Harmonization of Respiratory Data From 9 US Population-Based Cohorts: The NHLBI Pooled Cohorts Study.

Chronic lower respiratory diseases (CLRDs) are the fourth leading cause of death in the United States. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed prebronchodilator spirometry and were harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for noncardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRD-related or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in 9 cohorts followed-up for CLRD-related mortality over 653,380 person-years during 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% white, 22% black, 28% Hispanic/Latino, and 5% American Indian. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry examinations (13%), there were 105,696 valid examinations (median, 2 per participant). Of 29,351 participants followed for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost to follow-up at 10 years. The NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.

Cigarette smoking and lung obstruction among adults aged 40-79: United States, 2007-2012.

During 2007-2012, about 46% of U.S. adults aged 40-79 with lung obstruction currently smoked cigarettes. This was more than double the smoking rate for those without lung obstruction (19.8%). In the United States, a greater percentage of men (20.5%) than women (15.3%) were current cigarette smokers in 2013. Some studies have suggested that women are more susceptible than men to the effects of tobacco smoke. Since 2000, the number of women dying from COPD has exceeded the number of men dying from the disease. In the present report, a similar percentage of men and women overall, and at each level of lung obstruction severity, currently smoked cigarettes. Notable differences were seen in smoking rates by race and Hispanic origin. Among adults aged 40-79 with mild lung obstruction, a significantly greater percentage of non-Hispanic black adults currently smoked cigarettes compared with the two other race and Hispanic origin groups. With moderate or worse lung obstruction, however, a significantly greater percentage of non-Hispanic white adults currently smoked cigarettes compared with those in the other race and Hispanic origin groups. Smoking rates among those with lung obstruction also varied by education, with progressively higher rates of smoking among those with decreasing levels of education. This inverse relationship between smoking and education level is consistent across all severity levels of lung obstruction. Smoking tobacco can increase respiratory symptoms, loss of lung function, and the progression of COPD. The data presented here show that during 2007-2012, almost one-half of U.S. adults aged 40-79 with lung obstruction currently smoked cigarettes.

Socioeconomic Characteristics Are Major Contributors to Ethnic Differences in Health Status in Obstructive Lung Disease: An Analysis of the National Health and Nutrition Examination Survey 2007-2010.

BACKGROUND: Understanding ethnic differences in health status (HS) could help in designing culturally appropriate interventions. We hypothesized that racial and ethnic differences exist in HS between non-Hispanic whites and Mexican Americans with obstructive lung disease (OLD) and that these differences are mediated by socioeconomic factors. METHODS: We analyzed 826 US adults aged ≥ 30 years self-identified as Mexican American or non-Hispanic white with spirometry-confirmed OLD (FEV1/FVC < 0.7) who participated in the National Health and Nutrition Examination Survey 2007-2010. We assessed associations between Mexican American ethnicity and self-reported HS using logistic regression models adjusted for demographics, smoking status, number of comorbidities, limitations for work, and lung function and tested the contribution of education and health-care access to ethnic differences in HS. RESULTS: Among Mexican Americans with OLD, worse (fair or poor) HS was more prevalent than among non-Hispanic whites (weighted percentage [SE], 46.6% [5.0] vs 15.2% [1.6]; P < .001). In bivariate analysis, socioeconomic characteristics were associated with lower odds of reporting poor HS (high school graduation: OR, 0.24 [95% CI, 0.10-0.40]; access to health care: OR, 0.50 [95% CI, 0.30-0.80]). In fully adjusted models, a strong association was found between Mexican American ethnicity (vs non-Hispanic white) and fair or poor HS (OR, 7.52; 95% CI, 4.43-12.78; P < .001). Higher education and access to health care contributed to lowering the Mexican American ethnicity odds of fair or poor HS by 47% and 16%, respectively, and together, they contributed 55% to reducing the differences in HS with non-Hispanic whites. CONCLUSIONS: Mexican Americans with OLD report poorer overall HS than non-Hispanic whites, and education and access to health care are large contributors to the difference.

Airflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.

BACKGROUND: Reduced low forced expiratory volume in 1 second (FEV1) is reportedly associated with an increased risk of atrial fibrillation (AF). Extant reports do not provide separate estimates for never smokers or for blacks, who incongruously have lower AF incidence than whites. METHODS AND RESULTS: We examined 15 004 middle-aged blacks and whites enrolled in the Atherosclerosis Risk in Communities (ARIC) cohort study. Standardized spirometry data were collected at the baseline examination. Incident AF was identified from the first among the following: International Classification of Diseases codes for AF on hospital discharge records or death certificates or 12-lead ECGs performed during 3 triennial follow-up visits. Over an average follow-up of 17.5 years, a total of 1691 participants (11%) developed new-onset AF. The rate of incident AF was inversely associated with FEV1 in each of the 4 race and sex groups. After multivariable adjustment for traditional cardiovascular disease risk factors and height, hazard ratios of AF comparing the lowest with the highest quartile of FEV1 were 1.37 (95% confidence interval, 1.02-1.83) for white women, 1.49 (95% confidence interval, 1.16-1.91) for white men, 1.63 (95% confidence interval, 1.00-2.66) for black women, and 2.36 (95% confidence interval, 1.30-4.29) for black men. The above associations were observed across all smoking status categories. Moderate/severe airflow obstruction (FEV1/forced vital capacity <0.70 and FEV1 < 80% of predicted value) was also associated with higher AF incidence. CONCLUSIONS: In this large population-based study with a long-term follow-up, reduced FEV1 and obstructive respiratory disease were associated with a higher AF incidence after adjustment for measured confounders.

Pulmonary involvement in systemic sclerosis: associations with genetic, serologic, sociodemographic, and behavioral factors.

OBJECTIVE: To determine the relative contributions of genetic, clinical, serologic, sociodemographic, and behavioral/psychological variables to early pulmonary involvement in the Genetics versus Environment in Scleroderma Outcome Study cohort. METHODS: At the baseline visit (V0), 203 patients with systemic sclerosis (SSc) were examined (104 whites, 39 African Americans, and 60 Hispanics). We obtained sociodemographic, behavioral/psychological (illness behavior, social support, learned helplessness, smoking, drinking), clinical, serologic (autoantibodies), and genetic (HLA class II and FBN1 genotypes) factors; pulmonary function test results; electrocardiograms; and chest radiographs. Data analysis included Fisher's exact test, chi-square test, Student's t-test, analysis of variance, and stepwise linear and logistic regression methods. RESULTS: Significant pulmonary involvement was seen in 25% of patients within 2.8 years of SSc diagnosis. At V0, pulmonary fibrosis was significantly higher in African Americans compared with whites or Hispanics. African Americans had significantly lower percent predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV(1)) compared with whites and significantly lower percent predicted diffusing capacity for carbon monoxide (DLCO) compared with whites and Hispanics. Significant, independent associations impacting early pulmonary involvement included African American ethnicity, skin score, serum creatinine and creatine phosphokinase values, hypothyroidism, and cardiac involvement. Anticentromere antibody seropositivity was a significant, independent, protective factor for restrictive lung disease and FVC or DLCO values. African Americans had significantly increased frequencies of anti-topoisomerase I, fibrillarin, and RNP autoantibodies compared with whites. African Americans scored significantly lower on the Interpersonal Support Evaluation List and significantly higher on the Illness Behavior Questionnaire. CONCLUSION: Early pulmonary involvement in SSc appears to be influenced by several factors delineated by ethnicity, including racial, socioeconomic, behavioral, and serologic determinants.

Spirometric criteria for airway obstruction: Use percentage of FEV1/FVC ratio below the fifth percentile, not < 70%.

BACKGROUND: Current authoritative spirometry guidelines use conflicting percentage of FEV1/FVC ratios (FEV1/FVC%) to define airway obstruction. The American Thoracic Society/European Respiratory Society Task Force characterizes obstruction as a FEV1/FVC% below the statistically defined fifth percentile of normal. However, many recent publications continue to use the Global Initiative for Chronic Obstructive Lung Disease (GOLD) primary criterion that defines obstruction as a FEV1/FVC% < 70%. Data from the Third National Health and Nutrition Examination Survey (NHANES-III) should identify and quantify differences, help resolve this conflict, and reduce inappropriate medical and public health decisions resulting from misidentification. METHODS: Using these two guidelines, individual values of FEV1/FVC% were compared by decades in 5,906 healthy never-smoking adults and 3,497 current-smokers of black (African American), Hispanic (Latin), or white ethnicities aged 20.0 to 79.9 years. RESULTS: In the never-smoking population, the lower limits of normal used in other reference equations fit reasonably well the NHANES-III statistically defined fifth percentile guidelines. But nearly one half of young adults with FEV1/FVC% below the NHANES-III fifth percentile of normal were misidentified as normal because their FEV1/FVC% was > 70% (abnormals misidentified as normal). Approximately one fifth of older adults with observed FEV1/FVC% above the NHANES-III fifth percentile had FEV1/FVC% ratios < 70% (normals misidentified as abnormal). CONCLUSIONS: The GOLD guidelines misidentify nearly one half of abnormal younger adults as normal and misidentify approximately one fifth of normal older adults as abnormal.

Differences in rates of obstructive lung disease between Africans and African Americans.

OBJECTIVE: The prevalence of obstructive lung disease is rising in the United States, particularly among those of African descent. Rates of ventilatory impairment and reported respiratory symptoms were examined in a cross-sectional study of urban Nigerian civil servants who are in transition to a westernized lifestyle. DESIGN: 410 civil servants (235 men, 175 women) aged 30-69 years in Benin City, Nigeria (West Africa) were recruited for a cross-sectional study on respiratory health and compared to 3,397 African Americans enrolled in NHANES III between 1988 and 1994. METHODS: Forced vital capacity (FVC), expiratory flow rate in 1 sec (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR) were measured by spirometry. Demographic characteristics and respiratory symptoms were ascertained by questionnaire. RESULTS: Nigerians had lower age and height adjusted FVC and FEV1 than African Americans in both genders, independent of smoking and respiratory disease. However, relative lung function was better among Nigerians. Fewer Nigerians had an age-adjusted FEV1/FVC ratio below 0.70 than African Americans (10.54 vs 14.10/100 men, 6.29 vs 8.67/100 women). Overall, Nigerians had a lower age-adjusted prevalence of any self-reported respiratory symptoms than African Americans (3.65 vs 22.90/100 men, 4.57 vs 35.38/100 women). Similarly, Nigerians had a lower age-adjusted prevalence of current smoking than African Americans (10.82 vs 46.50/100 in men and 0 vs 30.93/100 in women). CONCLUSIONS: Urban Nigerians who have limited exposure to cigarette smoke and who work in a non-industrial setting have a low prevalence of obstructive lung disease.

Doença pulmonar sistêmica obstrutiva crônica: um nome grande para um grande problema / Chronic obstrutive pulmonary diseases: a big name for a big problem

O autor aborda a epidemiologia da doença pulmonar obstrutiva crônica, discutindo sua gênese e sua prevençäo. Comenta sobre as manifestaçöes sistêmica da doença e sobre o comportamento de outros órgäos à distância,sugerindo uma nova denominaçäo para a entidade: doença pulmonar sistêmica obstrutiva crônica. Enfoca os dados sobre sua prevalência em diferentes partes do mundo e sobre o custo financeiro que ela provoca, decorrente do seu manejo e da incapacidade que causa. Aponta e discute os diferentes fatores envolvidos em sua gênese que vêm sendo apresentados na literatura especializada. Finaliza por apresentar as estratégias possíveis para os diferentes níveis de prevençäo da doença, desde a primária até a terciária

Genetic susceptibility to chronic obstructive pulmonary disease in Koreans: combined analysis of polymorphic genotypes for microsomal epoxide hydrolase and glutathione S-transferase M1 and T1.

BACKGROUND: Although smoking is the major causal factor in the development of chronic obstructive pulmonary disease (COPD), only 10-20% of chronic heavy cigarette smokers develop symptomatic COPD which suggests the presence of genetic susceptibility. This genetic susceptibility to COPD might depend on variations in enzyme activities that detoxify cigarette smoke products such as microsomal epoxide hydrolase (mEPHX) and glutathione-S transferase (GST). As there is increasing evidence that several genes influence the development of COPD, multiple gene polymorphisms should be investigated to find out the genetic susceptibility to COPD. METHODS: The genotypes of 83 patients with COPD and 76 healthy smoking control subjects were determined by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (PCR-RFLP) for the mEPHX gene, and multiplex PCR for GST M1 and GST T1 genes. The frequencies of polymorphic genotypes of mEPHX, GST M1, and GST T1 genes were compared both individually and in combination in patients with COPD and healthy smokers. RESULTS: No differences were observed in the frequency of polymorphic genotypes in exons 3 and 4 of mEPHX, GST M1, and GST T1 genes between patients with COPD and healthy smokers. The frequencies of any combination of these genotypes also showed no differences between the COPD group and the control group. CONCLUSIONS: Genetic polymorphisms in mEPHX, GST M1, and GST T1 genes are not associated with the development of COPD in Koreans.

Respiratory symptoms and risk factors in an Arizona population sample of Anglo and Mexican-American whites.

Prevalence rates of respiratory symptoms and diseases in a large group of Anglos and Mexican-Americans were analyzed. Each subject completed a questionnaire. Among current smokers, chronic productive cough and dyspnea were significantly higher in both ethnic groups; wheezy symptoms were higher in Anglos. There were no significant differences in the symptom prevalence rates between the two groups, after stratifying by current cigarette consumption and CRT. The spirometric values were not significantly different. In both ethnic groups, the prevalence rates of wheeze, SOBWHZ and asthma were significantly higher in those who had CRT. Among Anglos, less educated smokers had significantly higher prevalence rates of SOBWHZ and dyspnea; nonsmokers with less education had higher prevalence rates of cough, chronic cough and dyspnea. Our results confirm the importance of CRT and lower educational level as risk factors for respiratory symptoms. Ethnicity is not associated with symptomatology or lung function impairment.

The major respiratory diseases of American Indians.

The most prominent respiratory diseases of American Indian adults are pneumonia, cancer of the lung, chronic obstructive pulmonary disease (COPD), and tuberculosis. Mortality and hospitalization rates of these diseases were compared with those for the rest of the U.S. population and between Indian groups in the various Indian Health Service Areas. Pneumonia and influenza constitute the sixth leading cause of death among Indians and the fifth leading cause of death among the U.S. All Races population. Chronic obstructive pulmonary disease is the fourth leading cause of death among U.S. All Races, but only the tenth leading cause of death among Indians. Pneumonia and tuberculosis are more significant causes of death and disability for Indians than are COPD and cancer of the lung. The explanation for these differences in mortality rates between Indians and the general population are not known. Respiratory system diseases are responsible for 10.6% of Indian hospitalizations. The most frequent is pneumonia, which accounts for approximately 4% of all Indian hospitalizations. Differences in respiratory diseases between Indian groups are sometimes striking, with a sharp increase in mortality and hospitalization in the Areas across the northern border of the lower 48 states. There is also a much higher prevalence of cigarette smoking in those same Areas.

Ethnic differences in the prevalence of pulmonary airflow obstruction among grain workers.

World Health Organization data suggest that British males over 45 have a higher death rate from chronic bronchitis, emphysema, and asthma combined than do other Europeans. Although widely supposed that this is due to particularly unfavorable environmental factors in the British Isles, as well as a higher rate of tobacco consumption, ethnicity itself may be a significant factor in determining risk of obstructive airways disease. To test this hypothesis, we have analyzed the prevalence of airflow obstruction (100 x FEV1:FVC less than 68% and FEV1 less than 84 percent predicted) in Saskatchewan grain workers of British, German, and Eastern European ancestry using the Mantel-Haenszel odds ratio (OMH) and stepwise logistic regression. We found that the British grain workers had a significantly greater prevalence of airflow obstruction (OMH = 3.2; p less than 0.01) than the Eastern Europeans. We also found that ethnic origin made a significant contribution to the estimation of risk of airflow obstruction among grain workers independent of the effects of age and smoking.

Mortality from lung cancer and chronic obstructive pulmonary disease in New Mexico, 1958-82.

We examined mortality from lung cancer and from chronic obstructive pulmonary disease in Hispanic White, Other White, and Native American residents of New Mexico during the period 1958-82. Age-specific mortality was calculated by combining death certificate data with population estimates based on the 1960, 1970, and 1980 censuses that were adjusted for inconsistencies in the designation of race and ethnicity. In Other Whites, age-adjusted mortality rates from lung cancer and from chronic obstructive pulmonary disease increased progressively in males and females. Mortality rates for both diseases also increased in Hispanics during the study period, but the most recent rates for Hispanics were well below those for Other Whites. Age-specific mortality rates for lung cancer declined for more recently born Hispanic women at older ages. In Native Americans, rates for both diseases were low throughout the study period and did not show consistent temporal trends.

Airway obstruction in sarcoidosis. A study of 123 nonsmoking black American patients with sarcoidosis.

Airway obstruction in sarcoidosis is infrequent; however, its exact incidence is not known. The extent and severity of the functional impairment are governed by genetic, racial and environmental factors. In order to test the validity of this assumption we studied 123 black American, nonsmoking patients. Airway obstruction was present in 78 (63 percent) of the patients, considerably higher than the white European and American, and the Japanese patients.

Tests of small airway function in black smokers and nonsmokers.

Tests of small airway function (closing volume, forced expiratory flow in the middle half of the vital capacity, specific airway conductance, and peak expiratory flow) and routine spirometric tests (forced vital capacity, forced expiratory volume in one second, and residual volume) were performed in 848 adult black subjects of both sexes. The group included 422 smokers and 426 nonsmokers. No significant difference was found between smokers and nonsmokers for any of the tests, although some values were higher for men than for women. These findings suggest that reported abnormalities in small airway function in smokers in the general population may not be applicable to black smokers. This may be an important finding in ethnic variability in the incidence of chronic obstructive pulmonary disease.

Pulmonary functions and respiratory symptoms and diseases among adult Israelis. Variations by country of origin.

A study group of 1,299 adult Israelis aged 30 to 65 years was chosen from persons referred for evaluation of possible pulmonary diseases in two outpatient chest clinics. They were interviewed using the ATS-NHLI (American Thoracic Society-National Heart and Lung Institute) health questionnaire and underwent the pulmonary function test (PFT), which included the following parameters: forced vital capacity (FVC), forced expiratory volume in 1st sec (FEV1), FEV1/FVC, peak expiratory flow (PEF), FEF50 and FEF25 (forced expiratory flow at 50 and 25% of FVC, respectively). The effect of the country of origin of the subjects on the distribution of respiratory symptoms, pulmonary diseases and PFT was analyzed. The lowest PFT values and an excess of reported respiratory symptoms and chronic obstructive airways diseases--especially asthma--among subjects and their parents were found among immigrants from Iraq-Iran. In immigrants from Morocco, reported respiratory symptoms, pulmonary diseases and impaired PFT were relatively uncommon. The different distribution of reported respiratory symptoms, pulmonary diseases and impaired PFT by country of origin could not be explained by environmental factors, such as smoking habits and socioeconomic background. The high prevalence of reported asthma among immigrants from Iraq-Iran is most probably due to a genetic factor.