Showing papers by "Josep M. Antó published in 2013"

Echocardiographic abnormalities in patients with COPD at their first hospital admission

Abstract: Cardiovascular disease accounts for significant morbidity and mortality in chronic obstructive pulmonary disease (COPD). Its prevalence and mechanisms of association have not been elucidated. The study aimed to assess the prevalence of echocardiographic abnormalities and potential risk factors in patients with COPD at their first exacerbation requiring hospital admission. Transthoracic echocardiography was prospectively performed in 342 patients (forced expiratory volume in 1 s 52 ± 16% predicted) 3 months after discharge. Significant cardiac alterations were present in 64% of patients; 27% left- and 48% right-heart disorders. The most common were right ventricle enlargement (30%) and pulmonary hypertension (19%). Left ventricle enlargement was present in 6%, left ventricle systolic dysfunction in 13%, left ventricle diastolic impairment in 12% and left atrial dilatation in 29%. Echocardiographic abnormalities were unrelated to COPD severity and were more frequent in patients with self-reported cardiac disease. They were also observed in 63% of patients with no known cardiac disease or cardiovascular risk factors other than smoking. We conclude that cardiac abnormalities are highly prevalent in COPD patients at the time of their first severe exacerbation, even in the absence of established cardiac disease or cardiovascular risk factors. Considering the prognostic and therapeutic implications of cardiac comorbidity, echocardiography should be considered in the assessment of patients with clinically significant COPD.

Ten-Year Follow-up of Cluster-based Asthma Phenotypes in Adults A Pooled Analysis of Three Cohorts

Abstract: Rationale: The temporal stability of adult asthma phenotypes identified using clustering methods has never been addressed. Longitudinal cluster-based methods may provide novel insights in the study ...

Physical activity in COPD patients : Patterns and bouts

Abstract: The present study aims to describe the pattern of physical activity and the frequency, duration and intensity of physical activity bouts in patients with chronic obstructive pulmonary disease (COPD), to assess how these patterns differ according to COPD severity, and to explore whether these patients meet the general guidelines for physical activity for older adults. 177 patients (94% male, mean±sd age 71±8 years and forced expiratory volume in 1 s 52±16% predicted) wore the SenseWear Pro2 Armband accelerometer for eight consecutive days. Physical activity bouts were defined as periods of ≥10 min above 1.5 metabolic equivalent tasks and classified according to their median intensity. Patients engaged in activity a median of 153 min·day(-1) and 57% of that time was spent in bouts. Median frequencies of bouts per day were four and three for all and moderate-to-vigorous intensities, respectively. With increasing COPD severity, time in physical activity, proportion of time in bouts and frequency of bouts decreased. 61% of patients fulfilled the recommended physical activity guidelines. In conclusion, COPD patients of all spirometric severity stages engage in physical activity bouts of moderate-to-vigorous intensities. Patients with severe and very severe COPD perform their daily activities in fewer and shorter bouts than those in mild and moderate stages.

The influence of sensitisation to pollens and moulds on seasonal variations in asthma attacks

Abstract: No large study has described the seasonal variation in asthma attacks in population-based asthmatics in whom sensitisation to allergen has been measured. 2,637 young adults with asthma living in 15 countries reported the months in which they usually had attacks of asthma and had skin-prick tests performed. Differences in seasonal patterns by sensitisation status were assessed using generalised estimating equations. Most young adults with asthma reported periods of the year when their asthma attacks were more common (range: 47% in Sweden to 86% in Spain). Seasonal variation in asthma was not modified by sensitisation to house dust mite or cat allergens. Asthmatics sensitised to grass, birch and Alternaria allergens had different seasonal patterns to those not sensitised to each allergen, with some geographical variation. In southern Europe, those sensitised to grass allergens were more likely to report attacks occurred in spring or summer than in winter (OR March/April 2.60, 95% CI 1.70-3.97; OR May/June 4.43, 95% CI 2.34-8.39) and smaller later peaks were observed in northern Europe (OR May/June 1.25, 95% CI 0.60-2.64; OR July/August 1.66, 95% CI 0.89-3.10). Asthmatics reporting hay fever but who were not sensitised to grass showed no seasonal variations. Seasonal variations in asthma attacks in young adults are common and are different depending on sensitisation to outdoor, but not indoor, allergens.

A Framework for Multiple Imputation in Cluster Analysis

Abstract: Multiple imputation is a common technique for dealing with missing values and is mostly applied in regression settings. Its application in cluster analysis problems, where the main objective is to classify individuals into homogenous groups, involves several difficulties which are not well characterized in the current literature. In this paper, we propose a framework for applying multiple imputation to cluster analysis when the original data contain missing values. The proposed framework incorporates the selection of the final number of clusters and a variable reduction procedure, which may be needed in data sets where the ratio of the number of persons to the number of variables is small. We suggest some ways to report how the uncertainty due to multiple imputation of missing data affects the cluster analysis outcomes-namely the final number of clusters, the results of a variable selection procedure (if applied), and the assignment of individuals to clusters. The proposed framework is illustrated with data from the Phenotype and Course of Chronic Obstructive Pulmonary Disease (PAC-COPD) Study (Spain, 2004-2008), which aimed to classify patients with chronic obstructive pulmonary disease into different disease subtypes.

Pooling birth cohorts in allergy and asthma : European Union-funded initiatives - a MeDALL, CHICOS, ENRIECO, and GA²LEN joint paper

Abstract: Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA(2)LEN: Global Allergy and European Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim of this paper is to review current and past EU-funded projects in order to make a summary of their goals and achievements and to suggest future research needs of these European birth cohort networks.

Serum levels of Clara cell secretory protein, asthma, and lung function in the adult general population

Abstract: a Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain b Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, Respiratory and Environmental Epidemiology Team, Villejuif, France c Universite Paris Sud 11, Villejuif, France d IMIM (Hospital del Mar Research Institute), Barcelona, Spain e CIBER Epidemiologia y Salud Publica (CIBERESP), Spain f Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), Hospital del Mar-IMIM, Parc de Recerca Biomedica de Barcelona (PRBB), Barcelona, and Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Bunyola, Majorca, Balearic Islands, Spain g Hospital General de Almansa, Complejo Hospitalario Universitario de Albacete, Spain, and the Unit of Epidemiology and Health Information, Public Health of Bizkaia, Bizkaia, Spain h Department of Health, Basque Government, Bilbao, Basque Country, Spain i Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy j Universitat Pompeu Fabra, Barcelona, Spain k Arizona Respiratory Center, University of Arizona, Tucson, Ariz

Impact of early diagnosis and control of chronic respiratory diseases on active and healthy ageing. A debate at the European Union Parliament.

Abstract: A debate at the European Union Parliament was held on 13 November 2012 on the Impact of early diagnosis and control of chronic respiratory diseases on Active and Healthy Ageing (AHA). The debate was held under the auspices of theCyprus Presidency of the European Union (2012) and represents a follow-up of the priorities of the Polish Presidency of the European Union (2011). It highlighted the importance of early life events on the occurrence of chronic respiratory diseases later in life and their impact on active and healthy ageing. Epidemiologic evidence was followed by actions that should be taken to prevent and manage chronic respiratory diseases in children. The debate ended by practical, feasible and achievable projects, demonstrating the strength of the political action in the field. Three projects will be initiated from this debate: The first will be a meeting sponsored by the Region Languedoc-Roussillon on the developmental origins of chronic diseases and ageing: from research to policies and value creation. The second project is being led by the WHO Collaborating Centre for Asthma and Rhinitis: Prevention of Asthma, Prevention of Allergy (PAPA). The third project is the GA2LEN sentinel network.

Chromosomal bands affected by acute oil exposure and DNA repair errors.

Abstract: Background: In a previous study, we showed that individuals who had participated in oil clean-up tasks after the wreckage of the Prestige presented an increase of structural chromosomal alterations two years after the acute exposure had occurred. Other studies have also reported the presence of DNA damage during acute oil exposure, but little is known about the long term persistence of chromosomal alterations, which can be considered as a marker of cancer risk. Objectives: We analyzed whether the breakpoints involved in chromosomal damage can help to assess the risk of cancer as well as to investigate their possible association with DNA repair efficiency. Methods: Cytogenetic analyses were carried out on the same individuals of our previous study and DNA repair errors were assessed in cultures with aphidicolin. Results: Three chromosomal bands, 2q21, 3q27 and 5q31, were most affected by acute oil exposure. The dysfunction in DNA repair mechanisms, expressed as chromosomal damage, was significantly higher in exposed-oil participants than in those not exposed (p= 0.016). Conclusion: The present study shows that breaks in 2q21, 3q27 and 5q31 chromosomal bands, which are commonly involved in hematological cancer, could be considered useful genotoxic oil biomarkers. Moreover, breakages in these bands could induce chromosomal instability, which can explain the increased risk of cancer (leukemia and lymphomas) reported in chronically benzene-exposed individuals. In addition, it has been determined that the individuals who participated in clean-up of the oil spill presented an alteration of their DNA repair mechanisms two years after exposure.

Serum Total Immunoglobulin E Is a Surrogate of Atopy in Adult-Onset Asthma: A Longitudinal Study

Abstract: Background: Studies have shown that serum total immunoglobulin E (IgE) levels are higher in asthmatics. However, the role of the serum total IgE level, independen

Comorbidity and persistence of allergy-related phenotypes in children in the longitudinal MeDALL study

Abstract: There is evidence in the literature that eczema (E), rhinitis (R) and asthma (A) coexist. It is unknown to what extent this comorbidity could be ascribed to chance or common causal mechanisms. In 12 ongoing European birth cohorts participating in the MeDALL (Mechanisms of the Development of Allergy) consortium, we assessed comorbidities at 4 and 8 years excluding coexistence by chance, the role of sensitization in phenotypic development and the predictive value of single or comorbid phenotypes at 4 years on the presence of comorbid phenotypes at 8 years. A cross-sectional survey on 4 and 8-year-old children (n=22,417 and 18,975 respectively) investigated E, R and A from questionnaires and specific IgE to common allergens. Comorbidity defined as the coexistence of two or three allergy-related phenotypes in the same individual was estimated through the degree to which an observed frequency differs from the expected value due to chance alone. A longitudinal study of 10,099 children with data at both ages assessed persistence and comorbidity of E, R and A, using logistic regression models. The prevalence of having any phenotype (E or R or A or combined phenotypes) was 28% both at 4 and 8 years and the prevalence of comorbid phenotypes, which were more commonly observed than expected, was 4% both at 4 and 8 years. The presence of single and comorbid phenotypes at age 4 years increased the risk of having comorbid phenotypes by age 8 following a strong dose-response pattern, regardless of sensitization status. Coexisting E, R and A in the same children may have a causal relationship. The degree and distribution of the three comorbidities is independent of the presence of sensitization.

Correspondence on the paper by Krauss–Etschmann S, Bush A, Bellusci S, et al.

Abstract: We have read with interest the paper of Krauss–Etschmann et al .1 This is an important contribution to the current understanding of prenatal and early life events impacting chronic respiratory disease development and progression across the life cycle. A major challenge is to combine expertise in human conditions with complementary model systems. Better understanding of these links should allow novel prevention strategies to promote healthy ageing. In its important final message, the authors propose a roadmap for integrative research. Since 2004, several initiatives funded under the EU Framework Programme for Research and Technological Development FP6-FP7 have attempted to identify, compare and evaluate pooling data from existing European birth cohorts with …