Related Articles

Mechanistic links between COPD and lung cancer.

Nat Rev Cancer. 2013 Mar 7;

Authors: Houghton AM

Abstract
Numerous epidemiological studies have consistently linked the presence of chronic obstructive pulmonary disease (COPD) to the development of lung cancer, independently of cigarette smoking dosage. The mechanistic explanation for this remains poorly understood. Progress towards uncovering this link has been hampered by the heterogeneous nature of the two disorders: each is characterized by multiple sub-phenotypes of disease. In this Review, I discuss the nature of the link between the two diseases and consider specific mechanisms that operate in both COPD and lung cancer, some of which might represent either chemopreventive or chemotherapeutic targets.

PMID: 23467302 [PubMed - as supplied by publisher]

Vena cava filters in hospitalised patients with chronic obstructive pulmonary disease and pulmonary embolism.

Thromb Haemost. 2013 Mar 7;109(5)

Authors: Stein PD, Matta F

Abstract
In view of the high case fatality rates of patients with chronic obstructive pulmonary disease (COPD) who have pulmonary embolism (PE) we speculated that such patients might benefit from vena cava filters. To test this hypothesis we assessed the database of the Nationwide Inpatient Sample. From 1998-2009, 440,370 patients were hospitalised with PE and COPD who were not in shock or ventilator-dependent and did not receive thrombolytic therapy or pulmonary embolectomy. In-hospital all-cause case fatality rate among those with filters was 5,890 of 68,800 (8.6%) (95% confidence interval [CI] = 8.4-8.8) compared with 38,960 of 371,570 (10.5%) (95% CI = 10.4-10.6) (p<0.0001) who did not receive filters. Case fatality rate was age-dependent. Only those who were older than aged 50 years had a lower in-hospital all-cause case fatality rate with filters. Among such patients, absolute risk reduction was 2.1% (95% CI = 1.9-2.3). The greatest reduction of case fatality rate with vena cava filters was shown in patients >aged 80 years, 11,720 of 81,600 (14.4%) compared with 1,570 of 17,220 (9.1%) (p<0.0001). In conclusion, a somewhat lower in-hospital all-cause case fatality rate was shown with vena filters in stable patients with PE >aged 50 years who also had COPD. The benefit was greatest in elderly patients. The benefit in terms of a decreased case fatality rate would seem to outweigh the risks of vena cava filters in such patients.

PMID: 23467701 [PubMed - as supplied by publisher]

Related Articles

A New Approach to Classification of Disease Severity and Progression of Chronic Obstructive Pulmonary Disease.

Chest. 2013 Mar 7;

Authors: Mannino DM, Diaz-Guzman E, Pospisil J

Abstract
ABSTRACT BACKGROUND: Most current classification schemes for chronic obstructive pulmonary disease (COPD) use lung function as the primary way to classify disease severity and monitor disease progression. This approach misses important components of the disease process. METHODS: We evaluated existing data to develop a classification scheme for COPD using measures beyond lung function, including respiratory symptoms, exacerbation history, quality of life assessment, comorbidity, and body mass index. We then applied this scheme to data from the Lung Health Study, calculating a score for study subjects in year 1 and year 5 of the study, along with the difference between year 1 and year 5. FINDINGS: We developed a 4 point scale ranging from 1.00 (mild) to 4.00 (very severe). In year 1 of the study, the mean COPD score was 1.76, in year 5 it was 1.82. The mean difference from year 1 to year 5 was an increase (worsening) of 0.06, and a range from -1.0 to 1.6. The COPD score at year 1, year 5, and the difference between these scores were all predictive of mortality at follow-up. For example, the 14.0% of subjects whose score improved by at least 0.25 between year 1 and 5 had decreased mortality compared to those with stable scores (between -0.25 and 0.25, hazard ratio 0.6, 95% confidence interval 0.4, 0.8). INTERPRETATION: A COPD severity score that includes components in addition to lung function and allows for both improvement and worsening of disease may provide additional guidance to COPD classification, management, and prognosis.

PMID: 23471264 [PubMed - as supplied by publisher]

Ambient air pollution- a cause for COPD?

Eur Respir J. 2013 Mar 7;

Authors: Schikowski T, Mills IC, Anderson HR, Cohen A, Hansell A, Kauffmann F, Krämer U, Marcon A, Perez L, Sunyer J, Probst-Hensch N, Künzli N

Abstract
The role of ambient air pollution in the development of chronic obstructive pulmonary disease (COPD) is considered to be uncertain. We review the evidence in the light of recent studies.Eight morbidity and six mortality studies were identified. These were heterogeneous in design, characterization of exposure to air pollution, and methods of outcome definition. Six morbidity studies with objectively defined COPD (FEV1/FVC ratio) were cross-sectional analyses. One longitudinal study defined incidence of COPD as the first hospitalization due to COPD. However, neither mortality nor hospitalization studies can unambiguously distinguish acute from long-term effects on the development of the underlying patho-physiological changes.Most studies were based on within-communities exposure contrasts which mainly assess traffic-related air pollution. Overall, evidence of chronic effects of air pollution on the prevalence and incidence of COPD among adults was suggestive but not conclusive despite plausible biologic mechanisms and good evidence that air pollution affects lung development in childhood and triggers exacerbations in COPD patients. To fully integrate this evidence in the assessment, the life-time course of COPD should be better defined. Larger studies with longer follow-up periods, specific definitions of COPD phenotypes, and more refined and source-specific exposure assessments are needed.

PMID: 23471349 [PubMed - as supplied by publisher]