Identification and prospective validation of clinically relevant chronic obstructive pulmonary disease (COPD) subtypes
Judith Garcia-Aymerich,Federico P. Gómez,Marta Benet,Eva Farrero,Xavier Basagaña,Angel Gayete,Carles Paré,Xavier Freixa,Jaume Ferrer,Antoni Ferrer,Josep Roca,Juan B. Galdiz,Jaume Sauleda,Eduard Monsó,Joaquim Gea,Joan Albert Barberà,Alvar Agusti,Josep M. Antó +17 more
TLDR
In patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated: ‘severe respiratory COPD’, ‘moderate respiratory COPd’ and ‘systemic COPD'.Abstract:
Background Chronic obstructive pulmonary disease (COPD) is increasingly considered a heterogeneous condition. It was hypothesised that COPD, as currently defined, includes different clinically relevant subtypes. Methods To identify and validate COPD subtypes, 342 subjects hospitalised for the first time because of a COPD exacerbation were recruited. Three months after discharge, when clinically stable, symptoms and quality of life, lung function, exercise capacity, nutritional status, biomarkers of systemic and bronchial inflammation, sputum microbiology, CT of the thorax and echocardiography were assessed. COPD groups were identified by partitioning cluster analysis and validated prospectively against cause-specific hospitalisations and all-cause mortality during a 4 year follow-up. Results Three COPD groups were identified: group 1 (n¼126, 67 years) was characterised by severe airflow limitation (postbronchodilator forced expiratory volume in 1 s (FEV1) 38% predicted) and worse performance in most of the respiratory domains of the disease; group 2 (n¼125, 69 years) showed milder airflow limitation (FEV1 63% predicted); and group 3 (n¼91, 67 years) combined a similarly milder airflow limitation (FEV1 58% predicted) with a high proportion of obesity, cardiovascular disorders, diabetes and systemic inflammation. During follow-up, group 1 had more frequent hospitalisations due to COPD (HR 3.28, p<0.001) and higher all-cause mortality (HR 2.36, p¼0.018) than the other two groups, whereas group 3 had more admissions due to cardiovascular disease (HR 2.87, p¼0.014). Conclusions In patients with COPD recruited at their first hospitalisation, three different COPD subtypes were identified and prospectively validated: ‘severe respiratory COPD’, ‘moderate respiratory COPD’, and ‘systemic COPD’.read more
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Using Hierarchical Cluster Models to Systematically Identify Groups of Jobs With Similar Occupational Questionnaire Response Patterns to Assist Rule-Based Expert Exposure Assessment in Population-Based Studies
Melissa C. Friesen,Susan M. Shortreed,David C. Wheeler,Igor Burstyn,Roel Vermeulen,Anjoeka Pronk,Joanne S. Colt,Dalsu Baris,Margaret R. Karagas,Molly Schwenn,Alison Johnson,Karla R. Armenti,Debra T. Silverman,Kai Yu +13 more
TL;DR: Using cluster models as a data reduction step to identify jobs with similar response patterns prior to obtaining expert ratings has the potential to aid rule-based assessment by systematically reducing the number of exposure decisions needed.
COPD and comorbidity
TL;DR: It was shown that neither separateComorbid conditions nor comorbidity clusters prevent pulmonary rehabilitation from being effective in COPD patients.
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Impact of Comorbidities on the Treatment of Chronic Obstructive Pulmonary Disease.
Chris Garvey,Gerard J. Criner +1 more
TL;DR: Studies indicate that management of comorbid COPD can be improved by engaging in a multidisciplinary team-based approach, and a collaborative effort from different disease specialists and health care professionals, together with disease self-management and management programs, could improve the outcomes of patients with COMD.
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Systematic review protocol to define classical IgE-associated diseases from birth to adolescence: the MeDALL study
Mariona Pinart,Dieter Maier,Elena Gimeno-Santos,J. Garcia-Aymerich,S. Guerra,Renato T. Stein,Marta Benet,K-H. Carlsen,M. Herr,Francine Kauffmann,Momas,Pin,Fanny Rancière,Henriette A. Smit,Raphaëlle Varraso,Annesi-Maesano,Charles Auffray,Claus Bachert,Ferran Ballester,Xavier Bonfill,Eleni Fthenou,C. Hohmann,Jocelyne Just,T. Keil,Marjan Kerkhof,Manolis Kogevinas,Gerard H. Koppelman,Marek L. Kowalski,Kull,Lavi,E. Melen,Leyla Namazova-Baranova,Martijn C. Nawijn,C. Normand,Sam Oddie,Dirkje S. Postma,Siroux,Jordi Sunyer,Maria Vassilaki,Magnus Wickman,C. Zabaleta Camino,Torsten Zuberbier,Jean Bousquet,Josep M. Antó +43 more
TL;DR: The in-depth analysis of the existing literature on the classification of IgE-associated allergic diseases through such a systematic review will provide relevant information on the current epidemiologic definitions of allergic diseases, address heterogeneity and interrelationships and identify gaps in knowledge.
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The Effects of Mandatory Vaccination Laws on Childhood Health and Adult Educational Attainment
TL;DR: It is shown that the state mandates were effective in reducing the incidence rates of the targeted diseases, suggesting that the mandates did improve child health and sizable and positive effects on educational attainment are found.
References
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Jørgen Vestbo,Suzanne S. Hurd,Alvar Agusti,Paul W. Jones,Claus Vogelmeier,Antonio Anzueto,Peter J. Barnes,Leonardo M. Fabbri,Fernando J. Martinez,Masaharu Nishimura,Robert A. Stockley,Don D. Sin,Roberto Rodriguez-Roisin +12 more
TL;DR: It is recommended that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation.
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Inference and missing data
TL;DR: In this article, it was shown that ignoring the process that causes missing data when making sampling distribution inferences about the parameter of the data, θ, is generally appropriate if and only if the missing data are missing at random and the observed data are observed at random, and then such inferences are generally conditional on the observed pattern of missing data.
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Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper
Bartolome R. Celli,William MacNee,Alvar Agusti,Antonio Anzueto,B. Berg,A. S. Buist,Peter M.A. Calverley,Niels H. Chavannes,T. Dillard,Bonnie F. Fahy,Alan M. Fein,John E. Heffner,Suzanne C. Lareau,Paula Meek,Fernando J. Martinez,Walter T. McNicholas,Jean W M Muris,E. Austegard,Romain Pauwels,S. I. Rennard,Adriano G. Rossi,NM Siafakas,B. Tiep,Jørgen Vestbo,E. F. M. Wouters,Richard ZuWallack +25 more
TL;DR: The main goals of the updated document are to improve the quality of care provided to patients with COPD and to develop the project using a disease-oriented approach.
Journal ArticleDOI
The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease
Bartolome R. Celli,Claudia Cote,Jose M. Marin,Ciro Casanova,Maria Montes de Oca,Reina A. Mendez,Victor Pinto Plata,Howard Cabral +7 more
TL;DR: The BODE index, a simple multidimensional grading system, is better than the FEV1 at predicting the risk of death from any cause and from respiratory causes among patients with COPD.
Book
Users' Guides to the Medical Literature
Gordon H. Guyatt,Drummond Rennie +1 more
TL;DR: Without a way of critically appraising the information they receive, clinicians are relatively helpless in deciding what new information to learn and decide how to modify their practice.