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Chronic Obstructive PulmonaryDisease: Early detection and prevention in primary care
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims. Early detection of Chronic Obstructive Pulmonary Disease (COPD) and secondary prevention by means of smoking cessation are the only available methods of stopping the progression of the disease. The overall aim was to examine the possibilities of early detection and prevention of COPD in General Practice. The specific aims were to evaluate a method of detecting COPD at its early stages, to investigate the rate of emphysema in smokers with normal lung function and smokers defined as preclinical COPD, to investigate the effects of performed spirometries and brief smoking cessation advice on smoking habits and to test if concentrations of certain biomarkers in blood, saliva and exhaled breath condensate (EBC) could identify subjects with COPD or non-COPD subjects supposed to be at risk of developing COPD.

Methods. The first study evaluated an invitational method, which offered voluntary screening spirometry to a targeted population of smokers 40-55 years old. In the second follow-up study, all smokers with COPD and half of the smokers with normal lung function (NLF) were annually invited for spirometry and brief smoking cessation advice for a duration of 3 years, with half of the smokers with NLF being tested only last year. In the third study, 54 smokers with NLF were examined with High Resolution Computed Tomography (HRCT), with blood samples also being collected from each subject. In study four, 19 subjects categorised as having COPD, 30 non-COPD subjects and 15 healthy non-smoking volunteers were studied by means of spirometry, DLCO, and analysis of biomarkers in EBC, saliva and serum.

Results. A total of 512 smokers responded. The prevalence of COPD was 27.5% and was classified as mild in 85% of the sufferers, moderate in 13% and severe in 2%. At year 1, 10% of the smokers with COPD had been continuously abstinent from smoking, compared to 2% of smokers with NLF. The prolonged abstinence rate increased yearly, and at year 3 the smoking cessation rates in smokers with COPD was 25% compared to 7% in smokers with NLF. By visual analysis, HRCT showed signs of emphysema in 43% of the subjects. Emphysema was also associated with low BMI. Higher serum concentrations of lysozyme and lower DLCO were recorded in those with COPD compared to non-COPD subjects. With the exception of chlorine, none of the remaining biomarkers were detected in EBC.

Conclusions. By invitational targeted screening, COPD can be easily detected in its mild stages by using spirometry. By becoming diagnosed with COPD, smokers seem to be more motivated to stop smoking, and COPD patients should repeatedly be offered spirometry and smoking cessation advice which may prevent the progression of the disease to a severe disabling form. HRCT may detect smoke related parenchymal lung damage (i.e. emphysema) in symptom-free smokers with normal spirometry. Serum lysozyme and DLCO appeared to be the strongest discriminator between COPD and non-COPD subjects. The use of EBC as a tool to measure exhaled inflammatory biomarkers involved in COPD is as yet uncertain.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 102 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1093
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-20736ISBN: 978-91-7393-721-4 (print)OAI: oai:DiVA.org:liu-20736DiVA: diva2:235808
Public defence
2009-06-01, Elsa Brändströmsalen, Hälsouniversitetet, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2009-09-18Bibliographically approved
List of papers
1. Early detection of COPD in primary care: screening by invitation of smokers aged 40 to 55 years
Open this publication in new window or tab >>Early detection of COPD in primary care: screening by invitation of smokers aged 40 to 55 years
2004 (English)In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 54, no 500, 201-206 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The incidence of chronic obstructive pulmonary disease (COPD) is increasing in developed countries, as is the mortality rate. The main cause of COPD is smoking, and COPD is usually diagnosed at a late stage. AIM: To evaluate a method to detect COPD at an early stage in smokers in a young age group (40-55 years).

DESIGN OF STUDY: Prospective descriptive study.

SETTING: The city of Motala (45,000 inhabitants) and its surrounding rural areas (43,000 inhabitants) in south-east Sweden. Nineteen thousand, seven hundred and fifty subjects were between 40 and 55 years of age. According to Swedish statistics, approximately 27% of this population are smokers.

METHOD: Smokers aged between 40 and 55 years were invited to have free spirometry testing in primary healthcare centres. Placards were placed in pharmacies and health centres and advertising was carried out locally twice a year.

RESULTS: A total of 512 smokers responded. The prevalence of COPD was 27% (n = 141). The COPD was classified as mild obstruction in 85% (n = 120), moderate in 13% (n = 18) and severe in 2% (n = 3) according to the European Respiratory Society classification. Knowledge of the disease COPD was acknowledged by 39% of the responders to the questionnaire. Logistic regression analysis showed that age, male sex, number of pack years, dyspnoea and symptoms of chronic bronchitis significantly increased the odds of having COPD. The adjusted odds ratio was significant for having > 30 pack years.

CONCLUSIONS: This method of inviting relatively young smokers selected a population of smokers with a high incidence of COPD, and may be one way of identifying smokers with COPD in the early stages.

Keyword
Body mass index, computed tomography, family practice, pulmonary emphysema, smoking, spirometry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20729 (URN)15006126 (PubMedID)
Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2017-12-13
2. The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD
Open this publication in new window or tab >>The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD
2006 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 3, 133-139 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Smoking cessation is the most important therapeutic intervention in patients with chronic obstructive pulmonary diseases (COPD) and the health benefits are immediate and substantial. Major efforts have been made to develop methods with high smoking cessation rates.

OBJECTIVES: To study whether a combination of spirometry and brief smoking cessation advice to smokers with COPD, annually for three years, increased their smoking cessation rate in comparison with groups of smokers with normal lung function.

METHOD: Prospective, randomized study in primary care. Smoking cessation rates were compared between smokers with COPD followed-up yearly over a period of three years and smokers with normal lung function followed-up yearly for three years or followed-up only once after three years.

RESULTS: The point-prevalence abstinence rate and prolonged abstinence rate at 6 and 12 months increased yearly and in smokers with COPD at year 3 was 29%, 28%, and 25%, respectively. The abstinence rates were significantly higher in smokers with COPD than in smokers with normal lung function. Smoking cessation rates among smokers with normal lung function did not increase with increasing number of follow-ups.

CONCLUSION: Smokers diagnosed with COPD stopped smoking significantly more often than those with normal lung function.

Keyword
COPD, family practice, general practice, primary health care, smoking cessation, spirometry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20733 (URN)10.1080/02813430600819751 (DOI)16923621 (PubMedID)
Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2017-12-13
3. High prevalence of emphysema and its association with BMI: A study of smokers with normal spirometry
Open this publication in new window or tab >>High prevalence of emphysema and its association with BMI: A study of smokers with normal spirometry
Show others...
2008 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 4, 241-247 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate to what extent emphysema was evident, as identified by High Resolution Computed Tomography (HRCT), in smokers with normal lung function and to relate age, gender, smoking history, and body mass index (BMI) to the HRCT results. A secondary aim was to study to what extent emphysema was present in smokers with lower normal values of lung function defined as FEV1/FVC ratio percentage of predicted value (89-93% of predicted value for males and 90-93% for females) or FEF50 60% of predicted compared with smokers without this definition.

Methods: Fifty-nine smokers, with a mean age of 53 years and with normal lung function, were examined with HRCT.

Results: Emphysema evidenced visually by HRCT was present in 43% of the subjects. Using a 0-5 grade scale (0=normal finding; 5=emphysema in most slices), the degree of emphysema was almost exclusively 3-4. The type of emphysema was distributed as centrilobular emphysema predominant in 43.5%, paraseptal emphysema predominant in 43.5%, and as an equal mixture of these types in 13%. The presence of emphysema did not differ between the group of smokers with lower normal values of lung function and the rest of the smokers. Smokers with emphysema had significantly lower BMI than those devoid of emphysema, 24 and 27 respectively (p0.0011).

Conclusion: There was a high occurrence of visual emphysema in middle-aged smokers with normal lung function. The densitometric quantitative analysis method is inadequate for detecting mild emphysema. High prevalence of emphysema was associated with low BMI.

Keyword
Body mass index, computed tomography, family practice, pulmonary emphysema, smoking, spirometry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16159 (URN)10.1080/02813430802452732 (DOI)
Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14
4. Can we predict development of COPD?
Open this publication in new window or tab >>Can we predict development of COPD?
2008 (English)Article in journal (Refereed) Submitted
Abstract [en]

Background: Cigarette smoking is one of the main causes of chronic obstructive pulmonarydisease (COPD). Chronic inflammation of airways may start years before manifestation ofclinical symptoms, thus early identification of smokers at risk to develop COPD is crucial.Objectives: To evaluate if a single breath test for diffusion capacity (DLCO) or concentrationsof certain biomarkers in exhaled breath condensate (EBC), saliva or serum could identifysubjects with COPD or non-COPD smokers and ex-smokers supposed to be at risk to developCOPD, as suggested by rapid decline of forced expiratory volume in one second (FEV1) during afive year period.

Methods: Twenty-nine symptom free smokers/ex-smokers, 16 smokers/ex-smokers with COPDand 19 matched healthy non-smoking volunteers were studied by means of spirometry, DLCO,and analyses of EBC, saliva and serum [chlorine, lysozyme, eosinophil cationic protein (ECP)and myeloperoxidase (MPO)]. Area under a receiver operated curve (AUCROC) was used toassess sensitivity and specificity of measurements to identify manifest or risk to get COPD.

Results: Only DLCO could identify subjects with COPD or risk to develop COPD, as judged byAUCROC (0.85 or 0.75, respectively). Lower DLCO (p=0.003) and higher serum concentrationsof lysozyme (p=0.011) were recorded in those with COPD than non-COPD subjects.Furthermore, concentration of chlorine was higher in EBC from COPD subjects than fromhealthy volunteers (p<0.05). Except for chlorine, none of the remaining biomarkers weredetected in EBC and there was a vast variability of concentrations of biomarkers in saliva.

Conclusion: DLCO was the most effective discriminator of COPD and rapid decline of lungfunction. Serum concentration of lysozyme was the second strongest discriminator, confirmingprevious findings on involvement of neutrophils in the disease process. The use of EBC as a toolto measure exhaled biomarkers involved in COPD is dubious due to large variability and lowconcentrations of markers in EBC.

Keyword
Exhaled Breath Condensate, serum, DLCO, COPD, lysozyme and chlorine
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16293 (URN)
Available from: 2009-01-13 Created: 2009-01-13 Last updated: 2009-09-18Bibliographically approved

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