University of British Columbia James Hogg Research Laboratories, Providence Heart and Lung Institute, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. firstname.lastname@example.org
To measure the prevalence of chronic obstructive pulmonary disease (COPD) and determine the effect of age and sex on the variation in prevalence across major cities within the same country and health care system.
We used the Burden of Obstructive Lung Disease (BOLD) methodology to estimate the prevalence of COPD in adults aged = 40 years in different Canadian cities. The study used interviewer-administered questionnaires on respiratory, smoking and occupational history, medication use and comorbidities. Post-bronchodilator spirometry was used to classify subjects. We determined the prevalence and severity of COPD with and without adjustments for age and sex distribution across different cities.
The study population was 3042. Overall, 16.7% (95%CI 14.8-18.7) of study subjects met the criteria for Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity Stage 1 or higher. The prevalence according to the criteria for the lower limits of normal of the ratio forced expiratory volume in 1 second/forced vital capacity was 11.6% (95%CI 9.9-13.3). COPD prevalence varied by severity across site (P = 0.0025). After age-sex adjustment, the variation disappeared (P> 0.16).
Age and sex differences account for most of the heterogeneity in COPD estimates across large cities within the same country. Adjustments for age and sex are essential in comparing COPD rates across the country.
Area-based markers of deprivation (e.g., postal codes) are commonly used to identify groups of people with low socioeconomic status (SES); the validity of this approach, however, remains unknown. In this study, we determined the accuracy of using income quintile groups calculated on the basis of the median family income of each forward sortation area (1996 Canadian census) to identify those living in poverty (i.e., annual family income of
Exacerbations of COPD are defined clinically by worsening of chronic respiratory symptoms. Chronic respiratory symptoms are common in the general population. There are no data on the frequency of exacerbation-like events in individuals without spirometric evidence of COPD.
To determine the occurrence of 'exacerbation-like' events in individuals without airflow limitation, their associated risk factors, healthcare utilisation and social impacts.
We analysed the cross-sectional data from 5176 people aged 40 years and older who participated in a multisite, population-based study on lung health. The study cohort was stratified into spirometrically defined COPD (post-bronchodilator FEV1/FVC?
Cites: Eur Respir J. 2013 Sep;42(3):858-6024000253
Cites: BMC Med. 2013;11:18123945277
Cites: Transl Res. 2013 Oct;162(4):208-1823684710
Cites: Respir Med. 2014 Jan;108(1):129-3524041746
Cites: Prim Care Respir J. 2013 Sep;22(3):264-523959046
Cites: Am J Respir Crit Care Med. 2000 May;161(5):1608-1310806163
The Institute for Clinical Evaluative Sciences and The Department of Medicine, Sunnybrook and Women's College Health Science Center, University of Toronto, Toronto, Ontario, Canada. email@example.com
Am J Respir Crit Care Med. 2001 Aug 15;164(4):580-4
There is considerable controversy concerning the utility of inhaled corticosteroids for the long-term treatment of patients with COPD. Recent studies have suggested that although inhaled corticosteroids do not alter the rate of decline in lung function, they may reduce airway hyperresponsiveness, decrease the frequency of exacerbations, and slow the rate of decline in the patients' health status. The relationship between inhaled corticosteroids and subsequent risk of hospitalization or mortality remains unknown. We therefore conducted a population-based cohort study using administrative databases in Ontario, Canada (n = 22,620) to determine the association between inhaled corticosteroid therapy and the combined risk of repeat hospitalization and all-cause mortality in elderly patients with COPD. Patients who received inhaled corticosteroid therapy postdischarge (within 90 d) had 24% fewer repeat hospitalizations for COPD (95% confidence interval [CI], 22 to 35%) and were 29% less likely to experience mortality (95% CI, 22 to 35%) during 1 yr of follow-up after adjustment for various confounding factors. This cohort study has suggested that inhaled corticosteroid therapy is associated with reduced COPD-related morbidity and mortality in elderly patients. Although not definitive, because of the observational nature of these findings, these data provide a compelling rationale for a large randomized trial to determine the effect of inhaled corticosteroids on COPD-related morbidity and mortality.
Comment In: Am J Respir Crit Care Med. 2003 Jul 1;168(1):12712870509
Comment In: Am J Respir Crit Care Med. 2003 Jul 1;168(1):126-712826595
Comment In: Am J Respir Crit Care Med. 2001 Aug 15;164(4):514-511520707
To determine the association between outpatient use of oral antibiotics and 30-day all-cause mortality following hospitalization in a group of elderly chronic obstructive pulmonary disease (COPD) patients.
A population-based retrospective cohort study.
All 26,301 patients, 65 years of age or older, who were hospitalized for COPD between 1992 and 1996 in Ontario.
All elderly patients admitted at least once with a most responsible diagnosis of COPD using the Canadian Institute for Health Information database were identified. They were then linked to the Ontario Drug Benefit database to determine the use of antibiotics within 30 days of the index hospitalization and to the Ontario registered persons database to determine the 30-day mortality following their index hospitalization.
Outpatient use of antibiotics within 30 days before the index hospitalization was associated with a significant reduction in the 30-day mortality following hospitalization (odds ratio [OR] 0.83, 95% CI 0.75 to 0.92). Use of macrolides had the lowest relative odds for mortality (OR 0.58, 95% CI 0.47 to 0.73), while use of fluoroquinolones had the highest relative odds (OR 0.98, 95% CI 0.84 to 1.15).
Use of antibiotics before hospitalization was associated with a significant reduction in the risk of short term mortality among a group of elderly COPD patients who eventually required hospitalization for their disease. These findings support the early use of antibiotics in COPD patients who experience an acute exacerbation.
Despite their proven efficacy, inhaled steroids may be underused in the elderly asthmatic population. The objectives of this study were to determine if inhaled steroids are underused in the elderly asthmatic population, who are at a high risk for rehospitalization and mortality, and to identify certain risk factors that predict lower use of inhaled steroids in this group of patients.
Population-based, retrospective, cohort study using linked data from hospital discharge and outpatient drug databases.
All people > or = 65 years old in Ontario, Canada, who survived an acute exacerbation of asthma between April 1992 and March 1997.
Of the 6,254 patients, 2,495 patients (40%) did not receive inhaled steroid therapy within 90 days of discharge from their initial hospitalization for asthma. Patients > 80 years old were at a greater risk of not receiving inhaled steroid therapy, compared to those 65 to 70 years of age (adjusted odds ratio [OR], 1.23; 95% confidence interval [CI], 1.05 to 1.47). Patients with a Charlson comorbidity index of > or = 3 were also at an increased risk of not receiving inhaled steroid therapy, compared to those having no comorbidities (adjusted OR, 3.45; 95% CI, 1.56 to 7.69). Moreover, receipt of care from a primary-care physician was independently associated with an elevated risk of not receiving inhaled steroid therapy, compared to receipt of care from respirologists/allergists (adjusted OR, 1.35; 95% CI, 1.10 to 1.61).
Forty percent of Ontario patients > or = 65 years old who experienced a recent acute exacerbation of asthma did not receive inhaled steroid therapy near discharge from their initial hospitalization for asthma. Nonreceipt of inhaled steroid therapy was particularly prominent in the older patients with multiple comorbidities. Moreover, those who received care from primary-care physicians were also less likely to receive inhaled steroid therapy, compared to those who received care from specialists.