COPD most commonly refers to chronic bronchitis, Mild and Moderate-to-Severe COPD in Nonsmokers* Distinct Demographic Profiles
|
|
- Ophelia Lee
- 6 years ago
- Views:
Transcription
1 Mild and Moderate-to-Severe COPD in Nonsmokers* Distinct Demographic Profiles Carolyn E. Behrendt, PhD Study objective: To investigate the risk of COPD among nonsmokers. Design: Case-control study, logistic regression analysis. Setting: Third National Health and Nutrition Examination Survey, from 1988 to Participants: Community residents 18 to 80 years of age, of white, black, or Mexican-American ethnicity. Nonsmokers included never-smokers and former smokers with a < 5 pack-year smoking history who had never smoked cigars or pipes. Measurements: COPD (FEV 1 /FVC < 70%) was classified as mild (FEV 1 > 80% predicted) or moderate to severe (FEV 1 23 to 79% predicted). Results: Among 13,995 examinees, % were female, mean age was years, % were nonsmokers, % had mild COPD, and % had moderate-tosevere COPD [ SE]. One fourth of mild and moderate-to-severe cases were nonsmokers. Among 7,526 nonsmokers, % had mild COPD (n 403; age, years) and were mostly female (82.5%), while % had moderate-to-severe COPD (n 92, age ) and were mostly male (88.1%). Few nonsmokers with COPD ( %) had a previous diagnosis of chronic bronchitis or emphysema. Among nonsmokers, physician-diagnosed asthma increased the risk of mild and especially of moderate-to-severe COPD. Independently of asthma, risk of mild COPD in nonsmokers increased with age (doubling every 12 years), before age 60 was lower among men than women, and was inversely associated with current exposure to tobacco smoke at home and at work. In contrast, the risk of moderate-to-severe COPD in nonsmokers was markedly associated with male gender, peaked in middle age, and was inversely associated with nonwhite ethnicity. COPD risks did not vary by minimal smoking history, longest-held occupation, urban residence, income, allergies, thyroid disease, or Helicobacter pylori antibody. Conclusions: Among nonsmokers, mild and moderate-to-severe COPD are associated with asthma but otherwise have distinct demographic profiles, suggesting that moderate-to-severe disease is not a mere progression of mild COPD. (CHEST 2005; 128: ) Key words: asthma; COPD; epidemiology; nonsmoker Abbreviations: CI confidence interval; OR odds ratio COPD most commonly refers to chronic bronchitis, emphysema, and the subset of asthma characterized by irreversible or partly reversible airflow obstruction. 1 Although the majority of COPD occurs in current or former smokers, the disease also occurs in persons who have never smoked. According to the *From Epidemiology, Pfizer Global Research and Development. This work was performed at Pfizer La Jolla Laboratories, San Diego, CA. Financial support was provided by Pfizer, Inc. Manuscript received October 7, 2004; revision accepted January 29, Reproduction of this article is prohibited without written permission from the American College of Chest Physicians ( org/misc/reprints.shtml). Correspondence to: Carolyn Behrendt, PhD, 3413 Paseo del Campo, Palos Verdes Estates, CA 90274; carolynbehrendt@ yahoo.com previous epidemiologic study 2 of COPD in nonsmokers, prevalence is greater among women than men until the age of 60 years, when prevalence ceases to differ by sex. Neither urban residence nor occupational category is associated with COPD in nonsmokers. 2 In the general population, COPD is independently associated with smoking, age, and asthma but not with atopy alone. 3,4 In addition, genetic predisposition, environmental tobacco smoke, air pollution, Helicobacter pylori infection, and autoimmune thyroid disease have been proposed as risk factors for COPD. 5 9 The possibility that risk factors for COPD differ according to the severity of disease has not been investigated to date. Using data from a national health examination, the current study identifies and CHEST / 128 / 3/ SEPTEMBER,
2 compares risk factors for mild and moderate-tosevere COPD among nonsmokers. Spirometry Materials and Methods In the Third National Health and Nutrition Examination Survey (from 1988 to 1994), a representative sample of the civilian, noninstitutionalized population of the United States consented to an interview (assessing demographic characteristics, medical history, medication use, risk behaviors) and a medical examination (including spirometry and a battery of laboratory tests). 10 Spirometry was conducted by a trained technician either in the mobile examination center or in the home of examinees aged 60 years who were unwilling or unable to come to the center. 10 Excluded from spirometry were examinees who had undergone chest or abdominal surgery within 3 weeks or had been hospitalized for myocardial infarction, chest pain, or congestive heart failure within 6 weeks. Study Population Current subjects were white, black, or Mexican-American examinees aged 18 to 80 years whose spirometry findings met the reproducibility and reliability criteria of the American Thoracic Society 11,12 and who provided data on smoking history and height. The upper age limit for the study was chosen to accord with formulas used to derive predicted values of FEV 1 and FVC. 13 Most of the current analysis was restricted to nonsmokers, a group that included both lifelong nonsmokers of cigarettes, cigars, or pipe tobacco and former cigarette smokers with a 5 pack-year smoking history who had never smoked cigars or pipes. 9 Pack-years of smoking were calculated taking into account not only the most recent level of daily smoking but also periods of higher usage or abstinence. COPD. In addition, long-term occupational exposure to airway irritants was considered likely for persons in the following categories of longest held occupation: extractive or precision production, farm or nursery work, cleaning or building services, laborer, cook, and waiter. Income was analyzed using the poverty index, a ratio of family income to the Census Bureau poverty threshold value for the calendar year. 10 Statistical Analysis Sampling weights were taken into account in all analyses (SUDAAN; Research Triangle Institute; Research Triangle Park, NC). Means and percentages were reported with their SEs. Logistic regression analysis was used to identify independent risk factors. Variables found significant (p 0.05) in univariate analysis were tested in multivariate analysis and retained if they improved the fit of the model. As suggested by published data 2 and Figure 1, an interaction term for the effect of sex 60 years and 60 years was tested in the model of mild COPD. Study Sample Results Of the 16,238 examinees, aged 18 to 80 years and identified as white, black, or Mexican American, % underwent spirometry; of these, % produced reproducible and reliable results. After excluding 6 persons with acceptable spirometry who lacked data on smoking history or height, eligibility criteria were met by 13,995 examinees, who represented million adults nationwide (female gender, %; mean age, years). Among this general sample, one half ( %) were nonsmokers (n 7,526), who represented million adults (female gender, %; mean age, years). A Definitions Using a modification of the Global Initiative for Chronic Obstructive Lung Disease criteria, COPD was defined as a FEV 1 /FVC 70% and categorized as mild (FEV 1 80% of predicted) or moderate to severe (FEV 1 80% predicted). 14,15 Respiratory symptoms (cough or phlegm on most days for 3 months per year, dyspnea on exertion, or wheezing during the past year) and physician diagnosis of asthma, chronic bronchitis, and/or emphysema were recorded; however, none of these was a current criterion for COPD. Allergies included history of allergic reaction (to insect sting, food, allergy shot, skin test), allergy symptoms (nose, eyes) during the past year, or physician diagnosis of hay fever. Thyroid disease was defined as thyroid stimulating hormone level of 0.1 or 4.5 miu/l, a physician diagnosis of goiter or other thyroid disease, or current use of thyroid medication. 16 H pylori antibody was measured by enzyme-linked immunoassay during phase 1 (from 1988 to 1991) of the survey. 17 Current exposure to environmental tobacco smoke was reported separately for the home and the workplace. Exposure at home was present if a household member smoked cigarettes in the home. Exposure at work was present if examinees smelled tobacco smoke at the workplace for 4 h/d; lesser daily exposure at work was currently found not to associate significantly with Figure 1. Prevalence of mild and moderate-to-severe COPD in nonsmoking adults, by age and sex Clinical Investigations
3 minority of nonsmokers ( %) had smoked 5 pack-years before quitting at age years. Among the general sample (smokers and nonsmokers), mild COPD was present in % and moderate-to-severe COPD was present in %. Nonsmokers comprised approximately one fourth of COPD cases: % of mild COPD cases, and % of moderate-tosevere cases. Among nonsmokers, mild COPD was present in % (n 403) and moderate-tosevere COPD was present in % (n 92, of which 31 cases were severe, with FEV 1 23 to 49% predicted). Nonsmokers with and without COPD are described in Table 1. Nonsmokers With COPD The prevalence of mild and moderate-to-severe COPD varied by age and sex (Fig 1). Most nonsmokers ( %) with mild COPD were older (age 50 years), while most nonsmokers ( %) with moderate-to-severe COPD were younger (age 50). Women comprised the majority of nonsmokers with mild COPD, but a small minority of those with moderate-to-severe disease (Table 1). The ratio Table 1 Characteristics, Respiratory Symptoms, and Physician Diagnoses Among Nonsmokers Aged 18 to 80 Years, by Level of COPD* Characteristics No COPD Mild COPD of mild to moderate-to-severe COPD was 1:2 among nonsmoking men but 17.2:1 among nonsmoking women. The percentage of nonsmokers who had received a physician diagnosis of asthma increased with the degree of COPD (Table 1). Nonsmokers median age at diagnosis of asthma was 10 years (interquartile range, 5 to 28 years). Among nonsmokers with asthma (n 470), nearly one fourth had some degree of COPD at the time of the survey, % having mild COPD, and % having moderate-to-severe disease. Few nonsmokers (63 of 495 nonsmokers [ %]) with COPD had ever received a physician diagnosis of chronic bronchitis or emphysema (Table 1). According to multivariate analysis, such a diagnosis among nonsmokers with COPD was more likely in women age 50 years (odds ratio [OR], 7.4; 95% confidence interval [CI], 2.6 to 20.7) and persons reporting allergies (OR, 15.2; 95% CI, 3.4 to 67.9), chronic cough (OR, 6.1; 95% CI, 2.7 to 14.0), wheezing (OR, 6.0; 95% CI, 2.3 to 15.6), or dyspnea on exertion (OR, 3.3; 95% CI, 1.3 to 8.2). Likelihood of diagnosis did not vary by severity of COPD, diagnosis of asthma, minimal smoking his- Moderate-to- Severe COPD Subjects, No. 7, Population represented, millions Mean age, yr Female gender Ever smoked Now exposed to smoking at home Now exposed to smoking at work Thyroid disease H pylori antibody positive Education 12 yr White race Respiratory symptoms in past year Chronic cough Chronic phlegm Wheezing Dyspnea on exertion Any of the above symptoms Physician diagnosis, ever Asthma Chronic bronchitis Emphysema Any of the above diagnoses *Data are presented as % ( SE) unless otherwise indicated. p vs nonsmokers without COPD. p 0.01 vs nonsmokers without COPD. p 0.05 vs nonsmokers without COPD. CHEST / 128 / 3/ SEPTEMBER,
4 tory, current exposure to smoking in the home or workplace, urban residence, income, occupation, or education. Nonsmoker Risk of Mild COPD Univariate associations with thyroid disease, H pylori antibody, education, and ethnicity (Table 1) became nonsignificant after adjustment for age and sex. Instead, multivariate analysis (Table 2) indicated that risk of mild COPD increased with asthma and with age (doubling every 12 years). Risk was reduced among men before age 60 years; thereafter, risk did not differ significantly by sex. Compared to persons without COPD, mild cases were half as likely to be currently exposed to smoking in the home and one fourth as likely to be currently exposed to smoking in the workplace. Nonsmoker Risk of Moderate-to-Severe COPD Asthma was even more strongly associated with moderate-to-severe COPD than with mild COPD (Table 2). Unlike mild COPD, the risk of moderateto-severe COPD was markedly increased among males, peaked in middle age, and was inversely associated with nonwhite ethnicity. Also unlike mild COPD, moderate-to-severe COPD was not associated with current exposure to smoking at home or at work. Nonrisks for COPD Neither mild nor moderate-to-severe COPD among nonsmokers was associated with ever smoking up to 5 pack-years (Table 1), occupation involving exposure to airway irritants, urban residence, income, or allergies (data not shown). Associations between COPD and asthma (described above) did not vary by age at asthma diagnosis. Discussion According to the current study, nonsmokers account for one fourth ( %) of COPD cases in the United States. Similar proportions of nonsmokers have been reported among COPD cases in the United Kingdom and Spain (22.9% and 23.4%, respectively). 9,18 Few nonsmokers with COPD in the current study had had a previous diagnosis of chronic bronchitis or emphysema. Mild and moderate-tosevere COPD were currently associated with distinct demographic profiles among nonsmokers, suggesting that moderate-to-severe disease is not a mere progression of mild COPD. The previous epidemiologic study of COPD among nonsmokers employed data from earlier National Health and Nutrition Examination Surveys (from 1971 to 1975, from 1976 to 1980, and from 1982 to 1984). 2 The current study differed from the previous study by defining COPD cases through spirometry rather than reported diagnosis of chronic bronchitis or emphysema, by considering mild and moderate-to-severe COPD separately, by considering asthma and current exposure to tobacco smoke as risk factors, and by reporting the prevalence of respiratory symptoms among COPD cases. In addition, while the previous study defined nonsmokers as persons who had not smoked 100 cigarettes in their lifetime, the current study demonstrated the appropriateness of including among nonsmokers those former smokers with minimal smoking history. 9 Table 2 Characteristics Independently Associated with Mild and Moderate-to-Severe COPD Among Nonsmokers Aged 18 to 80 Years Characteristics Mild COPD (397 Cases, 6,922 Controls*), OR (95% CI) Moderate-to-Severe COPD (92 cases, 7,030 Controls*), OR (95% CI) Asthma diagnosis 4.27 ( ) 18.8 ( ) Per year of age 1.06 ( ) 1.04 ( ) Per year of age ( ) Male gender 18.3 ( ) Gender by age category, yr Male, age ( ) Female, age ( ) Male, age ( ) Female, age Nonwhite ethnicity 0.58 ( ) Now exposed to smoking at home 0.56 ( ) Now exposed to smoking at work 0.26 ( ) *Controls are nonsmokers without COPD. Six cases and 109 controls were excluded from the model of mild COPD due to missing data, chiefly on current exposure to smoking at work. The R 2 values for the fit of the two models are 0.09 and 0.05, respectively Clinical Investigations
5 As the previous study reported for COPD in general, mild COPD was currently found more prevalent among women than men before age 60 years; in contrast, moderate-to-severe COPD was currently found to affect predominantly men throughout adulthood. The current study confirmed the finding of the previous study 2 of no association between COPD in nonsmokers and occupational category or urban residence. Among a prior case series of nonsmokers with COPD (n 22), none was currently exposed to smoking in the home or workplace; however, half had 20- to 30-year histories of such exposure. 9 In the current study, patients with mild COPD tended to avoid current exposure to smoking in the home and at work, but patients with moderate-tosevere COPD did not. Information on exposure history was unavailable. A previous survival analysis 19 detected no increased mortality hazard from moderate-to-severe COPD among nonsmokers. However, current inverse associations with age 60 years and nonwhite ethnicity suggest that moderate-to-severe COPD may indeed compromise survival among specific groups of nonsmokers. Longitudinal studies of COPD in nonsmokers are needed. The current study confirmed findings from earlier COPD studies not restricted to nonsmokers, specifically independent associations with increasing age and asthma but not with allergy alone. 3,4 The magnitude of the association between asthma and COPD was currently shown to increase with the severity of COPD. Limitations of the current study include its cross-sectional nature, limited numbers of nonsmokers with moderate and severe COPD (precluding separate analyses), and nonsampling of nursing home residents and homeless persons. 20 Also, as noted in the footnote to Table 2, current models explained a small fraction of the risk of mild and moderate-to-severe COPD among nonsmokers, indicating that important risk factors remain to be identified. Data on several proposed risks were not available for the current study: gestational age, birth weight, lower respiratory tract infections before age 7 years, parental smoking during gestation and childhood, exposure to environmental tobacco smoke and other airway irritants throughout adulthood, genetic markers, and family history of COPD. 5,6,21 23 Future spirometric studies, especially if lifetime medical and exposure histories are obtained and subjects are followed up prospectively, will provide a means of testing and improving on current models of COPD risk among nonsmokers. References 1 Mannino DM. Chronic obstructive pulmonary disease: definition and epidemiology. Respir Care 2003; 48: Whittemore AS, Perlin SA, DiCiccio Y. Chronic obstructive pulmonary disease in lifelong nonsmokers: results from NHANES. Am J Public Health 1995; 85: Silva GE, Sherrill DL, Guerra S, et al. Asthma as a risk factor for COPD in a longitudinal study. Chest 2004; 126: Hospers JJ, Schouten JP, Weiss ST, et al. Asthma attacks with eosinophilia predict mortality from chronic obstructive pulmonary disease in a general population sample. Am J Respir Crit Care Med 1999; 160: Molfino NA. Genetics of COPD. Chest 2004; 125: Jaakkola MS, Jaakkola JJ. Effects of environmental tobacco smoke on the respiratory health of adults. Scand J Work Environ Health 2002; 28(Suppl): Sunyer J. Urban air pollution and chronic obstructive pulmonary disease: a review. Eur Respir J 2001; 17: Shiotani A. Linking Helicobacter pylori and chronic bronchitis: fact or fancy? J Gastroenterol 2002; 37: Birring SS, Brightling CE, Bradding P, et al. Clinical, radiologic, and induced sputum features of chronic obstructive pulmonary disease in nonsmokers: a descriptive study. Am J Respir Crit Care Med 2002; 166: U.S. Department of Health and Human Services. National Center for Health Statistics. Plan and Operation of the Third National Health and Nutrition Examination Survey, Hyattsville, MD: Centers for Disease Control and Prevention, Available at: series/sr_01/sr01_032.pdf. Accessed December, 23, Standardization of spirometry, 1987 update: statement of the American Thoracic Society. Am Rev Respir Dis 1987; 136: Third National Health and Nutrition Examination Survey, spirometry procedure manual. Rockville, MD: Westat, Available at: cdrom/nchs/manuals/spiro.pdf. Accessed December 23, Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999; 159: Pauwels RA, Buist AS, Calverley PM, et al. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med 2001; 163: Mannino DM, Ford ES, Redd SC. Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination. Am J Med 2003; 114: Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T 4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: U.S. Department of Health and Human Services. National Center for Health Statistics. Third National Health and Nutrition Examination Survey, , NHANES III second laboratory data file documentation (Series 11, No. 2A). Hyattsville, MD: Centers for Disease Control and Prevention, Available at: nhanes/nhanes3/lab2-acc.pdf. Accessed December 23, Pena VS, Miravitlles M, Gabriel R, et al. Geographic variations in prevalence and underdiagnosis of COPD: results of the IBERPOC multicentre epidemiological study. Chest 2000; 118: Mannino DM, Buist AS, Petty TL, et al. Lung function and CHEST / 128 / 3/ SEPTEMBER,
6 mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax 2003; 58: Snyder LD, Eisner MD. Obstructive lung disease among the urban homeless. Chest 2004; 125: Bakke PS. Factors affecting growth of FEV 1. Monaldi Arch Chest Dis 2003; 59: Sandford AJ, Silverman EK. Chronic obstructive pulmonary disease: 1. Susceptibility factors for COPD, the genotypeenvironment interaction. Thorax 2002; 57: Montnemery P, Lanke J, Lindholm LH, et al. Familial related risk-factors in the development of chronic bronchitis/emphysema as compared to asthma assessed in a postal survey. Eur J Epidemiol 2000; 16: Clinical Investigations
This is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationClinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene
Clinical and radiographic predictors of GOLD-Unclassified smokers in COPDGene Emily S. Wan, John E. Hokanson, James R. Murphy, Elizabeth A. Regan, Barry J. Make, David A. Lynch, James D. Crapo, Edwin K.
More informationKey words: asthma; COPD; epidemiology; obstructive lung disease; Venn diagram
The Proportional Venn Diagram of Obstructive Lung Disease* Two Approximations From the United States and the United Kingdom Joan B. Soriano, MD; Kourtney J. Davis, PhD; Bobbie Coleman, BSc; George Visick,
More informationCOPD in Korea. Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center Park Yong Bum
COPD in Korea Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center Park Yong Bum Mortality Rate 1970-2002, USA JAMA,2005 Global Burden of Disease: COPD WHO & World
More informationC hronic obstructive pulmonary disease (COPD) is an
388 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study D M Mannino, A S Buist,
More informationChronic Obstructive Pulmonary Disease Surveillance --- United States,
University of Kentucky From the SelectedWorks of David M. Mannino October, 2002 Chronic Obstructive Pulmonary Disease Surveillance --- United States, 1971--2000 David M. Mannino David M. Homa Lara J. Akinbami
More informationOnline Data Supplement. Prevalence of Chronic Obstructive Pulmonary Disease in Korea: Results of a Population-based Spirometry Survey
Online Data Supplement Prevalence of Chronic Obstructive Pulmonary Disease in Korea: Results of a Population-based Spirometry Survey Dong Soon Kim, MD, Young Sam Kim MD, Kee Suk Chung MD, Jung Hyun Chang
More informationSGRQ Questionnaire assessing respiratory disease-specific quality of life. Questionnaire assessing general quality of life
SUPPLEMENTARY MATERIAL e-table 1: Outcomes studied in present analysis. Outcome Abbreviation Definition Nature of data, direction indicating adverse effect (continuous only) Clinical outcomes- subjective
More informationT he recent international guidelines from the Global
842 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Implications of reversibility testing on prevalence and risk factors for chronic obstructive pulmonary disease: a community study A Johannessen, E R Omenaas, P
More informationCigarette Smoking and Lung Obstruction Among Adults Aged 40 79: United States,
NCHS Data Brief No. 8 January 25 Cigarette Smoking and Lung Obstruction Among Adults Aged 4 79: United States, 27 22 Ryne Paulose-Ram, Ph.D., M.A.; Timothy Tilert, B.S.; Charles F. Dillon, M.D., Ph.D.;
More informationChronic respiratory diseases at primary health care level in Georgia: the results of the pilot study
Monaldi Arch Chest Dis 2009; 71: 4, 141-146 ORIGINAL ARTICLE Chronic respiratory diseases at primary health care level in Georgia: the results of the pilot study I. Chkhaidze 1, T. Maglakelidze 2, N. Khaltaev
More informationKey words: COPD; diagnosis; epidemiology; gender; incidence; prevalence; respiratory symptoms; risk factors
Ten-Year Cumulative Incidence of COPD and Risk Factors for Incident Disease in a Symptomatic Cohort* Anne Lindberg, MD; Ann-Christin Jonsson, SRN; Eva Rönmark, PhD; Rune Lundgren, MD, PhD, FCCP; Lars-Gunnar
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationLife-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
More informationPeople with asthma who smoke. The combination of asthma, a chronic airway disease, and smoking increases the risk of COPD even more.
COPD Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum (phlegm) production
More informationObstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination
University of Kentucky From the SelectedWorks of David M. Mannino June 15, 2003 Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination
More informationEpidemiology of COPD Prof. David M. Mannino, M.D.
Epidemiology of COPD David M. Mannino, M.D. Professor Department of Preventive Medicine and Environmental Health College of Public Health University of Kentucky 1 Outline Definitions Severity Progression
More informationPrevalence of Chronic Obstructive Pulmonary Disease and Tobacco Use in Veterans at Boise Veterans Affairs Medical Center
Prevalence of Chronic Obstructive Pulmonary Disease and Tobacco Use in Veterans at Boise Veterans Affairs Medical Center William H Thompson MD and Sophie St-Hilaire DVM PhD BACKGROUND: Although its prevalence
More informationThe Health Impact of Undiagnosed Airflow Obstruction in a National Sample of United States Adults
The Health Impact of Undiagnosed Airflow Obstruction in a National Sample of United States Adults DAVID B. COULTAS, DOUGLAS MAPEL, ROBERT GAGNON, and EVA LYDICK The University of Florida Health Science
More informationDifferential diagnosis
Differential diagnosis The onset of COPD is insidious. Pathological changes may begin years before symptoms appear. The major differential diagnosis is asthma, and in some cases, a clear distinction between
More informationCOPD and environmental risk factors other than smoking. 14. Summary
COPD and environmental risk factors other than smoking 14. Summary Author : P N Lee Date : 7 th March 2008 1. Objectives and general approach The objective was to obtain a good insight from the available
More informationUNDERSTANDING COPD MEDIA BACKGROUNDER
UNDERSTANDING COPD MEDIA BACKGROUNDER What is COPD? Chronic Obstructive Pulmonary Disease (COPD) also called emphysema and/or chronic obstructive bronchitis* is a preventable lung disease caused by the
More informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic Obstructive Pulmonary Disease (COPD) is a slowly progressive disease of the airways that is characterized by a gradual loss of lung function. In the U.S.,
More informationThe effects of secondhand smoke on chronic obstructive pulmonary disease in nonsmoking Korean adults
ORIGINAL ARTICLE Korean J Intern Med 2014;29:613-619 The effects of secondhand smoke on chronic obstructive pulmonary disease in nonsmoking Korean adults Woong Jun Kim 1, June Seok Song 2, Dong Won Park
More informationChronic obstructive pulmonary disease and hospitalizations for pneumonia in a US cohort
Respiratory Medicine (2009) 103, 224e229 available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/rmed Chronic obstructive pulmonary disease and hospitalizations for pneumonia in a
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationE. Prescott + **, P. Lange* +, J. Vestbo**
Eur Respir J, 1995, 8, 1333 1338 DOI: 10.1183/09031936.95.08081333 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1995 European Respiratory Journal ISSN 0903-1936 Chronic mucus hypersecretion
More informationPulmonary Function Testing
In the Clinic Pulmonary Function Testing Hawa Edriss MD, Gilbert Berdine MD The term PFT encompasses three different measures of lung function: spirometry, lung volumes, and diffusion capacity. In this
More informationMorbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study
< Supplementary data are published online only. To view these files please visit the journal online (http://thorax.bmj. com). 1 Arizona Respiratory Center, University of Arizona, Tucson, Arizona, USA 2
More informationBirth characteristics and asthma symptoms in young adults: results from a population-based cohort study in Norway
Eur Respir J 998; 2: 6 7 DOI:./996.98.266 Printed in UK - all rights reserved Copyright ERS Journals Ltd 998 European Respiratory Journal ISSN 9-96 Birth characteristics and asthma symptoms in young adults:
More informationAsthma COPD Overlap (ACO)
Asthma COPD Overlap (ACO) Dr Thomas Brown Consultant Respiratory Physician Thomas.Brown@porthosp.nhs.uk Dr Hitasha Rupani Consultant Respiratory Physician Hitasha.rupani@porthosp.nhs.uk What is Asthma
More informationAmerican Thoracic Society (ATS) Perspective
National Surveillance System for Chronic Lung Disease (CLD): American Thoracic Society (ATS) Perspective Gerard J. Criner, M.D. Chronic Obstructive Pulmonary Disease (COPD) l Definition: Group of chronic
More informationNew York State Department of Health Center for Environmental Health
New York State Department of Health Center for Environmental Health March 2002 Evaluation of Asthma and Other Respiratory Hospital Admissions among Residents of ZIP Codes 14043 and 14227, Cheektowaga,
More informationEffect Of Byrates (Barium Sulphate) On Pulmonary Function In Byrates Mine Workers
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 01 Ver. I January. (2018), PP 46-50 www.iosrjournals.org Effect Of Byrates (Barium Sulphate)
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationORIGINAL ARTICLE. Confirmations and Surprises in the Association of Tobacco Use With Sinusitis
Confirmations and Surprises in the Association of Tobacco Use With Sinusitis Judith E. C. Lieu, MD; Alvan R. Feinstein, MD ORIGINAL ARTICLE Objective: To generate estimates of sinusitis prevalence for
More informationDOES SMOKING MARIJUANA INCREASE THE RISK OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE?
DOES SMOKING MARIJUANA INCREASE THE RISK OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE Pubdate: Tue, 14 Apr 2009 Source: Canadian Medical Association Journal (Canada) Copyright: 2009 Canadian Medical Association
More informationProductivity losses in chronic obstructive pulmonary disease a population-based survey.
Online supplement to Productivity losses in chronic obstructive pulmonary disease a population-based survey. Running head: Productivity losses in COPD. Authors: Marta Erdal, Department of Thoracic Medicine,
More informationINTRODUCTION METHODS. Alanna M. Chamberlain, MPH; Matthew B. Schabath, PhD; Aaron R. Folsom, MD
ASSOCIATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH ALL-CAUSE MORTALITY IN BLACKS AND WHITES: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY Objective: To determine the burden of chronic obstructive
More informationCOPD is characterized by airflow obstruction with COPD* Epidemiology, Prevalence, Morbidity and Mortality, and Disease Heterogeneity.
COPD* Epidemiology, Prevalence, Morbidity and Mortality, and Disease Heterogeneity David M. Mannino, MD, FCCP COPD continues to cause a heavy health and economic burden both in the United States and around
More informationDefining COPD. Georgina Grantham Community Respiratory Team Leader/ Respiratory Nurse Specialist
Defining COPD Georgina Grantham Community Respiratory Team Leader/ Respiratory Nurse Specialist Defining COPD Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease
More informationDietary fiber and reduced cough with phlegm: a cohort study in Singapore
ON-LINE SUPPLEMENT DATA Dietary fiber and reduced cough with : a cohort study in Singapore Lesley M. Butler, Woon-Puay Koh, Hin-Peng Lee, Mimi C. Yu, Stephanie J. London Sections from the Singapore Chinese
More informationPrevalence of undetected persistent airflow obstruction in male smokers years old
2 Prevalence of undetected persistent airflow obstruction in male smokers 40-65 years old Geijer RMM Sachs APE Hoes AW Salomé PL Lammers J-WJ Verheij TJM Published in: Family Practice 2005;22:485-489 Abstract
More informationKnown Allergies: Shellfish. Symptoms: abdominal pain, nausea, diarrhea, or vomiting. congestion, trouble breathing, or wheezing.
CSTAR CASE STUDIES: BLOCK B Asthma or COPD? Setting: Walk in clinic. Dan: I havi g that cough thi g agai HPI: Dan is a 49-year-old male teacher who reports having had episodes of cough with mucus production
More informationHigh Prevalence of Chronic Obstructive Pulmonary Disease Among Veterans in the Urban Midwest
MILITARY MEDICINE, 176, 5:552, 2011 High Prevalence of Chronic Obstructive Pulmonary Disease Among Veterans in the Urban Midwest Daniel E. Murphy, MD * ; Zeshan Chaudhry * ; Khalid F. Almoosa, MD, MS ;
More informationCOPD Prevalence in Salzburg, Austria* Results From the Burden of Obstructive Lung Disease (BOLD) Study
Original Research COPD COPD Prevalence in Salzburg, Austria* Results From the Burden of Obstructive Lung Disease (BOLD) Study Lea Schirnhofer, MD; Bernd Lamprecht, MD; William M. Vollmer, PhD; Michael
More informationUse of Lambda-Mu-Sigma-Derived Z Score for Evaluating Respiratory Impairment in Middle-Aged Persons
Use of Lambda-Mu-Sigma-Derived Z Score for Evaluating Respiratory Impairment in Middle-Aged Persons Carlos A Vaz Fragoso MD, Thomas M Gill MD, Gail McAvay PhD, Peter H Van Ness PhD, H Klar Yaggi MD, and
More informationC hronic obstructive pulmonary disease (COPD) is one of
935 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Developing COPD: a 25 year follow up study of the general population A Løkke, P Lange, H Scharling, P Fabricius, J Vestbo... See end of article for authors affiliations...
More informationUsing subjective and objective measures to estimate respiratory health in a population of working older Kentucky farmers, Part 2.
Using subjective and objective measures to estimate respiratory health in a population of working older Kentucky farmers, Part 2. Reliability of symptom report in older farmers Nancy E. Johnson, DrPH,
More informationAvailable online at Scholars Research Library
Available online at www.scholarsresearchlibrary.com Annals of Biological Research, 2010, 1 (4) : 248-253 (http://scholarsresearchlibrary.com/archive.html) ISSN 0976-1233 CODEN (USA): ABRNBW A study on
More informationWhat s new in COPD? Apichart Khanichap MD. Department of Medicine, Faculty of Medicine, Thammasat university
What s new in COPD? Apichart Khanichap MD. Department of Medicine, Faculty of Medicine, Thammasat university Management stable COPD Relieve symptoms Improve exercise tolerance Improve health status Prevent
More informationCOPO Prevalence in Southeastem Kentucky* The Burden of Lung Disease Study
Original Research COPD COPO Prevalence in Southeastem Kentucky* The Burden of Lung Disease Study Jennifer N. Methvin, MPH; David M. Mannino, MD, FCCP; and Baretta R. Casey, MD Background: The Burden ofobstructive
More informationEvolution of asthma from childhood. Carlos Nunes Center of Allergy and Immunology of Algarve, PT
Evolution of asthma from childhood Carlos Nunes Center of Allergy and Immunology of Algarve, PT allergy@mail.telepac.pt Questionnaire data Symptoms occurring once or several times at follow-up (wheeze,
More informationSecondhand smoke, lung disease, & public health
Overview Secondhand smoke, lung disease, & public health Mark D. Eisner, MD, MPH University of California, San Francisco Secondhand smoke (SHS) exposure scope of the problem How much asthma / COPD is attributable
More informationStandardised mortality rates in females and males with COPD and asthma
Eur Respir J 2005; 25: 891 895 DOI: 10.1183/09031936.05.00099204 CopyrightßERS Journals Ltd 2005 Standardised mortality rates in females and males with COPD and asthma T. Ringbaek*, N. Seersholm # and
More informationTORCH: Salmeterol and Fluticasone Propionate and Survival in COPD
TORCH: and Propionate and Survival in COPD April 19, 2007 Justin Lee Pharmacy Resident University Health Network Outline Overview of COPD Pathophysiology Pharmacological Treatment Overview of the TORCH
More informationUKnowledge. University of Kentucky. Seth Siameh University of Kentucky. Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)
University of Kentucky UKnowledge Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.) College of Public Health 2016 EXAMINING ASSOCIATIONS BETWEEN PREVALENCE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
More informationGender Differences in the Severity of CT Emphysema in COPD*
Original Research COPD Gender Differences in the Severity of CT Emphysema in COPD* Mark T. Dransfield, MD; George R. Washko, MD; Marilyn G. Foreman, MD, FCCP; Raul San Jose Estepar, PhD; John Reilly, MD,
More informationAirway eosinophils in older teenagers with outgrown preschool wheeze: a pilot study
LETTERS Airway eosinophils in older teenagers with outgrown preschool wheeze: a pilot study To the Editor, Preschool wheezing affects one-third of all children growing up in the UK []. It varies in clinical
More informationCommunity COPD Service Protocol
Community COPD Service Protocol Acknowledgements This protocol is based on the following documents: 1. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults
More informationHealthy Lungs. Presented by: Brandi Bishop, RN and Patty Decker, RRT, RCP
Healthy Lungs Presented by: Brandi Bishop, RN and Patty Decker, RRT, RCP Chronic Lower Respiratory Disease Chronic Lower Respiratory Disease includes 1. Chronic Obstructive Pulmonary Disease 2. Asthma
More informationIntroduction to NHANES and NAMCS
Introduction to NHANES and NAMCS CMU Summer Institute 2002 NHANES: National Health and Nutrition Examination Survey Home Page: http://www.cdc.gov/nchs/nhanes.htm Goal: To provide national estimates of
More informationCitation for the original published paper (version of record):
http://www.diva-portal.org This is the published version of a paper published in The International Journal of Chronic Obstructive Pulmonary Disease. Citation for the original published paper (version of
More informationHealth Effects of Passive Smoking
Health Effects of Passive Smoking: Jonathan Samet, MD, MS Health Effects of Passive Smoking Jonathan Samet, MD, MS Johns Hopkins Bloomberg School of Public Health What Is Secondhand Smoke (SHS)? Mainstream
More informationCOPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases
COPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases «If you test one smoker with cough every day You will diagnose
More informationThe Relationship Between FEV 1 and Peak Expiratory Flow in Patients With Airways Obstruction Is Poor*
Original Research PULMONARY FUNCTION TESTING The Relationship Between FEV 1 and Peak Expiratory Flow in Patients With Airways Obstruction Is Poor* Ashutosh N. Aggarwal, MD, FCCP; Dheeraj Gupta, MD, FCCP;
More informationChronic bronchitis before age 50 years predicts incident airflow limitation and mortality risk
c Additional data, including tables and a figure, are published online only at http:// thorax.bmj.com/content/vol64/ issue10 1 Arizona Respiratory Center, University of Arizona, Tucson, Arizona, USA; 2
More informationClinical determinants of exacerbations in severe, early-onset COPD
Eur Respir J 2007; 30: 1124 1130 DOI: 10.1183/09031936.00009307 CopyrightßERS Journals Ltd 2007 Clinical determinants of exacerbations in severe, early-onset COPD M.G. Foreman*, D.L. DeMeo*,#, C.P. Hersh*,#,
More informationLung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects
Lung Function Basics of Diagnosis of Obstructive, Restrictive and Mixed Defects Use of GOLD and ATS Criteria Connie Paladenech, RRT, RCP, FAARC Benefits and Limitations of Pulmonary Function Testing Benefits
More informationCurrent Cigarette Smoking Among Workers in Accommodation and Food Services United States,
Current Cigarette Among Workers in Accommodation and Food Services United States, 2011 2013 Girija Syamlal, MPH 1 ; Ahmed Jamal, MBBS 2 ; Jacek M. Mazurek, MD 1 (Author affiliations at end of text) Tobacco
More informationThe State of Asthma in Arkansas
2013 The State of Asthma in Arkansas Jennifer Maulden, MA Martha Phillips, PhD University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health This project was supported by Award Number
More informationRespiratory symptoms and lung function in young adults with severe alpha(1)antitrypsin deficiency (PiZZ).
Respiratory symptoms and lung function in young adults with severe alpha(1)antitrypsin deficiency (PiZZ). Piitulainen, Eeva; Sveger, Tomas Published in: Thorax 2002 Link to publication Citation for published
More informationCOPD COPD. C - Chronic O - Obstructive P - Pulmonary D - Disease OBJECTIVES
COPD C - Chronic O - Obstructive P - Pulmonary D - Disease 1 OBJECTIVES Following this presentation the participant should be able to demonstrate understanding of chronic lung disease by successful completion
More informationRESPIRATORY CARE IN GENERAL PRACTICE
RESPIRATORY CARE IN GENERAL PRACTICE Definitions of Asthma and COPD Asthma is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they
More informationChronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, sputum (phlegm) production
More informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More informationDo current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma?
Respiratory Medicine (2006) 100, 458 462 Do current treatment protocols adequately prevent airway remodeling in children with mild intermittent asthma? Haim S. Bibi a,, David Feigenbaum a, Mariana Hessen
More informationPulmonary Pathophysiology
Pulmonary Pathophysiology 1 Reduction of Pulmonary Function 1. Inadequate blood flow to the lungs hypoperfusion 2. Inadequate air flow to the alveoli - hypoventilation 2 Signs and Symptoms of Pulmonary
More informationHow to treat COPD? What is the mechanism of dyspnea? Smoking cessation
: The Increasing Role of the FP Alan Kaplan, MD, CCFP(EM) Presented at the Primary Care Today: Education Conference and Medical Exposition, Toronto, Ontario, May 2006. Chronic obstructive pulmonary disease
More informationC hronic obstructive pulmonary disease (COPD) is a
1043 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample L Shahab, M
More informationWhat do pulmonary function tests tell you?
Pulmonary Function Testing Michael Wert, MD Assistant Professor Clinical Department of Internal Medicine Division of Pulmonary, Critical Care, and Sleep Medicine The Ohio State University Wexner Medical
More informationIndian Journal of Basic & Applied Medical Research; September 2013: Issue-8, Vol.-2, P
Original article: Study of pulmonary function in different age groups Dr.Geeta J Jagia*,Dr.Lalita Chandan Department of Physiology, Seth GS Medical College, Mumbai, India *Author for correspondence: drgrhegde@gmail.com
More informationExposure to Indoor Biomass Fuel Pollutants and Asthma Prevalence in Southeastern Kentucky: Results From the Burden of Lung Disease (BOLD) Study
University of Kentucky From the SelectedWorks of David M. Mannino September, 2010 Exposure to Indoor Biomass Fuel Pollutants and Asthma Prevalence in Southeastern Kentucky: Results From the Burden of Lung
More informationPeak Expiratory Flow Is Not a Quality Indicator for Spirometry*
Original Research PULMONARY FUNCTION TESTING Peak Expiratory Flow Is Not a Quality Indicator for Spirometry* Peak Expiratory Flow Variability and FEV 1 Are Poorly Correlated in an Elderly Population Matthew
More informationThe Impact of a Smoke-Free Ordinance on the Health and Attitudes of Bartenders
The Impact of a Smoke-Free Ordinance on the Health and Attitudes of Bartenders Karen A. Palmersheim, PhD, MS a, Patrick L. Remington, MD, MPH b, David F. Gundersen, MPH c Abstract Introduction: This report
More informationPrevalence of Chronic Obstructive Pulmonary Disease in Japanese People on Medical Check-Up
Tohoku J. Exp. Med., 2005, 207, Prevalence 41-50 of COPD on Medical Check-Up 41 Prevalence of Chronic Obstructive Pulmonary Disease in Japanese People on Medical Check-Up HIDEKAZU TAKEMURA, WATARU HIDA,
More informationSMOKING CESSATION. Why bother?
SMOKING CESSATION Why bother? Supporting policies COPD A disease characterised by airflow obstruction. It is usually progressive, not fully reversible and does not change markedly over several months.
More information12-year change in prevalence of respiratory symptoms in elderly Chinese living in Hong Kong
Respiratory Medicine (2006) 100, 1598 1607 12-year change in prevalence of respiratory symptoms in elderly Chinese living in Hong Kong Fanny W.S. Ko a,, Christopher K.W. Lai a, Jean Woo b, Suzanne C. Ho
More informationSymptomatology and Health Status in Patients With Chronic Obstructive Pulmonary Disease
ORIGINAL ARTICLE Symptomatology and Health Status in Patients With i&&tjljl!11b hi 2 L C Loh, MRCP, C H Lai,O H Liew, Y Y Siow IMU Lung Research, International Medical University, Clinical School, Jalan
More informationONLINE DATA SUPPLEMENT - ASTHMA INTERVENTION PROGRAM PREVENTS READMISSIONS IN HIGH HEALTHCARE UTILIZERS
R2 (REVISED MANUSCRIPT BLUE 200208-877OC) ONLINE DATA SUPPLEMENT - ASTHMA INTERVENTION PROGRAM PREVENTS READMISSIONS IN HIGH HEALTHCARE UTILIZERS Mario Castro, M.D., M.P.H. Nina A. Zimmermann R.N. Sue
More informationEva Hnizdo, Patricia A. Sullivan, Ki Moon Bang, and Gregory Wagner
American Journal of Epidemiology Copyright 2002 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 156, No. 8 Printed in U.S.A. DOI: 10.1093/aje/kwf105 Association between
More informationClinical application of a simple questionnaire for the differentiation of asthma and chronic obstructive pulmonary disease $
Respiratory Medicine (2004) 98, 591 597 Clinical application of a simple questionnaire for the differentiation of asthma and chronic obstructive pulmonary disease $ Kai Michael Beeh a, *, Oliver Kornmann
More informationan inflammation of the bronchial tubes
BRONCHITIS DEFINITION Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the trachea into the small airways and alveoli. Triggers may be infectious
More informationCardiovascular and Respiratory Disorders
Cardiovascular and Respiratory Disorders Blood Pressure Normal blood pressure is 120/80 mmhg (millimeters of mercury) Hypertension is when the resting blood pressure is too high Systolic BP is 140 mmhg
More informationIntermediate Methods in Epidemiology Exercise No. 4 - Passive smoking and atherosclerosis
Intermediate Methods in Epidemiology 2008 Exercise No. 4 - Passive smoking and atherosclerosis The purpose of this exercise is to allow students to recapitulate issues discussed throughout the course which
More informationUpdate on heterogeneity of COPD, evaluation of COPD severity and exacerbation
Update on heterogeneity of COPD, evaluation of COPD severity and exacerbation Yung-Yang Liu, MD Taipei Veterans General Hospital Aug 29, 2015 G O lobal Initiative for Chronic bstructive L D ung isease
More informationFish consumption and respiratory symptoms among young adults in a Norwegian community.
Eur Respir J 1; 1: 6 1 DOI: 10./0016..1006 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1 European Respiratory Journal ISSN 00-16 Fish consumption and respiratory symptoms among young
More informationExternal validation of a COPD diagnostic questionnaire
Eur Respir J 2008; 31: 298 303 DOI: 10.1183/09031936.00074307 CopyrightßERS Journals Ltd 2008 External validation of a COPD diagnostic questionnaire D. Kotz*,#, P. Nelemans #,", C.P. van Schayck*,# and
More informationCOPD: Current Medical Therapy
COPD: Current Medical Therapy Angela Golden, DNP, FNP-C, FAANP Owner, NP from Home, LLC Outcomes As a result of this activity, learners will be able to: 1. List the appropriate classes of medications for
More informationTrends in Allergic Conditions Among Children: United States,
Trends in Allergic Conditions Among Children: United States, 1997 2011 Kristen D. Jackson, M.P.H.; LaJeana D. Howie, M.P.H., C.H.E.S.; Lara J. Akinbami, M.D. Key findings Data from the National Health
More information