Cured meat consumption, lung function, and chronic obstructive pulmonary disease among United States adults

RATIONALE: Cured meats are high in nitrites. Nitrites generate reactive nitrogen species that may cause nitrative and nitrosative damage to the lung resulting in emphysema. OBJECTIVE: To test the hypothesis that frequent consumption of cured meats is associated with lower lung function and increased odds of chronic obstructive pulmonary disease (COPD). METHODS: Cross-sectional study of 7,352 participants in the Third National Health and Nutrition Examination Survey, 45 years of age or more, who had adequate measures of cured meat, fish, fruit, and vegetable intake, and spirometry. RESULTS: After adjustment for age, smoking, and multiple other potential confounders, frequency of cured meat consumption was inversely associated with FEV(1) and FEV(1)/FVC but not FVC. The adjusted differences in FEV(1) between individuals who did not consume cured meats and those who consumed cured meats 1 to 2, 3 to 4, 5 to 13, and 14 or more times per month were -37.6, -11.5, -42.0, and -110 ml, respectively (p for trend < 0.001). Corresponding differences for FEV(1)/FVC were -0.91, -0.54, -1.13, and -2.13% (p for trend = 0.001). These associations were not modified by smoking status. The multivariate odds ratio for COPD (FEV(1)/FVC 相似文献   

Association between soft drink consumption and asthma and chronic obstructive pulmonary disease among adults in Australia

Background and objective: The aim of this study was to examine the association between soft drink consumption and self‐reported doctor‐diagnosed asthma and COPD among adults living in South Australia. Methods: Data were collected using a risk factor surveillance system. Each month a representative random sample of South Australians were selected from the electronic White Pages and interviews were conducted using computer‐assisted telephone interviewing (CATI). Results: Among 16 907 participants aged 16 years and older, 11.4% reported daily soft drink consumption of more than half a litre. High levels of soft drink consumption were positively associated with asthma and COPD. Overall, 13.3% of participants with asthma and 15.6% of those with COPD reported consuming more than half a litre of soft drink per day. By multivariate analysis, after adjusting for socio‐demographic and lifestyle factors, the odds ratio (OR) for asthma was 1.26 (95% confidence interval (CI): 1.01–1.58) and the OR for COPD was 1.79 (95% CI: 1.32–2.43), comparing those who consumed more than half a litre of soft drink per day with those who did not consume soft drinks. Conclusions: There was a positive association between consumption of soft drinks and asthma/COPD among adults living in South Australia.     

Alcohol consumption and chronic obstructive pulmonary disease

This study examined the relationship between lifetime alcohol consumption and respiratory symptoms in 195 subjects (including 111 alcoholics) and FEV1 level in 165 subjects (including 91 alcoholics). After adjustment for age and cigarette smoking status, using multiple logistic regression, lifetime alcohol consumption was a significant predictor of chronic cough and chronic phlegm, but not of any wheeze or persistent wheeze. Multiple linear regression analysis indicated that lifetime alcohol consumption was also a predictor of lower levels of FEV1 in a model that included age, pack-years of cigarette smoking, and an interaction between alcohol consumption and pack-years. The interaction between smoking and alcohol consumption was in a direction opposite to the independent effects of alcohol and smoking, suggesting a protective effect of alcohol with heavier amounts of smoking. Additional study is needed to further assess the relationship between respiratory symptoms and alcohol consumption, and between pulmonary function and alcohol consumption.     

Utilization of health care services by patients with chronic obstructive pulmonary disease

In order to identify healthcare resource use patterns associated with chronic obstructive pulmonary disease (COPD), resource utilization (RU) data collection was integrated into a randomized, double-blind placebo-controlled study of Viozan™ (sibenadet HCI). This study enrolled patients with symptomatic, smoking-related COPD, randomized to receive sibenadet or placebo for a 52-week treatment period. A questionnaire establishing typical pre-trial, COPD, randomized to RU was completed by each patient. Subsequent data were collected by means of an Interactive Voice Response System (IVRS) at 30-day intervals (14 time points) during the study and in the follow-up period. The IVRS system facilitated data collection and minimized inconvient to the patients. Subsequent data were collected by means of an Interactive Voice Response System health services during the year-long study was high.No overall trend for lower RU was associated with sibenadet therapy, which correlates with the lack of sustained clinical effect seen in studies conducted concurrently. These data do, however, provide valuable information on RU associated with COPD and insights into adjustments associated with changes in disease course. Physicians were seen to be the most common source of care for patients with COPD and more of the patients with severe COPD (stage III) than mild (stage I) were seen to utilize the most expensive resources (e.g. inpatient hospital care). For those patients who experienced an exacerbation during the trial (irrespective of treatment group), resource use was increased during the periods when an exacerbation was reported when compared with the periods before or after an exacerbation. The proportion of cases attending the physician doubled and with a trip to the Emergency Room (ER) increased approximately ninefold during the reporting period in which the exacerbation occurred compared with the previous month.This study has shown that use of an IVRS, even in elderly patients, is an effective means of gathering RU data over long periods. The study findings suggest that the advent of effective therapeutic interventions, particularly any with the ability to minimize exacerbations and limit disease progression, could impact on the health care services used and potentially reduce associated costs.     

Asthma,chronic obstructive pulmonary disease,and type 2 diabetes in the Women's Health Study

BackgroundChronic airway inflammation in asthma or chronic obstructive pulmonary disease (COPD) may be involved in the pathogenesis of type 2 diabetes; however, prospective data have been limited.MethodsA prospective cohort of 38,570 women who were aged ≥45 years, free of cardiovascular disease and cancer at baseline, and free of diabetes at baseline and in the first 12 months were analyzed. We classified all women into three groups according to the presence and absence of self-reported asthma or COPD (including emphysema, chronic bronchitis, and bronchiectasis).ResultsDuring a median follow-up of 12.2 years, 2472 incident type 2 diabetes events were documented. Women who had ever reported asthma or COPD were associated with an increased diabetes risk; the multivariate RRs were 1.37 (95% CI, 1.20–1.57) for women who had asthma alone and 1.38 (95% CI, 1.14–1.67) for COPD without asthmatic symptoms. Furthermore, these associations were not significantly modified by age, smoking status, physical activity, BMI, alcohol intake, hormone replacement therapy, menopausal status or randomized treatment.ConclusionsAsthma and COPD were individually and independently associated with an increased risk of type 2 diabetes in women, indicating that chronic airway inflammation may contribute to diabetes pathogenesis.     

Presence of in-home caregiver and health outcomes of older adults with chronic obstructive pulmonary disease

OBJECTIVES: To determine whether the presence of in‐home caregivers is associated with changes in the health outcomes of older adults with chronic obstructive pulmonary disease (COPD). DESIGN: Cross‐sectional study. SETTING: Geriatric medical center and academic respiratory clinic in Japan. PARTICIPANTS: Community‐dwelling adults with COPD and their caregivers. MEASUREMENTS: Outcome measures (pulmonary function tests, distance on the 6‐minute walking test (6MWT), activities of daily living (ADLs), quality of life (Medical Outcomes Study 36‐item Short Form Survey and St. George's Respiratory Questionnaire), and frequencies of emergency visits and hospitalizations of those living alone (group A), those living with one caregiver (group B), and those living with two or more caregivers (group C) were compared. RESULTS: Three hundred eighty‐nine participants (315 men and 74 women; mean age 73.3) were enrolled. Mean predicted forced expiratory volume in 1 second was 57.5%. The numbers of participants allocated into the global initiative for chronic obstructive lung disease stages I, II, III, and IV were 105, 107, 122, and 55, respectively. Group A had 87 participants; group B, 125; and group C, 177. Instrumental ADL scores were highest in group A (P<.001), whereas 6MWT distance was longest in group B and shortest in group A. The frequency of emergency visits was highest in group A (P<.001). CONCLUSION: Participants with COPD living alone were higher functioning in terms of instrumental ADLs, but they had less exercise capacity and more‐frequent emergency visits than participants in the in‐home caregiver groups and no difference in hospitalizations.     

Health economics of chronic obstructive pulmonary disease

Studies describing the economic impact of chronic obstructive pulmonary disease (COPD) are used for several purposes. There can, however, be limitations as costs based on results of a clinical trial are likely to be significantly different from real world practice. Sometimes, it may be more useful to capture the costs of the important components accurately rather than the often unachievable aim of capturing every cost however small. Burden of illness studies can help identify clinical targets or patterns of care-for example, hospitalization-that are major health care cost drivers. In the United Kingdom, burden of COPD studies suggest an annual cost of 781 pounds sterlings- 1,154 pounds sterlings per patient. Cost analyses can be divided into four types: cost minimization, cost-effectiveness, cost benefit, and cost utility. Utilities such as quality-adjusted life year (QALY) measure the effectiveness of different therapies, and can be obtained in various ways and in different populations, potentially leading to significant differences in the results. Payers often apply cost per QALY thresholds when assessing whether a new therapy should be used or not. In the United Kingdom, it is accepted that there is a sigmoid relationship between the cost per QALY and the likelihood of a therapy being recommended, with a lower inflection between 5,000 pounds sterlings and 15,000 sterlings, below which rejection is unlikely and an upper inflection between 25,000 pounds sterlings and 35,000, above which acceptance is unlikely, but not impossible. On this basis, pulmonary rehabilitation and inhaled steroids are unlikely to be rejected but lung volume reduction surgery may be.     

Bronchodilator reversibility in Australian adults with chronic obstructive pulmonary disease

Abstract Background and aims: Bronchodilator reversibility (BDR) and inhaled corticosteroid (ICS) use were assessed for volunteers who responded to an advertisement requesting current or ex‐smokers who were experiencing breathlessness to attend for lung function testing. Methods: One hundred and fifty‐four volunteers responded. Forced expiratory volume (FEV₁) was measured before and after 400 µg of salbutamol. Significant BDR was assessed according to guidelines of: (i) the American Thoracic Society (≥12% plus 200 mL of baseline FEV₁ or forced vital capacity), (ii) the British ­Thoracic Society (BTS) (≥15% plus 200 mL of baseline FEV₁), (iii) the European Thoracic Society (≥10% predicted FEV₁), and (iv) the most commonly used criteria in Australia and New Zealand (≥15% of baseline FEV₁). Results: One hundred and twenty‐three subjects (33 female; 40 current smokers; median pack years 48 (range 5?144)) were suitable for analysis (i.e. had no history of asthma, demonstrable airflow limitation and a forced expiratory ratio (FER) of <70%). Twenty (16%) patients had an FEV₁ within the normal range but FER of <70%, 24 (20%) patients had mild disease (FEV₁ 60?80% predicted), 31 (24%) patients had moderate disease (FEV₁ 40?59% predicted), and 48 (39%) patients had severe disease (FEV₁ <40% predicted), according to BTS criteria. Significant BDR was evident in: (i) 58 (47%) subjects by American criteria, (ii) 26 (21%) subjects by British criteria, (iii) 19 (15%) subjects by European criteria and (iv) 36 (29%) subjects by Australasian criteria. ICS use was reported by 71 (58%) subjects overall and was weakly, but significantly, related to poorer FEV₁ (r = ?0.2; P < 0.01), and greater BDR (r = 0.3; P < 0.005). Conclusion: Chronic obstructive pulmonary disease in Australian volunteers with no history of asthma encompasses many individuals with significant BDR. Interestingly, most volunteers reported ICS use and this was related to poorer spirometry and greater BDR. However, until the underlying immuno­pathology has been determined they cannot be assumed to have ‘asthma’ or even an ‘asthmatic element’. (Intern Med J 2003; 33: 572?577)     

慢性阻塞性肺疾病患者合并肺部真菌感染的综合护理

慢性阻塞性肺疾病（chronic obstructive pulmonary diseases,COPD）是一组气流受限的慢性支气管炎和/或肺气肿的呼吸系统疾病,气流受限呈不完全可逆,进行性发展.COPD常引起呼吸道黏膜清除功能下降,从而导致患者机体免疫力下降,使真菌容易增生.为了探讨COPD患者合并肺部真菌感染的护理对策,现回顾我科从2010年1月至2014年1月收治的57例COPD合并肺部真菌感染患者的护理情况,报道如下.     

Health care utilization in chronic obstructive pulmonary disease. A case-control study in a health maintenance organization

BACKGROUND: Information about health care utilization and costs among patients with chronic obstructive pulmonary disease (COPD) is needed to improve care and for appropriate allocation of resources for patients with COPD (COPD patients or cases) in managed care organizations. METHODS: Analysis of all inpatient, outpatient, and pharmacy utilization of 1522 COPD patients continuously enrolled during 1997 in a 172,484-member health maintenance organization. Each COPD case was matched with 3 controls (n = 4566) by age (+/-5 years) and sex. Information on tobacco use and comorbidities was obtained by chart review of 200 patients from each group. RESULTS: Patients with COPD were 2.3 times more likely to be admitted to the hospital at least once during the year, and those admitted had longer average lengths of stay (4.7 vs 3.9 days; P<.001). Mean costs per case and control were $5093 vs $2026 for inpatient services, $5042 vs $3050 for outpatient services, and $1545 vs $739 for outpatient pharmacy services, respectively (P<.001 for all differences). Patients with COPD had a longer smoking history (49.5 vs 34.9 pack-years; P =.002) and a higher prevalence of smoking-related comorbid conditions and were more likely to use cigarettes during the study period (46.0% vs 13.5%; P<.001). CONCLUSIONS: Health care utilization among COPD patients is approximately twice that of age- and sex-matched controls, with much of the difference attributable to smoking-related diseases. In this health maintenance organization, inpatient costs were similar to and outpatient costs were much higher than national averages for COPD patients covered by Medicare.     

Oxygen consumption and transport in stable patients with chronic obstructive pulmonary disease

We studied the relationship between oxygen consumption and systemic oxygen transport in 30 clinically stable patients with chronic obstructive pulmonary disease (COPD) before and after increasing oxygen transport by passive leg elevation to raise the cardiac output. Results were compared with those observed in 10 patients with silicosis. The effect of leg elevation on oxygen consumption was also studied in 12 normal subjects. Oxygen consumption was measured by a closed circuit system, cardiac output by the direct Fick method, and arterial oxygen content by a cooximeter. Supine oxygen consumption was correlated with oxygen transport in patients with COPD (r = 0.50, p less than 0.01), and with leg elevation transport increased from a mean of 516 +/- 23 (SEM) to 567 +/- 26 ml X min-1 X m-2 and consumption increased from a mean of 136 +/- 3 to 148 +/- 4 ml X min-1 X m-2 (both p less than 0.01). In patients with silicosis, leg elevation raised mean oxygen transport from 620 +/- 40.0 to 745 +/- 54.0 ml X min-1 X m-2 and mean consumption from 161 +/- 6 to 192 +/- 6 ml X min-1 X m-2 (both p less than 0.01). In normal subjects, no change in oxygen consumption was observed with leg elevation (154 +/- 8 to 152 +/- 6 ml X min-1 X m-2).(ABSTRACT TRUNCATED AT 250 WORDS)     

Health status deterioration in patients with chronic obstructive pulmonary disease

This study examined health status decline in patients with chronic obstructive pulmonary disease (COPD). Data are from the Inhaled Steroids in Obstructive Lung Disease (ISOLDE) trial. After an 8-wk run-in, 751 patients (566 male), mean age 64 yr, were randomized to receive fluticasone propionate (FP) 500 microg twice daily (376 patients) or placebo (375 patients). Mean baseline postbronchodilator FEV1 was 50 +/- 15% predicted. Patients completed the St George's Respiratory Questionnaire (SGRQ) and the Short-Form 36 (SF-36) at baseline and every 6 mo for 3 yr. FEV1 and smoking status were assessed at baseline and at 3-mo intervals. A total of 387 (212 FP) patients completed the trial. All SGRQ components (p = 0.03 to 0.004) and Physical Function, Mental Health, Energy/ Vitality, and Physical Role Limitation scales of the SF-36 (p = 0.05 to 0.005) deteriorated faster in the placebo group. FEV1 and SGRQ scores correlated at baseline values (r = -0.25, p < 0.0001), as did change in FEV1 and change in SGRQ (Delta r = -0.24, p < 0.0001). At baseline values smokers had worse SGRQ Total, Symptoms, and Impacts scores than ex-smokers. This difference was maintained throughout the study. Smoking status did not influence the rate of decline in health status. The SGRQ Total scores of FP-treated patients took 59% longer than placebo to deteriorate by a clinically significant amount. We conclude that health status decline in moderate to severe COPD can be reduced by high-dose fluticasone.     

Prevalence of chronic obstructive pulmonary disease among stable chronic disease subjects in primary care in Trinidad, West Indies

The prevalence of COPD in the Caribbean is uncertain. Spirometric indices were assessed at chronic disease clinics in 353 subjects (African, 66; East Indian, 198; 109 male), mean age 56.51 years (non-COPD) vs 59.30 years (COPD). 77 (21.8%) patients had COPD. 33.3% of COPD subjects had chronic cough vs 19.7% of subjects without COPD. A history of at least one chest infection was related to low FEV1 (P=0.005). In subjects presenting with vascular disease the FVC was reduced when compared to other subjects. Prevalence of COPD is 21.8%. A history of chest infections is related to decreased FEV1%.