Airflow Limitation is Underrecognized in Well‐Functioning Older People

Waterer, Grant; Wan, Jim Y.; Kritchevsky, Stephen B.; Wunderink, Richard G.; Satterfield, Suzy; Bauer, Douglas C.; Newman, Anne B.; Taaffe, Dennis R.; Jensen, Robert L.; Crapo, Robert O.; Study, For The Health ABC

doi:10.1046/j.1532-5415.2001.49205.x

Cited by 39 publications

(39 citation statements)

References 34 publications

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“…Most of the invalid measurements were observed with forced expiration (37% of the initial population sample), as only 9% of the participants did not manage to produce valid NEP data. The figure for invalid forced expiration manoeuvres was greater than that reported by WATERER et al [15] (11.4%). However, the study by WATERER et al [15] excluded all people with a medical history, thereby including only healthy subjects, whereby in the present study only a few healthy subjects (15.5%) were tested.…”

Section: Methodological Aspectscontrasting

confidence: 54%

“…The figure for invalid forced expiration manoeuvres was greater than that reported by WATERER et al [15] (11.4%). However, the study by WATERER et al [15] excluded all people with a medical history, thereby including only healthy subjects, whereby in the present study only a few healthy subjects (15.5%) were tested. It is likely that disabled individuals were less likely to succeed, when compared with those in good health, in performing forced expiratory manoeuvres.…”

Section: Methodological Aspectscontrasting

confidence: 54%

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Expiratory flow limitation and obstruction in the elderly

Bisschop

Marty²,

Tessier³

et al. 2005

Eur Respir J

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Elderly people commonly suffer from dyspnoea, which may stem from expiratory flow limitation (EFL). The relationship between EFL, as assessed by the negative expiratory pressure method and spirometric indices, was investigated in an elderly French population. Subjects, aged 66-88 yrs, filled in socio-demographic and standardised questionnaires, which dealt with: medical history, smoking status and respiratory symptoms. EFL measurements and forced expiratory manoeuvres were performed.Validated measurements were obtained in 750 out of 1,318 subjects: 47% were EFL+ (EFL .0), with a higher prevalence in females than in males. EFL and forced expiratory volume in one second (FEV1) were correlated with age. A total of 116, from the 750 subjects, with no medical history and no symptoms, served as a healthy group. The prevalence of EFL+ subjects increased with the grade of dyspnoea and was highest in respiratory and cardiac patients when compared with the healthy subjects. EFL did not correlate with FEV1/forced vital capacity (FVC), the usual index of obstruction. Some elderly subjects (15%) with dyspnoea but with no medical history, mainly females with small FVC and normal FEV1/FVC, had a greater EFL than the healthy subjects.In elderly people, expiratory flow limitation measurements, along with the usual forced expiratory volume in one second/ forced vital capacity ratio, may be of value for the interpretation of dyspnoea.

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Section: Methodological Aspectscontrasting

confidence: 54%

Section: Methodological Aspectscontrasting

confidence: 54%

Expiratory flow limitation and obstruction in the elderly

Bisschop

Marty²,

Tessier³

et al. 2005

Eur Respir J

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“…However, pulmonary function tests were seldom performed in these studies. Self-report often underestimates underlying lung dysfunction in elderly individuals (32). Spirometry results that met ATS criteria for acceptability and reproducibility were available in 93% of subjects in our study.…”

Section: Discussionmentioning

confidence: 77%

Preinfection Systemic Inflammatory Markers and Risk of Hospitalization Due to Pneumonia

Yende

Tuomanen

Wunderink

et al. 2005

Am J Respir Crit Care Med

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119

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Rationale: Elevated proinflammatory cytokines are associated with severity of pneumonia, but the role of preinfection cytokine levels in the predisposition to pneumonia in humans is less clear. Objective: To ascertain role of preinfection inflammatory markers on susceptibility to community-acquired pneumonia (CAP). Methods: Longitudinal analysis over 6.5 yr of a cohort that consisted of 70-to 79-yr-old well-functioning elderly individuals. Measurements: Association between preinfection tumor necrosis factor (TNF), interleukin 6 (IL-6), and C-reactive protein (CRP) levels and CAP requiring hospitalization. Results: Of the 3,075 participants, 161 (5.2%) developed at least one episode of CAP requiring hospitalization over a median duration of 3.3 yr. The highest tertiles of TNF (Ͼ 3.7 pg/ml) and IL-6 (Ͼ 2.4 pg/ml) were associated with increased risk of CAP, and the adjusted odds ratios were 1.6 (95% confidence interval [CI], 1.02-2.7) and 1.7 (95% CI, 1.1-2.8), respectively. The adjusted risk of CAP with at least one of these markers in the highest tertile was 1.6 (95% CI, 1.1-2.3). TNF and IL-6 levels in the highest tertile had a synergistic effect (p ϭ 0.01 for interaction), and risk of CAP for both markers in the highest tertile was 2.8 (95% CI, 1.8-4.3). An FEV 1 of 50% or less of predicted was associated with the highest risk of CAP (adjusted odds ratio, 3.6; 95% CI, 2.3-5.6). Furthermore, TNF and IL-6 levels modified risk of CAP in participants with coexisting medical conditions and history of smoking. Conclusion: In the well-functioning elderly subjects, preinfection systemic levels of TNF and IL-6 were associated with higher risk of CAP requiring hospitalization in smokers and those with coexisting medical conditions.

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“…Total nonbone lean mass was calculated by subtracting bone mineral content from total lean mass obtained by DXA (13). Spirometry was performed at year 1 using a horizontal dry rolling seal HF6 Spirometer (Sensor Medics Corporation, Yorba Linda, CA) according to standard guidelines (14).…”

Section: Measurementsmentioning

confidence: 99%

Bicarbonate Concentration, Acid-Base Status, and Mortality in the Health, Aging, and Body Composition Study

Raphael¹,

Murphy²,

Shlipak³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Low serum bicarbonate associates with mortality in CKD. This study investigated the associations of bicarbonate and acid-base status with mortality in healthy older individuals.Design, setting, participants, & measurements We analyzed data from the Health, Aging, and Body Composition Study, a prospective study of well functioning black and white adults ages 70-79 years old from 1997. Participants with arterialized venous blood gas measurements (n=2287) were grouped into ,23.0 mEq/L (low), 23.0-27.9 mEq/L (reference group), and $28.0 mEq/L (high) bicarbonate categories and according to acid-base status. Survival data were collected through February of 2014. Mortality hazard ratios (HRs; 95% confidence intervals [95% CIs]) in the low and high bicarbonate groups compared with the reference group were determined using Cox models adjusted for demographics, eGFR, albuminuria, chronic obstructive pulmonary disease, smoking, and systemic pH. Similarly adjusted Cox models were performed according to acid-base status.Results The mean age was 76 years, 51% were women, and 38% were black. Mean pH was 7.41, mean bicarbonate was 25.1 mEq/L, 11% had low bicarbonate, and 10% had high bicarbonate. Mean eGFR was 82.1 ml/min per 1.73 m 2 , and 12% had CKD. Over a mean follow-up of 10.3 years, 1326 (58%) participants died. Compared with the reference group, the mortality HRs were 1.24 (95% CI, 1.02 to 1.49) in the low bicarbonate and 1.03 (95% CI, 0.84 to 1.26) in the high bicarbonate categories. Compared with the normal acid-base group, the mortality HRs were 1.17 (95% CI, 0.94 to 1.47) for metabolic acidosis, 1.21 (95% CI, 1.01 to 1.46) for respiratory alkalosis, and 1.35 (95% CI, 1.08 to 1.69) for metabolic alkalosis categories. Respiratory acidosis did not associate with mortality.Conclusions In generally healthy older individuals, low serum bicarbonate associated with higher mortality independent of systemic pH and potential confounders. This association seemed to be present regardless of whether the cause of low bicarbonate was metabolic acidosis or respiratory alkalosis. Metabolic alkalosis also associated with higher mortality.

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Airflow Limitation is Underrecognized in Well‐Functioning Older People

Cited by 39 publications

References 34 publications

Expiratory flow limitation and obstruction in the elderly

Expiratory flow limitation and obstruction in the elderly

Preinfection Systemic Inflammatory Markers and Risk of Hospitalization Due to Pneumonia

Bicarbonate Concentration, Acid-Base Status, and Mortality in the Health, Aging, and Body Composition Study

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