Showing papers by "Judith Garcia-Aymerich published in 2019"
01 Jan 2019
TL;DR: Genome-wide analysis of chronic obstructive pulmonary disease identifies 82 loci, 35 of which are new, and integrates gene expression and genomic annotation data shows enrichment of signals in lung tissue, smooth muscle and several lung cell types.
155 citations
Pompeu Fabra University1, Université Paris-Saclay2, University of Porto3, University of Coimbra4, University of Salerno5, University of Bari6, Federal University of Bahia7, University of São Paulo8, Universidade Federal de Santa Catarina9, Mexican Social Security Institute10, Vilnius University11, European Union of Medical Specialists12, Medical University of Łódź13, Medical University of Warsaw14, Heidelberg University15, University of Cologne16, University of Paris17, University of Montpellier18, University of Barcelona19, Medical University of Graz20, Leiden University Medical Center21, University of Amsterdam22, University of Edinburgh23, University of Helsinki24, University of Turku25, National and Kapodistrian University of Athens26, University of Manchester27, University of Crete28, Eskişehir Osmangazi University29, Istanbul University30, Celal Bayar University31, Woolcock Institute of Medical Research32, Monash University33, Ghent University Hospital34, Odense University Hospital35, Karolinska Institutet36, Uppsala University37, Transylvania University38, Saint Louis University39, University of South Florida40, Nova Southeastern University41, McMaster University42, French Institute of Health and Medical Research43
TL;DR: This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible on medication use, disease control, and work productivity in patients with AR.
Abstract: Background: Mobile health can be used to generate innovative insights into optimizing treatment to improve allergic rhinitis (AR) control.Objectives: A cross-sectional real-world observational study was undertaken in 22 countries to complement a pilot study and provide novel information on medication use, disease control, and work productivity in the everyday life of patients with AR.Methods: A mobile phone app (Allergy Diary, which is freely available on Google Play and Apple stores) was used to collect the data of daily visual analogue scale (VAS) scores for (1) overall allergic symptoms; (2) nasal, ocular, and asthma symptoms; (3) work; and (4) medication use by using a treatment scroll list including all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral H-1-antihistamines were studied.Results: Nine thousand one hundred twenty-two users filled in 112,054 days of VASs in 2016 and 2017. Assessment of days was informative. Control of days with rhinitis differed between no (best control), single (good control for intranasal corticosteroid-treated days), or multiple (worst control) treatments. Users with the worst control increased the range of treatments being used. The same trend was found for asthma, eye symptoms, and work productivity. Differences between oral H-1-antihistamines were found.Conclusions: This study confirms the usefulness of the Allergy Diary in accessing and assessing behavior in patients with AR. This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible.
96 citations
TL;DR: ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
Abstract: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted “patient activation”, (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Sante as a Good Practice in the field of digitally-enabled, integrated, person-centred care. In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
72 citations
Uppsala University1, National Institutes of Health2, University of Verona3, Charité4, Oregon Health & Science University5, Humanitas University6, Karolinska Institutet7, Pompeu Fabra University8, Clinical Trial Service Unit9, Medical University of Łódź10, University of British Columbia11, University of Gothenburg12
TL;DR: Bronchodilator reversibility was at least as common in participants with COPD as those with asthma, indicating that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies; however, in asthma, bronchodilic reversibility may be a phenotypic marker.
Abstract: Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and chronic obstructive pulmonary disease (COPD) and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged ≥16 years from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146) and no airway disease (n=31 649). Three definitions for flow-related reversibility (increase in FEV1) and three for volume-related reversibility (increase in FVC) were used. The prevalence of bronchodilator reversibility expressed as increase FEV1 ≥12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR 1.36, 95% CI 1.04–1.79), atopy (OR 1.36, 95% CI 1.04–1.79) and higher exhaled nitric oxide fraction, while in COPD neither flow- nor volume-related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for pre-bronchodilator FEV1. Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. However, in asthma, bronchodilator reversibility may be a phenotypic marker.
67 citations
TL;DR: Higher lean body mass during childhood and adolescence is consistently associated with higher lung function at 15 years in both sexes, whereas higher fat mass is associated with lower levels of only some lung function parameters.
Abstract: Rationale: Body composition changes throughout life may explain the inconsistent associations reported between body mass index and lung function in children.Objectives: To assess the associations o...
29 citations
TL;DR: Higher PA is associated with attenuated decline in lung function and reduced health status (symptoms domain) deterioration in moderate-to-very severe COPD patients.
Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) progression is variable and affects several disease domains, including decline in lung function, exercise capacity, muscle strength, and health status as well as changes in body composition. We aimed to assess the longitudinal association of physical activity (PA) with these a priori selected components of disease progression. Methods: We studied 114 COPD patients from the PAC-COPD cohort (94% male, mean [SD], 70 yr [8 yr] of age, 54 [16] forced expiratory volume in 1 s % predicted) at baseline and 2.6 yr (0.6 yr) later. Baseline PA was assessed by accelerometry. Multivariable general linear models were built to assess the association between PA and changes in lung function, functional exercise capacity, muscle strength, health status, and body composition. All models were adjusted for confounders and the respective baseline value of each measure. Results: Per each 1000 steps higher baseline PA, forced expiratory volume in 1 s declined 7 mL less (P < 0.01), forced vital capacity 9 mL less (P = 0.03) and carbon monoxide diffusing capacity 0.10 mL[middle dot]min-1[middle dot]mm Hg-1 less (P = 0.04), while the St George's Respiratory Questionnaire symptom domain deteriorated 0.4 points less (P = 0.03), per year follow-up. Physical activity was not associated with changes in functional exercise capacity, muscle strength, other domains of health status or body composition. Conclusions: Higher PA is associated with attenuated decline in lung function and reduced health status (symptoms domain) deterioration in moderate-to-very severe COPD patients.
26 citations
University of Grenoble1, University of Verona2, Pompeu Fabra University3, French Institute of Health and Medical Research4, Ludwig Maximilian University of Munich5, Uppsala University6, Swiss Tropical and Public Health Institute7, Lille University of Science and Technology8, University of Bordeaux9, National Institutes of Health10, Paris Diderot University11
TL;DR: This work aimed to estimate risk of poor asthma events between asthma clusters identified 20 years earlier, and confirmed the identification of particular phenotypes confirming phenotypic heterogeneity of asthma.
Abstract: Background Research based on cluster analyses led to the identification of particular phenotypes confirming phenotypic heterogeneity of asthma. The long-term clinical course of asthma phenotypes defined by clustering analysis remains unknown, although it is a key aspect to underpin their clinical relevance. We aimed to estimate risk of poor asthma events between asthma clusters identified 20 years earlier. Methods The study relied on two cohorts of adults with asthma with 20-year follow-up, ECRHS (European Community Respiratory Health Survey) and EGEA (Epidemiological study on Genetics and Environment of Asthma). Regression models were used to compare asthma characteristics (current asthma, asthma exacerbations, asthma control, quality of life, and FEV1 ) at follow-up and the course of FEV1 between seven cluster-based asthma phenotypes identified 20 years earlier. Results The analysis included 1325 adults with ever asthma. For each asthma characteristic assessed at follow-up, the risk for adverse outcomes differed significantly between the seven asthma clusters identified at baseline. As compared with the mildest asthma phenotype, ORs (95% CI) for asthma exacerbations varied from 0.9 (0.4 to 2.0) to 4.0 (2.0 to 7.8) and the regression estimates (95% CI) for FEV1 % predicted varied from 0.6 (-3.5 to 4.6) to -9.9 (-14.2 to -5.5) between clusters. Change in FEV1 over time did not differ significantly across clusters. Conclusion Our findings show that the long-term risk for poor asthma outcomes differed between comprehensive adult asthma phenotypes identified 20 years earlier, and suggest a strong tracking of asthma activity and impaired lung function over time.
25 citations
Pompeu Fabra University1, National Institutes of Health2, Imperial College London3, University of Verona4, Monash University5, Aarhus University6, University of Bergen7, Haukeland University Hospital8, Sahlgrenska University Hospital9, Ludwig Maximilian University of Munich10, University of Tartu11, University of Castilla–La Mancha12, University of Montpellier13, University of Paris14, Uppsala University15, University of Iceland16, University of Turin17, Umeå University18, French Institute of Health and Medical Research19, Paris Diderot University20, University of Pavia21, University of Basel22, Swiss Tropical and Public Health Institute23, University of Melbourne24
TL;DR: Exposure to second-hand smoke may lead to respiratory symptoms, but this is not accompanied by lung function changes, and associations between increase in SHS exposure and incidence of COPD were not apparent.
Abstract: Early life exposure to tobacco smoke has been extensively studied but the role of second-hand smoke (SHS) for new-onset respiratory symptoms and lung function decline in adulthood has not been widely investigated in longitudinal studies. Our aim is to investigate the associations of exposure to SHS in adults with respiratory symptoms, respiratory conditions and lung function over 20 years. We used information from 3011 adults from 26 centres in 12 countries who participated in the European Community Respiratory Health Surveys I-III and were never or former smokers at all three surveys. Associations of SHS exposure with respiratory health (asthma symptom score, asthma, chronic bronchitis, COPD) were analysed using generalised linear mixed-effects models adjusted for confounding factors (including sex, age, smoking status, socioeconomic status and allergic sensitisation). Linear mixed-effects models with additional adjustment for height were used to assess the relationships between SHS exposure and lung function levels and decline. Reported exposure to SHS decreased in all 26 study centres over time. The prevalence of SHS exposure was 38.7% at baseline (1990–1994) and 7.1% after the 20-year follow-up (2008–2011). On average 2.4% of the study participants were not exposed at the first, but were exposed at the third examination. An increase in SHS exposure over time was associated with doctor-diagnosed asthma (odds ratio (OR): 2.7; 95% confidence interval (95%-CI): 1.2–5.9), chronic bronchitis (OR: 4.8; 95%-CI: 1.6–15.0), asthma symptom score (count ratio (CR): 1.9; 95%-CI: 1.2–2.9) and dyspnoea (OR: 2.7; 95%-CI: 1.1–6.7) compared to never exposed to SHS. Associations between increase in SHS exposure and incidence of COPD (OR: 2.0; 95%-CI: 0.6–6.0) or lung function (β: − 49 ml; 95%-CI: -132, 35 for FEV1 and β: − 62 ml; 95%-CI: -165, 40 for FVC) were not apparent. Exposure to second-hand smoke may lead to respiratory symptoms, but this is not accompanied by lung function changes.
21 citations
TL;DR: Mendelian randomisation, an approach not affected by classical confounding, shows that early menopause has a protective effect on airflow obstruction, which points to the importance of investigating the effects of female sex hormones on the airways.
Abstract: In observational studies, early menopause is associated with lower forced vital capacity (FVC) and a higher risk of spirometric restriction, but not airflow obstruction. It is, however, unclear if this association is causal. We therefore used a Mendelian randomisation (MR) approach, which is not affected by classical confounding, to assess the effect of age at natural menopause on lung function.We included 94 742 naturally post-menopausal women from the UK Biobank and performed MR analyses on the effect of age at menopause on forced expiratory volume in 1 s (FEV1), FVC, FEV1/FVC, spirometric restriction (FVC
20 citations
TL;DR: COPD patients demonstrate a significant decrease in PA over 1 year follow-up, which is further affected by hours of rainfall, but not by other climate considerations.
Abstract: Purpose: Longitudinal data on the effect of time and environmental conditions on physical activity (PA) among COPD patients are currently scarce, but this is an important factor in the design of trials to test interventions that might impact on it. Thus, we aimed to assess the effect of time and climate conditions (temperature, day length and rainfall) on progression of PA in a cohort of COPD patients.
Patients and methods: This is a prospective, multicenter, cohort study undertaken as part of the EU/IMI PROactive project, in which we assessed 236 COPD patients simultaneously wearing two activity monitors (Dynaport MiniMod and Actigraph GT3X). A multivariable generalized linear model analysis was conducted to describe the effect of the explanatory variables on PA measures, over three time points (baseline, 6 and 12 months).
Results: At 12 months (n= 157; FEV1% predicted = 57.7 +/- 21.9) there was a significant reduction in all PA measures (Actigraph step count (4284 +/- 3533 vs 3533 +/- 293)), Actigraph moderate- to vigorous-intensity PA ratio (8.8 (18.8) vs 6.1 (15.7)), Actigraph vector magnitude units (374,902.4 (265,269) vs 336,240 (214,432)), MiniMod walking time (59.1 (34.9) vs 56.9 (38.7) mins) and MiniMod PA intensity (0.183 (0) vs 0.181 (0)). Time had a significant, negative effect on most PA measures in multivariable analysis, after correcting for climate factors, study center, age, FEV1% predicted, 6MWD and other disease severity measures. Rainfall was the only climate factor with a negative effect on most PA parameters.
Conclusion: COPD patients demonstrate a significant decrease in PA over 1 year follow-up, which is further affected by hours of rainfall, but not by other climate considerations.
19 citations
National Institutes of Health1, Uppsala University2, University of Verona3, University of Pavia4, University of Grenoble5, Monash University6, Federal University of Paraná7, Pompeu Fabra University8, University of Bergen9, Haukeland University Hospital10, Tartu University Hospital11, University of Castilla–La Mancha12, University of Turin13, Umeå University14, University of Gothenburg15, University of Melbourne16, Ludwig Maximilian University of Munich17, University of Huelva18, University of Antwerp19
TL;DR: Increases in the treatment of asthma over a 20-year period were studied and factors associated with the regular use of inhaled corticosteroid (ICS) treatment were identified, indicating underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma.
Abstract: Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identifie ...
TL;DR: The role of leptin, an adipocyte‐derived proinflammatory protein, as a mediator in the association between body adiposity (assessed using BMI, waist circumference, and body fat percentage) and persistent asthma is investigated.
Abstract: Objective Obesity is a likely risk factor for asthma. However, underlying mechanisms by which obesity affects asthma activity remain poorly understood. This study aimed to investigate the role of leptin, an adipocyte-derived proinflammatory protein, as a mediator in the association between body adiposity (assessed using BMI, waist circumference, and body fat percentage) and persistent asthma. Methods A causal approach to mediation analysis was used to disentangle total and direct effects and the indirect effect mediated by leptin, using data from the French prospective French Epidemiological Study on the Genetics and Environment of Asthma (EGEA) (baseline: 2003-2007; follow-up: 2011-2013; mean follow-up time: 7 years). A total of 331 participants with current asthma at baseline were included. Results Per 1-SD increment in BMI, waist circumference, and body fat percentage, the adjusted odds ratios of the total effect were 1.59 (95% CI: 0.95-2.97), 2.06 (1.06-4.00), and 3.25 (1.01-9.41), respectively; the odds ratios of the indirect effect mediated by leptin were 1.68 (1.09-2.46), 1.55 (0.99-2.57), and 1.99 (0.94-4.83), respectively. Conclusions Leptin partly (> 60%) mediated the association between high body adiposity and persistent asthma over time. Using a newly developed analytic approach, this longitudinal study brought new insight into one mechanism by which obesity may affect asthma activity.
Pompeu Fabra University1, Biomax Informatics AG2, Charité3, Pierre-and-Marie-Curie University4, French Institute of Health and Medical Research5, Odense University Hospital6, Oslo University Hospital7, University of Bologna8, Utrecht University9, Stockholm County Council10, Karolinska Institutet11, University of Bradford12, Paris Descartes University13, Loughborough University14, Centre for Health Protection15
TL;DR: In asthma and allergy birth cohorts, the harmonization of data for pooled analyses is feasible, and high inferential comparability may be achieved, and the MeDALL approach can be used in other collaborative projects.
Abstract: The numbers of international collaborations among birth cohort studies designed to better understand asthma and allergies have increased in the last several years. However, differences in definitions and methods preclude direct pooling of original data on individual participants. As part of the Mechanisms of the Development of Allergy (MeDALL) Project, we harmonized data from 14 birth cohort studies (each with 3-20 follow-up periods) carried out in 9 European countries during 1990-1998 or 2003-2009. The harmonization process followed 6 steps: 1) organization of the harmonization panel; 2) identification of variables relevant to MeDALL objectives (candidate variables); 3) proposal of a definition for each candidate variable (reference definition); 4) assessment of the compatibility of each cohort variable with its reference definition (inferential equivalence) and classification of this inferential equivalence as complete, partial, or impossible; 5) convocation of a workshop to agree on the reference definitions and classifications of inferential equivalence; and 6) preparation and delivery of data through a knowledge management portal. We agreed on 137 reference definitions. The inferential equivalence of 3,551 cohort variables to their corresponding reference definitions was classified as complete, partial, and impossible for 70%, 15%, and 15% of the variables, respectively. A harmonized database was delivered to MeDALL investigators. In asthma and allergy birth cohorts, the harmonization of data for pooled analyses is feasible, and high inferential comparability may be achieved. The MeDALL harmonization approach can be used in other collaborative projects.
Pompeu Fabra University1, Swiss Tropical and Public Health Institute2, National Institutes of Health3, University of Melbourne4, University of Turin5, Haukeland University Hospital6, University of Antwerp7, Ludwig Maximilian University of Munich8, University of Castilla–La Mancha9, University of Huelva10, University of Bordeaux11, French Institute of Health and Medical Research12, University of Paris13, University of Pavia14, University of Verona15, Umeå University16, Uppsala University17, Tartu University Hospital18, Paris Diderot University19, University of Arizona20
TL;DR: In this paper, the authors compared physical activity levels between adults with a restrictive spirometry pattern with a poor morbidity and mortality prognosis, and found that restricting spirometry patterns is an under-recognised disorder with poor prognosis.
University of Bergen1, University of Verona2, Haukeland University Hospital3, University of Iceland4, University of Montpellier5, University of Melbourne6, Umeå University7, Pompeu Fabra University8, Ludwig Maximilian University of Munich9, University of Gothenburg10, National Institutes of Health11, Tartu University Hospital12, Uppsala University Hospital13, Basque Government14, University of Grenoble15, Swiss Tropical and Public Health Institute16, University of Huelva17, Aarhus University18
TL;DR: The decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors, which may signify that female sex hormones are of importance for lung ageing.
TL;DR: Peak flow variability in childhood is a significant and independent predictor of subsequent body mass index increase up to age 26 and shared developmental and genetic factors may explain the association between these two phenotypes.
Abstract: Peak flow variability in childhood is a significant and independent predictor of subsequent body mass index increase up to age 26. Shared developmental and genetic factors may explain, at least in part, the association between these two phenotypes.
TL;DR: The EARLY COPD (Early COPD) study as mentioned in this paper ) is a multidimensional study of adult patients with pulmonar obstructiva cronica (EPOC) with and without EPOC.
Abstract: Resumen Introduccion y objetivos Los determinantes en fases iniciales de la historia natural de la enfermedad pulmonar obstructiva cronica (EPOC) son poco conocidos. Entenderlos mejor es de capital importancia para poder disenar intervenciones dirigidas a modificar su pronostico. Los principales objetivos del estudio son: a) caracterizar a una poblacion de adultos jovenes con EPOC de forma multidimensional; b) comparar estos pacientes con sujetos fumadores con funcion pulmonar normal; y c) establecer una cohorte de adultos jovenes con y sin EPOC, que pueda ser seguida a largo plazo para conocer mejor la historia natural de la enfermedad. Participantes y metodo EARLY COPD es un estudio multicentrico de casos y controles que permitira establecer una cohorte de sujetos para su seguimiento posterior. Se seleccionaron 311 (101 casos y 210 controles) participantes reclutados en una treintena de centros de atencion primaria y 12 hospitales de 8 comunidades autonomas espanolas. Los participantes eran fumadores o exfumadores (> 10 paquetes ano) de entre 35-50 anos de edad. Los casos presentaban una espirometria obstructiva con un FEV1/FVC
TL;DR: This is a case–control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up, to improve understanding of the natural history of the disease.
Abstract: Introduction and Objectives Determinants of chronic obstructive pulmonary disease (COPD) in the early stages of its natural history are not well known. Improving our knowledge of these factors will help to design interventions that can modify prognosis. Study objectives are: (a) to characterize a COPD population of young adults aged 35–50 years from a multidimensional point of view; (b) to compare these patients with smokers with normal lung function; and (c) to create a cohort of young adults aged 35–50 years (smokers or former smokers), with and without COPD, who will be followed in the future to improve understanding of the natural history of the disease. Participants and Method This is a case–control multicenter study aimed at establishing a well-characterized cohort of young adults, smokers or former-smokers, with and without COPD, for subsequent follow-up. A total of 311 participants (101 cases and 210 controls) were selected from approximately 30 primary care settings and 12 hospitals in 8 Spanish regions. Subjects were smokers or former smokers (>10 pack-years) aged 35–50 years. Diagnosis of COPD was based on a post-bronchodilator result of FEV1/FVC The main study variables were: questionnaires on health, symptoms, exacerbations and daily physical activity, lung function tests, blood and sputum samples, and low-dose computed tomography. In the statistical analysis, COPD patient characteristics will be described and compared with control subjects using a logistic regression analysis.
TL;DR: This study found that 12-month completion of a behavioral physical activity intervention was generally determined by previous physical activity habits as well as interpersonal and environmental physical activity facilitators while response was related to diverse factors thought to modify the individual motivation to change to an active lifestyle.
Abstract: Objectives
Physical activity is key to improve the prognosis of chronic obstructive pulmonary disease (COPD). To help to tailor future interventions we aimed to identify the baseline characteristics of COPD patients which predict 12-month completion and response to a behavioral physical activity intervention.
Methods
This is a 12-month cohort study of the intervention arm of the Urban Training randomized controlled trial (NCT01897298), an intervention proven to be efficacious to increase physical activity. We considered baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics as potential determinants of completion and response. We defined completion as attending the 12-month study visit. Among completers, we defined response as increasing physical activity ≥1100 steps/day from baseline to 12 months, measured by accelerometer. We estimated the factors independently for completion and response using multivariable logistic regression models.
Results
Of a total of 202 patients (m (SD) 69 (9) years, 84% male), 132 (65%) completed the study. Among those, 37 (28%) qualified as responders. Higher numbers of baseline steps/day (OR [95% CI] 1.11 [1.02–1.21] per increase of 1000 steps, p<0.05) and living with a partner (2.77 [1.41–5.48], p<0.01) were related to a higher probability of completion while more neighborhood vulnerability (0.70 [0.57–0.86] per increase of 0.1 units in urban vulnerability index, p<0.01) was related to a lower probability. Among the completers, working (3.14 [1.05–9.33], p<0.05) and having an endocrino-metabolic disease (4.36 [1.49–12.80], p<0.01) were related to a higher probability of response while unwillingness to follow the intervention (0.21 [0.05–0.98], p<0.05) was related to a lower probability.
Conclusions
This study found that 12-month completion of a behavioral physical activity intervention was generally determined by previous physical activity habits as well as interpersonal and environmental physical activity facilitators while response was related to diverse factors thought to modify the individual motivation to change to an active lifestyle.
TL;DR: Progression of physical inactivity in COPD patients: The effect of time and climate conditions a multicenter prospective cohort study.
Abstract: Citation for published version (APA): PROactive Consortium, Boutou, A. K., Raste, Y., Demeyer, H., Troosters, T., Polkey, M. I., Vogiatzis, I., Louvaris, Z., Rabinovich, R. A., van der Molen, T., Garcia-Aymerich, J., & Hopkinson, N. S. (2019). Progression of physical inactivity in COPD patients: The effect of time and climate conditions a multicenter prospective cohort study. International Journal of Chronic Obstructive Pulmonary Disease, 14, 1979-1992. https://doi.org/10.2147/COPD.S208826
TL;DR: Prenatal exposure to p,p'-DDE may decrease lung function during childhood, especially FEV1 and at medium levels of exposure.
TL;DR: Middle-aged adults with habitual snoring have a steeper decline in lung function over 10 years compared to controls, and snorers with nocturnal gastro-oesophageal reflux have a higher prevalence ofNocturnal respiratory symptoms than controls.
Abstract: Introduction: The study aim was to examine the association of snoring and nocturnal gastro-oesophageal reflux (nGOR) with respiratory symptoms and lung function, and if snoring and/or nGOR associat ...
Dartmouth College1, Johannes Kepler University of Linz2, Universidad Autónoma de San Luis Potosí3, Paracelsus Private Medical University of Salzburg4, University of Seville5, University of La Laguna6, Hospital Universitari Arnau de Vilanova7, University of Navarra8, Brigham and Women's Hospital9, University of Copenhagen10, Pompeu Fabra University11, University of Birmingham12, University of Michigan13, Norwegian University of Science and Technology14, Johns Hopkins University15, Northern Norway Regional Health Authority16, University of Bergen17, Kyoto University18, University of British Columbia19, St. Paul's Hospital20, University of Zurich21
TL;DR: In conclusion, CODEX and mCODEX index are good predictors of mortality in patients with COPD, regardless of disease severity or duration of follow-up.
Abstract: The CODEX index was developed and validated in patients hospitalized for COPD exacerbation to predict the risk of death and readmission within one year after discharge. Our study aimed to validate the CODEX index in a large external population of COPD patients with variable durations of follow-up. Additionally, we aimed to recalculate the thresholds of the CODEX index using the cutoffs of variables previously suggested in the 3CIA study (mCODEX). Individual data on 2,755 patients included in the COPD Cohorts Collaborative International Assessment Plus (3CIA+) were explored. A further two cohorts (ESMI AND EGARPOC-2) were added. To validate the CODEX index, the relationship between mortality and the CODEX index was assessed using cumulative/dynamic ROC curves at different follow-up periods, ranging from 3 months up to 10 years. Calibration was performed using univariate and multivariate Cox proportional hazard models and Hosmer-Lemeshow test. A total of 3,321 (87.8% males) patients were included with a mean ± SD age of 66.9 ± 10.5 years, and a median follow-up of 1,064 days (IQR 25–75% 426–1643), totaling 11,190 person-years. The CODEX index was statistically associated with mortality in the short- (≤3 months), medium- (≤1 year) and long-term (10 years), with an area under the curve of 0.72, 0.70 and 0.76, respectively. The mCODEX index performed better in the medium-term (<1 year) than the original CODEX, and similarly in the long-term. In conclusion, CODEX and mCODEX index are good predictors of mortality in patients with COPD, regardless of disease severity or duration of follow-up.
Pompeu Fabra University1, Johns Hopkins University2, University of Grenoble3, French Institute of Health and Medical Research4, Paris Diderot University5, University of Verona6, University of Castilla–La Mancha7, Ludwig Maximilian University of Munich8, Tartu University Hospital9, Uppsala University10, National Institutes of Health11, Imperial College London12
TL;DR: In a population of adults, it is found no consistent evidence that the association of physical activity with forced expiratory volume in one second or forced vital capacity is influenced by the level of C-reactive protein in blood.
Abstract: Objective Regular physical activity may be associated with improved lung function via reduced systemic inflammation, although studies exploring this mechanism are rare. We evaluated the role of C-reactive protein in blood, which is a common marker of systemic inflammation, on the association of physical activity with forced expiratory volume in one second and forced vital capacity. Methods Cross-sectional data on spirometry, C-reactive protein levels and self-reported physical activity (yes/no; ≥2 times and ≥1hr per week of vigorous physical activity) were available in the European Community Respiratory Health Survey (N = 2347 adults, 49.3% male, 28-56 years-old). A subsample was also assessed 10 years later using the International Physical Activity Questionnaire, and tertiles of Metabolic Equivalent of Task-minutes per week spent in vigorous, moderate and walking activities were calculated (N = 671, 49.6% male, 40-67 years-old). Adjusted cross-sectional mixed linear regression models and the "mediate" package in "R" were used to assess the presence of mediation. Results Despite positive significant associations between nearly all physical activity metrics with forced expiratory volume in one second and forced vital capacity, there was no evidence that C-reactive protein levels played a role. An influence of C-reactive protein levels was only apparent in the smaller subsample when comparing the medium to low tertiles of moderate activity (mean difference [95% CIs]: 21.1ml [5.2, 41.9] for forced expiratory volume in one second and 17.3ml [2.6, 38.0] for forced vital capacity). Conclusions In a population of adults, we found no consistent evidence that the association of physical activity with forced expiratory volume in one second or forced vital capacity is influenced by the level of C-reactive protein in blood.
TL;DR: Assessment of BMI trajectories from birth to 4 years with lung function and current asthma at 7 years included 1399 participants from the population-based INMA birth cohort study to identify adverse growth patterns associated with future poorer respiratory health.
Abstract: Previous studies assessing the association of birthweight and infant weight gain with lung function and asthma have focused on the difference between two time points or on growth patterns. Body mass index (BMI) trajectories, which integrate information on multiple aspects of growth, may allow a more accurate identification of children at higher risk of future respiratory diseases. We assessed the associations of BMI trajectories from birth to 4 years with lung function and current asthma at 7 years. We included 1399 participants from the population-based INMA birth cohort study. Five BMI trajectories were previously identified: ‘average birth size-slower BMI gain’, ‘higher birth size-accelerated BMI gain’, ‘higher birth size-slower BMI gain’, ‘lower birth size-accelerated BMI gain’ and ‘lower birth size-slower BMI gain’. At 7 years, lung function (FVC, FEV1, FEV1/FVC) was assessed by spirometry and current asthma was assessed by questionnaire. After adjustment for potential confounders, children in the accelerated BMI gain trajectories had higher FVC at 7 years either if they departed from lower (37mL; 95%CI: -1.2 to 75) or higher (51mL; 13 to 90) birth size, compared to children in the ‘average birth size-slower BMI gain’ trajectory. These two groups also presented lower FEV1/FVC at 7 years, although the associations were not statistically significant. Children in the ‘low birth size-slower BMI gain’ trajectory had -47mL (95%CI: -84 to -11) lower FVC at 7 years, compared to children in the ‘average birth size-slower BMI gain’ trajectory. No associations were observed for FEV1 or asthma. Early infancy BMI trajectories can identify adverse growth patterns associated with future poorer respiratory health.
01 Oct 2019
TL;DR: In this article, the authors investigated the associations between major air pollutants (ozone and PM2.5) and allergic rhinitis control, during grass and birch pollen seasons, using the Allergy Diary app.
Abstract: A few studies have suggested an interaction between air pollution and pollen exposure on allergy symptoms but more research is needed. As part of the POLLAR (Impact of Air Pollution in Asthma and Rhinitis) project, we investigated the associations between major air pollutants (ozone and PM2.5) and allergic rhinitis control, during grass and birch pollen seasons, using the Allergy Diary app (a validated mHealth tool for allergic rhinitis management). The daily impact of allergic symptoms was recorded, using visual analogue scale (VAS), by 3,328 geolocated app users in 2017 and 2018 in Northern Europe, representing 36,523 VAS days. Uncontrolled allergic rhinitis was defined either as 1) VAS≥50, 2) VAS≥35 with intra-nasal corticosteroids or azelastine-fluticasone propionate use or 3) VAS≥20 and use of ≥3 allergic rhinitis medications. For each VAS recorded with geolocation, pollutants levels were assessed using the SILAM (System for integrated modelling of atmospheric composition) database, and pollen seasons were assessed by regions using Google Trends. Generalized estimating equation models were used to account for repeated measures per user, adjusting for gender, age, treatment and country. Positive associations were found between ozone and uncontrolled allergic rhinitis during the grass pollen season only (ORs=1.25 [1.11-1.41] and 1.14 [1.04-1.25], per interquartile range increase in ozone, for 2017 and 2018 respectively). A similar trend was found for PM2.5 levels in 2017 while results for 2018 did not suggest any effect modification by pollen seasons. These results show the importance of air pollution and allergen concentrations, and their interaction, as predictors of allergic rhinitis control.
TL;DR: Preliminary results showed that prenatal exposure to BPA might increase the odds of wheezing in school-age children, although there are other substitutes that could also interfere with the developing respiratory system.
Abstract: Prenatal exposure to phenolic compounds, widely used in many consumer products, can alter lung development and increase the risk of respiratory disorders in the offspring. However, evidence is scarce and mostly focused on bisphenol-A (BPA), although there are other substitutes that could also interfere with the developing respiratory system. We aim to estimate the association between exposure to 5 phenols during pregnancy (BPA, BPAF, BPB, BPF, and BPS) and lung function, wheeze, and asthma in school-age children. We included 2685 mother-child pairs from 8 European birth cohorts. Phenols concentrations were determined in urinary maternal samples collected during pregnancy (1999-2010). Between 6 and 10 years of age, spirometry was performed, and wheeze and asthma were assessed from questionnaires. Adjusted multivariable linear regression and logistic regression models were used to assess the associations. We performed meta-analyses of cohort-specific estimates. We observed widespread prenatal BPA exposure with 79% of the samples above detectable limits; the other phenols were detected in fewer samples. Median BPA concentrations ranged from 1.04 to 9.54 ng/g of creatinine. Increasing BPA concentrations during pregnancy tended to be associated with lower FVC and FEV1 and were associated with increased odds of wheezing between ages 6 and 10 years (adjusted odds ratio=1.09; 95% CI=0.96, 1.24), but not with asthma. Final results including associations of the other phenols with respiratory outcomes including wheezing patterns from birth will be presented. Preliminary results showed that prenatal exposure to BPA might increase the odds of wheezing in school-age children.
TL;DR: The interpretation was that neither flow-related nor volume-related bronchodilator reversibility were independently associated with the symptom burden, health status or dyspnoea in the COPD population.
Abstract: Neither flow-related nor volume-related bronchodilator reversibility were independently associated with the symptom burden, health status or dyspnoea in the COPD populationhttp://bit.ly/2rigD1r
TL;DR: In this paper, the association between allergic responses and chronotype among adolescents was estimated using the International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire modules.
Abstract: Introduction: Although asthma/allergic diseases are known to follow circadian rhythmicity, whether these are associated with individual circadian preference/chronotype (CT) is not known. Objective: To estimate the association between allergic responses and chronotype among adolescents. Methods: Among 1684 adolescents (58% male) aged between 13 and 14 years, recruited from 23 randomly selected schools of 16 districts of West Bengal (India), prevalence of asthma, wheeze, rhinitis, rhinoconjunctivitis, and eczema were assessed using the English-back Bengali version of the International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire modules. Chronotypes were determined using a validated Bengali-translated version of the reduced Morningness-Eveningness Questionnaire (rMEQ). Results: Compared to the non-asthmatics, asthmatics were more prone to be evening-type (8% vs. 18%) and neither-type (48% vs. 59%) but not morning-type (44% vs. 23%) (chi-squared p Conclusion: This is the first study to demonstrate the chronotype patterns differ significantly between adolescents with or without allergic diseases. However, the bidirectional causal-effects of this association also needs further investigation.
TL;DR: The natural course of PA in patients with COPD was heterogeneous and one group improved PA over time, while improvers and decliners were very similar in their baseline characteristics and improvers showed a significant reduction in weight during follow-up compared to decliners.
Abstract: Background: A mean annual decline in physical activity (PA) of 450 steps/d approximately has been reported in patients with COPD but it is not known if the evolution is the same for all patients. Aims: To identify PA trajectories and their determinants using a hypothesis-free approach. Methods: We pooled data from the PROactive initial validation (NCT01388218) study and the usual care arm of the Urban Training study (NCT01897298), including an objective measure of PA at baseline and 12 months. We identified clusters of individual PA trajectories (steps/d), using a k-means approach and compared baseline sociodemographic, interpersonal, clinical and psychological characteristics across clusters. Results: Based on 293 COPD patients (mean (SD) 68 (8) y, 82% male, FEV1 58% pred), we identified three distinct PA trajectories: inactive (59%), improvers (17%) and decliners (24%) (Fig 1). Being in the inactive group was associated with a lower proportion of patients still working and a worse general status (lower lung function, exercise capacity and quality of life, and higher dyspnoea and depression score) at baseline. While improvers and decliners were very similar in their baseline characteristics, improvers showed a significant reduction in weight during follow-up compared to decliners. Conclusions: The natural course of PA in patients with COPD was heterogeneous and one group improved PA over time.