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https://hdl.handle.net/2440/61990
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Type: | Journal article |
Title: | Global initiative for chronic obstructive lung disease stage 0 is associated with excess FEV₁ decline in a representative population sample |
Other Titles: | Global initiative for chronic obstructive lung disease stage 0 is associated with excess FEV(1) decline in a representative population sample |
Author: | Brito-Mutunayagam, R. Appleton, S. Wilson, D. Ruffin, R. Adams, R. |
Citation: | Chest, 2010; 138(3):605-613 |
Publisher: | Amer Coll Chest Physicians |
Issue Date: | 2010 |
ISSN: | 0012-3692 1931-3543 |
Statement of Responsibility: | Roshan Brito-Mutunayagam, Sarah L. Appleton, David H. Wilson, Richard E. Ruffin, and Robert J. Adams on behalf of the North West Adelaide Cohort Health Study Team |
Abstract: | Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline removed stage 0 (chronic cough and sputum without airflow obstruction, GOLD-0) because of poor prognostic value. Preventative intervention may be relevant for those with chronic symptoms; therefore, we assessed the stability, morbidity, and FEV1 decline associated with GOLD stage 0 in a representative adult population cohort. Methods: Baseline (n = 4,060) and follow-up (n = 3,206, mean 3.5 years) clinic assessment of the North West Adelaide Health Study included postbronchodilator spirometry, anthropometry, and measures of doctor-diagnosed asthma, respiratory symptoms, smoking status, quality of life, and depression. Results: Baseline GOLD-0 prevalence was 17.0% (n = 584). At follow-up (n = 420), 39.8% remained stable, 1.4% progressed to GOLD stages 1 to 2, and 58.8% resolved to no symptoms. Persistent GOLD-0 at follow-up was associated with persistent smoking (men: odds ratio [OR] = 11.9, 95% CI, 6.4-22.1; women: OR = 4.0, 95% CI, 2.1-7.4), and depressive symptoms (men: OR = 3.8, 95% CI, 1.9-7.6; women: OR = 3.2, 95% CI, 1.7-5.9), with highest quartile of FEV1 decline (mL) per year (OR = 2.1, 95% CI, 1.2-3.7) and the metabolic syndrome (OR = 1.7, 95% CI, 1.01-3.0) in men, and with older age in women. These associations generally held in smokers and never-smokers. Resolving GOLD-0 was associated with smoking cessation (OR = 13.7; 95% CI, 4.6-40.1), FEV1 decline (mL) per year below the median (OR = 2.0; 95% CI, 1.1-3.5), normal BMI, and younger age groups. Sensitivity analyses based on the presence of sputum did not change the observed associations. Conclusion: Persistent GOLD-0 identified people with physical and psychologic morbidity in both smokers and nonsmokers. Identification of those with persistent respiratory symptoms is therefore important. Excess FEV1 decline in men suggests GOLD-0 may identify a group at risk to progress to COPD over time. |
Keywords: | North West Adelaide Cohort Health Study Team Humans Pulmonary Disease, Chronic Obstructive Forced Expiratory Volume Prognosis Severity of Illness Index Risk Assessment Cohort Studies Predictive Value of Tests Health Status Quality of Life Adult Aged Middle Aged Female Male |
Rights: | © 2010 American College of Chest Physicians |
DOI: | 10.1378/chest.09-2607 |
Grant ID: | NHMRC ARC |
Published version: | http://dx.doi.org/10.1378/chest.09-2607 |
Appears in Collections: | Aurora harvest Medicine publications |
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