Nocturnal gastroesophageal reflux, lung function and symptoms of obstructive sleep apnea: Results from an epidemiological survey.

Respir Med. 2012 Mar;106(3):459-66

Authors: Emilsson OI, Janson C, Benediktsdóttir B, Júlíusson S, Gíslason T

Abstract
BACKGROUND: Nocturnal gastroesophageal reflux (nGER) has received increasing interest as a predisposing factor for respiratory diseases and sleep disturbances. The possible role of obstructive sleep apnea (OSA) contributing to nGER is of special interest. The aim of this study was to explore the association between nGER and respiratory diseases, lung function and symptoms of OSA.
METHODS: Participants in the Burden of Obstructive Lung Disease (BOLD) initiative in Iceland and Sweden, a random sample from the general population of 1325 adults aged 40+ (>70% response rate), were compared by pre- and post-bronchodilator spirometry, answers to questionnaires about OSA and respiratory symptoms, health, and symptoms of GER.
RESULTS: Altogether 102 (7.7%) reported nGER and 249 had used medication against GER. The participants were divided into three groups: 1) No nGER (n = 1040), 2) treated GER without nGER (n = 183) and 3) nGER (n = 102). The nGER group had a significantly higher prevalence of respiratory and OSA symptoms than subjects without nGER. The nGER group also had a higher prevalence of COPD (GOLD stage 1+), (25.0% vs. 15.6%) (p = 0.02) and lower FEV(1)/FVC ratio (95.9% vs. 98.9% of the predicted, p = 0.01). These associations remained significant after adjusting for smoking, weight and other possible confounders. No independent association was found between having treated GER and lung function, respiratory or OSA symptoms.
CONCLUSIONS: In our cross-sectional epidemiological study, untreated nGER is strongly associated with both respiratory and OSA symptoms as well as airflow obstruction.

PMID: 22197048 [PubMed - in process]

Update on mortality in COPD - report from the OLIN COPD study.

BMC Pulm Med. 2012 Jan 9;12(1):1

Authors: Lindberg A, Larsson LG, Muellerova H, Ronmark E, Lundback B

Abstract
ABSTRACT: BACKGROUND: The poor recognition and related underdiagnosis of COPD contributes to an underestimation of mortality in subjects with COPD. Data derived from population studies can advance our understanding of the true burden of COPD. The objective of this report was to evaluate the impact of COPD on mortality and its predictors in a cohort of subjects with and without COPD recruited during the twenty first century. METHODS: All subjects with COPD (n=993) defined according to the GOLD spirometric criteria, FEV1/FVC<0.70, and gender- and age-matched subjects without airway obstruction, non-COPD (n=993), were identified in a clinical follow-up survey of the Obstructive Lung Disease in Northern Sweden (OLIN) Studies cohorts in 2002-2004. Mortality was observed until the end of year 2007. Baseline data from examination at recruitment were used in the risk factor analyses; age, smoking status, lung function (FEV1 % predicted) and reported heart disease. RESULTS: The mortality was significantly higher among subjects with COPD, 10.9%, compared to subjects without COPD, 5.8% (p<0.001). Mortality was associated with higher age, being a current smoker, male gender, and COPD. Replacing COPD with FEV1 % predicted in the multivariate model resulted in the decreasing level of FEV1 being a significant risk factor for death, while heart disease was not a significant risk factor for death in any of the models. CONCLUSIONS: In this cohort COPD and decreased FEV1 were significant risk factors for death when adjusted for age, gender, smoking habits and reported heart disease.

PMID: 22230685 [PubMed - as supplied by publisher]

Diagnostic management of chronic obstructive pulmonary disease.

Neth J Med. 2012 Jan;70(1):6-11

Authors: Broekhuizen BD, Sachs AP, Hoes AW, Verheij TJ, Moons KG

Abstract
Detection of early chronic obstructive pulmonary disease (COPD) in patients presenting with respiratory symptoms is recommended&semi; however, diagnosing COPD is difficult because a single gold standard is not available. The aim of this article is to review and interpret the existing evidence, theories and consensus on the individual parts of the diagnostic work-up for COPD. Relevant articles are discussed under the subheadings: history taking, physical examination, spirometry and additional lung function assessment. Wheezing, cough, phlegm and breathlessness on exertion are suggestive signs for COPD. The diagnostic value of the physical examination is limited, except for auscultated pulmonary wheezing or reduced breath sounds, increasing the probability of COPD. Spirometric airflow obstruction after bronchodilation, defined as a lowered ratio of the forced volume in one second to the forced vital capacity (FEV1÷ FVC ratio), is a prerequisite, but can only confirm COPD in combination with suggestive symptoms. Different thresholds are being recommended to define low FEV1÷FVC, including a fixed threshold, and one varying with gender and age&semi; however, the way physicians interpret these thresholds in their assessment is not well known. Body plethysmography allows a more complete assessment of pulmonary function, providing results on the total lung capacity and the residual volume and is indicated when conventional spirometry results are inconclusive. Chest radiography has no diagnostic value for COPD but is useful to exclude alternative diagnoses such as heart failure or lung cancer. Extensive history taking is of key importance in diagnosing COPD.

PMID: 22271808 [PubMed - in process]

Colonisation with Pseudomonas aeruginosa and antibiotic resistance patterns in COPD patients.

Swiss Med Wkly. 2012;142:0

Authors: Engler K, Mühlemann K, Garzoni C, Pfahler H, Geiser T, von G

Abstract
QUESTIONS: P. aeruginosa infections are assumed to play a major role in the frequency of exacerbations and severity of chronic obstructive pulmonary disease (COPD). Colonisation with P. aeruginosa accelerates lung function decline, most probably due to more frequent exacerbations. In this retrospective study we aimed to determine the prevalence of colonisation with P. aeruginosa in COPD patients treated in a tertiary hospital centre.
METHODS: 112 patients diagnosed with COPD testing positive for P. aeruginosa in at least one respiratory sample during the study period (2004-2008) were retrospectively analysed to estimate GOLD stage-specific prevalences, colonisation patterns, morphology and antibiotic resistance profiles of P. aeruginosa strains.
RESULTS: Colonisation with P. aeruginosa was present in all COPD stages, but prevalence significantly increased with disease severity (GOLD 1: 0.7%, GOLD 2: 1.5%; GOLD 3: 1.5%; GOLD 4: 2.6%; p = 0.0003). 41% of COPD patients with P. aeruginosa-positive respiratory samples were chronic carriers, of whom 8% had mucoid strains. Carriage of a mucoid strain was associated with advanced COPD stage GOLD 4 (p = 0.01). Resistance to cephalosporins was most frequently encountered and resistance to ciprofloxacin was found in more advanced stages of COPD.
CONCLUSIONS: Colonisation with P. aeruginosa was present in all COPD severity stages and colonisation with mucoid strains was more frequent in advanced COPD. Resistance to the only oral anti-pseudomonas antibiotic ciprofloxacin was more frequently encountered in severe COPD stages.

PMID: 22290607 [PubMed - in process]