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FEV1 Is a Better Predictor of Mortality than FVC: The PLATINO Cohort Study.

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FEV1 Is a Better Predictor of Mortality than FVC: The PLATINO Cohort Study.

PLoS One. 2014;9(10):e109732

Authors: Menezes AM, Pérez-Padilla R, Wehrmeister FC, Lopez-Varela MV, Muiño A, Valdivia G, Lisboa C, Jardim JR, de Oca MM, Talamo C, Bielemann R, Gazzotti M, Laurenti R, Celli B, Victora CG, PLATINO team

Abstract
OBJECTIVE: To determine whether the presence of chronic obstructive lung disease (COPD) and reduction of lung function parameters were predictors of mortality in a cohort.
MATERIALS/PATIENTS AND METHODS: Population based cohorts were followed in Montevideo, Santiago and Sao Paulo during 5, 6 and 9 years, respectively. Outcomes included all-cause, cardiovascular, respiratory and cancer mortality; exposures were COPD, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cox regression was used for analyses. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics curves and Youden's index were calculated.
RESULTS: Main causes of death were cardiovascular, respiratory and cancer. Baseline COPD was associated with overall mortality (HR = 1.43 for FEV1/FVC<LLN; 2.01 for GOLD 2-4; 1.46 for GOLD 1-4; 1.50 for FEV1/FEV6 <LLN). For cardiovascular mortality, significant associations were found with GOLD 2-4 (HR = 2.68) and with GOLD 1-4 (HR = 1.78) for both genders together (not among women). Low FEV1 was risk for overall and respiratory mortality (both genders combined). FVC was not associated with overall mortality. For most COPD criteria sensitivity was low and specificity high. The area under the curve for FEV1 was greater than for FVC for overall and cardiovascular mortality.
ANSWER TO THE QUESTION: COPD and low FEV1 are important predictors for overall and cardiovascular mortality in Latin America.

PMID: 25285441 [PubMed - in process]

Outdoor air pollution: a global perspective.

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kje10481_fm-2Although the air quality in Western countries has continued to improve over the past decades, rapid economic growth in developing countries has left air quality in many cities notoriously poor.

The World Health Organization estimates that urban outdoor air pollution is estimated to cause 1.3 million deaths worldwide per year. The primary health concerns of outdoor air pollution come from particulate matter less than 2.5 μm (PM2.5) and ozone (O3). Short-term exposure to PM2.5 increases cardiopulmonary morbidity and mortality. Long-term exposure to PM2.5 has been linked to adverse perinatal outcomes and lung cancer. Excessive O3 exposure is known to increase respiratory morbidity. Patients with chronic cardiopulmonary diseases are more susceptible to the adverse effects of air pollution.

Counseling these patients about air pollution and the associated risks should be part of the regular management plans in clinical practice.

Advanced diagnostic studies: exhaled breath and sputum analyses.

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The present paper aims to review the advantages and limitations of sputum cell counts and exhaled nitric oxide (FeNO) levels in the investigation of occupational asthma (OA).

METHODS: The American College of Chest physicians held a course on occupational and Environmental Lung Diseases in Toronto in 2013. A summary of the session on non-invasive measures of airway inflammation in OA is presented here.

RESULTS: Occupational asthma is associated with an increase in sputum eosinophil percentage during periods at work or after positive specific inhalation challenges. Changes in FeNO are less sensitive than sputum eosinophil counts for predicting OA.

CONCLUSIONS: In settings where this tool is available, sputum eosinophil counts may complement the current investigation of OA. The interpretation of FeNO remains sometimes difficult. The phenotypes of patients who may benefit from this measure needs to be better defined.

Climate change and respiratory health.

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shutterstock_153806906OBJECTIVE: To discuss the nature of climate change and both its immediate and long-term effects on human respiratory health.

METHODS: This review is based on information from a presentation of the American College of Chest Physicians course on Occupational and Environmental Lung Disease held in Toronto, Canada, June 2013. It is supplemented by a PubMed search for climate change, global warming, respiratory tract diseases, and respiratory health. It is also supplemented by a search of Web sites including the Environmental Protection Agency, National Oceanic and Atmospheric Administration, World Meteorological Association, National Snow and Ice Data Center, Carbon Dioxide Information Analysis Center, Inter-Governmental Panel on Climate Change, and the World Health Organization.

RESULTS: Health effects of climate change include an increase in the prevalence of certain respiratory diseases, exacerbations of chronic lung disease, premature mortality, allergic responses, and declines in lung function.

CONCLUSIONS: Climate change, mediated by greenhouse gases, causes adverse health effects to the most vulnerable patient populations-the elderly, children, and those in distressed socioeconomic strata.

The COPD Assessment Test: what have we learned over its first 5 years?

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The original idea behind the CAT’s development was that it should aid communication between patient and clinician. Use of modern psychometrics in its development allows it to do much more than that. This review has shown that it provides reliable measurement of a complex construct, overall health status impairment, using a very small number of items. CAT scores can aid assessment of patients and communication between healthcare professionals in routine practice, and help characterise patients and measure outcomes in clinical studies.

The fact that this review of the CAT identified so many studies, performed in so many patients, in such a short time is clearly a testament to its strengths: it is short, easy, reliable, responsive and very cheap to use.

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