Geographical Distribution of COPD Prevalence in the Americas.

Surveys estimating chronic obstructive pulmonary disease (COPD) prevalence are unevenly distributed in the Americas, which make it difficult to estimate accurately its geographical distribution. The geographic information system inverse distance weighted (IDW) interpolation technique has proved to be an effective tool in spatial distribution estimation of epidemiological variables, even when real data are few or widely spread. We aimed to represent cartographically the COPD prevalence in the Americas by means of a blue to red scale representation of the prevalence data, where different values are represented as different colours, and a population density filtered IDW interpolation mapping, where areas with a population density <0.1 inhabitants/km2 are hidden. We systematically searched for prevalence rates from population surveys of individuals 40 years and older, and a COPD diagnosis confirmed by spirometry. Interpolation maps were obtained for the whole Americas, even from extensive areas lacking real data. Maps showed high prevalence values in the Southeast and Southwest regions of Canada bordering the United States; in several states of the Great Lakes region, and in the lower Missouri, Ohio and Mississippi basins of the United States; in the coastal regions of south-eastern and southern Brazil; Uruguay, and the Argentine Pampas. In general, most of the remaining American regions showed intermediate values of COPD prevalence. IDW interpolation seems to be a suitable tool to visually display estimates of COPD prevalence, and it may be a valuable help to draw attention about the worrying prevalence of this preventable and treatable disease.

Prevalence of COPD in 6 Urban Clusters in Argentina: The EPOC.AR Study. / Prevalencia de enfermedad pulmonar obstructiva crónica en 6 aglomerados urbanos de Argentina: el estudio EPOC.AR.

INTRODUCTION: The prevalence of chronic obstructive pulmonary disease (COPD) has not been studied in Argentina. OBJECTIVES: To determine the prevalence and relevant clinical characteristics of COPD in a representative sample. MATERIAL AND METHODS: We performed a cross-sectional study in a population of adults aged ≥ 40 years randomly selected by cluster sampling in 6 urban locations. Subjects answered a structured survey and performed pre- and post-bronchodilator spirometry (PBD). COPD was defined as FEV1/FVC ratio < 0.7 predicted value. The total prevalence was estimated for each cluster with its 95% confidence interval (CI). RESULTS: Of 4,599 surveys and 3,999 spirometries, 3,469 were considered of adequate quality (86.8%) for our study. The prevalence of COPD was 14.5% (CI: 13.4-15.7). The distribution of COPD cases according to FEV1 (GOLD 2017) was stage 1: 38% (CI: 34-43); stage 2: 52% (CI: 47-56); stage 3: 10% (CI: 7-13); and stage 4: 1% (CI: 0-2), and according to the refined ABCD (GOLD 2017) assessment: A: 52% (CI: 47-56); B: 43% (CI: 39-48); C: 1% (CI: 0-2); D: 4% (CI: 2-6). The rate of underdiagnosis was 77.4% (CI 73.7-81.1%) and diagnostic error 60.7% (CI 55.1-66.3%). A significant association was found between COPD and age (OR 3.77 in individuals 50-59 years of age and 19.23 in those > 80 years), male gender (OR 1.62; CI 1.31-2), smoking (OR 1.95; CI 1.49-2.54), low socioeconomic status (OR 1.33; CI 1.02-1.73), and previous tuberculosis (OR 3.3; CI 1.43-7.62). CONCLUSIONS: We estimate that more than 2.3 million Argentineans have COPD, with high rates of underdiagnosis and diagnostic error.

Altitude and COPD prevalence: analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study.

BACKGROUND: COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors. METHODS: A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as >1500 m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD. RESULTS: Among 30,874 participants aged 56.1 ± 11.3 years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500 m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p < 0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude. CONCLUSION: Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD.

Asthma in the elderly: what we know and what we have yet to know.

In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.

Epidemiology of Asthma / Epidemiologia da asma

Quando comparadas às principais causas globais de doença e morte, as doenças respiratórias recebem menos atenção e financiamento. Particularmente na asma, todos os indicadores epidemiológicos sinalizam um grande e crescente problema de saúde pública. Estima-se que 300 milhões de pessoas em todo o mundo sejam asmáticas e que 180.000 mortes anuais sejam causadas por asma. No Brasil, o estudo ISAAC identificou áreas com altas prevalências de asma, similares às do norte da Europa e da Oceania. Enquanto um estudo de mortalidade concluiu que a asma é responsável por mais de 2.000 mortes anuais no Brasil, ou seja, cerca de 6 por dia, com uma grande variação regional, outro estudo sobre morbidade quantificou cerca de mil hospitalizações diárias, representando um custo de R$100 milhões anuais para o Sistema Único de Saúde. Pode-se concluir que, face às mudanças demográficas nas populações, no estilo de vida e à epidemia tabágica, a asma continuará sendo um peso crescente em vários países do mundo, incluindo o Brasil.

Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey.

OBJECTIVES: The aims of this survey were (1) to assess the quality of asthma treatment and control in Latin America, (2) to determine how closely asthma management guidelines are being followed, and (3) to assess perception, knowledge and attitudes related to asthma in Latin America. METHODS: We surveyed a household sample of 2,184 adults or parents of children with asthma in 2003 in 11 countries in Latin America. Respondents were asked about healthcare utilization, symptom severity, activity limitations and medication use. RESULTS: Daytime asthma symptoms were reported by 56% of the respondents, and 51% reported being awakened by their asthma at night. More than half of those surveyed had been hospitalized, attended a hospital emergency service or made unscheduled emergency visits to other healthcare facilities for asthma during the previous year. Patient perception of asthma control did not match symptom severity, even in patients with severe persistent asthma, 44.7% of whom regarded their disease as being well or completely controlled. Only 2.4% (2.3% adults and 2.6% children) met all criteria for asthma control. Although 37% reported treatment with prescription medications, only 6% were using inhaled corticosteroids. Most adults (79%) and children (68%) in this survey reported that asthma symptoms limited their activities. Absence from school and work was reported by 58% of the children and 31% of adults, respectively. CONCLUSIONS: Asthma control in Latin America falls short of goals in international guidelines, and in many aspects asthma care and control in Latin America suffer from the same shortcomings as in other areas of the world.

Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey / El control del asma en América Latina: la encuesta de Percepción y Realidad del Asma en América Latina

Objetivos. Los objetivos de esta encuesta fueron 1) determinar la calidad del tratamiento y control del asma en América Latina, 2) determinar el grado de adherencia a las guías de tratamiento, y 3) determinar la percepción, los conocimientos y las actitudes con respecto al asma en América Latina. Método. La encuesta se realizó en una muestra de hogares donde se entrevistó a 2 184 adultos asmáticos o padres de niños con asma en 11 países de América Latina. Se obtuvo información sobre la utilización de los recursos del sistema de salud, la gravedad de los síntomas, la limitación de actividades y el uso de medicamentos. Resultados. El 56% de los encuestados refirió síntomas diurnos, y 51% mencionaron despertarse por la noche debido al asma. Más de la mitad habían sido hospitalizados o atendidos en salas de urgencia hospitalarias, o habían realizado consultas no progra madas a cualquier otro nivel del sistema sanitario. La percepción del control del asma por parte de los pacientes no se corresponde con la gravedad de los síntomas, incluso en aquellos pacientes con asma persistente, ya que 44,7% de estos consideraban que el control de su enfermedad era bueno o total. Solo 2,4% de los pacientes (2,3% de los adultos y 2,6% de los niños) cumplían todos los criterios correspondientes a un control total del asma. Aunque 37% de los participantes refirieron haber sido tratados con algún medicamento adquirible por receta médica, solamente 6% utilizaban corticoesteroides inhalados. El 79% de los pacientes adultos y 68% de los niños con asma mencionaron que sus síntomas limitaban sus actividades de alguna manera. El 58% de los niños habían faltado al colegio, y 31% de los adultos habían faltado al trabajo debido al asma. Conclusiones. Los niveles actuales de control del asma en América Latina distan mucho de los objetivos especificados por las guías internacionales para el manejo del asma, y en muchos aspectos referidos al cuidado y al control de la enfermedad se observan en América Latina las mismas carencias que en otras áreas del mundo

Objectives. The aims of this survey were (1) to assess the quality of asthma treatment and control in Latin America, (2) to determine how closely asthma management guidelines are being followed, and (3) to assess perception, knowledge and attitudes related to asthma in Latin America. Methods. We surveyed a household sample of 2 184 adults or parents of children with asthma in 2003 in 11 countries in Latin America. Respondents were asked about healthcare utilization, symptom severity, activity limitations and medication use. Results. Daytime asthma symptoms were reported by 56% of the respondents, and 51% reported being awakened by their asthma at night. More than half of those surveyed had been hospitalized, attended a hospital emergency service or made unscheduled emergency visits to other healthcare facilities for asthma during the previous year. Patient perception of asthma control did not match symptom severity, even in patients with severe persistent asthma, 44.7% of whom regarded their disease as being well or completely controlled. Only 2.4% (2.3% adults and 2.6% children) met all criteria for asthma control. Although 37% reported treatment with prescription medications, only 6% were using inhaled corticosteroids. Most adults (79%) and children (68%) in this survey reported that asthma symptoms limited their activities. Absence from school and work was reported by 58% of the children and 31% of adults, respectively. Conclusions. Asthma control in Latin America falls short of goals in international guidelines, and in many aspects asthma care and control in Latin America suffer from the same shortcomings as in other areas of the world