Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD
Haval BalataJonathan HarveyPhil BarberDenis ColliganRebecca DuerdenPeter EltonMatthew EvisonMelanie GreavesJ. HowellsKlaus IrionDevinda KarunaratneStuart MellorTom NewtonRichard SawyerAnna SharmanElaine SmithBen TaylorSarah H. TaylorJanet TongeAnna WalshamJ. WhittakerJørgen VestboRichard BootonPhilip Crosbie
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Abstract:
Background COPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme. Methods Ever smokers, age 55–74, resident in three deprived areas of Manchester were invited to a ‘Lung Health Check’ (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCO M2012 )), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCO M2012 ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV 1 /FVC<0.7. Primary care databases were searched for any prior diagnosis of COPD. Results 99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex ( adj OR 1.84, 95% CI 1.37 to 2.47; p<0.0001), younger age (p=0.015), lower smoking duration (p<0.0001), fewer cigarettes per day (p=0.035), higher FEV 1 /FVC ratio (<0.0001) and being asymptomatic ( adj OR 4.19, 95% CI 2.95 to 5.95; p<0.0001). The likelihood of screen detected lung cancer was significantly greater in those with evidence of airflow obstruction who had a previous diagnosis of COPD ( adj OR 2.80, 95% CI 1.60 to 8.42; p=0.002). Conclusions Incorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.Keywords:
Airway obstruction
现在，医药社区应该很好知道长期的妨碍的肺的疾病(COPD ) 的重要性，有高病态和死亡的一个逐渐地普通的条件。在现代条款， COPD 来了意味着并发的长期的支气管炎，气喘的支气管炎和肺气肿。香烟吸烟长作为占优势的病因论的代理人被认出了。动脉的 hypoxaemia， COPD 的经常的复杂并发症，能导致肺的高血压和英国管 pulmonale。COPD 影响超过 5% 成年人口并且是其病态和死亡在几个国家正在增加的死亡的唯一的主要原因。在中国，确定是困难的多少人与 COPD 被影响。然而，最近的流行病学的调查显示那 COPD 流行在中国是 8.2% 。在男人的 COPD 流行比在女人显著地高(12.4% cf 5.1%) 。在农村区域的流行在城市的区域(8.8%cf7.8%) 比那高。有 COPD 的病人， 61.5% 是吸烟者。报告也声明 COPD 是在在中国和在城市的区域的死亡的第四个领先的原因的农村区域的死亡的主要原因，升起到在 2020 的死亡的第三个领先的原因。疾病的流行与年龄增加，最高的率在超过 70 年岁的人看。COPD 是有升起的发生和世界范围的流行的死亡的唯一的主要原因，显示它一逐渐地使人烦恼的。
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瞄准：为了调查手术后的肺的复杂并发症(POPC ) 的各种各样的类型的发生并且评估起作用的仙子的意义，在有食道的癌症的病人的动脉的血气体在食管切除术以后与长期的妨碍的肺的疾病(COPD ) 伴随了。方法：358 个病人被划分成 POPC 组和 COPD 组。我们为食道的癌症在食管切除术以后执行了 358 个连续病人的回顾的评论与或没有 COPD 在手术后的肺的复杂并发症上估计 COPD 的可能的影响。我们在 1 s (FEV1 ) 根据预言百分比的强迫的吐气的体积分类 COPD 进四个等级并且在四个等级之中分析了复杂并发症的发生率。Perioperative 动脉的血气体在 COPD 组并且与 POPC 组相比在病人被测试与或没有肺的复杂并发症。结果：有 COPD 的病人(29/86， 33.7%) 没有 COPD，比那些有更肺的复杂并发症(36/272， 13.2%)(P 或 =80% 预言) COPD (P < 0.05 ) 。PaO (2 ) 被减少， PaCO (2 ) 在第一个手术后的星期内在 COPD 组与肺的复杂并发症在病人被增加。结论：COPD 的标准是为在经历食管切除术的食道的癌症病人的肺的复杂并发症的批评预言者。COPD 的严厉影响肺的复杂并发症的发生率，并且预言百分比的 FEV1 是为在有 COPD 的病人的肺的复杂并发症的一个好预兆的变量。动脉的血气体在指导起作用的仙子是有用的管理。
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BackgroundDiagnosing Chronic Obstructive Pulmonary Disease (COPD) without spirometry is difficult; we had developed previously a scale (DS-COPD) in an epidemiological setting. It allowed diagnosing COPD confidently when scored high, and excluded confidently when low.AimTo validate the DS-COPD in clinical setting through a case-control study, and to evaluate the cost saving by its use.MethodsIn two tertiary care hospitals, we calculated the DS-COPD scale in suspected COPD and controls; COPD was predicted in the study sample and in symptomatic individuals. COPD status was confirmed by post-bronchodilator spirometry.ResultsFrom the ROC curve, the Area Under Curve was 0.945. The Positive Predictive Value was 79% if DS-COPD was >17 and the Negative Predictive Value was 83% if DS-COPD was <10 in symptomatic individuals. A DS-COPD of 10–17 represented a gray zone mostly suggestive of no COPD. For every 100 symptomatic patients 4150$ were saved combining spirometry and scale when inconclusive compared to systematic use of spirometry.ConclusionsWe were able to validate a scale (DS-COPD) for COPD diagnosis in clinical setting. It would be valuable in primary care settings, where spirometry may not be available and in clinical settings before availability of spirometry results. Future prospective studies are still needed to confirm its value.
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서론: 만성폐쇄성폐질환(chronic obstructive pulmonary disease, COPD)는 최근 사망률과 유병률이 증가하는 만성적인 질환이다. 국내에서의 유병률은 간헐적으로 보고되고 있지만, 수년간에 걸친 COPD 유병률의 변화와 그리고 COPD 위험인자의 변화에 관한 연구는 없었다. 이 연구는 국민건강영양조사 자료를 이용하여 8년 간의 COPD 빈도와 위험인자의 변화에 관해 알아보고자 하였다. 방법: 2007년부터 2014년 간의 국민건강영양조사 원시자료를 이용하였으며, 이중 나이 40세 이상이면서 폐기능 검사를 시행한 총 24,500명 (남자 43.8%, 여자 56.2%)의 자료를 분석하였다. COPD의 진단은 FEV1/FVC 비가 0.7 미만인 경우로 하였다. COPD 위험인자의 분석에는 거주 지역, 소득, 교육, 흡연, BMI, vitamin D를 이용하였다. 결과: COPD 빈도는 2007년도에 18.4%로 가장 높았으며, 이후 감소하는 추세를 보여 2009년에는 11.9% 였다. 2011년도부터 다시 증가하기 시작하여 2014년도 까지 COPD 빈도는 13.5%에서 15.4 % 였다. 여자와 남자 모두 비슷한 형태를 보였다. 다항 로지스틱 회귀 분석에서 2007년도부터 2014년 전체를 대상으로 하였을 때, COPD 위험인자는 저소득, 낮은 교육, 흡연, 낮은 BMI 와 혈중 vitamin D 였으며, 거주 지역은 위험인자가 아니었다. 년도별 분석에서도 저소득, 흡연, 낮은 BMI는 COPD의 위험인자였지만, 낮은 교육은 2009년도 이후부터는 COPD의 위험인자가 아니었다. Vitamin D는 년도에 따라 다른 결과를 보였다. 결론: 낮은 교육 수준은 COPD의 위험인자가 아니었다.
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Introduction. Our objective was to review articles that report the prevalence of cervical disc herniations in asymptomatic subjects using MRIs and conduct a qualitative systematic review.Methods. A MEDLINE search for articles published between 1974 and 2004 was performed, and five articles were retained in this review.Results. Teresi et al. (1987) studied 35 asymptomatic subjects retrospectively and 65 asymptomatic subjects prospectively, and found 20% of subjects aged 45–54 years, 35% of subjects aged 55–64 years, and 57% of subjects older than 64 years had cervical disc herniations/bulges. Boden et al. (1990) studied 63 asymptomatic subjects and found 10% of subjects of less than 40 years and 5% of subjects older than 40 years had disc herniations. Lehto et al. (1994) studied 89 asymptomatic subjects and found that each of 2 subjects (one 29 and the other 56 years) had a disc prolapse; the prevalence was 2.2%. Matsumoto et al. (1998) studied 497 asymptomatic subjects. They found that 70 of 2480 discs scanned were prolapsed posteriorly (2.8%), and reported that the frequency of these lesions increased after 40 years. Siivola et al. (2002) compared 15 asymptomatic and 16 symptomatic subjects after 7 years and found no disc herniations (0%) in the asymptomatic group and 4 disc herniations (25%) in the symptomatic group.Conclusions. The prevalence of cervical disc herniations in asymptomatic subjects of less than 40 years of age is 3% to 10% and increases to 20% in subjects up to 54 years of age. The prevalence increases with age—from 5% to 35% in subjects between 40 and 64 years of age.
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・GOLD (Global Initiative for Chronic Obstructive Lung Disease) は, EBM (evidence based medi-cine) に基づいて作成され, 2001年に公表されたCOPD (Chronic Obstructive Pulmonary Dis-ease) の治療と管理に関する国際的ガイドラインである。・COPDに関して, 定義, 危険因子, 診断, 管理計画, 薬物治療, 患者教育, 急性増悪の7つのキーポイントを指摘している。・従来の慢性気管支炎や肺気腫などの診断名は用いず, COPDという診断名で新しい定義を規定している。・COPD発症のもっとも重要な危険因子は喫煙である。・COPDの診断にスパイロメトリーが必須である。・COPDの病期分類は, 一秒量 (FEV1) の程度にしたがって重症度を軽症-最重症の4段階に分類しているが, 新たに呼吸機能は正常であるが呼吸器症状 (咳, 痰) がある群をstage 0として設定し, 早期診断と早期予防を重視している。・COPDの管理として, 疾患の評価とモニタリング, 危険因子の縮小, 安定期COPDの管理, 急性増悪の管理の4つの要素を指摘している.・治療は, 全ての病期で, 危険因子の回避 (特に禁煙) とインフルエンザワクチンの接種を推奨している。・薬物治療と非薬物治療に関して, EBMに基づいて段階的治療を推奨している。
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Introduction: The prevalence of peripheral arterial disease (PAD) ranges between 4.5% and 57% and is independently associated with cardiovascular disease burden irrespective of symptoms. Two thirds of cases are thought to be asymptomatic and may go unrecognised. Local prevalence and natural progression of asymptomatic PAD is unknown.Methods: This one year, non-interventional longitudinal study, aimed to determine prevalence and progression of asymptomatic PAD in patients with cardiovascular risk factors. Results: Of 217 patients screened, 36% had asymptomatic disease in 113 legs. Of sixty two who returned for follow-up, eight normal legs developed asymptomatic PAD, and 46%, asymptomatic at baseline showed disease progression. Initial baseline ABI showed significant change over 1 year of follow-up (p=0.001) and 21% (13) of patients eventually developed intermittent claudication. Also, 52% of baseline asymptomatic participants having at least one associated cardiovascular risk factor showed disease progression over 1 year. Those developing claudication demonstrated significant ABI deterioration. Having two or more cardiovascular risk factors significantly affected progression of asymptomatic disease, (p = 0.031). Conclusion: Study confirms high prevalence of asymptomatic PAD in our population and significant disease progression in one year.Key words: Peripheral Artery Disease, Risk Factors, Asymptomatic, Disease Progression
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To define characteristics of pediatric asymptomatic idiopathic intracranial hypertension (IIH).We retrospectively reviewed our Neuro-Ophthalmology database (2000-2006) for all cases of symptomatic and asymptomatic pediatric IIH.Out of 45 IIH cases, 14 (31.1%) were asymptomatic (incidental examination). When compared with children with symptomatic IIH, asymptomatic cases were younger [5.6 (1.8-15) vs 11.0 (5-17) years, P = 0.007], had lower percentage of obesity (14.3% vs 48.4%, P = 0.046), and had male predominance (71.4% vs 38.7%, P = 0.06). Asymptomatic cases required shorter duration of acetazolamide treatment [3 (0-8), vs 6 (0-20) months, P = 0.021], and resulted in complete resolution of swollen discs.We speculate that asymptomatic IIH may be more common in young children and could represent a milder form or a presymptomatic phase before evolving into classic symptomatic IIH. Further studies to assess the clinical significance of asymptomatic IIH are warranted.
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