Three-Year Hospitalization and Mortality in Elderly Smokers with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure.

BACKGROUND: In elderly smokers, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) usually present with dyspnoea. COPD and CHF are associated -almost invariably with concomitant chronic diseases, which contribute to severity and prognosis. OBJECTIVES: We investigated similarities and differences in the clinical presentation, concomitant chronic diseases and risk factors for -mortality and hospitalization at 3-year follow-up in elderly smokers/ex-smokers with a primary diagnosis of COPD or CHF recruited and followed in specialized centers. METHODS: We examined 144 patients with COPD and 96 with CHF, ≥65 years, ≥20 pack/years, and measured COPD Assessment Test (CAT) score, modified Medical Research Council, NYHA, and Charlson Index, routine blood test, estimated glomerular filtration rate, HRCT scan, 6-min walk test. In addition, in each patient we actively searched for CHF, COPD, peripheral vascular disease, and metabolic syndrome. RESULTS: COPD and CHF patients had mild to moderate disease, but the majority was symptomatic. Comorbidities were highly prevalent and often unrecognized in both groups. COPD and CHF patients had a similar risk of hospitalization and death at 3 years. Lower glomerular filtration rate, shorter 6MWT, and ascending aorta calcification score ≥2 were independent predictors of mortality in COPD, whereas previous 12 months hospitalizations, renal disease, and heart diameter were in CHF patients. Lower glomerular filtration rate value, higher CAT score, and lower FEV1/FVC ratio were associated with hospitalization in COPD, while age, lower FEV1% predicted, and peripheral vascular disease were in CHF. CONCLUSIONS: There are relevant similarities and differences between patients with COPD and CHF even when admitted to specialized outpatient centers, suggesting that these patients should be manage in multidisciplinary units.

Biomarkers of oxidative-stress and inflammation in exhaled breath condensate from hospital cleaners.

OBJECTIVE: We studied the impact of chlorinated agents exposure on exhaled breath condensate (EBC) biomarkers in cleaners. METHODS: Malondialdehyde (MDA), 4-hydroxynonenal (4-HNE), nitrites (NO2(-)), nitrates (NO3(-)), pH, hydrogen peroxide (H2O2) and ammonium (NH3(+)) were tested in EBC of 40 cleaners and 40 non-exposed controls. Pentraxin-3 (PTX3) and soluble type II receptor of IL-1 (sIL-1RII) were analyzed also in plasma. RESULTS: Levels of MDA-EBC, 4-HNE-EBC and NO3(-)-EBC were higher, while pH-EBC values were lower, in cleaners. MDA-EBC was associated with 4-HNE-EBC, NO3(-)-EBC and pH. 4-HNE-EBC correlated with PTX3. CONCLUSION: Professional exposure to chlorinated agents increases EBC biomarkers of oxidative stress and inflammation.

Forced expiratory volume in one second: A novel predictor of work disability in subjects with suspected obstructive sleep apnea.

Whether the association of work disability with obstructive sleep apnea (OSA) is mainly due to the disease, i.e. the number and frequency of apneas-hypoapneas, or to coexisting factors independent from the disease, is not well-established. In this study, we aim to evaluate work ability in a group of subjects undergoing OSA workup and to identify the major contributors of impaired work ability. In a cross-sectional study, we enrolled 146 consecutive subjects who have been working for the last five years and referred to the sleep disorders outpatients' clinic of the University-Hospital of Ferrara, Italy, with suspected OSA. After completing an interview in which the Work Ability Index (WAI) and the Epworth Sleepiness Scale (ESS) questionnaires were administered to assess work ability and excessive daytime sleepiness, respectively, subjects underwent overnight polysomnography for OSA diagnosing and spirometry. Of the 146 subjects, 140 (96%) completed the tests and questionnaires and, of these, 66 exhibited work disability (WAI < 37). OSA was diagnosed (apnea-hypopnea index ≥ 5) in 45 (68%) of the 66 subjects. After controlling for confounders, a lower level of forced expiratory volume at 1 second (FEV1), [odds ratio 0.97 (95% CI 0.95-1.00)], older age [1.09 (95% CI 1.03-1.15)], excessive daytime sleepiness [3.16 (95% CI 1.20-8.34)] and a worse quality of life [0.96 (95% CI 0.94-1.00)], but not OSA [1.04 (95% CI 0.41-2.62)], were associated with work disability. Patients with a higher number of diseases, in which OSA was not included, and a lower quality of life had an increased probability of absenteeism in the previous 12 months. In subjects with suspected OSA, FEV1 can be an important predictor of work disability.

Breathlessness, but not cough, suggests chronic obstructive pulmonary disease in elderly smokers with stable heart failure.

Chronic obstructive pulmonary disease (COPD) is a common comorbidity of heart failure (HF), but remains often undiagnosed, and we aimed to identify symptoms predicting COPD in HF. As part of an observational, prospective study, we investigated stable smokers with a confirmed diagnosis of HF, using the 8-item COPD-Assessment-Test (CAT) questionnaire to assess symptoms. All the items were correlated with the presence of COPD, and logistic regression models were used to identify independent predictors. 96 HF patients were included, aged 74, 33% with COPD. Patients with HF and COPD were more symptomatic, but only breathlessness when walking up a hill was an independent predictor of COPD (odds ratio = 1.33, p = 0.0484). Interestingly, COPD-specific symptoms such as cough and phlegm were not significant. Thus, in elderly smokers with stable HF, significant breathlessness when walking up a hill is most indicative of associated COPD, and may indicate the need for further lung function evaluation.

Chronic diseases are strongly associated with sickness absences in a sample of Italian public employees.

OBJECTIVES: Data on the prevalence of chronic diseases and their relationship with sickness absence in the Italian public employees are rather scarce. Therefore, in the first place, we assessed the distribution of chronic diseases in the employees of the University of Ferrara. As a next step, we investigated the possible associations between each chronic disease and cumulative days of all-cause sickness absence, and finally we investigated the odds ratio of each single chronic disease on sickness absence. MATERIAL AND METHODS: A total of 514 employees, 269 sick-listed and 245 not sick-listed in 2012, were studied. Demographical/clinical characteristics and chronic diseases were obtained from all study participants during medical surveillance procedures. Sickness absence days and job seniority data were obtained from the administrative office. RESULTS: Gastrointestinal and psychiatric diseases were the most reported in the sick-listed sample (p = 0.01 and p = 0.02, respectively, compared to the not sick-listed). In the interquantile regression analysis, the sickness absence days were associated with psychiatric diseases (ß = 65.1, 95% CI: 13.2-117.1, p = 0.01) and with the presence of 2 or more chronic diseases (ß = 23.3, 95% CI: 4.5-42, p = 0.02). Furthermore, the logistic regression analysis showed that the odds of sickness absence were increased 2 fold by psychiatric diseases (OR = 2.2, 95% CI: 1.01-4.93, p = 0.04), and gastrointestinal diseases (OR = 1.9, 95% CI: 1.07-3.42, p = 0.02) and, to a lesser extent, by high body mass index (OR = 1.05, 95% CI: 1-1.11, p = 0.03). Conversely, female gender reduced by half the odds of sickness absence (OR = 0.5, 95% CI: 0.3-0.8, p = 0.04). CONCLUSIONS: This study highlights the relevant association between chronic diseases and sickness absence in Italian public employees. Our findings indicate the importance of considering the health status when designing preventive interventions aimed at decreasing sickness absences in this population.