Mortality from chronic obstructive pulmonary diseases and asthma in France, 1969-1983. Comparisons with the United States and Canada.

This article focuses on international similarities and differences in levels and trends of mortality for chronic obstructive pulmonary disease (COPD) and asthma in the US, Canada and France from 1969 to 1983. Comparisons have been made of national vital statistics data for age groups 55-64 years, 65-74 years and 75-84 years. From 1969 to 1978, under the 8th revision of the International Classification of Diseases (ICD), the COPD and asthma category included the codes 490-493 and, for the US and Canada, a special code 519.3. From 1979, under the 9th revision, COPD and asthma codes 490-493, 496 were in use in all three countries. The analyses of US, Canadian and French data show lower death rates for COPD and asthma in France. The ratio of male to female deaths from COPD increased with age in the US and Canada, but not in France. The proportion of COPD and asthma deaths attributed to bronchitis was higher in France. An increased use of code 496 (under 9th revision) was observed in the US and above all in Canada. In the three countries, death rates increased faster between 1979 and 1983 in women than in men and increases in women were steeper in the US and Canada than in France. Intercountry comparability is better for COPD mortality in the 9th revision than the 8th revision. Some differences observed between the three countries can be partly explained by coding practices and ICD revisions, but, allowing for differences in coding and classifying respiratory causes of death as well as ICD revisions, death rates are obviously higher in the US and Canada than in France. This suggests that the difference is real.

Office spirometry for lung health assessment in adults: A consensus statement from the National Lung Health Education Program.

COPD is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients >/= 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry-office spirometry-for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study.

Spirometry was performed by 5,201 elderly participants of the Cardiovascular Health Study during their baseline examination and a subset of the ATS/DLD-78 respiratory questionnaire was administered by trained interviewers. In never smokers (46 percent of the cohort), the overall prevalence of chronic cough was 9 percent, chronic phlegm was 13 percent, attacks of wheezing with dyspnea were 8 percent, and grade 3 dyspnea on exertion was 10 percent. The prevalence of lung disease in current smokers (12 percent of the cohort) was 8/7 percent (men/women) with chronic bronchitis and 14/5 percent with emphysema. Overall, 6 percent reported asthma (a physician-confirmed history) and 12 percent reported hay fever. Using a logistic regression model, attacks of wheezing with dyspnea were strongly associated with a lower FEV1, coronary heart disease, heart failure, and a large waist size (in participants without a diagnosis of asthma, chronic bronchitis, or emphysema). Undiagnosed airways obstruction was twice as likely in women and those with lower income, and was associated with current and former smoking, pack-years of smoking, and chronic cough. Dyspnea on exertion (DOE) was three times or more likely if a participant reported heart failure, coronary heart disease, or emphysema; and much more likely if their FEV1 or FVC was substantially reduced. Dyspnea on exertion was also positively associated with older age, chronic bronchitis or asthma, a larger waist or hip size, pack-years of smoking, and less education. We conclude that DOE and attacks of wheezing with dyspnea are commonly associated with cardiovascular disease and a low FEV1 in those over 65 years and that airways obstruction frequently remains undiagnosed in the elderly.

Breathlessness, chronic bronchitis and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland and the United States.

Relationships between cardiovascular disease (CVD) mortality and breathlessness, a definition of chronic bronchitis, and pulmonary function are investigated among men in two employed populations (17,717 London civil servants and 4904 Scottish workers) and in two communities (844 men in Tecumseh, Michigan and 6859 men in Renfrew and Paisley Burghs, Scotland). Men are aged 40-64 years at entry in all studies except Renfrew-Paisley, where they are aged 45-64 years. Length of follow-up ranges from 6 to 16 years. Age and smoking habits were controlled for in all analyses. Chronic phlegm production is not significantly associated with CVD mortality, and 'chronic bronchitis' is significantly associated with mortality only in the employed populations. Low FEV1 is significantly associated with CVD mortality only in the Whitehall study; however, the rate ratios are above one in all studies. Breathlessness is significantly associated with CVD mortality in all studies. These associations between CVD mortality and 'chronic bronchitis', low FEV1, and breathlessness persist after also controlling for employment grade, systolic blood pressure, antihypertensive medication, ECG changes, plasma cholesterol level, body mass index and diabetes. Only the associations between breathlessness and mortality persist after further controlling for low FEV1 and myocardial ischaemia. The rate ratios between breathlessness and mortality are about two for all studies. It is concluded that in these populations, breathlessness is an independent and major predictor of CVD mortality.

Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program.

Chronic obstructive pulmonary disease (COPD) is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients > or = 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry-office spirometry--for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Comparison of respiratory symptoms and pulmonary function between two communities; Tecumseh (US) and Bordeaux (France).

Respiratory symptoms, pulmonary function and smoking habits in two adult populations, aged 20-59 years, are compared in Tecumseh (Michigan) and Bordeaux (France). Personal, demographic, and medical characteristics were ascertained by self-administered questionnaires; Forced vital capacity and Forced expiratory volume in one second (FEV1) were measured. In Tecumseh, the proportion of smokers was higher, people started to smoke earlier and the number of cigarettes per day was higher, the differences were significant. The prevalences of respiratory symptoms tended to be higher in Tecumseh than in Bordeaux although the differences did not reach statistical significance. The age-adjusted odds ratios according to smoking and socio-economic status for respiratory conditions, or relating FEV1 less than 80% predicted did not differ significantly but tended to be greater in Tecumseh. These trends might suggest a greater morbidity and/or a greater impact of risk factors in Tecumseh.

Effects of cooking fuels on lung function in nonsmoking women.

A case-control study of 20- to 39-yr-old female participants in the Tecumseh Community Health Study compared use of cooking fuels and other factors in women from the highest and lowest quartiles of the lung function distribution. The forced expiratory volume in 1 second (FEV1.0) was used as the index of ventilatory lung function. The use of a kitchen exhaust fan was significantly associated with low lung function. A larger proportion of women with low FEV1.0 used gas for cooking, but this difference was not statistically significant.

Trends in COPD morbidity and mortality in Tecumseh, Michigan.

Trends in COPD morbidity and mortality were investigated among the population of Tecumseh, Michigan, for the period 1959 to 1987. COPD was mentioned on the death certificates of 11% (102) of deceased men and 13% (24) of deceased women. Forty-one percent of these deaths was attributed to COPD as the underlying cause and the remainder to COPD as a contributory cause. Usage of diagnostic terms changed during the course of the study; emphysema was mentioned on 81% of certificates completed prior to 1968, whereas COPD was entered on 77% of the certificates written after 1978. Proportional mortality rates of COPD increased from 8% during 1959 to 1967 to 13.3% during 1979 to 1987 among men, and from 2.7% during the earlier years to 4.3% during the later years among women. Death rates for COPD and for all causes combined increased among men from the early 1960s to the late 1970s, then declined. Death rates for all causes combined were stable among women, but COPD death rates may have increased. Prevalence rates for chronic bronchitis were lower at the third examination than at the second in both sexes. Prevalence of obstructive airway disease was highest at the first and lower at the second and third examinations in men but not in women. Agreement between study diagnoses of COPD and entry of COPD on death certificates was poor. COPD was recorded on the death certificate for only 21% of men and only 6% of women who had COPD diagnosed at a study examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Median age at onset of asthma and allergic rhinitis in Tecumseh, Michigan.

The ages at which allergies are likely to first become manifest is a subject of epidemiologic interest. The distribution of the onset ages reported in a population survey provides a distorted picture because it is a function of the age distribution of the population at the time of survey, and hence does not represent generational experience. A lifetable method is presented which transforms the raw cross-sectional data to a longitudinal basis. The information on onset age of asthma and allergic rhinitis collected in the 1962-1965 cycle of the Tecumseh Community Health Study is used to illustrate the method. The resultant distributions have median onset ages for the respective allergies which are considerably higher than those based on the onset frequency distributions of enumerated data.

Cardiovascular risk factors and obesity: are baseline levels of blood pressure, glucose, cholesterol and uric acid elevated prior to weight gain?

The increased risk of cardiovascular morbidity and mortality experienced by the obese may be partially mediated through alterations induced in other associated risk factors. The attribution of this cardiovascular risk to obesity presumes that levels of those risk factors are not elevated independently of, or prior to, weight gain. We therefore examined baseline levels of blood pressure, glucose, cholesterol, and uric acid within age and sex specific strata of a population of 4015 individuals followed an average of 15 years to determine if an increasing level of fatness (weight/height 2) at follow-up was associated with elevation of other risk factors at baseline. After controlling for baseline fatness we were unable to demonstrate any consistent relationship between future fatness and baseline elevation of any of the factors. The magnitude of the partial correlation coefficients for those age 6-24 or 25-65 years at baseline were less than 0.11 for all of the risk factors. While a metabolic predisposition may link obesity to alterations of other risk factors it appears unlikely that their elevation commonly precedes weight gain. A pre-existing elevation of risk factors has not resulted in the misattribution of cardiovascular risk to obesity.

Smoking, socioeconomic status, and chronic respiratory disease.

Prevalence rates of chronic bronchitis and asthma and mean levels of ventilatory lung function were related to age, smoking habits, occupation, education, and income in 4,699 men and women living in Tecumseh, Michigan. The prevalence of chronic bronchitis was higher and mean levels of 1-sec forced expiratory volume were lower in cigarette smokers than in other men and women, and heavy smokers were affected more than light smokers. The prevalence of chronic bronchitis was higher and mean 1-sec forced expiratory volume was lower in blue collar workers than in white collar workers. Men and women with some college education had higher mean values for 1-sec forced expiratory volume than did those with less formal education, and the prevalence of chronic bronchitis was least among men with most education. Mean levels of 1-sec forced expiratory volume were slightly lower in those with the smallest incomes. There were no significant associations between the prevalence of asthma and smoking habits, occupation, education, or income. Most of the differences in the prevalence of chronic bronchitis and mean 1-sec forced expiratory volume in men and women of different occupational, educational, or income classes were due to differences in smoking habits. In comparison with smoking, poor occupational, educational, or economic circumstances had only a weak deleterious effect.

Obesity and coronary heart disease.

Obesity carries a penalty of an associated adverse cardiovascular risk profile. Largely as a consequence of this, it is associated with an excess occurrence of cardiovascular disease morbidity and mortality. It is concluded on the basis of data from the Framingham study and other large prospective studies that the rate of development of cardiovascular disease rises rapidly in relation to even modest amounts of adiposity. The abdominal pattern of adiposity, and specifically visceral adiposity, appears to be the most hazardous. First identified as a cause of glucose intolerance, abdominal adiposity has been identified as promoting insulin resistance, hypertension and dyslipidemia, as well as CHD. While the impact of epidemic obesity on the health of white Americans is becoming more fully understood, there are important gaps in the knowledge about the nature of influence of adiposity on CHD in large subgroups of the population. The dearth of detailed and long term prospective studies of African-Americans is the most conspicuous shortcoming of the research base. Finally, because there is a great potential benefit of remaining lean or achieving a sustained weight loss when indicated, and given the high prevalence of obesity, research on adiposity prevention and more effective weight reduction methodology are urgently needed.