that maintaining a BMI in the healthy range could contribute to independence in activities of daily living.     

Six-Minute Walking Distance in Women with COPD

Background: The 6-minute walk distance (6MWD) has been useful in the evaluation of men with COPD. Little is known about 6MWD in women with the disease. Objectives: Using healthy women as a reference, to evaluate the factors that help determine 6MWD in women with COPD. To explore if the 350 meters threshold differentiates survival in women as it does in men.Methods: Healthy women (n = 164) and with COPD (n = 223) were included in the study. Age, pack-years history, smoking status, comorbidities (Charlson Index), BMI, MRC dyspnea, spirometry and 6MWD were recorded in all participants and PaO₂ and IC/TLC in COPD women. The patients were prospectively followed and deaths registered. Factors predicting 6MWD were determined by multiple regression analysis. ROC analysis was used to calculate the best threshold value for the 6MWD with mortality as gold standard. Kaplan-Meier curves compared survival of patients that walked more or less than 350 m by age categories. Results: The 6MWD is decreased in women with COPD. Values decrease with age and GOLD stages. Age, BMI, smoking status, comorbidities, MRC and FEV_1% are statistical significant predictors of 6MWD. A 350 m cut-off value has a good sensitivity and specificity to predict (73% and 80% respectively) and differentiate survival (p < 0.001 for log rank comparisons) in these patients. Conclusions: In women with COPD, the 6MWD decreases with age and GOLD stages. A 350 m distance is a valid threshold to differentiate survival. Further studies in different settings should confirm our findings.     

Medical therapies and invasive treatments for coronary artery disease by body mass: the "obesity paradox" in the Get With The Guidelines database

Previous studies of hospitalized patients have suggested an "obesity paradox" with lower short-term mortality as weight increases. We hypothesized that some of this difference might be related to more aggressive management. To evaluate the effect of body mass index (BMI) on treatments and outcomes in patients with coronary artery disease (CAD), the Get With The Guidelines database was investigated. From 409 United States hospitals, 130,139 hospitalizations for CAD were identified with documented height and weight. Patients were stratified by BMI, with 3,305 (2.5%) underweight (BMI <18.5 kg/m(2)), 34,697 (27%) of healthy weight (BMI 18.5 to 24.9 kg/m(2)), 47,883 (37%) overweight (BMI 25 to 29.9 kg/m(2)), 37,686 (29%) obese (BMI 30 to 39.9 kg/m(2)), and 6,568 (5%) extremely obese (BMI > or =40 kg/m(2)). As BMI increased, patients were significantly younger but more likely to be men and have hypertension, diabetes, and hyperlipidemia. Unadjusted in-hospital mortality was highest in the underweight group (10.4%) and significantly lower in the healthy-weight (5.4%), overweight (3.1%), obese (2.4%), and extremely obese (2.9%) patients. Higher BMI was associated with increased use of standard medical therapies such as aspirin, beta blockers, inhibitors of the renin-angiotensin system, and lipid-lowering therapy in the hospital and at discharge. In adjusted analyses, compared with the healthy-weight group, overweight and obese patients were more likely to undergo invasive procedures and had lower mortality (p <0.01 for all odds ratios). In conclusion, increasing BMI appears to be associated with better use of guideline-recommended medical treatment and invasive management of CAD, which may explain the observed lower rates of in-hospital mortality.     

Impact of body mass index on in-hospital outcomes following percutaneous coronary intervention (report from the New York State Angioplasty Registry)

Although obesity traditionally has been considered a risk factor for coronary revascularization, recent data from registry studies have shown a possible protective effect of obesity on outcomes after percutaneous coronary intervention (PCI). Using data from the New York State Angioplasty database over a 4-year period, we analyzed 95,435 consecutive patients who underwent PCI. Classification of body mass index (BMI) was: underweight (<18.5 kg/m(2)), healthy weight (18.5 to 24.9 kg/m(2)), overweight (25 to 29.9 kg/m(2)), moderate obesity (class I) (30 to 34.9 kg/m(2)), severe obesity (class II) (35 to 39.9 kg/m(2)), and very severe obesity (class III) (>40 kg/m(2)). In-hospital postprocedural mortality and complications were compared among these groups. Compared with healthy weight patients, patient with class I or II obesity had lower in-hospital mortality and major adverse cardiac events (MACE) (combined death, myocardial infarction, and emergency surgery), whereas patients at the extremes of BMI (underweight and class III obese patients) had significantly higher mortality and MACE rates. Adjusted hazards ratios for in-hospital mortality according to BMI were: underweight (2.69), healthy weight (1.0), overweight (0.90), class I obese (0.74), class II obese (0.67), and class III obese (1.63). Patients at the extremes of BMI (<18.5 and >40 kg/m(2)) were at increased risk of MACEs, including mortality after PCI, whereas patients who were moderately to severely obese (BMIs 30 to 40 kg/m(2)) were at lower risk than healthy weight patients.     

Sarcopenia in COPD: relationship with COPD severity and prognosis

Objective:

To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD.

Methods:

A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height² only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage) was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index.

Results:

We recruited 91 patients (50 females), with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m². Sarcopenia was observed in 36 (39.6%) of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV₁ (used as an indicator of the degree of obstruction). The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001). Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009). The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage.

Conclusions:

In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis.     

Body mass index and serum and sputum TNF-alpha levels relation in asthma and COPD

Previous studies have revealed the relationship between asthma with obesity and low body mass index (BMI) with chronic obstructive pulmonary disease (COPD). Tumor necrosis factor-alpha (TNF-alpha) is thought to be related with low BMI. The aim of this study was to determine sputum and serum TNF-alpha levels in patients with COPD and asthma and to evaluate whether these parameters had correlation with BMI. Thirty patients with moderate persistent asthma and 26 patients with moderate -severe COPD were included. After BMI values were calculated, sputum was induced by inhalation of hypertonic saline solution and blood was drawn for analysis of serum TNF-alpha levels. There were significant differences in age, serum and sputum TNF-alpha levels between asthma and COPD subjects (Sputum TNF-alpha: asthma; 513 +/- 151 pg/mL-COPD: 333 +/- 126 pg/mL, p< 0.001; Serum TNF-alpha: asthma; 332 +/- 114 pg/mL-COPD: 197 +/- 81 pg/mL, p< 0.001), however there was no difference in BMI (asthma; 28 +/- 5.7-COPD; 26.6 +/- 12.9, p= 0.1). Patients were divided into four categories according to their BMI values as underweight, normal, overweight and obese. In asthmatics; there were 12 (40%) obese and 11 (36%) overweight patients while 9 (34%) of COPD patients were underweight. No significant difference was observed among these four groups according to serum-sputum TNF-alpha and smoking history both in asthmatics and in COPD subjects. While there was no correlation between BMI and serum-sputum TNF-alpha levels, BMI was significantly correlated with both smoking history and duration of disease in COPD patients. As a result, most of the asthmatic patients were described as overweight and obese while no such variation was noted in the COPD patients. The induced sputum TNF-alpha levels has no additional benefit on serum TNF-alpha levels which has already known to be associated with BMI.     

稳定期慢性阻塞性肺疾病患者的气道阻力与运动相关呼吸困难肺功能参数的关系

目的观察稳定期慢性阻塞性肺疾病(COPD)患者的各项气道阻力(Raw)参数与运动相关呼吸困难肺功能参数的相关关系。方法前瞻性纳入上海交通大学附属胸科医院和第一人民医院门诊稳定期COPD患者180例,根据慢性阻塞性肺疾病全球倡议(GOLD 2017版)制订的肺功能诊断标准分为Ⅰ-Ⅳ级4组,受试前8 h内均未应用支气管舒张剂。所有患者在吸入沙丁胺醇400μg后接受常规肺功能和气道阻力测试。同期选择42例成年健康体检者作为对照组。结果Ⅱ级以上COPD患者的第1秒用力呼气容积和呼出50%肺活量时流量均显著低于健康成年人和Ⅰ级COPD患者,总气道阻力、有效气道阻力、吸气阻力和呼气阻力则呈进行性增高。Ⅲ-Ⅳ级COPD患者的深吸气量占预计值百分比(IC%pred)<80%,同时改良英国医学研究委员会呼吸困难量表评分超过2分;7例Ⅲ级(13.2%)和14例Ⅳ级COPD患者(33.3%)的吸气分数(IC/TLC)≤25%,而仅有1例Ⅱ级COPD患者的IC/TLC≤25%(1.9%)。结论稳定期中重度COPD患者呼出气流受限趋于加重,Raw各项参数中呼气阻力增高尤为显著。Ⅲ-Ⅳ级COPD患者更易出现运动相关呼吸困难症状,且IC/TLC≤25%。     

COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care.

AIMS: To describe the distribution of COPD disease severity in primary care based on airway obstruction, and to assess the extent to which dyspnoea scores, body mass index (BMI) and fat free mass (FFM) index contribute to the distribution of COPD severity in primary care. DESIGN: Cross sectional population-based study. METHODS: 317 patients with COPD were recruited from an outpatient disease management programme. Prevalence of moderate to severe dyspnoea, underweight, obesity and FFM depletion by GOLD stage were measured. RESULTS: According to GOLD guidelines, 29% of patients had mild COPD, 48% moderate, 17% severe and 5% very severe. A substantial number of patients classified as GOLD stage 2 reported severe dyspnoea (28.1%) and/or suffered from FFM depletion (16.3%). Prevalence of low body weight strongly increased in GOLD stage 4. Prevalence of obesity is highest in GOLD stages 1 and 2. CONCLUSION: The use of a multidimensional grading system, taking into account dyspnoea as well as the nutritional status of COPD patients, is likely to influence the distribution of disease severity in a primary care population. This might have implications for prevention, non-medical treatment, and estimates of health care utilisation in primary care.     

The local prevalence of COPD by post-bronchodilator GOLD criteria in Korea.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a disease characterised by not fully reversible airflow limitation. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee decided to diagnose COPD using post-bronchodilator spirometry values. We aimed to examine the prevalence and risk factors of COPD in Ansan, an industrialised city of Korea, by using the post-bronchodilator GOLD criteria. We then investigated the implications of brenchodilation on the prevalence of COPD. DESIGN: A total of 3642 participants in the Korean Health and Genome Study were interviewed about age, income, smoking status and respiratory symptoms and completed pulmonary function tests, including postbronchodilator spirometry. RESULTS: COPD prevalence by post-bronchodilator spirometry was 3.7% (134/3642), which was significantly different from that estimated using pre-bronchodilator criteria (7.7%, 282/3642). Exclusion of subjects with significant bronchodilator response (BDR) significantly lowered the prevalence of COPD to 3.3% (117/3572), compared with including subjects with post-bronchodilatory residual obstruction with significant BDR. Prevalence was associated with old age, smoking history, male sex and respiratory symptoms. CONCLUSION: COPD prevalence by post-bronchodilator GOLD criteria was 3.7%, which was much lower than that of pre-bronchodilator criteria. The bronchodilator reversibility test substantially affects estimations of COPD prevalence.     

低体质指数的慢性阻塞性肺疾病患者临床和实验室研究

目的 探讨低体质指数(BMI)的慢性阻塞性肺疾病(COPD)患者的临床特征及与COPD患者BMI相关的因素. 方法 选取中、重度稳定期COPD患者38例,测量身高、体质量,按BMI分为低体质量组:16例,BMI<20}正常体质量组22例,20≤BMI<26.所有患者行肺功能检查;记录吸烟指数;测6 min步行距离(6MWD);采用英国医学研究委员会呼吸困难量表(MRC)记录气促分级并评分;St George's呼吸问卷(SGRQ)和一般健康状况调查问卷(SF-36)评价生活质量,用酶联免疫吸附试验(ELISA)测定血清瘦素、格列林的水平. 结果 低体质量组与正常体质量组比较,深吸气量(IC)明显降低(P<0.01);第1秒用力呼气量(FEVl)、肺活量(VC)、最大通气量(MVV)、最大呼气峰值流速(PEF)均下降(P<0.05);残气量与肺总量比值(RV/TLC)明显增高(P<0.01).低体质量组吸烟指数增加,6MWD减少(P<0.05),MRC气促评分增高(P<0.01).低体质量组SGRQ评分中活动分、影响分与总均分增高(P<0.05),SF-36量表中情感职能、社会功能评分明显减低(P<0.05).低体质量组瘦素水平明显降低(P<0.01),格列林水平增高(P<0.05).经多元逐步回归分析发现,与BMI独立相关的因素分别是:IC、SF-36量表的精神健康和生理机能、瘦索、6MWD、吸烟指数. 结论 低BMI COPD患者肺功能、营养状况、运动能力及生活质量较正常BMI患者下降;IC与BMI关系最密切,患者的精神健康、运动能力、血清瘦素水平、吸烟指数均与BMI独立相关;纠正低BMI应为COPD综合治疗的重要组成部分.     

Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study

RATIONALE: Low body mass index (BMI) is a marker of poor prognosis in chronic obstructive pulmonary disease (COPD). In the general population, the harmful effect of low BMI is due to the deleterious effects of a low fat-free mass index (FFMI; fat-free mass/weight(2)). OBJECTIVES: We explored distribution of low FFMI and its association with prognosis in a population-based cohort of patients with COPD. METHODS: We used data on 1,898 patients with COPD identified in a population-based epidemiologic study in Copenhagen. FFM was measured using bioelectrical impedance analysis. Patients were followed up for a mean of 7 yr and the association between BMI and FFMI and mortality was examined taking age, sex, smoking, and lung function into account. MAIN RESULTS: The mean FFMI was 16.0 kg/m(2) for women and 18.7 kg/m(2) for men. Among subjects with normal BMI, 26.1% had an FFMI lower than the lowest 10th percentile of the general population. BMI and FFMI were significant predictors of mortality, independent of relevant covariates. Being in the lowest 10th percentile of the general population for FFMI was associated with a hazard ratio of 1.5 (95% confidence interval, 1.2-1.8) for overall mortality and 2.4 (1.4-4.0) for COPD-related mortality. FFMI was also a predictor of overall mortality when analyses were restricted to subjects with normal BMI. CONCLUSIONS: FFMI provides information in addition to BMI and assessment of FFM should be considered in the routine assessment of COPD.     

Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages?

OBJECTIVE: To assess the discriminative properties of the EuroQol five-dimension questionnaire (EQ-5D) with respect to COPD severity according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria in a large multinational study. METHODS: Baseline EQ-5D visual analog scale (VAS) scores, EQ-5D utility scores, and St. George Respiratory Questionnaire scores were obtained from a subset of patients in the Understanding the Potential Long-term Impact on Function with Tiotropium trial, which was a 4-year placebo-controlled trial designed to assess the effect of tiotropium on the rate of decline in FEV(1) in COPD patients aged > or = 40 years, an FEV(1) of < 70% predicted, an FEV(1)/FVC ratio of < or = 70%, and a smoking history of >/= 10 pack-years. RESULTS: A total of 1,235 patients (mean post bronchodilator FEV(1), 48.8% predicted) from 13 countries completed the EQ-5D. The EQ-5D VAS and utility scores differed significantly among patients in GOLD stages 2, 3, and 4, also after correction for age, sex, smoking, body mass index (BMI), and comorbidity (p < 0.001). The mean EQ-5D VAS scores for patients in GOLD stages 2, 3, and 4 were 68 (SD, 16), 62 (SD, 17), and 58 (SD, 16), respectively. The mean utility scores were 0.79 (SD, 0.20) for patients in GOLD stage 2, 0.75 (SD, 0.21) for patients in GOLD stage 3, and 0.65 (SD, 0.23) for patients in GOLD stage 4. Effect sizes for the difference in utility scores between patients in GOLD stages 3 and 4 were more than twice as high as those for the difference between patients in GOLD stages 2 and 3. Gender, postbronchodilator FEV(1) percent predicted, the number of hospital admissions and emergency department visits in the year prior to baseline measurements, measures of comorbidity, and BMI were independently associated with EQ-5D utility. EQ-5D utility scores also differed between patients from different countries. French patients especially had lower utility scores than US patients. Utility scores calculated with the US value set were on average 5% higher than those calculated with the UK value set. CONCLUSIONS: Increasing severity of COPD was associated with a significant decline in EQ-5D VAS scores and utility scores. These results demonstrate that a generic instrument can assess COPD impact on quality of life and that the scores discriminate between patient groups of known severity. These utility scores will be useful in cost-effectiveness assessments.     

Nutritional status, dietary energy intake and the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD)

Loss of body weight, as a result of imbalance between increased energy demand and/or reduced dietary intake, is a common problem in patients with COPD. The aim of this investigation was to examine the relationship between nutritional intake, change in body weight and the risk of exacerbation in patients with COPD. The study comprised 41 patients who were hospitalised because of an exacerbation of COPD. The follow-up period was 12 months. Weight, height and lung function were measured at baseline. At the 12-month follow-up, weight change and current weight were assessed by an interview and nutritional intake was recorded in a food diary for 7 days. An acute exacerbation was defined as having been admitted to hospital and/or making an emergency visit to hospital, due to COPD during the follow-up period. At baseline, 24% of the patients were underweight (body mass index (BMI)<20 kg/m2), 46% were of normal weight (BMI 20-25 kg/m2) and 29% were overweight (BMI>25 kg/m2). Energy intake was lower than the calculated energy demand for all groups. During the follow-up period, 24 of the 41 patients had an exacerbation. A low BMI at inclusion and weight loss during the follow-up period were independent risk factors for having an exacerbation (P=0.003 and 0.006, respectively). We conclude that, in patients who are hospitalised because of COPD, underweight and weight loss during the follow-up period are related to a higher risk of having new exacerbations.     

Low Body Mass Index Is Associated with Higher Odds of COPD and Lower Lung Function in Low- and Middle-Income Countries

The relationship of body mass index (BMI) with lung function and COPD has been previously described in several high-income settings. However, few studies have examined this relationship in resource-limited settings where being underweight is more common. We evaluated the association between BMI and lung function outcomes across 14 diverse low- and middle-income countries. We included data from 12,396 participants aged 35–95 years and used multivariable regressions to assess the relationship between BMI with either COPD and lung function while adjusting for known risk factors. An inflection point was observed at a BMI of 19.8?kg/m². Participants with BMI < 19.8?kg/m² had a 2.28 greater odds (95% CI 1.83–2.86) of having COPD and had a 0.21 (0.13–0.30) lower FEV₁ and 0.34 (0.27–0.41) lower FEV₁/FVC z-score compared to those with BMI ≥ 19.8?kg/m². The association with lung function remained even after excluding participants with COPD. Individuals with lower BMI were more likely to have COPD and had lower lung function compared to those in higher BMI. The association with lung function remained positive even after excluding participants with COPD, suggesting that being underweight may also play a role in having worse lung function.     

Newly diagnosed chronic obstructive pulmonary disease. Clinical features and distribution of the novel stages of the Global Initiative for Obstructive Lung Disease

BACKGROUND: The new guidelines of the Global Initiative for Obstructive Lung Disease (GOLD) propose a novel staging system for COPD. This study describes the frequency distribution of GOLD stages in newly diagnosed COPD patients in a large city pulmonary practice. METHODS: All patients newly admitted between 1995 and 1996 were analyzed retrospectively. Incident COPD cases were classified according to GOLD criteria. RESULTS: Among 1,434 patients, 210 were diagnosed with chronic obstructive pulmonary disease (COPD) (60% males, age 55 years, range 20-82 years). 67.5% of the patients were current smokers, 27% ex-smokers, and 5.5% nonsmokers. Based on GOLD criteria, 37% had stage 0, 5% stage I, 46% stage II, and 12% stage III COPD. Symptoms leading patients to seek medical advice were cough (84%), exertional dyspnea (70%), and sputum (45%), with a median symptom duration of 12 months (range 1-240 months). Compared with patients with GOLD stages 0-1, those with stages 2-3 were older (60 vs. 47 years, p < 0.001), heavier smokers (40 vs. 20 pack-years, p < 0.001), had a longer duration of symptoms (24 vs. 6 months, p < 0.001), and elevated IgE (stage 3 only, p < 0.04 vs. stages 0-2). Interestingly, stage 0 COPD patients did not have 'normal' spirometry, as indicated by significantly lower FEV(1) (% predicted) and FEF(25-75) (% predicted), compared with age-matched nonsmoking controls (93.1 +/- 1.8 vs. 99 +/- 1.6, p = 0.004; and 76.2 +/- 2.8 vs. 91.2 +/- 2.9, p = 0.0003, respectively). CONCLUSIONS: The majority of COPD patients seek medical advice at advanced disease stages, and smoke actively despite severe symptoms and functional impairment. However, nearly every second patient presents at stages 0-1, thus opening a window for therapeutic or behavioral intervention. GOLD guidelines are a useful basis to reinforce screening programs aimed at early detection and prevention of progressive COPD in individuals at risk and smoking cessation.     

Early detection and impaired quality of life in COPD GOLD stage 0: a pilot study

This pilot study aimed to identify early stages of chronic obstructive pulmonary disease (COPD) in an urban population of smokers and ex-smokers using the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2001, 2003) classification guidelines and to assess the impact of early disease on quality of life. Smokers and ex-smokers of >or= 10 pack years and age >or= 50 years were recruited. After an initial telephone interview, eligible subjects completed a clinical assessment, spirometry tests, and the St. George's Respiratory Questionnaire (SGRQ). A total of 244 subjects completed the study; 91 subjects (37%) were normal, 153 subjects (63%) met the criteria for GOLD stages 0 to III: 65 stage 0 (27%), 43 stage I (18%), 38 stage II (16%), 7 stage III (3%) and 0 in stage IV. The stage 0 patients were younger than any other COPD groups (p<0.0005), including normal subjects (55.5+/-5.4 years vs. 59.6+/-7.2 years; p=0.0005). The frequency of current smoking in stage 0 patients was greater than those in the normal category (80% vs. 33%; p<0.0001). There were significant impairments in quality of life measures between normal subjects and all GOLD stages (SGRQ total scores; p<0.0001) except for stage I (SGRQ total scores; p=0.1409). Subjects with COPD at GOLD stage 0 were markedly under-diagnosed. These subjects had a significant impairment in their health-related quality of life measures, were younger than other categories, and were mostly current smokers. Thus, detection of COPD at GOLD stage 0 may provide a unique opportunity for early intervention and smoking cessation and the removal of GOLD stage 0 from the 2006 update should be re-assessed.     

Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study.

An association between low body mass index (BMI) and poor prognosis in patients with chronic obstructive pulmonary disease (COPD) has been found in a number of studies. The prevalence and prognostic importance of weight change in unselected subjects with COPD was examined. Subjects with COPD, defined as forced expiratory volume in one second/forced vital capacity < 0.7 in the Copenhagen City Heart Study and who attended two examinations 5 yrs apart, were followed for 14 yrs for COPD-related and all-cause mortality. The proportion of subjects who lost > 1 unit BMI (approximately 3.8 kg) between the two examinations was significantly associated with level of COPD, reaching approximately 30% in subjects with severe COPD. After adjusting for age, smoking habits, baseline BMI and lung function, weight loss was associated with higher mortality in both persons with and without COPD (rate ratio (RR) for weight loss > 3 BMI units 1.71 (95% confidence interval (CI): 1.32-2.23) and 1.63 (95% CI 1.38-1.92), respectively). Weight gain was associated with increased mortality, but not significantly so in subjects with COPD. Risk of COPD-related death increased with weight loss (RR 2.14 (95% CI 1.18-3.89)), but not with weight gain (RR 0.95 (95% CI 0.43-2.08)). In subjects without COPD or with mild-to-moderate COPD, the effect of weight change was the same irrespective of initial weight. In subjects with severe COPD, there was a significant risk ratio modification (p=0.045) between effect of baseline BMI and weight change: in the normal-to-underweight (BMI < 25), best survival was seen in those who gained weight, whereas for the overweight and obese (BMI > or = 25), best survival was seen in stable weight. A high proportion of subjects with chronic obstructive pulmonary disease experienced a significant weight loss, which was associated with increased mortality. The results support further intervention studies that aim at avoiding weight loss in normal-to-underweight chronic obstructive pulmonary disease patients.