Juan P de Torres
Universidad de Navarra, Medicina Interna, Faculty Member
The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) update includes airflow limitation, history of COPD exacerbations, and symptoms to classify and grade COPD severity. We aimed to determine their distribution in 11... more
The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) update includes airflow limitation, history of COPD exacerbations, and symptoms to classify and grade COPD severity. We aimed to determine their distribution in 11 well-defined COPD cohorts and their prognostic validity up to 10 years to predict time to death. Spirometry in all 11 cohorts was postbronchodilator. Survival analysis and C statistics were used to compare the two GOLD systems by varying time points. Of 3,633 patients, 1,064 (33.6%) were in new GOLD patient group A (low risk, less symptoms), 515 (16.3%) were B (low risk, more symptoms), 561 (17.7%) were C (high risk, less symptoms), and 1,023 (32.3%) were D (high risk, more symptoms). There was great heterogeneity of this distribution within the cohorts ( x (2) , P < .01). No differences were seen in the C statistics of old vs new GOLD grading to predict mortality at 1 year (0.635 vs 0.639, P = .53), at 3 years (0.637 vs 0.645, P = .21), or at 10 years (0.639 vs 0.642, P = .76). The new GOLD grading produces an uneven split of the COPD population, one third each in A and D patient groups, and its prognostic validity to predict time to death is no different than the old GOLD staging based in spirometry only.
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Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real-life are still low among COPD patients. We sought to evaluate the clinical consequences of changes in smoking habits in a large... more
Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real-life are still low among COPD patients. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of COPD patients. CHAIN is a Spanish multicenter study carried out at pulmonary clinics including active and former smokers with COPD. Smoking status was certified by clinical history and co-oximetry. Clinical presentation and disease impact were recorded via validated questionnaires, including the London Chest Activity of Daily Living (LCADL) and the Hospital Anxiety and Depression Scale (HADS). No specific smoking cessation intervention was carried out. Clinical consequences of smoking cessation were analyzed by multivariate regression and decision tree analyses. One thousand and eighty-one COPD patients were included (80.8% males, 65.2 (SD 8.9) years of age, FEV60.2 (20.5)%). During the two-year follow-up time (visit 2: 906 patients; visit 3...
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COPD is an heterogeneous disease better characterized by multidimensional phenotyping. Clustering is a technique used to identify discrete subgroups with similar combinations of traits. Except for pulmonary function variables, many other... more
COPD is an heterogeneous disease better characterized by multidimensional phenotyping. Clustering is a technique used to identify discrete subgroups with similar combinations of traits. Except for pulmonary function variables, many other characteristics (6MWT, BMI, QOL) are not unique to COPD. Aim: To compare how discrete clusters form in a mixed cohort of 120 individuals with COPD and controls. Methods: Hundred and twenty patients matched by age and gender were selected, 90 with COPD of which 60 died at 3 years of follow-up. Hierarchical clustering was applied using pulmonary function, functional, anthropometric and QOL variables. Clusters were compared against a selected reference. Results: Four clusters were identified and their composition is shown in A. Cluster 4 composed with 84% controls was used as reference and the comparison and descriptions are shown in B. Conclusion: Clustering is a useful tool to discriminate clinical meaningful phenotypes and by including “controls” we showed that >10% were assigned in COPD predominant clusters. This could be important when designing exploratory studies.
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The 6-minute walk distance (6MWD) has been useful in the evaluation of men with COPD. Little is known about 6MWD in women with the disease. Using healthy women as a reference, to evaluate the factors that help determine 6MWD in women with... more
The 6-minute walk distance (6MWD) has been useful in the evaluation of men with COPD. Little is known about 6MWD in women with the disease. Using healthy women as a reference, to evaluate the factors that help determine 6MWD in women with COPD. To explore if the 350 meters threshold differentiates survival in women as it does in men. Healthy women (n = 164) and with COPD (n = 223) were included in the study. Age, pack-years history, smoking status, comorbidities (Charlson Index), BMI, MRC dyspnea, spirometry and 6MWD were recorded in all participants and PaO(2) and IC/TLC in COPD women. The patients were prospectively followed and deaths registered. Factors predicting 6MWD were determined by multiple regression analysis. ROC analysis was used to calculate the best threshold value for the 6MWD with mortality as gold standard. Kaplan-Meier curves compared survival of patients that walked more or less than 350 m by age categories. The 6MWD is decreased in women with COPD. Values decrease with age and GOLD stages. Age, BMI, smoking status, comorbidities, MRC and FEV(1%) are statistical significant predictors of 6MWD. A 350 m cut-off value has a good sensitivity and specificity to predict (73% and 80% respectively) and differentiate survival (p…
Research Interests: Medicine, Comorbidity, Prospective studies, Humans, COPD, and 15 moreInternal Medicine, Female, Regression Analysis, Body Mass Index, ROC Curve, Aged, Middle Aged, Adult, Analysis of Variance, Proportional hazards model, Age Factors, Cross Sectional Studies, Predictive value of tests, Respiratory function tests, and Pulmonary Disease Chronic Obstructive
COPD is a leading cause of dead worldwide and tobacco smoking is its major risk factor. IL8 is a proinflammatory chemokine mainly involved in the acute inflammatory reaction. The aim of this study was to test the association of IL-8,... more
COPD is a leading cause of dead worldwide and tobacco smoking is its major risk factor. IL8 is a proinflammatory chemokine mainly involved in the acute inflammatory reaction. The aim of this study was to test the association of IL-8, CXCR1 and CXCR2 gene variants and COPD susceptibility as part of a replication study and explore the effect of these variations in disease progression. 9 tagSNPs were genotyped in 728 Caucasian individuals (196 COPD patients, 80 smokers and 452 non-smoking controls). Pulmonary compromise was evaluated using spirometry and clinical parameters at baseline and annually over a 2 years period. We also determined plasma levels of TNF-α, IL-6, IL-8 and IL-16 in COPD patients. There was a lack of association between gene variants or haplotypes with predisposition to COPD. No correlation was observed between the polymorphisms and cytokines levels. Interestingly, significant associations were found between carriers of the rs4073A (OR = 3.53, CI 1.34-9.35, p = 0.01), rs2227306C (OR = 5.65, CI 1.75-18.88, p = 0.004) and rs2227307T (OR = 4.52, CI = 1.49-12.82, p = 0.007) alleles in the IL-8 gene and patients who scored higher in the BODE index and showed an important decrease in their FEV1 and FVC during the 2 years follow-up period (p < 0.05). Despite no association was found between the studied genes and COPD susceptibility, three polymorphisms in the IL-8 gene appear to be involved in a worse progression of the disease, with an affectation beyond the pulmonary function and importantly, a reduction in lung function along the follow-up years.
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Research Interests: Medicine, Humans, COPD, Internal Medicine, Female, and 15 moreMale, Clinical Sciences, Aged, Middle Aged, Chest, Chronic obstructive pulmonary disease, Exercise Test, Oxygen Consumption, Exercise Tolerance, Logistic Models, Predictive value of tests, Oxygen saturation, Confidence Interval, Cohort Studies, and Pulmonary Disease Chronic Obstructive
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Rationale and objective Patients with chronic obstructive pulmonary disease (COPD), usually diagnosed after the 6th decade, frequently suffer from comorbidities. Whether COPD patients 50 years or younger (Young COPD) have similar... more
Rationale and objective Patients with chronic obstructive pulmonary disease (COPD), usually diagnosed after the 6th decade, frequently suffer from comorbidities. Whether COPD patients 50 years or younger (Young COPD) have similar comorbidities with the same frequency and mortality impact as aged-matched controls or older COPD patients is unknown. Methods We compared comorbidity number, prevalence and type in 3 groups of individuals with ≥ 10 pack-years of smoking: A Young (≤ 50 years) COPD group (n = 160), an age-balanced control group without airflow obstruction (n = 125), and Old (> 50 years) COPD group (n = 1860). We also compared survival between the young COPD and control subjects. Using Cox proportional model, we determined the comorbidities associated with mortality risk and generated Comorbidomes for the “Young” and “Old” COPD groups. Results The severity distribution by GOLD spirometric stages and BODE quartiles were similar between Young and Old COPD groups. After adjus...
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Rationale: Programmed Death Ligand 1 (PD-L1) is crucial in regulating the immunological tolerance in non-small cell lung cancer (NSCLC). Alveolar macrophage (AM)-derived PD-L1 binds to its receptor, PD-1, on surveilling lymphocytes,... more
Rationale: Programmed Death Ligand 1 (PD-L1) is crucial in regulating the immunological tolerance in non-small cell lung cancer (NSCLC). Alveolar macrophage (AM)-derived PD-L1 binds to its receptor, PD-1, on surveilling lymphocytes, leading to lymphocyte exhaustion. Increased PD-L1 expression is associated with cigarette smoke (CS)-exposure. However, the PD-L1 role in CS-associated lung diseases associated with NSCLC, such as chronic obstructive pulmonary disease (COPD), is still unclear.Methods: In two different cohorts of ever smokers with COPD or NSCLC, and ever and never smoker controls, we evaluated PD-L1 expression: 1) via cutting-edge digital spatial proteomic profiling (Geomx) of formalin-fixed paraffin-embedded (FFPE) lung tissue sections (n=19); and 2) via triple immunofluorescence staining of bronchoalveolar lavage (BAL) AMs (n = 83). PD-L1 mRNA expression was also quantified in BAL AMs exposed to CS extract.Results: PD-L1 expression was increased in the bronchiolar wall,...
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This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses.Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed... more
This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses.Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed using cluster analysis resulting in the identification of subgroups, for which clinical relevance was determined by comparing 3-year all-cause mortality. Classification and regression trees (CARTs) were used to develop an algorithm for allocating patients to these subgroups. This algorithm was tested in 3651 patients from the COPD Cohorts Collaborative International Assessment (3CIA) initiative.Cluster analysis identified five subgroups of COPD patients with different clinical characteristics (especially regarding severity of respiratory disease and the presence of cardiovascular comorbidities and diabetes). The CART-based algorithm indicated that the variables relevant for patient grouping differed markedly between patients with isolated respirato...
Research Interests: Algorithms, International Cooperation, Medicine, France, Comorbidity, and 15 moreBelgium, Humans, COPD, Internal Medicine, Diabetes mellitus, Female, Journal Article, Male, Cluster Analysis, Body Mass Index, Aged, Chronic obstructive pulmonary disease, Clinical Significance, Cohort Studies, and Medical and Health Sciences
Introduction: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis. In these patients, the relationship between osteoporosis measured by bone density in chest computed tomography (CT) and... more
Introduction: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis. In these patients, the relationship between osteoporosis measured by bone density in chest computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) is not well established. Objectives: To determine the association between the bone mineral density (BMD) measured in the first lumbar vertebra (L1) of a low dose chest CT (LDCT) with the one measured in a bone DXA. We also aim at exploring the possible association of this measurement with the severity of radiological emphysema. Methods: 43 COPD patients with emphysema were evaluated. In a LDCT we determined BMD in the central part of L1 body. DXA was in all patients. The quantification of emphysema in CT was performed using a specific software (Volume, Siemens Healthcar) considering 3 different thresholds: -900, -950 and -960 Hounsfield Units (HU), and the emphysema index (EI) was calculated. Spearman correlation coefficient was used for the statistical analysis. Results: The correlation between the BMD in L1 by CT and the lumbar spine (L1-L4) density by DXA was 0.40 (p Conclusions: There is a weak correlation between BMD measured in CT and DXA. In the same way, there is a weak inverse correlation between IE and BMD determined by CT. Further studies are needed to establish the relationship between these two diseases processes.
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Glatiramer acetate (GA) is a synthetic copolymer-1 approved as first-line treatment for relapsing-remitting multiple sclerosis (RRMS). Several studies have indicated that GA modulates different levels of the immune response, but no... more
Glatiramer acetate (GA) is a synthetic copolymer-1 approved as first-line treatment for relapsing-remitting multiple sclerosis (RRMS). Several studies have indicated that GA modulates different levels of the immune response, but no specific warnings regarding its use and potential reactivation of latent tuberculosis (TB) infection exist.1 A 37-year-old man, engineer, active smoker (10 pack-years), with a 6-year history of RRMS but otherwise healthy, attended our pulmonary clinic reporting a 1-week history of productive cough, fever, left side pleuritic chest pain, and malaise. He had been taking daily subcutaneous GA since his RRMS diagnosis, but no other concomitant medication. Relevant past medical history included a 9-month course of isoniazid as primary chemoprophylaxis for TB 16 years previously, after a positive tuberculin skin test as part of a TB contact study. He denied any other subsequent known contacts or exposure to high-risk environments. His physical exam was normal and blood tests showed a mild elevation of acute phase reactants. A chest computed tomography revealed left upper lobe alveolar infiltrate and a 1.8 cm lung cavity. The sputum smear was positive for acid-fast bacilli and empiric 4-drug treatment was started. Sputum culture confirmed Mycobacterium tuberculosis and the patient recovered completely after 6 months of treatment. Peripheral immunomodulatory mechanisms of GA include: binding to major histocompatiblity class II molecules, alteration
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Background: Little is known about the clinical factors associated with development of lung cancer in patients with Chronic Obstructive Pulmonary Disease (COPD). Objective: To explore incidence, histological type and factors associated... more
Background: Little is known about the clinical factors associated with development of lung cancer in patients with Chronic Obstructive Pulmonary Disease (COPD). Objective: To explore incidence, histological type and factors associated with development of lung cancer diagnosis in a cohort of patients with COPD. Methods: A cohort of 2507 patients without initial clinical or radiological evidence of lung cancer was followed for 62±38 months. At baseline, anthropometrics, smoking history, lung function and body composition were recorded. Time to diagnosis and histological type of lung cancer was then registered. Multivariate Cox analysis were used to explore factors associated with lung cancer diagnosis. Results: Incidence density of lung cancer was 16.7 cases/1000 person-years. The most frequent histological type was squamous cell carcinoma (44%). Conclusions: Incidence density of lung cancer is high in COPD patients and occurs more frequently in older patients with milder airflow obstruction (GOLD stages I and II), a DLCO
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Research Interests: Cardiology, Medicine, Cardiovascular Risk, Humans, COPD, and 15 moreInternal Medicine, Health related Quality of Life, Female, Male, Body Mass Index, Aged, C reactive protein, Forced Vital Capacity, Body Mass, Cardiovascular Risk Factor, Chronic obstructive pulmonary disease, Indexation, Inspiratory capacity, Medical and Health Sciences, and exercise capacity
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Gender and respiratory factors associated with dyspnea in chronic obstructive pulmonary disease
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RATIONALE Chronic obstructive pulmonary disease (COPD) is a well-established independent risk factor for lung cancer, while the literature on the association between asthma and lung cancer is mixed. Whether Asthma COPD Overlap (ACO) is... more
RATIONALE Chronic obstructive pulmonary disease (COPD) is a well-established independent risk factor for lung cancer, while the literature on the association between asthma and lung cancer is mixed. Whether Asthma COPD Overlap (ACO) is associated with lung cancer has not been studied. OBJECTIVES We aimed to compare lung cancer risk among patients with ACO vs. COPD and other conditions associated with airway obstruction. METHODS We studied 13,939 smokers from the National Lung Cancer Screening Trial who had baseline spirometry, and utilized spirometric indices and history of childhood asthma to categorize participants into 5 specific airway disease subgroups. We used Poisson regression to compare unadjusted and adjusted lung cancer risk. RESULTS The incidence rate of lung cancer per 1,000 person-years was: ACO, 13.2 (95% confidence interval [CI]: 8.1-21.5); COPD, 11.7 (95% CI: 10.5-13.1); asthmatic smokers, 1.8 (95% CI: 0.6-5.4); Global Initiative for Chronic Obstructive Lung Disease-Unclassified, 7.7 (95% CI: 6.4-9.2); and normal-spirometry smokers, 4.1 (95% CI: 3.5-4.8). ACO patients had increased adjusted risk of lung cancer compared to patients with asthma (incidence rate ratio [IRR]: 4.5, 95% CI: 1.3-15.8) and normal spirometry smokers (IRR: 2.3, 95% CI: 1.3-4.2) in models adjusting for other risk factors. Adjusted lung cancer incidence in patients with ACO and COPD were not found to be different (IRR: 1.2, 95% CI 0.7 - 2.1). CONCLUSIONS Risk of lung cancer among patients with ACO is similar to those with COPD and higher than other groups of smokers. These results provide further evidence that COPD, with or without a history of childhood asthma, is an independent risk factor for lung cancer.
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Background Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences.... more
Background Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. Methods We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. Results 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regar...
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Research Interests: Biochemistry, Genetics, Developmental Biology, Molecular Biology, Biotechnology, and 15 moreCancer, Cell Biology, Medicine, Multidisciplinary, Logistic Regression, COPD, Internal Medicine, BMI, Body Mass Index, Logistic Regression Analysis, Ci, DXA, Chronic obstructive pulmonary disease, Bone turnover markers, and IQR
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Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different... more
Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scor...
Research Interests: Evidence Based Medicine, Global Health, Medicine, Humans, COPD, and 15 moreInternal Medicine, Gold, Female, Male, Health Status, Clinical Sciences, Aged, Middle Aged, Public health systems and services research, Age Factors, Chronic obstructive pulmonary disease, Disease Progression, Clinical Significance, R, and Pulmonary Disease Chronic Obstructive
Cluster analysis has been utilized to explore phenotypic heterogeneity in chronic obstructive pulmonary disease (COPD). To date, little is known about the longitudinal variability of clusters in COPD patients. We aimed to evaluate the... more
Cluster analysis has been utilized to explore phenotypic heterogeneity in chronic obstructive pulmonary disease (COPD). To date, little is known about the longitudinal variability of clusters in COPD patients. We aimed to evaluate the 2-year cluster variability in stable COPD patients. We evaluated the following variables in COPD patients at baseline and 2 years later: age, gender, pack-year history, body mass index (BMI), modified Medical Research Council (MMRC) scale, 6-min walking distance (6MWD), spirometry and COPD Assessment Test (CAT). Patient classification was performed using cluster analysis at baseline and 2 years later. Each patient's cluster variability after 2 years and its parameters associated with cluster change were explored. A total of 521 smokers with COPD were evaluated at baseline and 2 years later. Three different clusters were consistently identified at both evaluation times: cluster A (of younger age, mild airway limitation, few symptoms), cluster B (int...
Research Interests: Quality of life, Medicine, Physical Therapy, Humans, COPD, and 15 moreInternal Medicine, Female, Male, Cluster Analysis, Body Mass Index, Aged, Middle Aged, Longitudinal Studies, Airway, Sex Factors, Age Factors, Exercise Tolerance, Respirology, Medical and Health Sciences, and Pulmonary Disease Chronic Obstructive
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Chronic Obstructive Pulmonary Disease (COPD) may be associated with accelerated aging. Telomere shortening is a biomarker of aging. Cross-sectional studies describe shorter telomeres in COPD compared with matched controls. No studies have... more
Chronic Obstructive Pulmonary Disease (COPD) may be associated with accelerated aging. Telomere shortening is a biomarker of aging. Cross-sectional studies describe shorter telomeres in COPD compared with matched controls. No studies have described telomere length trajectory and its relationship with COPD progression. We investigated telomere shortening over time and its relationship to clinical and lung function parameters in a COPD cohort and smoker controls without COPD. At baseline leukocyte telomere length was measured by qPCR in 121 smokers with COPD and 121 without COPD matched by age (T/S0). The measurements were repeated in 70 of those patients with COPD and 73 non-COPD smokers after 3 years of follow up (T/S3). At initial measurement, telomeres were shorter in COPD patients when compared to smoker controls (T/S = 0.68 ± 0.25 vs. 0.88 ± 0.52, p = 0.003) independent from age and sex. During the follow-up period, we observed an accelerated telomere shortening in individuals w...
Research Interests: Aging, Medicine, Humans, COPD, Internal Medicine, and 15 moreSmoking, Female, Male, Cohort, Clinical Sciences, Middle Aged, Longitudinal Studies, Biomarker, Respiratory, Disease Progression, Cohort Studies, Severity of Illness Index, Respiratory function tests, Cardiovascular medicine and haematology, and Pulmonary Disease Chronic Obstructive
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Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a... more
Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function.The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988).Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good ...
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Objective: To explore NLST criteria among COPD patients and to develop a COPD-tailored score that improves it9s predictive capability for LC risk. Methods: We analyzed the databases from the Pamplona-IELCAP LC screening study (P-IELCAP)... more
Objective: To explore NLST criteria among COPD patients and to develop a COPD-tailored score that improves it9s predictive capability for LC risk. Methods: We analyzed the databases from the Pamplona-IELCAP LC screening study (P-IELCAP) and the Pittsburgh Lung Screening Study (PLuSS). Only patients with spirometricaly proven COPD were included. NLST criteria were applied to both populations. By logistic regression we determined which factors were independently associated with LC, and then developed a COPD screening score (COPDss). Results: Forty-eight percent of COPD patients in P-IELCAP and 30% in PluSS did not meet NLST criteria (Table 1, panel A), resulting in the exclusion of 33% and 22% of lung cancers in each cohort, respectively (panel B). Factors associated with lung cancer risk are shown in Table 2. Variables finally included in the calculation of the COPDss are shown in Table 3. Figure 1 shows the ROC for NLST criteria and for COPDss in each COPD cohort (panels 2 & 3), and in both combined (panel 1). Conclusions: In patients with COPD undergoing screening, NLST criteria results in the exclusion of a large proportion of patients with LC. The COPDss improves the prediction of lung cancer risk among COPD patients.
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The influence of gender on the expression of COPD has received limited attention. Quality of Life (QoL) has become an important outcome in COPD patients. The aim of our study was to explore factors contributing to gender differences in... more
The influence of gender on the expression of COPD has received limited attention. Quality of Life (QoL) has become an important outcome in COPD patients. The aim of our study was to explore factors contributing to gender differences in Quality of Life of COPD patients. In 146 men and women with COPD from a pulmonary clinic we measured: Saint George's Respiratory Questionnaire (SGRQ), age, smoking history, PaO2, PaCO2, FEV1, FVC, IC/TLC, FRC, body mass index (BMI), 6 minute walk distance (6MWD), dyspnea (modified MRC), degree of comorbidity (Charlson index) and exacerbations in the previous year. We explored differences between genders using Mann-Whitney U-rank test. To investigate the main determinants of QoL, a multiple lineal regression analysis was performed using backward Wald's criteria, with those variables that significantly correlated with SGRQ total scores. Compared with men, women had worse scores in all domains of the SGRQ (total 38 vs 26, p = 0.01, symptoms 48 vs...
Research Interests: Psychometrics, Quality of life, Medicine, Comorbidity, Activities of Daily Living, and 15 moreHumans, COPD, Internal Medicine, Female, Male, Gender Difference, Body Mass Index, Health Status, Aged, Middle Aged, Questionnaires, Indexation, Health Quality, Pulmonary Disease Chronic Obstructive, and exercise capacity
The BODE index was recently validated as a multidimensional tool for the evaluation of patients with COPD. The influence of gender on the BODE index has not been studied. The contribution of each component of the disease to the BODE index... more
The BODE index was recently validated as a multidimensional tool for the evaluation of patients with COPD. The influence of gender on the BODE index has not been studied. The contribution of each component of the disease to the BODE index may differ according to gender. We evaluated age, forced expiratory volume in one second (FEV1), Modified Medical Research Council (MMRC) score, 6-min walk distance (6MWD), and body mass index (BMI) in 52 men and 52 women with COPD and the same BODE index. We compared the studied parameters between men and women and then performed a multiple regression analysis by gender. We found statistically significant differences between men and women in all parameters: FEV1 % (55 +/- 17 vs 63 +/- 18, p < 0.001), MMRC [1 (0-2) vs 1 (1-2) p = 0.03], BMI [28 (26-30) vs 25 (22-30), p = 0.05], and 6MWD [546 (451-592) vs 462 (419-520), p = 0.001]. Multiple regression analysis revealed that each component of the BODE index had different weight (beta standardized ...
Research Interests: Chronic, Medicine, Humans, COPD, Walking, and 12 moreFemale, Male, Body Mass Index, Aged, Middle Aged, Sex Factors, Age Factors, Chronic obstructive pulmonary disease, Cross Sectional Studies, Severity of Illness Index, Cardiovascular medicine and haematology, and Pulmonary Disease Chronic Obstructive
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Research Interests: Prediction, Medicine, Prospective studies, Humans, COPD, and 15 moreFemale, Male, Nocturnal, Clinical Sciences, Ambulatory, Aged, Middle Aged, Oxygen, Oximetry, Hypoxemia, Exercise Test, Exercise Tolerance, Predictive value of tests, Cardiovascular medicine and haematology, and Pulmonary Disease Chronic Obstructive
Background:Pseudomonas aeruginosa (PA) is isolated in advanced stages of chronic obstructive pulmonary disease (COPD). Objectives: The aim of our study was to determine whether PA isolation during hospitalization for COPD exacerbation was... more
Background:Pseudomonas aeruginosa (PA) is isolated in advanced stages of chronic obstructive pulmonary disease (COPD). Objectives: The aim of our study was to determine whether PA isolation during hospitalization for COPD exacerbation was associated with a poorer prognosis after discharge. Methods: We prospectively studied all patients with COPD exacerbation admitted between June 2003 and September 2004. A sputum culture was obtained at admission. Comorbidity, functional dependence, hospitalizations during the previous year, dyspnea, quality of life and other variables previously associated with mortality in COPD were studied. Spirometry and a 6-min walking test were performed 1 month after discharge. Mortality was evaluated 3 years after discharge. Results: A total of 181 patients were included in the study. Of these, 29 (16%) had PA in the sputum. The mean age was 72 years, and mean basal postbronchodilator forced expiratory volume in 1 s was 45.2% predicted (SD 14.4). The mean po...
Research Interests: Gastroenterology, Medicine, Multivariate Analysis, Humans, COPD, and 15 moreInternal Medicine, Hospitalization, Female, Male, Aged, Middle Aged, Chronic obstructive pulmonary disease, Disease Progression, Indexation, Confidence Interval, Cohort Studies, Functional Dependency, Hospital Admission, Exacerbation, and Cardiovascular medicine and haematology
Several studies have described a clear association between respiratory syncytial virus (RSV) lower respiratory tract infection in infancy and the subsequent development of persistent wheezing in children. Using the mouse model we... more
Several studies have described a clear association between respiratory syncytial virus (RSV) lower respiratory tract infection in infancy and the subsequent development of persistent wheezing in children. Using the mouse model we demonstrated that RSV induces long-term airway disease characterized by chronic airway inflammation and airway hyperreactivity (AHR). The RSV murine model offers great advantages to study the immunopathogenesis of RSV-induced long-term airway disease. Mice can be challenged with aerosolized methylcholine to determine the presence of AHR. We can apply the reverse transcription-polymerase chain reaction assay (RT-PCR) to detect RSV RNA in the respiratory tract and we can perform lung gene expression analysis to further characterize the chronic changes induced by RSV infection. Compared with sham-inoculated controls, RSV-infected mice developed chronic airway disease characterized by AHR and persistent airway inflammation. Forty-two days after RSV infection, a...
Research Interests: Pediatrics, Immunology, RNA, Medicine, Models, and 15 moreRespiratory Disease, Virus, Mice, Chronic Disease, Animals, Respiratory Syncytial Virus, Human Respiratory Syncytial Viruses, Mouse Model, Respiratory System, Time Factors, Respiratory Sounds, Respiratory Syncytial Virus Infections Industry, bronchial hyperreactivity (BHR), Gene expression profiling, and Paediatrics and reproductive medicine(Respiratory Disease, Virus, Mice, Chronic Disease, Animals, Respiratory Syncytial Virus, Human Respiratory Syncytial Viruses, Mouse Model, Respiratory System, Time Factors, Respiratory Sounds, Respiratory Syncytial Virus Infections Industry, bronchial hyperreactivity (BHR), Gene expression profiling, and Paediatrics and reproductive medicine)
(Respiratory Disease, Virus, Mice, Chronic Disease, Animals, Respiratory Syncytial Virus, Human Respiratory Syncytial Viruses, Mouse Model, Respiratory System, Time Factors, Respiratory Sounds, Respiratory Syncytial Virus Infections Industry, bronchial hyperreactivity (BHR), Gene expression profiling, and Paediatrics and reproductive medicine)