Assessment of Variables Associated with Smoking Cessation in Crohn’s Disease

Background

Patients with Crohn’s disease (CD) who smoke have a more complicated disease course.

Aims

Our primary objective was to assess smoking related variables that were associated with smoking cessation versus continued smoking in patients with CD.

Methods

A multi-center study identified CD patients who were seen at the University of Chicago and University of Calgary IBD clinics. Patients were categorized into three subgroups: lifetime non-smokers, current smokers, or ex-smokers. Participants completed questionnaires assessing their cigarette smoking behavior. Current smokers were prospectively followed for 6?months to assess smoking status and attempts to quit. Logistic regression analysis was performed to identify factors associated with smoking cessation.

Results

Three hundred patients were enrolled with 148 identifying themselves as lifetime non-smokers, 70 as current smokers, and 82 as ex-smokers. Patients who reported their first cigarette within 5?min of waking were more likely to be current smokers (OR?=?21; 95% CI 3.94–107.3) as compared to patients who waited greater than 60?min. Current smokers were more likely to have one or more household members who smoked compared to ex-smokers (P?Conclusions Patients who report a short time to first cigarette in the morning may have more difficulty in smoking cessation. Current smokers were more likely to have another smoker in the household compared to ex-smokers. Current smokers had low levels of motivation to quit smoking and consequently with no intervention, very few quit 6?months after the baseline assessment.     

Association Between CD4<Superscript>+</Superscript>, Viral Load,and Pulmonary Function in HIV

Purpose

The antiretroviral therapy era has shifted the epidemiology of HIV-associated diseases, increasing the recognition of non-infectious pulmonary complications secondary to HIV. We aimed to determine the association between CD4⁺, viral load, and pulmonary function in individuals with uncontrolled HIV, and determine how changes in these parameters are associated with pulmonary function longitudinally.

Methods

This is a retrospective observational study of individuals with HIV who underwent pulmonary function testing in an urban medical center between August 1997 and November 2015.

Results

Of the 146 participants (mean age 52 ± 10 years), 49% were Hispanic, 56% were men, and 44% were current smokers. CD4⁺ <200 cells/μl was associated with significant diffusion impairment compared to CD4⁺ ≥200 cells/μl (DL_CO 56 vs. 70%, p = <0.01). VL (viral load) ≥75 copies/ml was associated with significant diffusion impairment compared to VL <75 copies/ml (DL_CO 60 vs. 71%, p = <0.01). No difference in FEV1, FEV1/FVC, or TLC was noted between groups. In univariate analysis, CD4⁺ and VL correlated with DL_CO (r = +0.33; p = <0.01; r = ?0.26; p = <0.01) and no correlation was noted with FEV₁, FEV₁/FVC, or TLC. Current smoking and history of AIDS correlated with DL_CO (r = ?0.20; p = 0.03; r = ?0.20; p = 0.04). After adjusting for smoking and other confounders, VL ≥75 copies/ml correlated with a 11.2 (CI 95% [3.03–19.4], p = <0.01) decrease in DL_CO. In Spearman’s Rank correlation, there was a negative correlation between change in VL and change in DL_CO over time (ρ = ?0.47; p = <0.01).

Conclusion

The presence of viremia in individuals with HIV is independently associated with impaired DL_CO. Suppression of VL may allow for recovery in diffusing capacity over time, though the degree to which this occurs requires further investigation.

     

Gender Differences in the Association of Individual and Contextual Exposures with Lung Function in a Rural Canadian Population

Introduction

To investigate the association of individual and contextual exposures with lung function by gender in rural-dwelling Canadians.

Methods

A cross-sectional mail survey obtained completed questionnaires on exposures from 8263 individuals; a sub-sample of 1609 individuals (762 men, 847 women) additionally participated in clinical lung function testing. The three dependent variables were forced expired volume in one second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC ratio. Independent variables included smoking, waist circumference, body mass index, indoor household exposures (secondhand smoke, dampness, mold, musty odor), occupational exposures (grain dust, pesticides, livestock, farm residence), and socioeconomic status. The primary analysis was multiple linear regression, conducted separately for each outcome. The potential modifying influence of gender was tested in multivariable models using product terms between gender and each independent variable.

Results

High-risk waist circumference was related to reduced FVC and FEV₁ for both genders, but the effect was more pronounced in men. Greater pack-years smoking was associated with lower lung function values. Exposure to household smoke was related to reduced FEV₁, and exposure to livestock, with increased FEV₁. Lower income adequacy was associated with reduced FVC and FEV₁.

Conclusion

High-risk waist circumference was more strongly associated with reduced lung function in men than women. Longitudinal research combined with rigorous exposure assessment is needed to clarify how sex and gender interact to impact lung function in rural populations.

     

Decrease in Small Pulmonary Vessels on Chest Computed Tomography in Light Smokers Without COPD: An Early Change,but Correlated with Smoking Index

Purpose

The aim of this study was to evaluate the relationship between the amount of smoking and the cross-sectional area (CSA) of small pulmonary vessels in light smokers without a diagnosis of chronic obstructive pulmonary disease (COPD).

Methods

This retrospective study was approved by our institutional review board, which waived the need for informed consent from patients. The study included 34 current smokers without COPD, who were defined as light smokers based on their smoking history (≤25 pack years). The CSA of small pulmonary vessels (<5 mm² [CSA_<5]) was measured on computed tomography (CT) scans, and the percentage of total CSA of the lung (%CSA_<5) was calculated. The extent of emphysema was also assessed as the percentage of low attenuation area (%LAA, <?950 Hounsfield units). The correlations of %CSA_<5 and %LAA with pack years were determined using the Spearman rank correlation.

Results

There was a significant negative correlation between %CSA_<5 and pack years, whereas no significant correlation was found between %LAA and pack years. The correlations between pack years and percent predicted forced expiratory volume in 1 s (FEV₁) and FEV₁/forced vital capacity were not significant.

Conclusions

The percentage of total CSA of the lung made up of small pulmonary vessels in light smokers without COPD significantly decreases with increasing amount of smoking, in contrast to emphysema measurements. This suggests that small pulmonary vessels might have been injured or might have degenerated because of smoking, and might represent an initial stage in the development of COPD.

     

Hospital Readmissions with Exacerbation of Obstructive Pulmonary Disease in Illicit Drug Smokers

Purpose

Patients with obstructive pulmonary disease (asthma or chronic obstructive pulmonary disease—COPD) who smoke illicit drugs are at an increased risk of hospital admissions. We compared hospital readmission rates due to exacerbations of obstructive pulmonary disease amongst patients who were current/ex-illicit drug smokers versus current/ex-tobacco smokers.

Methods

We reviewed all the admissions between January 2009 and September 2011 with a presumptive diagnosis of an ‘exacerbation of COPD’ retrospectively from our COPD admission database.

Results

There were 950 sequential hospital admissions in 709 patients over a 33-month period; 250 ex-tobacco smokers, 370 current tobacco smokers and 89 current/ex-illicit drug smokers. Recurrent hospital admission rates with exacerbation of obstructive pulmonary disease were higher in the illicit drug smokers compared with current/ex-tobacco smokers (1.00 versus 0.22/0.26, p < 0.001). Illicit drug smokers were younger [50 versus 72.9/69.9 (mean 71.2) years, p < 0.001] and had shorter length of hospital stay [7.44 versus 9.28/10.69 (mean 9.87) days, p = 0.038]. Illicit drug smokers with FEV₁ < 1 litre (L) had higher readmissions than ex/current tobacco smokers with FEV₁ < 1 L (p < 0.001). Admissions requiring non-invasive ventilation for type 2 respiratory failure were more common in illicit drug smokers (8.4 versus 3 %, p < 0.002).

Conclusion

We have shown that readmission rates in illicit drug smokers with FEV₁ < 1 L are higher than in tobacco smokers. Studies are needed to determine whether targeting these illicit drug users with an intensive community intervention package (to include early therapy, pulmonary rehabilitation) will reduce readmission rates in this often neglected population.     

Dust Is in the Air: Effects of Occupational Exposure to Mineral Dust on Lung Function in a 9-year Study

Background

Occupational mineral dust exposure is a well-known risk factor for numerous respiratory and systemic diseases. The aim of the present longitudinal study was to assess the influence of work-associated dust exposure on spirometric results. Furthermore, the impact of implementation of stricter limit values for occupational contact with quartz dust on lung function was evaluated.

Methods

Anthropometric data (age, gender, BMI), smoking behavior, and lung function parameters (FVC, FEV₁, MEF50) from 7,204 medical examinations of 3,229 female and male workers during the years 2002–2010 were examined following Austrian standards for occupational medicine and the guidelines of the European Respiratory Society. Analysis of data was performed using models of multiple linear regression.

Results

Lung function decrease over time was associated with smoking habits and duration of occupational dust exposure. Specifically, occupational quartz exposure negatively influenced the annual lung function parameters (FVC, ?6.68 ml; FEV₁, ?6.71 ml; and MEF50, ?16.15 ml/s, all p < 0.001). Thus, an overadditive effect of smoking and work-related contact with quartz was found regarding decline in MEF50 (p < 0.05). Implementation of stricter occupational limit values for dust exposure resulted in a highly significant deceleration of the annual decrease in respiratory function (p = 0.001).

Conclusions

Individual smoking habits and occupational dust exposure had a negative impact on lung function. To reduce the risk of loss of respiratory capacity, smoking cessation is especially recommended to workers exposed to quartz dust. Moreover, stricter limit values could prevent chronic occupational damage to the respiratory system.     

Bronchial Responsiveness to Dry Air Hyperventilation in Smokers May Predict Decline in Airway Status Using Indirect Methods

Background

Disabling respiratory symptoms and rapid decline of lung function may occur in susceptible tobacco smokers. Bronchial hyperresponsiveness (BHR) elicited by direct challenge methods predicts worse lung function outcomes. The aim of this study was to evaluate whether BHR to isocapnic hyperventilation of dry air (IHDA) was associated with rapid deterioration in airway status and respiratory symptoms.

Methods

One hundred twenty-eight smokers and 26 age- and sex-matched healthy individuals with no history of smoking were investigated. All subjects completed a questionnaire. Spirometry and impulse oscillometry (IOS) measurements were recorded before and after 4 min of IHDA. The tests were repeated after 3 years in 102 smokers and 11 controls.

Results

Eighty-five smokers (66 %) responded to the challenge with a ≥2.4-Hz increase in resonant frequency (F _res), the cutoff limit defining BHR, as recorded by IOS. They had higher F _res at baseline compared to nonresponding smokers [12.8 ± 3.2 vs. 11.5 ± 3.4 Hz (p < 0.05)] and lower FEV₁ [83 ± 13 vs. 89 ± 13 % predicted (p < 0.05)]. Multivariable logistic regression analysis indicated that wheezing (odds ratio = 3.7, p < 0.01) and coughing (odds ratio = 8.1, p < 0.05) were significantly associated with hyperresponsiveness. An increase in F _res was recorded after 3 years in responding smokers but not in nonresponders or controls. The difference remained when subjects with COPD were excluded.

Conclusions

The proportion of hyperresponsive smokers was unexpectedly high and there was a close association between wheezing and coughing and BHR. Only BHR could discriminate smokers with rapid deterioration of airway status from others.     

Gender-spezifische Unterschiede der Komorbidität bei rheumatoider Arthritis

Background

Comorbidities play an important role in the course and therapy of rheumatoid arthritis (RA). Sex-specific aspects are observed with regard to prevalence and manifestation of RA-related comorbidities.

Aim

A summary of current insights into sex and gender-related aspects of frequent comorbidities in RA is given.

Material and methods

National data were analyzed and literature findings from meta-analyses, observational studies and reviews with regard to gender and RA-associated comorbidities are presented.

Results

There are gender-specific differences in the prevalence of comorbidities of RA. Depression, fibromyalgia and hypothyroidism are more frequent in women than in men, whereas cardiovascular diseases and diabetes are more common in men. Osteoarthritis and osteoporosis are frequent in both sexes.

Conclusion

Sex and gender-specific aspects should be taken into consideration in the diagnostics and treatment of RA-related comorbidities.     

Relationship of Serum Gamma-Glutamyltransferase Levels with Pulmonary Function and Chronic Obstructive Pulmonary Disease

Background

Gamma-glutamyltransferase (GGT) levels within the normal reference range, possibly a biomarker of oxidative stress and/or exposure to various environmental chemicals, are associated with pulmonary function. However, it is unclear whether it is totally independent of cigarette smoking. Also, the potential interaction between serum GGT and cigarette smoking has not ever been evaluated. Therefore, this study investigated (1) whether serum GGT levels are associated with pulmonary function and chronic obstructive pulmonary disease (COPD), independent of cigarette smoking, and (2) whether there is any interaction between serum GGT and cigarette smoking status on pulmonary function.

Methods

The study subjects were 4,583 participants aged ≥40 in the 2010–2011 Korean National Health and Nutrition Examination Survey. The outcomes were pulmonary function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]) and spirometrically defined COPD.

Results

After adjusting for potential confounders, including cigarette smoking, serum GGT levels were inversely associated with FEV1 and FVC in both genders and positively associated with the risk of COPD in men (all P values <0.01). In men, adjusted odds ratios of COPD were 1.0, 1.69, 1.97, and 2.02 across the quartiles of GGT level (P _trend = 0.002). However, the associations between serum GGT and pulmonary function seemed to differ depending on the smoking status; inverse associations of GGT with FEV1 % and FVC % were clearly observed only among non-current smokers.

Conclusions

In conclusion, in non-smokers serum GGT levels can be used to detect individuals at high risk of decreased pulmonary function and/or COPD.     

Overexpression of RAGE Contributes to Cigarette Smoke-Induced Nitric Oxide Generation in COPD

Background

Receptor for advanced glycation end products (RAGE), a multiple-ligands receptor, is implicated in chronic obstructive pulmonary disease (COPD). This study was designed to investigate the potential role of RAGE in nitric oxide (NO) generation, an endogenous marker of nitrosative stress in COPD.

Methods

Lung tissues from COPD patients were used to describe the relationship between RAGE expression and NO level. RAGE expression was assessed by immunohistochemistry, western blot, and ELISA. Human bronchial epithelial cells (16HBE) were cultured with cigarette smoke extract (CSE). Neutralizing antibody against RAGE was used to detect the role of RAGE in CSE-induced NO generation by 16HBE cells.

Results

Compared with nonsmoker controls, overexpression of RAGE was significantly detected in COPD smokers (p < 0.01), but not healthy smokers and nonsmokers with COPD, which was dominantly expressed at bronchiolar epithelia. Correlation analysis showed that RAGE in COPD smokers was positively related to NO level, smoking status, and lung function decline. In cultured 16HBE cells treated with CSE, soluble RAGE was reduced; however, full-length RAGE was enhanced significantly as the same trend as NO generation. Moreover, increased NO level and NO synthase activity, decreased total glutathione (a major cellular antioxidant), enhanced nuclear translocation of p65 (a key molecule of nuclear factor (NF)-κB) and release of NF-κB-dependent proinflammatory cytokines were all reversed by pretreatment of anti-RAGE antibody.

Conclusions

These findings suggest that overexpression of RAGE contributes to CS-induced NO generation in COPD with involvement in NF-κB activation.     

Response–Dose Ratio is a Surrogate of Cumulative Provocative Dosage for Bronchial Provocation Tests in Asthma

Background

Response–dose ratio (RDR) and cumulative provocative dosage (PD) are useful indices reflecting airway responsiveness in asthma.

Objectives

To compare the diagnostic value of RDR and PD, by conducting leukotriene D₄ (LTD₄-BPT) and methacholine bronchial provocation test (MCh-BPT), in different asthma control levels.

Methods

Healthy subjects and asthmatic patients underwent LTD₄-BPT and MCh-BPT, at 2–14-day interval. This entailed assessment of the distribution characteristics, correlation, and diagnostic value of PD inducing 20 % fall in forced expiratory volume in one second (PD₂₀FEV₁) and the RDR, defined as FEV₁ fall (%) at the final step divided by the corresponding provocative dosage.

Results

Twenty uncontrolled, 22 partly controlled, 20 controlled asthmatics, and 21 healthy subjects were enrolled. Log₁₀RDR was positively correlated with log₁₀PD₂₀FEV₁ in both BPTs (all P < 0.05). Poorer asthma control was associated with significantly lower PD₂₀FEV₁ and higher RDR (both P < 0.05). The differences in PD₂₀FEV₁ and RDR between partly controlled and controlled asthma were unremarkable (both P > 0.05). Compared with log₁₀PD₂₀FEV₁, the log₁₀RDR yielded similar diagnostic values in both BPTs. A lower percentile of RDR (≤25th percentile) was associated with higher baseline FEV₁ (P < 0.05) and an increased proportion of well-controlled asthmatic patients. The combination of RDR and PD₂₀FEV₁ led to an increased diagnostic value compared with either parameter alone.

Conclusions

RDR is a surrogate of PD₂₀FEV₁ for BPTs in asthma. This finding was not modified by different asthma control levels or the types of bronchoprovocants.     

Dose-dependent effect of smoking on risk of coronary heart disease,heart failure and stroke in individuals with type 1 diabetes

Aims/hypothesis

The aim of this study was to assess the potential dose-dependent effects of smoking on the risk of CHD, heart failure and stroke in individuals with type 1 diabetes.

Methods

The study included 4506 individuals with type 1 diabetes who were participating in the Finnish Diabetic Nephropathy (FinnDiane) study. Intensity of smoking was estimated by packs per day and cumulative smoking by pack-years. Cox regression analyses were used to estimate the risk of incident CHD, heart failure or stroke during follow-up.

Results

One pack per day significantly increased the risk of incident CHD in current smokers compared with never smokers (HR 1.45 [95% CI 1.15, 1.84]), after adjustment for age, sex, HbA_1c, hypertension, duration of diabetes and BMI. The risk of CHD in former smokers was similar to the risk in never smokers. The risk of incident heart failure was 1.43 (95% CI 1.03, 1.97) in current smokers per one pack per day and 1.37 (95% CI 1.05, 1.77) in former smokers, while the risk of incident stroke was 1.70 (95% CI 1.26, 2.29) and 1.49 (95% CI 1.14, 1.93), respectively. After further adjustments for lipids, however, the difference in the risk of heart failure in current and former smokers was no longer significant. Cumulative smoking data were similar to smoking intensity data.

Conclusions/interpretation

There is a dose-dependent association between smoking and cardiovascular disease in individuals with type 1 diabetes. In men in particular, the risk of incident stroke remains high even after smoking cessation and is increased in current and former smokers independently of other risk factors.

     

Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in smokers

Introduction

The aim of this study was to evaluate the relationship between cigarette smoking and atrial rhythm disorders with the use of noninvasive methods.

Methods

The study population consisted of 50 healthy volunteer smokers and 40 healthy volunteer non-smokers who had normal echocardiographic parameters and similar sex and age profiles. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG. Left ventricle (LV) end-systolic and end-diastolic diameters, LV ejection fraction, and interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography.

Results

Isovolumetric relaxation time and deceleration time were significantly higher (91.5?±?11 vs. 82.35?±?8.6, p?p?p?=?0.003). There were no significant differences between the groups with respect to Sm and Em values, Am value, and E/A and E/Em ratios. However, the Em/Am ratio was significantly lower in smokers (1.28?±?0.21 vs. 1.44?±?0.33, p?p?p?r?=?0.567, p?r?=?0.653, p?=?0.001).

Conclusion

We have demonstrated the relationship between inter- and intraatrial electromechanical delay and PWD. These parameters may be useful predictive markers for the development of AF in the asymptomatic period before cardiac rhythm disturbances occur. This finding may indicate that smokers have an increased risk of developing atrial rhythm disturbances.     

The Effect of Quitting Smoking on Costs and Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease: A Comparison of Current Smokers Versus Ex-Smokers in Routine Clinical Practice

Purpose

Chronic obstructive pulmonary disease (COPD) is a prevalent condition mainly related to smoking, which is associated with a substantial economic burden. The purpose was to compare healthcare resource utilization and costs according to smoking status in patients with COPD in routine clinical practice.

Methods

A retrospective cohort nested case–control study was designed. The cohort was composed of male and female COPD outpatients, 40 years or older, covered by the Badalona Serveis Assistencials (a health provider) health plan. Cases were current smokers with COPD and controls (two per case) were former smokers with COPD (at least 12 months without smoking), matched for age, sex, duration of COPD, and burden of comorbidity. The index date was the last visit recorded in the database, and the analysis was performed retrospectively on healthcare resource utilization data for the 12 months before the index date.

Results

A total of 930 COPD records were analyzed: 310 current and 620 former smokers [mean age 69.4 years (84.6 % male)]. Cases had more exacerbations, physician visits of any type, and drug therapies related to COPD were more common. As a consequence, current smokers had higher average annual healthcare costs: €3,784 (1,888) versus €2,302 (2,451), p < 0.001. This difference persisted after adjusting for severity of COPD.

Conclusions

Current smokers with COPD had significantly higher use of healthcare resources, mainly COPD drugs and physician visits, compared with former smokers who had abstained for at least 12 months. As a consequence, current smokers had higher healthcare costs to the National Health System in Spain than ex-smokers.     

Expression of Matrix Metalloproteinase-1 in Alveolar Macrophages,Type II Pneumocytes,and Airways in Smokers: Relationship to Lung Function and Emphysema

Background

An imbalance between proteolytic enzymes and their inhibitors is thought to be involved in the pathogenesis of chronic obstructive pulmonary disease. Matrix metalloproteinase-1, also known as interstitial collagenase, has been implicated as a potentially important proteinase in the genesis of chronic obstructive pulmonary disease and, more specifically, emphysema.

Methods

We performed quantitative immunohistochemical assessment of matrix metalloproteinase-1 expression in the resected lung of 20 smokers/ex-smokers who had varying severity of airflow obstruction and emphysema and compared this with the lungs of 5 nonsmokers. Emphysema was measured using a morphometric measure of the lungs’ surface area/volume ratio and with qualitative and quantitative computed tomography (CT) measures of emphysema.

Results

There were significantly more matrix metalloproteinase-1-expressing alveolar macrophages and type II pneumocytes as well as a greater percentage of small airways that stained positively for matrix metalloproteinase-1 in the lungs of smokers than in those of nonsmokers (p < 0.0001, p < 0.0001, and p = 0.0003, respectively). The extent of staining of type II pneumocytes and airways for matrix metalloproteinase-1 was significantly related to the extent of smoking (p = 0.012 and p = 0.013, respectively). In addition, the extent of matrix metalloproteinase-1 staining of alveolar macrophages was related to the lung surface area/volume ratio and to qualitative estimates of emphysema on CT.

Conclusion

These findings suggest that cigarette smoking increases expression of matrix metalloproteinase-1 in alveolar macrophages as well as in alveolar and small airway epithelial cells. Smokers who develop emphysema have increased alveolar macrophage expression of matrix metalloproteinase-1.     

A randomized controlled trial to assess the efficacy of tiotropium in Canadian patients with chronic obstructive pulmonary disease

BACKGROUND:

Patients with chronic obstructive pulmonary disease (COPD) who smoke have a greater annual rate of decline in forced expiratory volume in 1 s (FEV₁) than those patients who have stopped smoking.

OBJECTIVES:

To assess the effect of tiotropium on pre-dose (trough) FEV₁ in patients with COPD followed in Canada.

METHODS:

A total of 913 patients were randomly assigned to receive either tiotropium 18 μg once daily (n=608) or placebo (usual care minus inhaled anticholinergics) (n=305) for 48 weeks in the present randomized, double-blind, parallel-group study. The effect of tiotropium on measurements of lung function (FEV₁, FEV₆ and forced vital capacity), symptoms, health-related quality of life (St George’s Respiratory Questionnaire) and exacerbations were examined.

RESULTS:

Tiotropium improved trough FEV₁ in both current and ex-smokers compared with placebo. Baseline FEV₁ in smokers and ex-smokers was 1.03 L and 0.93 L, respectively (P<0.001). At week 48, the mean difference between the tiotropium and placebo groups was 0.14±0.04 L (P<0.001) in the smoker group and 0.08±0.02 L (P<0.0001) in the ex-smoker group. Tiotropium also significantly improved trough forced vital capacity and FEV₆ compared with placebo throughout the treatment period (P<0.05, for all). Furthermore, tiotropium significantly improved the St George’s Respiratory Questionnaire total score compared with placebo at week 48 (40.9 versus 43.7 units, P<0.005).

CONCLUSIONS:

Compared with the placebo group, tiotropium provides sustained improvements in lung function in patients with COPD, with improvements for smokers and ex-smokers.     

Smoking Status and Incidence of Cancer After Myocardial Infarction: A Follow-Up Study of over 20 Years

Objectives

We evaluated long-term incidence of cancer after myocardial infarction among current, former, and never smokers, and assessed whether reducing cigarette consumption is associated with decreased cancer risk.

Risk of Chronic Bronchitis in Twin Pairs Discordant for Smoking

Background

It is well known that smoking is a major risk factor for lung disease and respiratory symptoms. We examined the association between smoking and the risk of chronic bronchitis in a large twin sample.

Methods

In a population-based questionnaire study of 13,649 twins, aged 50–71?years, from the Danish Twin Registry, we identified 1,146 twin pairs, discordant for a lifetime history smoking. We performed co-twin control analysis to examine the impact of smoking on the risk of chronic bronchitis.

Results

The prevalence of chronic bronchitis was 9.7?%. In the total sample, high age, living without a spouse, and smoking remained statistically significant predictors with an up to tenfold increased risk of chronic bronchitis in the heaviest smokers compared with never-smokers, after multivariate adjustment. Among twin pairs discordant for smoking, chronic bronchitis was significantly more common in the smoking twin compared with the nonsmoking co-twin. There was no differential effect of smoking on the risk of chronic bronchitis in monozygotic and dizygotic twins.

Conclusions

The risk of chronic bronchitis increases with age and increasing tobacco consumption. The results indicate a direct relationship between smoking and development of chronic bronchitis, but other environmental factors, such as exposure to household smoking in childhood and living without a spouse, also play a role.     

Effect of Heliox- and Air-Driven Nebulized Bronchodilator Therapy on Lung Function in Patients with Asthma

Background

This study compares the effect of heliox-driven to that of air-driven bronchodilator therapy on the pulmonary function test (PFT) in patients with different levels of asthma severity.

Methods

One-hundred thirty-two participants were included in the study. Participants underwent spirometry twice with bronchodilator testing on two consecutive days. Air-driven nebulization was used one day and heliox-driven nebulization the other day in random order crossover design. After a baseline PFT, each participant received 2.5 mg of albuterol sulfate nebulized with the randomized driving gas. Post bronchodilator PFT was repeated after 30 min. The next day, the exact same protocol was repeated, except that the other driving gas was used to nebulize the drug. Participants were subgrouped and analyzed according to their baseline FEV₁ on day 1: Group I, FEV₁ ≥80 %; Group II, 80 % > FEV₁ > 50 %; Group III, FEV₁ ≤50 %. The proportion of participants with greater than 12 % and 200-mL increases from their baseline FEV₁ and the changes from baseline in PFT variables were compared between heliox-driven versus air-driven bronchodilation therapy.

Results

The proportion of participants with >12 % and 200-mL increases from their baseline FEV₁ with air- or heliox-driven bronchodilation was not different with respect to the proportion of participants with baseline FEV₁ ≥80 % (20 vs. 18 %, respectively) and 80 % > FEV₁ > 50 % (36 vs. 43 %, respectively), but it was significantly greater with heliox-driven bronchodilation in participants with FEV₁ ≤50 % (43 vs. 73 %, respectively; p = 0.01). Changes from baseline FVC, FEV₁, FEV₁/FVC, FEF_25–75 %, FEF_max, FEF_25 %, FEF_50 %, and FEF_75 % were significantly larger with heliox-driven versus air-driven bronchodilation in participants with baseline FEV₁ ≤50 %.

Conclusion

Improvements in PFT variables are more frequent and profound with heliox-driven compared to air-driven bronchodilator therapy only in asthmatic patients with baseline FEV₁ ≤50 %.     

Predictors of cardiovascular disease in asthma and chronic obstructive pulmonary disease

Background

Cardiovascular disease (CVD) is a common comorbidity in patients with chronic airway obstruction, and is associated with systemic inflammation and airway obstruction. The aim of this study was to evaluate the predictors of CVD in two different conditions causing chronic airway obstruction, asthma and COPD.

Methods

Lung function tests, clinical and echocardiographic data were assessed in 229 consecutive patients, 100 with asthma and 129 with COPD. CVD was classified into: pressure overload (PO) and volume overload (VO). Sub-analysis of patients with ischemic heart disease (IHD) and pulmonary hypertension (PH) was also performed.

Results

CVD was found in 185 patients (81%: 51% COPD and 30% asthmatics) and consisted of PO in 42% and of VO in 38% patients. COPD patients, as compared to asthmatics, had older age, more severe airway obstruction, higher prevalence of males, of smokers, and of CVD (91% vs 68%), either PO (46% vs 38%) or VO (45% vs 30%). CVD was associated with older age and more severe airway obstruction both in asthma and COPD. In the overall patients the predictive factors of CVD were age, COPD, and male sex; those of PO were COPD, BMI, VC, FEV₁ and MEF₅₀ and those of VO were age, VC and MEF₅₀. In asthma, the predictors of CVD were VC, FEV₁, FEV₁ /VC%, and PaO₂, those of PO were VC, FEV₁ and FEV₁ /VC%, while for VO there was no predictor. In COPD the predictors of CVD were age, GOLD class and sex, those of VO age, VC and MEF₅₀, and that of PO was BMI. Sub-analysis showed that IHD was predicted by COPD, age, BMI and FEV₁, while PH (found only in 25 COPD patients), was predicted by VO (present in 80% of the patients) and FEV₁. In subjects aged 65 years or more the prevalence of CVD, PO and VO was similar in asthmatic and COPD patients, but COPD patients had higher prevalence of males, smokers, IHD, PH, lower FEV₁ and higher CRP.

Conclusions

The results of this study indicate that cardiovascular diseases are frequent in patients with chronic obstructive disorders, particularly in COPD patients. The strongest predictors of CVD are age and airway obstruction. COPD patients have higher prevalence of ischemic heart disease and pulmonary hypertension. In the elderly the prevalence of PO and VO in asthma and COPD patients is similar.