Occurrence of respiratory symptoms in persons with restrictive ventilatory impairment compared with persons with chronic obstructive pulmonary disease: The PLATINO study.

Patients with chronic obstructive pulmonary disease (COPD) usually complain of symptoms such as cough, sputum, wheezing, and dyspnea. Little is known about clinical symptoms in individuals with restrictive ventilatory impairment. The aim of this study was to compare the prevalence and type of respiratory symptoms in patients with COPD to those reported by individuals with restrictive ventilatory impairment in the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study. Between 2002 and 2004, individuals ≥40 years of age from five cities in Latin America performed pre and post-bronchodilator spirometry and had their respiratory symptoms recorded in a standardized questionnaire. Among the 5315 individuals evaluated, 260 (5.1%) had a restrictive spirometric diagnosis (forced vital capacity (FVC) < lower limit of normal (LLN) with forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) ≥ LLN; American Thoracic Society (ATS)/European Respiratory Society (ERS) 2005) and 610 (11.9%) were diagnosed with an obstructive pattern (FEV1/FVC < LLN; ATS/ERS 2005). Patients with mild restriction wheezed more ((30.8%) vs. (17.8%); p < 0.028). No difference was seen in dyspnea, cough, and sputum between the two groups after adjusting for severity stage. The health status scores for the short form 12 questionnaire were similar in restricted and obstructed patients for both physical (48.4 ± 9.4 vs. 48.3 ± 9.8) and mental (50.8 ± 10.6 vs. 50.0 ± 11.5) domains. Overall, respiratory symptoms are not frequently reported by patients with restricted and obstructed patterns as defined by spirometry. Wheezing was more frequent in patients with restricted pattern compared with those with obstructive ventilatory defect. However, the prevalence of cough, sputum production, and dyspnea are not different between the two groups when adjusted by the same severity stage.

Assessment of five different guideline indication criteria for spirometry, including modified GOLD criteria, in order to detect COPD: data from 5,315 subjects in the PLATINO study.

BACKGROUND: Spirometry is the gold standard for diagnosing chronic obstructive pulmonary disease (COPD). Although there are a number of different guideline criteria for deciding who should be selected for spirometric screening, to date it is not known which criteria are the best based on sensitivity and specificity. AIMS: Firstly, to evaluate the proportion of subjects in the PLATINO Study that would be recommended for spirometry testing according to Global initiative for Obstructive Lung Disease (GOLD)-modified, American College of Chest Physicians (ACCP), National Lung Health Education Program (NLHEP), GOLD and American Thoracic Society/European Respiratory Society (ATS/ERS) criteria. Secondly, we aimed to compare the sensitivity, specificity, and positive predictive and negative predictive values, of these five different criteria. METHODS: Data from the PLATINO study included information on respiratory symptoms, smoking and previous spirometry testing. The GOLD-modified spirometry indication criteria are based on three positive answers out of five questions: the presence of cough, phlegm in the morning, dyspnoea, age over 40 years and smoking status. RESULTS: Data from 5,315 subjects were reviewed. Fewer people had an indication for spirometry (41.3%) according to the GOLD-modified criteria, and more people had an indication for spirometry (80.4%) by the GOLD and ATS/ERS criteria. A low percentage had previously had spirometry performed: GOLD-modified (14.5%); ACCP (13.2%); NLHEP (12.6%); and GOLD and ATS/ERS (12.3%). The GOLD-modified criteria showed the least sensitivity (54.9) and the highest specificity (61.0) for detecting COPD, whereas GOLD and ATS/ERS criteria showed the highest sensitivity (87.9) and the least specificity (20.8). CONCLUSION: There is a considerable difference in the indication for spirometry according to the five different guideline criteria. The GOLD-modified criteria recruit less people with the greatest sum of sensitivity and specificity.

FEV1 is a better predictor of mortality than FVC: the PLATINO cohort study.

OBJECTIVE: To determine whether the presence of chronic obstructive lung disease (COPD) and reduction of lung function parameters were predictors of mortality in a cohort. MATERIALS/PATIENTS AND METHODS: Population based cohorts were followed in Montevideo, Santiago and Sao Paulo during 5, 6 and 9 years, respectively. Outcomes included all-cause, cardiovascular, respiratory and cancer mortality; exposures were COPD, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cox regression was used for analyses. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics curves and Youden's index were calculated. RESULTS: Main causes of death were cardiovascular, respiratory and cancer. Baseline COPD was associated with overall mortality (HR = 1.43 for FEV1/FVC

Estudio de cohorte de base poblacional sobre la enfermedad pulmonar obstructiva crónica en Latinoamérica: métodos y resultados preliminares. Fase II del estudio PLATINO / A Population-Based Cohort Study on Chronic Obstructive Pulmonary Disease in Latin America: Methods and Preliminary Results. The PLATINO Study Phase II

ANTECEDENTES: El estudio basal del PLATINO, llevado a cabo entre 2003 y 2005 en 5 ciudades latinoamericanas (São Paulo, Ciudad de México, Montevideo, Santiago, Caracas), mostró una prevalencia elevada de la enfermedad pulmonar obstructiva crónica (EPOC). Métodos/diseño: Se llevó a cabo un estudio de seguimiento en 3 de los 5 centros (Montevideo, Santiago y São Paulo) después de un periodo de 5, 6 y 9 años, respectivamente, con el objetivo de verificar la estabilidad del diagnóstico de EPOC a lo largo del tiempo, la evolución de la enfermedad en cuanto a supervivencia, morbilidad y función respiratoria, y análisis de los biomarcadores genéticos e inflamatorios en sangre. Se añadieron algunas preguntas adicionales al cuestionario original y se obtuvieron los certificados de defunción a partir de los registros oficiales nacionales. RESULTADOS: El trabajo de campo se ha completado en los 3 centros. De las muestras originales de la fase I del PLATINO pudimos localizar y entrevistar al 85,6% en Montevideo, al 84,7% en Santiago y al 77,7% en São Paulo. Los individuos no localizados se caracterizaban por un mayor nivel de estudios en Brasil y era más probable que fueran fumadores actuales en Santiago y São Paulo que en Montevideo. La calidad global de las espirometrías fue ≥ 80% según los criterios de la American Thoracic Society. El número de muertes fue de 71 (Montevideo), 95 (Santiago) y 135 (São Paulo), y se obtuvieron los certificados de defunción a partir de los registros de mortalidad nacionales del 76,1, del 88,3 y del 91,8% de los casos en Montevideo, Santiago y São Paulo, respectivamente. CONCLUSIONES: Este estudio muestra que es posible realizar estudios longitudinales de base poblacional en Latinoamérica, con tasas de seguimiento elevadas y una alta calidad de los datos de espirometría. La idoneidad de los registros de mortalidad nacionales varía en los distintos centros de Latinoamérica

BACKGROUND: The PLATINO baseline study, conducted from 2003-2005 in five Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, Caracas), showed a high prevalence of chronic obstructive pulmonary disease (COPD).Methods/design: A follow-up study was conducted in three out of the five centers (Montevideo, Santiago, and São Paulo) after a period of 5, 6 and 9 years, respectively, aimed at verifying the stability of the COPD diagnosis over time, the evolution of the disease in terms of survival, morbidity and respiratory function, and the analyses of inflammatory and genetic biomarkers in the blood. Some questions were added to the original questionnaire and death certificates were obtained from the national official registries. RESULTS: The fieldwork has been concluded in the three centers. From the original samples in the PLATINO study phase i, we were able to locate and interview 85.6% of patients in Montevideo, 84.7% in Santiago and 77.7% in São Paulo. Individuals who could not be located had higher education levels in Brazil, and were more likely to be current smokers in Santiago and São Paulo than in Montevideo. The overall quality of spirometries was ≥80% according to American Thoracic Society criteria. The number of deaths was 71 (Montevideo), 95 (Santiago) and 135 (São Paulo), with death certificates obtained from the national mortality registries for 76.1%, 88.3% and 91.8% of cases in Montevideo, Santiago and São Paulo, respectively. CONCLUSIONS: This study shows that is possible to perform population-based longitudinal studies in Latin American with high follow-up rates and high-quality spirometry data. The adequacy of national mortality registries varies among centers in Latin America

Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma.

BACKGROUND: Several COPD phenotypes have been described; the COPD-asthma overlap is one of the most recognized. The aim of this study was to evaluate the prevalence of three subgroups (asthma, COPD, and COPD-asthma overlap) in the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) study population, to describe their main characteristics, and to determine the association of the COPD-asthma overlap group with exacerbations, hospitalizations, limitations due to physical health, and perception of general health status (GHS). METHODS: The PLATINO study is a multicenter population-based survey carried out in five Latin American cities. Outcomes were self-reported exacerbations (defined by deterioration of breathing symptoms that affected usual daily activities or caused missed work), hospitalizations due to exacerbations, physical health limitations, and patients' perception of their GHS obtained by questionnaire. Subjects were classified in three specific groups: COPD--a postbronchodilator (post-BD) FEV1/FVC ratio of < 0.70; asthma--presence of wheezing in the last year and a minimum post-BD increase in FEV1 or FVC of 12% and 200 mL; and overlap COPD-asthma--the combination of the two. RESULTS: Out of 5,044 subjects, 767 were classified as having COPD (12%), asthma (1.7%), and COPD-asthma overlap (1.8%). Subjects with COPD-asthma overlap had more respiratory symptoms, had worse lung function, used more respiratory medication, had more hospitalization and exacerbations, and had worse GHS. After adjusting for confounders, the COPD-asthma overlap was associated with higher risks for exacerbations (prevalence ratio [PR], 2.11; 95% CI, 1.08-4.12), hospitalizations (PR, 4.11; 95% CI, 1.45-11.67), and worse GHS (PR, 1.47; 95% CI, 1.18-1.85) compared with those with COPD. CONCLUSIONS: The coexisting COPD-asthma phenotype is possibly associated with increased disease severity.

A population-based cohort study on chronic obstructive pulmonary disease in Latin America: methods and preliminary results. The PLATINO Study Phase II.

BACKGROUND: The PLATINO baseline study, conducted from 2003-2005 in five Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, Caracas), showed a high prevalence of chronic obstructive pulmonary disease (COPD). METHODS/DESIGN: A follow-up study was conducted in three out of the five centers (Montevideo, Santiago, and São Paulo) after a period of 5, 6 and 9years, respectively, aimed at verifying the stability of the COPD diagnosis over time, the evolution of the disease in terms of survival, morbidity and respiratory function, and the analyses of inflammatory and genetic biomarkers in the blood. Some questions were added to the original questionnaire and death certificates were obtained from the national official registries. RESULTS: The fieldwork has been concluded in the three centers. From the original samples in the PLATINO study phasei, we were able to locate and interview 85.6% of patients in Montevideo, 84.7% in Santiago and 77.7% in São Paulo. Individuals who could not be located had higher education levels in Brazil, and were more likely to be current smokers in Santiago and São Paulo than in Montevideo. The overall quality of spirometries was ≥80% according to American Thoracic Society criteria. The number of deaths was 71 (Montevideo), 95 (Santiago) and 135 (São Paulo), with death certificates obtained from the national mortality registries for 76.1%, 88.3% and 91.8% of cases in Montevideo, Santiago and São Paulo, respectively. CONCLUSIONS: This study shows that is possible to perform population-based longitudinal studies in Latin American with high follow-up rates and high-quality spirometry data. The adequacy of national mortality registries varies among centers in Latin America.

Comorbilidades y estado de salud en individuos con y sin EPOC en 5 ciudades de América Latina: Estudio PLATINO / Comorbidities and Health Status in Individuals With and Without COPD in Five Latin American Cities: The PLATINO Study

INTRODUCCIÓN: La enfermedad pulmonar obstructiva crónica (EPOC) se asocia a comorbilidades que influyen en el estado de salud y en el pronóstico de los pacientes. El estudio PLATINO aporta datos sobre comorbilidades autorreportadas y percepción del estado general de salud (EGS) en la EPOC. MÉTODOS: PLATINO es un estudio poblacional, sobre prevalencia de EPOC en 5 ciudades de Latinoamérica. El diagnóstico de EPOC se realizó según el criterio de GOLD (FEV1/FVC < 0,70 post-broncodilatador). Se recogió información sobre las siguientes comorbilidades: cardíaca, hipertensión, diabetes, accidente cerebrovascular (ACV), úlcera y asma. El EGS se evaluó mediante el cuestionario SF-12, con la pregunta: «En general ¿diría usted que su salud es: excelente, muy buena, buena, regular o pobre?». Sumando las comorbilidades, se elaboró un índice de comorbilidad. RESULTADOS: Sobre una población total de 5.314 individuos se realizó diagnóstico de EPOC en 759. Las comorbilidades reportadas en orden decreciente fueron: cualquier tipo de enfermedad cardiovascular, hipertensión, úlcera péptica, enfermedad cardíaca, diabetes, ACV, asma y cáncer de pulmón. Los sujetos con EPOC tuvieron mayor índice de comorbilidad, prevalencia de cáncer de pulmón (p < 0,0001) y asma (p < 0,0001), así como mayor tendencia a hipertensión (p = 0,0652) y ACV (p = 0,0750). Los factores asociados a comorbilidad en EPOC fueron la edad, el índice de masa corporal (IMC) y el género femenino. Con el deterioro del EGS aumenta el número de comorbilidades. CONCLUSIONES: En población no seleccionada los individuos con EPOC presentan más comorbilidades. La edad, el sexo femenino y mayor IMC son los principales factores asociados a comorbilidad en estos pacientes. Independientemente de la condición de EPOC, un mayor número de comorbilidades se asocia a peor EGS (AU)

INTRODUCTION: Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD), and have a significant impact on health status and prognosis. The PLATINO study provides data on self-reported comorbidities and perceived health status in COPD subjects. METHODS: PLATINO is a population-based study on COPD prevalence in five Latin American cities. COPD diagnosis was defined by GOLD criteria (FEV1/FVC<0.70 post-bronchodilator). Information was collected on the following comorbidities: heart disease, hypertension, diabetes, cerebrovascular disease, peptic ulcer and asthma. Health status was evaluated using the SF-12 questionnaire, derived from the question: "In general, would you say your health is excellent, very good, good, fair or poor?" A simple comorbidity score was calculated by adding the total number of comorbid conditions. RESULTS: Of a total population of 5314 individuals, 759 had COPD. Reported comorbidities by decreasing frequency were: any cardiovascular disease, hypertension, peptic ulcer, heart disease, diabetes, cerebrovascular disease, asthma and lung cancer. COPD patients had a higher comorbidity score and prevalence of lung cancer (P<0.0001) and asthma (P<0.0001), as well as a higher tendency to have hypertension (P=0.0652) and cerebrovascular disease (P=0.0750). Factors associated with comorbidities were age, body mass index (BMI) and female gender. The number of comorbidities increased as the health status deteriorated. CONCLUSIONS: In the PLATINO population-based study, COPD individuals had an increased number of comorbidities. Age, female gender and higher BMI were the factors associated with comorbidity in these patients. Comorbid conditions were associated with impaired health status, independently of the COPD status (AU)

Reliability of FEV1/FEV6 to diagnose airflow obstruction compared with FEV1/FVC: the PLATINO longitudinal study.

QUESTION: A 6-second spirometry test is easier than full exhalations. We compared the reliability of the ratio of the Forced expiratory volume in 1 second/Forced expiratory volume in 6 seconds (FEV1/FEV6) to the ratio of the FEV1/Forced vital capacity (FEV1/FVC) for the detection of airway obstruction. METHODS: The PLATINO population-based survey in individuals aged 40 years and over designed to estimate the prevalence of post-Bronchodilator airway obstruction repeated for the same study participants after 5-9 years in three Latin-American cities. RESULTS: Using the FEV1/FVC

Perceptions of short and long sleep duration and comorbid conditions: the PLATINO study.

OBJECTIVES: We aimed to describe the distribution of self-reported sleep duration in adults over the age of 40 years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL). METHODS: Our study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Data from 4533 individuals were analyzed using a single questionnaire entitled, PLATINO, which was designed to collect data on self-reported sleep symptoms. Spirometry also was performed in accordance with international standards. All statistical analyses took the study design into consideration with adjustments for each city. RESULTS: The prevalence of subjects who reported sleeping <7h was 38.4%, ≥ 7 to <9h was 51.4%, and ≥ 9h was 10.2%. In the multivariate analysis, individuals with shorter sleep duration had higher frequencies of insomnia, increased forced expiratory volume in one second in liters and percentage/forced vital capacity in liters (FEV1/FVC) of predicted ratios, and a higher presence of coughing and phlegm. The main risk factor associated with longer duration of sleep was the number of comorbidities. CONCLUSIONS: Self-reported sleep duration discriminated among groups that differed in sleep-related symptoms, respiratory symptoms, QoL and comorbid conditions.

Comorbidities and health status in individuals with and without COPD in five Latin American cities: the PLATINO study.

INTRODUCTION: Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD), and have a significant impact on health status and prognosis. The PLATINO study provides data on self-reported comorbidities and perceived health status in COPD subjects. METHODS: PLATINO is a population-based study on COPD prevalence in five Latin American cities. COPD diagnosis was defined by GOLD criteria (FEV1/FVC<.70 post-bronchodilator). Information was collected on the following comorbidities: heart disease, hypertension, diabetes, cerebrovascular disease, peptic ulcer and asthma. Health status was evaluated using the SF-12 questionnaire, derived from the question: «In general, would you say your health is excellent, very good, good, fair or poor?¼. A simple comorbidity score was calculated by adding the total number of comorbid conditions. RESULTS: Of a total population of 5314individuals, 759 had COPD. Reported comorbidities by decreasing frequency were: any cardiovascular disease, hypertension, peptic ulcer, heart disease, diabetes, cerebrovascular disease, asthma and lung cancer. COPD patients had a higher comorbidity score and prevalence of lung cancer (P<.0001) and asthma (P<.0001), as well as a higher tendency to have hypertension (P=.0652) and cerebrovascular disease (P=.0750). Factors associated with comorbidities were age, body mass index (BMI) and female gender. The number of comorbidities increased as the health status deteriorated. CONCLUSIONS: In the PLATINO population-based study, COPD individuals had an increased number of comorbidities. Age, female gender and higher BMI were the factors associated with comorbidity in these patients. Comorbid conditions were associated with impaired health status, independently of the COPD status.

Beta 2 adrenergic receptor polymorphisms, at codons 16 and 27, and bronchodilator responses in adult Venezuelan asthmatic patients.

BACKGROUND: One of the gene polymorphisms often studied in asthmatic patients is the ß2 adrenergic receptor (ADRß2). Even though in the Venezuelan Mestizo population there is a high incidence of asthma, there are no direct reports of ADRß2 gene polymorphism, and treatment response. The aim of this study was to assess, in this population, the gene frequency of ADRß2 polymorphisms at codons 16 Arg/Gly and 27 Gln/Glu, allergen sensitization, and its relationship to bronchodilator response. METHODS: Purified genomic DNA was obtained form 105 Mestizo asthmatic and 100 Mestizo healthy individuals from Venezuela. The two polymorphisms were assessed by PCR-RFLP. Patient sensitization to aeroallergens and their response to bronchodilatation were correlated. RESULTS: Significant differences between patients and controls were recorded in: 1) the prevalence of Arg/Arg at codon 16 (28.6% in patients vs. 47% in controls, P<0.01), 2) the frequency of heterozygotes Arg/Gly (55% in patients vs. 35% in controls, P<0.01). Conversely, no differences in polymorphism frequencies were found at codon 27. The haplotypes Arg/Gly-Gln/Gln were more common in patients than controls (P <0.01), whereas the Arg/Arg-Gln/Glu combination prevailed in the control group (P<0.01). The Arg/Gly and Gln/Glu genotypes were associated with better responses after salbutamol. The asthmatic homozygotes Arg/Arg have higher sensitivity to aeroallergens. CONCLUSION: The difference in Arg/Arg frequency between groups suggests that this could be a protective genotype although the asthmatic group had a higher sensitivity to aeroallergens. The asthmatic heterozygotes had better bronchodilator responses than the homozygotes.

Airflow obstruction in never smokers in five Latin American cities: the PLATINO study.

BACKGROUND: Although chronic obstructive pulmonary disease (COPD) is mostly related to tobacco smoking, a variable proportion of COPD occurs in never smokers. We investigated differences between COPD in never smokers compared with smokers and subjects without COPD. METHODS: PLATINO is a cross-sectional population-based study of five Latin American cities. COPD was defined as postbronchodilator FEV(1)/FVC <0.70 and FEV(1) <80% of predicted values. RESULTS: Among 5,315 subjects studied, 2278 were never smokers and 3036 were ever smokers. COPD was observed in 3.5% of never smokers and in 7.5% of ever smokers. Never smokers with COPD were most likely older and reported a medical diagnosis of asthma or previous tuberculosis. Underdiagnosis was as common in obstructed patients who never smoked as in ever smokers. CONCLUSIONS: Never smokers comprised 26% of all individuals with airflow obstruction. Obstruction was associated with female gender, older age and a diagnosis of asthma or tuberculosis.

The chronic bronchitis phenotype in subjects with and without COPD: the PLATINO study.

Little information exists regarding the epidemiology of the chronic bronchitis phenotype in unselected chronic obstructive pulmonary disease (COPD) populations. We examined the prevalence of the chronic bronchitis phenotype in COPD and non-COPD subjects from the PLATINO study, and investigated how it is associated with important outcomes. Post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.70 was used to define COPD. Chronic bronchitis was defined as phlegm on most days, at least 3 months per year for ≥ 2 yrs. We also analysed another definition: cough and phlegm on most days, at least 3 months per year for ≥ 2 yrs. Spirometry was performed in 5,314 subjects (759 with and 4,554 without COPD). The proportion of subjects with and without COPD with chronic bronchitis defined as phlegm on most days, at least 3 months per year for ≥ 2 yrs was 14.4 and 6.2%, respectively. Using the other definition the prevalence was lower: 7.4% with and 2.5% without COPD. Among subjects with COPD, those with chronic bronchitis had worse lung function and general health status, and had more respiratory symptoms, physical activity limitation and exacerbations. Our study helps to understand the prevalence of the chronic bronchitis phenotype in an unselected COPD population at a particular time-point and suggests that chronic bronchitis in COPD is possibly associated with worse outcomes.

Acute bronchodilator responsiveness in subjects with and without airflow obstruction in five Latin American cities: the PLATINO study.

BACKGROUND: Acute bronchodilator responsiveness is an area of discussion in COPD. No information exists regarding this aspect of the disease from an unselected COPD population. We assessed acute bronchodilator responsiveness and factors influencing it in subjects with and without airway obstruction in an epidemiologic sample. METHODS: COPD was defined by GOLD criteria (post-bronchodilator FEV(1)/FVC<0.70). In this analysis, subjects with pre-bronchodilator FEV(1)/FVC <0.70 but > or =0.70 post-bronchodilator were considered to have reversible obstruction. Bronchodilator responsiveness after albuterol 200microg was assessed using three definitions: a) FVC and/or FEV(1) increment > or =12% plus > or =200mL over baseline; b) FEV(1)> or =15% increase over baseline; and c) FEV(1) increase > or =10% of predicted value. RESULTS: There were 756 healthy respiratory subjects, 481 subjects with reversible obstruction and 759 COPD subjects. Depending on the criterion used the proportion of person with acute bronchodilator responsiveness ranged between 15.0-28.2% in COPD, 11.4-21.6% in reversible obstructed and 2.7-7.2% in respiratory healthy. FEV(1) changes were lower (110.6+/-7.40 vs. 164.7+/-11.8mL) and FVC higher (146.5+/-14.2mL vs. -131.0+/-19.6mL) in COPD subjects compared with reversible obstructed. Substantial overlap in FEV(1) and FVC changes was observed among the groups. Acute bronchodilator responsiveness in COPD persons was associated with less obstruction and never smoking. CONCLUSIONS: Over two-thirds of persons with COPD did not demonstrate acute bronchodilator responsiveness. The overall response was small and less than that considered as significant by ATS criteria. The overlap in FEV(1) and FVC changes after bronchodilator among the groups makes it difficult to determine a threshold for separating them.

Prevalence of smoking and incidence of initiation in the Latin American adult population: the PLATINO study.

BACKGROUND: The PLATINO project was launched in 2002 in order to study the prevalence of chronic obstructive pulmonary disease (COPD) in Latin America. Because smoking is the main risk factor for COPD, detailed data on it were obtained. The aim of this paper was to evaluate the prevalence of smoking and incidence of initiation among middle-aged and older adults (40 years or older). Special emphasis was given to the association between smoking and schooling. METHODS: PLATINO is a multicenter study comprising five cross-sectional population-based surveys of approximately 1,000 individuals per site in Sao Paulo (Brazil), Santiago (Chile), Mexico City (Mexico), Montevideo (Uruguay) and Caracas (Venezuela). The outcome variable was smoking status (never, former or current). Current smokers were those who reported to smoke within the previous 30 days. Former smokers were those who reported to quit smoking more than 30 days before the survey. Using information on year of birth and age of smoking onset and quitting, a retrospective cohort analysis was carried out. Smoking prevalence at each period was defined as the number of subjects who started to smoke during the period plus those who were already smokers at the beginning of the period, divided by the total number of subjects. Incidence of smoking initiation was calculated as the number of subjects who started to smoke during the period divided by the number of non-smokers at its beginning. The independent variables included were sex, age and schooling. RESULTS: Non-response rates ranged from 11.1% to 26.8%. The prevalence of smoking ranged from 23.9% (95%CI 21.3; 26.6) in Sao Paulo to 38.5% (95%CI 35.7; 41.2) in Santiago. Males and middle-aged adults were more likely to smoke in all sites. After adjustment for age, schooling was not associated with smoking. Using retrospective cohort analysis, it was possible to detect that the highest prevalence of smoking is found between 20-29 years, while the highest incidence is found between 10-19 years. Age of smoking onset tended to decline over time among females. CONCLUSION: The prevalence of smoking varied considerably across sites, but was lower among countries with national anti-smoking campaigns.

Frequency of self-reported COPD exacerbation and airflow obstruction in five Latin American cities: the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study.

BACKGROUND: Recurrent exacerbations are common in COPD patients. Limited information exists regarding exacerbation frequency in COPD patients from epidemiologic studies. We examined the frequency of self-reported exacerbations and the factors influencing exacerbation frequency among COPD patients in a population-based study conducted in Latin America. METHODS: We used a post-bronchodilator FEV(1)/FVC ratio of < 0.70 to define COPD. Exacerbation was self-reported and defined by symptoms (deterioration of breathing symptoms that affected usual daily activities or caused missed work). RESULTS: Spirometry was performed in 5,314 subjects. There were 759 subjects with airflow limitation; of these, 18.2% reported ever having had an exacerbation, 7.9% reported having an exacerbation, and 6.2% reported having an exacerbation requiring at least a doctor visit within the past year. The proportion of individuals with an exacerbation significantly increased by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, from 4.2% in stage 1 to 28.9% in stages 3 and 4. The self-reported exacerbation rate was 0.58 exacerbations per year. The rate of exacerbations requiring at least a doctor visit and length of stay in hospital due to exacerbations also increased as COPD severity progressed. The factors associated with having an exacerbation in the past year were dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and disease severity of GOLD stages 3 and 4. CONCLUSIONS: The proportion of individuals with airflow limitation and self-reported exacerbation increases as the disease severity progresses. Dyspnea, prior asthma diagnosis, receiving any respiratory therapy, and more severe obstruction were significantly associated with having an exacerbation in the past year.

Health status perception and airflow obstruction in five Latin American cities: the PLATINO study.

BACKGROUND: COPD is a highly prevalent disease but underdiagnosed, undertreated and possibly under-recognized by patients. Limited information exists regarding patients' perception of COPD severity. We compared patients' general health status perception, degree of breathlessness and physical activity limitation with the severity of their respiratory condition measured by airway obstruction, in a population-based sample. METHODS: We used postbronchodilator FEV(1)/FVC<0.70 to define COPD. Patients' perception of their general health status was derived from the question "in general you would say that your health is: excellent, very good, good, fair or poor?" RESULTS: Spirometry was performed in 5314 subjects: an FEV(1)/FVC ratio below 0.70 was found in 759 subjects. In persons with COPD, general health status decreased with increasing GOLD stages. Over one-half of subjects with stage 2 and one third of those with stages 3 and 4 reported their health status as good to excellent. There was also a disparity between airway obstruction severity and breathlessness intensity. Although the more severe COPD stages were frequently associated with significant compromise of work and everyday activities, patients often tended to provide an optimistic self evaluation of their health status. CONCLUSIONS: The discrepancy observed between general health status, dyspnea severity, physical activity limitation and airway obstruction most likely reflect patients' underperception of disease severity, emphasizing the need for improving case-finding measures and multi-component evaluation of COPD subjects.

Prevalence of sleep related symptoms in four Latin American cities.

STUDY OBJECTIVES: to estimate the prevalence of the most common sleep related symptoms (SRS) in the metropolitan areas of Mexico City, Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). METHODS: The study consisted of a multistage cluster sampling of adults aged > or = 40 years living in metropolitan areas. All participants completed a questionnaire on sleep related symptoms. Simplified respiratory polygraphy during sleep was conducted on 188 subjects from Mexico City. Obstructive sleep apnea syndrome was defined as Epworth Sleepiness Scale score > or = 11 and respiratory disturbance index (RDI) > or = 15 events/h; a cut-off of 15 was chosen because of its high sensitivity and specificity in association with the portable monitor used in the study. RESULTS: The study included 4,533 subjects (1,062 in Mexico City, 941 in Montevideo, 1,173 in Santiago, and 1,357 in Caracas). Snoring was reported by 60.2% (95% CI 58.8% to 61.6%), excessive daytime sleepiness by 16.4% (15.3% to 17.5%), observed apneas by 12.3% (11.4% to 13.3%), insomnia by 34.7% (33.3% to 36%), sedative use by 15.1% (14.1% to 16.2%), daytime napping by 29.2% (27.7% to 30.6%), and a combination of snoring, sleepiness, and observed apneas by 3.4% (2.9% to 4%). Men had a higher frequency of snoring and daytime napping, whereas women reported more insomnia and sedative use. Prevalence of OSAS varied from 2.9% among subjects who denied snoring, excessive daytime sleepiness, and observed apneas, to 23.5% among those reporting these 3 symptoms. CONCLUSIONS: A high prevalence of sleep related symptoms and undiagnosed obstructive sleep apnea in Latin America was observed.

Polimorfismos de receptores semejantes a Toll 2 y 4 en pacientes con asma bronquial y enfermedad pulmonar obstructiva crónica (EPOC) / Polymorphisms of Toll-like receptors 2 and 4 in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD)

Los receptores semejantes a Toll forman parte del sistema inmune. Algunas mutaciones en estos receptores se han relacionado con el desarrollo de enfermedades como el asma bronquial y la enfermedad pulmonar obstructiva crónica. Se realizó un estudio de casos-controles, en el que se incluyeron 100 pacientes con asma bronquial, 100 pacientes con enfermedad pulmonar obstructiva crónica y 100 controles. A través de la técnica de reacción en cadena de la polimerasa, se investigó la presencia de polimorfismos en TLR2 (Arg677Trp y Arg753Gln) y TLR4 (Asp299Gly y Thr399Ile) y su asociación con asma y enfermedad pulmonar obstructiva crónica. Se demostró la presencia de polimorfismos en TLR4 con una frecuencia del 9 por ciento en cada grupo de estudio. No se observó relación alguna entre la presencia de polimorfismos en TLR4 y los índices de gravedad para asma bronquial o enfermedad pulmonar obstructiva crónica. La gravedad de los pacientes con asma y enfermedad pulmonar obstructiva crónica no está relacionada con los polimorfismos en TLR 4

Toll like receptors are important in the inflammatory immune response. Several mutations of these receptors have been related to the development and chronicity of different inflammatory diseases as bronchial asthma and obstructive pulmonary disease. A case control study was performed, 100 patients with bronchial asthma, 100 obstructive pulmonary disease and 100 controls. Restriction based polymorphism PCR analysis was performed for TLR2 (Arg677Trp and Arg753Gln) and TLR4 (Asp299Gly and Thr399Ile) genes and its association with asthma and obstructive pulmonary disease was assessed. The frequency of TLR4 polymorphism was 9 percent in each group studied (asthma, obstructive pulmonary disease and controls). No association was found among TLR4 polymorphism and stage of disease for asthma or obstructive pulmonary disease. TLR4 polymorphism are not associated with the presence or severity of asthma or obstructive pulmonary disease in the Venezuelan population

Use of respiratory medication in five Latin American cities: The PLATINO study.

BACKGROUND: There is scanty information regarding respiratory medication prescription pattern in Latin America. We examined the use of bronchodilators and corticosteroids in a population-based study conducted in five Latin American cities. METHODS: Medication use was derived from questions regarding the use of medication "to help breathing" within the previous 12 months, type of medicine, and frequency of use. To minimize the possibility of overdiagnosis, we used postbronchodilator FEV(1)/FVC<0.70 plus FEV(1)<80% as the definition of obstruction. RESULTS: Interviews were completed in 5571 subjects from 6711 eligible individuals, and spirometry was performed in 5314 subjects. There were 360 (6.5%) treated subjects and 5211 not treated. Treated subjects were more likely to be older, women, unemployed, have higher tobacco consumption, higher body mass index, higher FEV(1) reversibility and airway obstruction. They were also more likely to report prior spirometry, prior diagnosis of COPD, asthma or tuberculosis, and more respiratory symptoms. Over half of treated subjects had neither obstruction nor FEV(1) reversibility, and approximately 30% reported no prior diagnosis of asthma or COPD. Prior respiratory diagnoses and wheezing were more strongly associated with treatment than objective measures of airway obstruction. CONCLUSIONS: The use of bronchodilators and/or corticosteroids is common in the general population aged 40 years or older, with over one-half of treated subjects using them without being obstructed.