Assessment of comorbidities and prognosis in patients with COPD diagnosed with the fixed ratio and the lower limit of normal: a systematic review and meta-analysis

Xiong, Huaiyu; Huang, Qiangru; Shuai, Tiankui; Zhu, Lei; Zhang, Chuchu; Zhang, Meng; Wang, Yalei; Liu, Jian

doi:10.1186/s12931-020-01450-9

Cited by 10 publications

(8 citation statements)

References 52 publications

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“…(25) No entanto, nem todos os estudos detectaram essa diferença. (26) Não conseguimos analisar a segunda categoria discordante para obstrução (GOLD−/LIN+), pois nenhum dos indivíduos de nossa amostra se enquadrou nessa categoria. Isso provavelmente se deve ao fato de que incluímos apenas indivíduos ≥ 40 anos de idade, visto que já foi demonstrado que o critério GOLD subestima a obstrução das vias aéreas em indivíduos entre 20 e 44 anos de idade.…”

Section: Discussionunclassified

Spirometry for the diagnosis of airway obstruction in patients with risk factors for COPD: the GOLD and lower limit of normal criteria

et al. 2021

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Objective: The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion. Methods: This was an observational study of individuals = 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD-, respectively) and according to the LLN criterion (LLN+ and LLN-, respectively). We also evaluated the level of agreement between the two criteria. Results: A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (? = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals = 70 years of age (? = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN- category (p = 0.03), as was the median DLCO (p = 0.04). Conclusions: The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.

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Section: Discussionunclassified

Spirometry for the diagnosis of airway obstruction in patients with risk factors for COPD: the GOLD and lower limit of normal criteria

et al. 2021

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“…Moreover, the main purpose of the present study was to detect airway obstruction using spirometry in a primary adult care setting. A recent meta-analysis showed that individuals with airflow limitations, when evaluated with LLN or FEV 1 /FVC < 0.70 fixed-ratio criteria, show no significant difference regarding the risk of developing comorbidities [ 50 ]. According to Celli, the use of the fixed threshold of FEV 1 /FVC < 0.70 can be considered a useful, simple tool that has prognostic and practical value, thus helping to remove barriers to widespread use of spirometry [ 46 , 51 ].…”

Section: Limitationsmentioning

confidence: 99%

Airway Obstruction in Primary Care Patients: Need for Implementing Spirometry Use

et al. 2022

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(1) Background: To detect early airway obstruction in an adult primary care setting. (2) Methods: Seventeen general practitioners (GP) were involved. A total of 912 patients consulting their GPs over 40 years were recruited: 583 of them (323M) agreed to perform/undergo all the procedures: respiratory questionnaire, mMRC questionnaire, and spirometry. We identified four subgroups: physician COPD patients; physician asthma patients; asthma-COPD overlap syndrome patients; and no respiratory diagnosis subjects, on the basis of physician diagnosis. For screening purposes, an FEV1/FVC < 70% was considered a marker of airway obstruction (AO). (3) Results: Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively. In the overall sample 16.3% showed airway obstruction: 26% mild, 56% moderate, 17% severe, and 1% very severe. In obstructed subjects, those reporting neither respiratory symptoms nor a physician’s respiratory diagnosis were 60% level I; 43% level II; 44% level III; and none level IV. Wheezing (p < 0.001), sputum (p = 0.01), older age (p < 0.0001), and male gender (p = 0.002) were the best predictors of airway obstruction. (4) Conclusions: A high prevalence of AO was found. In AO we found a high prevalence of subjects without respiratory symptoms or respiratory chronic diagnosis. Airway obstruction was predicted by the presence of wheezing, sputum, older age, and male gender.

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“…Author details 1 Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Fukuyama, Japan. 2 Department of Hematology, Oncology, Allergy and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. 3 First Department of Internal Medicine, Shinshu University School of Medicine, Mastumoto, Japan.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction that is not fully reversible, leading to respiratory insufficiency and functional disability [ 1 , 2 ]. Existing therapeutic options for COPD can reduce the severity of symptoms, and the frequency and severity of exacerbations.…”

Section: Introductionmentioning

confidence: 99%

Loss of IL-33 enhances elastase-induced and cigarette smoke extract-induced emphysema in mice

et al. 2021

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Background IL-33, which is known to induce type 2 immune responses via group 2 innate lymphoid cells, has been reported to contribute to neutrophilic airway inflammation in chronic obstructive pulmonary disease. However, its role in the pathogenesis of emphysema remains unclear. Methods We determined the role of interleukin (IL)-33 in the development of emphysema using porcine pancreas elastase (PPE) and cigarette smoke extract (CSE) in mice. First, IL-33−/− mice and wild-type (WT) mice were given PPE intratracheally. The numbers of inflammatory cells, and the levels of cytokines and chemokines in the bronchoalveolar lavage (BAL) fluid and lung homogenates, were analyzed; quantitative morphometry of lung sections was also performed. Second, mice received CSE by intratracheal instillation. Quantitative morphometry of lung sections was then performed again. Results Intratracheal instillation of PPE induced emphysematous changes and increased IL-33 levels in the lungs. Compared to WT mice, IL-33−/− mice showed significantly greater PPE-induced emphysematous changes. No differences were observed between IL-33−/− and WT mice in the numbers of macrophages or neutrophils in BAL fluid. The levels of hepatocyte growth factor were lower in the BAL fluid of PPE-treated IL-33−/− mice than WT mice. IL-33−/− mice also showed significantly greater emphysematous changes in the lungs, compared to WT mice, following intratracheal instillation of CSE. Conclusion These observations suggest that loss of IL-33 promotes the development of emphysema and may be potentially harmful to patients with COPD.

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Assessment of comorbidities and prognosis in patients with COPD diagnosed with the fixed ratio and the lower limit of normal: a systematic review and meta-analysis

Cited by 10 publications

References 52 publications

Spirometry for the diagnosis of airway obstruction in patients with risk factors for COPD: the GOLD and lower limit of normal criteria

Spirometry for the diagnosis of airway obstruction in patients with risk factors for COPD: the GOLD and lower limit of normal criteria

Airway Obstruction in Primary Care Patients: Need for Implementing Spirometry Use

Loss of IL-33 enhances elastase-induced and cigarette smoke extract-induced emphysema in mice

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