241. Burden of COPD 450s by dfgh4bnmu

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									         Thematic Poster Session                                                                                                             Hall B2-17 - 12:50-14:40
                                                                M ONDAY, S EPTEMBER 4 TH 2006




                                                                                           Fig. 1. Physical Component Summary scores from the SF-12 by site and stage for males.


                                                                                           The average decrease in PCS from Stage 0 to Stage 1 was 1.9% (sd=3.1) in men
                     241. Burden of COPD                                                   and 11.3% (sd=8.6) in women. The average decrease from Stage 0 to Stage 2+
                                                                                           was 11.1% (sd=8.6) in men and 14.7% (sd=6.9) in women. The impact of COPD
                                                                                           on the reported physical health status of patients was consistent across five sites
                                                                                           from around the world.

P2614
Depression prevalence in COPD and matched non-COPD cohorts                                 P2616
Hana Mullerova 1 , Richard Baxter 1 , Joan B. Soriano 2 , Kourtney J. Davis 3 .            Validation of the Saint George’s respiratory questionnaire in patients with
1
  Worldwide Epidemiology, GlaxoSmithKline R&D, Greenford, United Kingdom;                  chronic obstructive pulmonary disease in Morocco
2
  Program of Epidemiology and Clinical Research, Fundacio Caubet-Cimera,                   Karima El Rhazi 1 , Chakib Nejjari 1 , Mohammed Chakib Benjelloun 2 , Jamal
Mallorca, Balearic Islands, Spain; 3 Worldwide Epidemiology, GlaxoSmithKline               Eddine Bourkadi 3 , Siham Zaid 3 , Elhassan Assbaai 3 , Pascale Barberger-Gateau 4 .
                                                                                           1
R&D, RTP, United States                                                                      Epidemiology and Public Health, Faculty of Medicine, Fez, Morocco; 2 Service
                                                                                           of Pneumology, University Hospital Center Hassan II, Fez, Morocco; 3 Service of
Evidence for an increase of depression prevalence in COPD is based on small                Pneumology - My Youssef Hospital, University Hospital Center Avicenne, Rabat,
convenience cohorts. A population-based study study was conducted to assess                Morocco; 4 Public Health, Epidemiology and Development, University Bordeaux
the prevalence of depression in a cohort of diagnosed COPD patients and their              2, Bordeaux, France
matched non-COPD controls.
Methods. A cohort of incident COPD patients and matched non-COPD cohort                    The aim of this study was to check if an Arabic version of SGRQ (SGRGm) is a
(1:1 matching on age, gender and GP practice) with regular visits to their GP              valid tool to measure quality of life in patients with chronic obstructive pulmonary
were identified in the UK General Practice Research Database, during 1993-2003              disease (COPD) in Morocco.
(N= 24,786 pairs). Two definitions of depression were used: (1) a depression                After a translation process of SGRQ, The validation study was conducted and it
diagnosis, or (2) a depression diagnosis and/or an antidepressant script. Prevalence       was divided in two parts. The first part consisted of a clinical exam, spirometry,
was calculated for each definition for the total period and stratified by age, gender,       Fletcher scale of dyspnoea and a visual analogical scale (VAS) which applied for
smoking status and COPD severity (for COPD cohort).                                        every patient on recruitment. The data were used to examine the inter observer
Results. Period prevalence (11-year) of ever-diagnosed depression was increased            reliability and construct validity of the SGRQm. The second part entailed reassess-
in COPD compared to the non-COPD cohort for both depression definitions. For                ment of patients scheduled ten days on average after the initial for examination of
the medical diagnosis-based depression definition, the prevalence in the COPD               the test-retest reliability of the SGRQm.
population was 29.4% (95% CI 28.4, 30.4) compared to 17.3% (95% CI 16.6,                   We recruited 77 patients prospectively between January and December 2005. Sex
18.0) in the non-COPD population. When the diagnosis or antidepressant script              ratio Male/females was 11.8. The patients mean age was 59 (SD 10.5) years.
definition was applied, the prevalence in COPD population was 41.9% (95% CI                 The mean of FEV1 was 1.53 L, and % predicted FEV1 of 51%. 59 patients also
40.7, 43.1) compared to 25.9% (95% CI 25.0, 26.8) in the non-COPD population.              completed the SGRQm at the second administration. Cronbach α for the total score
Females, younger subjects (age: 45-65 years) and current smokers were more                 was 0.81. Internal consistency of the symptoms, activity and impact components
prevalent with depression in both cohorts. Severe COPD patients suffered by                were 0.93; 0.89; 0.88 respectively. The ICCs (test-retest reliability) were high for
depression more often than less severe patients, RR 1.18 (95%CI 1.01,1.68).                all components and ranged from 0.73 to 0.93. The SGRQm component scores and
Conclusions. In a primary care setting, an increased frequency of diagnosed                total scores significantly correlated with others measures. The Fletcher scale cor-
depression, RR 1.70 (95% CI 1.53, 1.81) was observed in this COPD cohort                   related with all SGRQm component and total scores, while the VAS had a similar
compared to the matched non-COPD cohort.                                                   correlation, except with the symptoms score (p > 0.05). FEV1 values correlated
                                                                                           negatively with the activity, impact and total scores except with symptoms.
                                                                                           the SGRQm has satisfactory psychometrics proprieties in this sample of patients
P2615                                                                                      with COPD.
Health status comparison of patients with COPD throughout the world: the
BOLD Initiative
Kevin B. Weiss 1 , Todd A. Lee 1 , Sean D. Sullivan 2 , William Vollmer 3 , A.             P2617
Sonia Buist 4 . 1 Institute for Healthcare Studies, Northwestern University and            Comparison of the quality of life of COPD patients between the United Arab
Hines VA Hospital, Chicago, IL, United States; 2 Department of Pharmacy,                   Emirates and the United Kingdom
University of Washington, Seattle, WA, United States; 3 Biostatistics, Center for          Imane Ben Bihi 1 , Mohammed Shamssain 2 , Malcolm Farrow 3 , Mirza Al
Health Research, Portland, OR, United States; 4 Pulmonary & Critical Care                  Sayegh 4 , Sayed Nasir 5 , Graham Burns 6 . 1 School of Health, Natural & Social
Medicine, Oregon Health & Science University, Portland, OR, United States                  Sciences, University of Sunderland, Sunderland, United Kingdom; 2 School of
                                                                                           Health, Natural & Social Sciences, University of Sunderland, Sunderland, United
Chronic obstructive pulmonary disease (COPD) has a significant impact on quality            Kingdom; 3 School of Mathematics and Statistics, University of Newcastle,
of life. However, it is not clear if patients in different parts of the world report the   Newcastle, United Kingdom; 4 Chest Clinics, Al-Makhtoum Hospital, Dubai,
impact of COPD on their health status differently. One objective of the Burden             United Arab Emirates; 5 Chest Clinics, Dubai Hospital, Dubai, United Arab
of Obstructive Lung Disease (BOLD) initiative, a study of the prevalence and               Emirates; 6 Chest Clinic, RVI Hospital, Newcastle, United Kingdom
burden of COPD around the world, is to compare the impact of COPD on physical
symptoms by each participating site. The objective of this study was to compare            This study is designed to compare the Quality of Life of stable COPD patients
Physical Component Summary (PCS) scores from the SF-12 by COPD stage and                   between the UAE (n=93) and the UK (n=82). The Quality of Life was measured
site. Data from the BOLD prevalence survey are available from a total of five sites         using the St. Georges’ respiratory questionnaire. Mahler Dyspnoea Index was used
(Austria, China, Iceland, South Africa, Turkey). We compared PCS scores from               to assess functional impairment, magnitude of task and magnitude of effort. Lung
each of the sites by GOLD stage (0, 1, 2+) and gender. Total participants from             function tests were measured by Vitalograph spirometer. The Mean (± S.D) age,
each site were: Austria = 1258; China = 473; Iceland = 748; South Africa = 845;            height and body weight in the UK patients were 74.9 (±6.92) y, 164.1 (±9.36)
Turkey = 805. With the exception of China, PCS scores decreased from Stage 0               cm and 70.7 (±13.61) kg, respectively, while in the UAE they were 58.6 (±15.04)
to Stage 1 to Stage 2+. The figure shows PCS scores for men by site and stage.              y, 171.1 (±7.1) cm and 73.7 (±13.11) kg, respectively. The Mean (SD) Forced
Overall, PCS scores for Stage 2 were significantly different from Stage 0 and 1.            Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) and


                                                                                      450s

                                    Abstract printing supported by Nonin Medical, Inc. Visit Nonin Medical, Inc. at stand C09
          Thematic Poster Session                                                                                                       Hall B2-17 - 12:50-14:40
                                                               M ONDAY, S EPTEMBER 4 TH 2006

Forced Expiratory Ratio (FEV1/FVC*100) in the UK patients were 1.36 (±0.73),              P2620
2.30 (±0.87) and 58.7 (±19.5%) respectively, and in the UAE patients they were            Post-bronchodilator spirometry reduces COPD diagnosis rate by 30%
1.46 (±0.87), 2.12 (±1.1) and 68.4 (±25.3%), respectively. For the UK patients            Michal Bednarek 1 , Janusz Maciejewski 2 , Robert Plywaczewski 1 ,
the mean symptoms, activity; impacts components and total scores were 50.44%,             Dorota Gorecka 1 , Jan Zielinski 1 . 1 Dept. of Respiratory Medicine, National
95.07%, 38.14% and 57.47%, respectively, while in the UAE patients they were              Research Institute of TB and Lung Disease, Warsaw, Poland; 2 Primary Care
60.67%, 72.92%, 43.48% and 55.27%, respectively. In both groups, patients with            Practice, NZOZ Medicar, Sierpc, Poland
grade 3 Functional Impairment components of baseline Mahler dyspnoea index
had significantly better Quality of Life (symptoms, activity, impact) than patients        Aim: To assess the value of bronchodilation test in diagnosis of COPD using
with grade 2 Functional Impairment component. The same pattern was observed               different prediction equations and diagnostic criteria.
with Magnitude of Task and Magnitude of Effort components.                                Material and Methods: In a single primary care practice (PCP) a program of early
In both groups, patients with low lung function and dyspnea index have lower              detection of COPD was introduced in subjects aged 40+ years. Spirometry was
quality of life. There was no significant difference in the total scores of the Quality    performed in 1960 subjects (87.5% of targeted group). There were 764 (39%) males
of Life and lung function measurements between the UK and UAE COPD patients.              and 1196 (61%) females, mean age 56.7±11.6, range 40-93 years. Spirometry was
                                                                                          performed according to ERS/ATS recommendations using EasyOne device (ndd
                                                                                          Switzerland). COPD was diagnosed using two different definitions: ERS/ATS and
P2618                                                                                     GOLD. Prediction equations of ECCS (Quanjer 1993) and HSE (Falaschetti 2004)
Lung function in patients attending a rapid access chest pain clinic                      were used. Airflow limitation (AL) was diagnosed if FEV1/FVC%pred was <5
Helen C. Francis 1 , Wendy V. Colecliffe 2 , Michelle L. Hazell 1 , Dave Singh 1 ,        percentile (ECCS), below lower limit of normal (Falaschetti) or FEV1/FVC<0.7
Robert McL. Niven 1 , Gerry W. Hagan 3 , Michael D. Spencer 3 , Timothy                   (GOLD). In 471 subjects with obstructive spirometry two puffs (200mcg) of
L. Frank 1 . 1 North West Lung Centre, Wythenshawe Hospital, Manchester, United           salbutamol were used in reversibility testing. The effects of post-bronchodilator
Kingdom; 2 Cardiology Unit, Wythenshawe Hospital, Manchester, United                      spirometry on diagnosis of COPD are shown in Table.
Kingdom; 3 R & D, GlaxoSmithKline, Greenford, United Kingdom
                                                                                                              ERS/ATS (Quanjer)      ERS/ATS (Falaschetti)    GOLD (Quanjer)
Many UK hospitals have set up specialised chest pain clinics to deal promptly and
efficiently with cases of possible cardiac chest pain. It is likely that a proportion      COPD pre (N)               229                     307                    392
of patients attending such clinics will have a respiratory cause for their chest          COPD post (N)              158                     217                    297
pain, or respiratory disease in addition to their cardiac pain. This study aimed to       Difference (N, %)        71 (31.0)               90 (29.3)              95 (24.2)
determine the prevalence of COPD, ischaemic heart disease and dual pathology in
such patients. As part of the study spirometry measurements were performed and            Conclusions: Bronchodilating test results in 24-30% reduction in COPD diagnosis
are presented in the table below.                                                         rate. Our findings confirm GOLD strategy of post-bronchodilator spirometry in
406 patients attending the rapid access chest pain clinic participated in the study.      the diagnosis of COPD.
Spirometry data from two patients was excluded due to poor technique. Abnor-
mal lung function [1] was detected in 87 (21%) of the patients that performed
spirometry. Of these, 56 (13.8%) showed evidence of airway obstruction.                   P2621
                                                                                          Usefulness of the chest CT scanning for screening of the emphysema in 40,924
                                                                                          Japanese undergoing routine medical checkup
Normal spirometry                                                         317 (78.5%)
                                                                                          Motonori Fukakusa 1 , Naoki Nishimura 2 , Masayo Tsukamoto 2 ,
Airway obstruction
   Reduced ratio, normal FEV1 [FEV1 /FVC<70%; FEV1 >80%*]                  14 (3.5%)
                                                                                          Noboru Uchiyama 2 , Katsunori Oikado 3 , Masaki Matsusako 3 , Akira Hayashibe 1 ,
   Mild obstruction [FEV1 /FVC<70%; FEV1 50-80%*]                          32 (7.9%)      Fumiko Kinoshita 3 , Naohiko Chonabayashi 2 , Sonoe Hiramatsu 1 . 1 Center for
   Moderate obstruction [FEV1 /FVC<70%; FEV1 30-49%*]                       7 (1.7%)      Preventive Medicine, St. Luke’s International Hospital, Tokyo, Japan;
                                                                                          2
   Severe obstruction [FEV1 /FVC<70%; FEV1 <30%*]                           3 (0.7%)        Department of Respiratory Medicine, St. Luke’s International Hospital, Tokyo,
Other abnormalities                                                                       Japan; 3 Department of Radiology, St. Luke’s International Hospital, Tokyo, Japan
   Reduced FEV1 , normal ratio [FEV1 <80%*; FEV1 /FVC≥70%]                 16 (4.0%)
   Restrictive disorder [FEV1 <80%*; FVC<80*]                              15 (3.7%)      Aim: Chest CT images at medical health check are considered as abnormal when
                                                                                          emphysematous lesions are observed. In order to investigate this idea, we have
*of predicted value
                                                                                          reviewed CT images from subjects.
Poor lung function has been shown to be as powerful a predictor of cardiac                Methods: In 40,924 cases (20,436 males) contiguous multi-slice CT images of the
mortality as total cholesterol [2]. A considerable number of patients referred for        annual health check were evaluated by our center between 2004 and 2005. Smok-
exclusion of ischaemic pain had abnormal lung function. This may impact both on           ing history had been obtained from questionnaires and pulmonary function tests
their cardiac and respiratory health.                                                     (forced vital capacity and forced expiratory volume in 1 second) were performed.
[1] National Institute for Clinical Excellence. Thorax 2004; 59(supp): i1-i232.           Total WBC (neutrophils and eosinophils), RBC, and Platelet counts in peripheral
[2] Hole DJ et al. BMJ 1996; 313(7059):711-715.                                           blood were determined using an automatic cell counter.
                                                                                          Results: 701 (650 male) subjects had emphysematous lung and the mean age was
                                                                                          61.4 (range 33-90). 686 (97.9%) were smokers. Also the overall rate of smoking
P2619                                                                                     was 19.9% at our center. FEV1/FVC ratio of less than 70% was in 6.6% for
Forecasting COPD winter hospital admissions to promote anticipatory care                  healthy subjects and in 48.2% for emphysematous lung group. Emphysematous
in England                                                                                lung group had significantly elevated neutrophil count (mean, 3837 SD 1383 per
Penny M. Marno, Helen A. Watkin, Clare Bryden, Mark Gibbs. Health                         mm3 ) than healthy subjects (3055 SD 1122 per mm3 , p less than 0.01).
Programme, Met Office, Exeter, United Kingdom                                              Conclusions: There were several emphysematous lung which was not detected in
                                                                                          respiratory function test. CT images appear to be useful for mild emphysematous
900,000 people in the United Kingdom (UK) have been diagnosed with Chronic                lung detection at medical health check. Total neutrophil count was significantly
Obstructive Pulmonary Disease (COPD) resulting in one million inpatient bed               higher in emphysematous than healthy subjects. It may become collaborating
days and 30,000 deaths each year. The UK Met Office has derived a methodology              evidence that neutrophils participate in inflammatory processes. In addition, male
to predict the risk during winter of COPD exacerbations resulting in admission            gender and the smoking factor may correlate with an emphysematous change.
to hospital. This was used as part of a Health Forecasting framework to forecast
demand and provide anticipatory care to COPD patients.
We investigated relationships between environmental variables and COPD hospital           P2622
admissions in England and used the strongest relationships to derive an algorithmic       Participant and technician predictors of spirometry quality factors in the
model. This provided a forecast at Primary Care Trust (PCT) level of whether              multi-ethnic study of atherosclerosis
COPD admissions were likely to be “average”, “above average”, “high” or “very             Karen Stukovsky 1 , John Hankinson 2 , Rui Jiang 3 , W. Craig Johnson 1 ,
high”. A peak in COPD admissions usually occurs at the end of December /                  Steven Kawut 3 , Lewis Smith 4 , R. Graham Barr 3 . 1 Biostatistics, University of
beginning of January. The amplitude of this peak was found to be related to the           Washington, Seattle, WA, United States; 2 Hankinson Consulting, Valdosta, GA,
dominant weather type in early December. Cold weather affects COPD hospital               United States; 3 Medicine and Epidemiology, Columbia University, New York, NY,
admissions with a 1-2 week lag. A final model was produced combining these                 United States; 4 Medicine, Northwestern University, Chicago, IL, United States
factors.
The success of predicting an event which was “above average” or higher ranged             Background Quality factor (QF) criteria for spirometry may improve technician
from 76% to 95% between PCTs. The percentage of predictions in the correct                coaching and facilitate analysis of collected spirometry data. We evaluated the dis-
category ranged from 50% to 61% based on a retrospective cohort.                          tribution and predictors of QF scores in the Multi-Ethnic Study of Atherosclerosis
In conclusion, COPD hospital admissions in England can be forecast with some              (MESA).
accuracy based on environmental conditions. This information has enabled general          Methods The MESA-Lung study is conducting spirometry in 3,800 MESA par-
practices to intervene early with patients at particular risk, with the objective of      ticipants. Spirometry is graded according to the number of acceptable curves and
reducing the likelihood of hospital admission and improving patients’ quality of          repeatability of measures. Tests are ranked on a scale of 0-4. Predictors of QF
life.                                                                                     scores were evaluated with ordinal logistic regression.
                                                                                          Results Of 1,851 completed tests, 96.8% percent of FVC and 97.5% of FEV1
                                                                                          tests received a passing score of at least 2. The mean FVC QF was 3.61 (sd=0.77)


                                                                                       451s

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         Thematic Poster Session                                                                                                        Hall B2-17 - 12:50-14:40
                                                              M ONDAY, S EPTEMBER 4 TH 2006

and mean FEV1 QF was 3.78 (sd=0.67). Age, gender, race/ethnicity, COPD and              rameters in patients with COPD. A total of 63 COPD patients (age=58.6±8.8
technician experience/knowledge were each associated with QF. In the multivariate       years, BMI=24.2±5.6, FEV1 %=35±14%, PImax=52.3±19.0 cm H2 O; mean ±
analysis, only female gender (OR 1.92, 95%CI 1.54, 2.38; p<.0001) and younger           SD), were enrolled in a 5 year, prospective study. Mortality was assessed as
age (OR 1.03, 95%CI 1.02, 1.04; p=<.0001) were consistently associated with             overall mortality. Subjects who died (n=32) had lower values of BMI, FEV1 ,
higher FVC QF scores.                                                                   DLCO /VA %, pO2 , PImax and six-minute walking test (6MWT) and had higher
Conclusion Spirometry quality scores were associated with the participant factors       value of RV/TLC% (p<0.05). The Cox proportional hazards model was used to
gender and age, which suggests quality of spirometry may be reflective of the            determine independent predictors of survival. Variables included in the regression
expiratory time required to reach a plateau.                                            model were age, body mass index, cumulative smoking (pack-years), FEV1 , FVC,
Funding National Institutes of Health HL075476, HL077612, N01-HC-95159                  transfer coefficient (DLCO /VA% ), lung hyperinflation (RV/TLC%), respiratory mus-
through N01-HC-95165, and N01-HC-95169.                                                 cle strength (PImax), PaO2 , PCO2 , hematocrit, pulmonary artery pressure (mPAP
                                                                                        – Doppler echocardiography), symptoms (Anthonisen scale), dyspnea (American
                                                                                        Thoracic Society scale), comorbidity (Charlson index), exacerbation rate (number
P2623                                                                                   of exacerbations in previous year) and exercise performance (6MWT). PImax
Use of respiratory drugs, flu vaccination and anti-smoking advice in patients            was among the variables that independently related to mortality (relative risk =
with COPD from 5 Latin American cities: the PLATINO study                               0.91; 95% confidence interval 0.85 - 0.97; p=0.005). Actual Kaplan-Meier survival
M.V. Lopez Varela 1 , A. Muinio 1 , A. Menezes 2 , P. Hallal 2 , R. Perez Padilla 3 ,   curves were plotted for the two subgroups of patients subdivided according to the
J. Jardim 4 , G. Valdivia 5 , J. Pertuze 5 , C. Talamo 6 , M. Montes de Oca 6 ,         mean value of PImax (cutoff value = 50 cm H2 O). There was significant difference
R. Halbert 7 . 1 Pulmonary Div, Universidad de la Republica del Uruguay,                in survival rate between subgroups (p<0.001).
Montevideo, Uruguay; 2 Epidemiology Div, Federal University of Pelotas, Pelotas,        In conclusion low PImax was associated with overall mortality in this cohort of
Brazil; 3 Pulmonary Function Div, Institute of Respiratory Diseases, Mexico,            COPD patients.
Mexico; 4 Pulmonary Div, Federal University, Sao Paulo, Brazil; 5 Public Health
Div, Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile;
6
  Pulmonary Div, Universidad Central de Venezuela, Caracas, Venezuela;                  P2626
7
  Statistics Div, UCLA School of Public Health, Los Angeles, CA, United States          The ratio of lean-to-fat mass and functional limitation in COPD
                                                                                        Mark D. Eisner 1 , Carlos Iribarren 2 , Edward H. Yelin 1 , Steven Sidney 2 , Patricia
The PLATINO study provides a unique opportunity to assess COPD treatment                P. Katz 1 , Phenius V. Lathon 2 , Irina Tolstykh 2 , Paul D. Blanc 1 . 1 Medicine,
patterns in 5 Latin American cities. Using a probability sample of adults aged          University of California, San Francisco, San Francisco, CA, United States;
                                                                                        2
40 and older, a total of 5571 interviews and 5315 spirometries were completed.            Division of Research, Kaiser Permanente Northern California, Oakland, CA,
Overall, 758 individuals had spirometric evidence of COPD (postbronchodilator           United States
FEV1 /FVC<70%). In this population, age was 64.1 ± 12.3 yrs; smoking expo-
sure was 19.4 ± 27.6 pack-yrs; GOLD stages were I 9.4%, II 33.8%, III 5.4%,             Body composition abnormalities, especially low body mass index, have been linked
IV 1.4%. Out of these, 672 (86.7%) subjects had no prior clinical diagnosis of          with increased mortality in COPD. The impact of body composition on physical
COPD. Compared with diagnosed subjects, undiagnosed ones were significantly              functional limitation, however, is less clear. We used data from 355 adults with
less symptomatic(p<0.001), less likely to have performed spirometry (19.9% vs.          COPD who were enrolled in the FLOW cohort study to evaluate the impact of
52.3%),or have received any respiratory medication (18.2% vs. 75.6%), any bron-         body composition on the risk of functional limitation, controlling for pulmonary
chodilator (8% vs. 36%) or any corticosteroid (1.2% vs. 12.8%), but were not            function impairment. The primary measure of body composition, the ratio of
less likely to receive flu vaccine (26.9% vs. 32.6%). Among the 519 current and          lean-to-fat mass, was calcluate by bioelectrical impedance. The key functional
former smokers with COPD, 461 (88.8%) had no prior clinical diagnosis. Com-             limitation outcomes were (1) self-reported difficulty or inability to perform any
pared with correctly diagnosed, smokers without prior diagnosis were significantly       of 10 domains of upper and lower body physical functioning and (2) distance
less likely to have received medical counselling to stop smoking in their lifetime      walked during the Six Minute Walk Test (SMWT). Multivariate analysis was
(50.8% vs. 69.0%) or in the past year (12.8% vs. 25.9%). Our study shows, even          used to control for age, height, FEV1 /FVC, race, education, and smoking history.
among those accurately diagnosed, that COPD treatment with respiratory drugs            Higher lean-to-fat ratio was associated with a lower risk of self-reported functional
differs considerably from that proposed by global guidelines, more important, anti      limitation among women (OR 0.45 per each 0.50 increment in lean-to-fat ratio;
smoking advice and influenza prevention is offered uncommonly.                           95% CI 0.28 to 0.74) but not in men after controlling for FEV1 /FVC and the other
                                                                                        covariates. Greater lean-to-fat ratio was also associated with a longer distance
                                                                                        walked during the SMWT among both men and women (mean increase 40 meters
P2624                                                                                   per 0.50 increment in lean-to-fat ratio; 95% CI 9 to 71 meters and 162 meters;
Short- and long-term mortality of COPD patients treated in the respiratory              95% CI 97 to 228 meters, respectively). In conclusion, a greater proportion of lean
intensive care unit for acute respiratory failure                                       mass relative to fat mass appears to be protective for physical functional limitation
Tulay Yarkin, Dilay Demiryontar, Zuhal Karakurt, Nalan Adiguzel, Hilal Altinoz.         in COPD, even after taking pulmonary function impairment into account. Body
Respiratory Intensive Care Unit, SB Sureyyapasa Chest and Cardiovascular                composition may be an important non-pulmonary impairment in the development
Diseases Teaching Hospital, Istanbul, Turkey                                            of COPD-related disability.

Aim: To evaluate the prognosis of COPD patients with acute respiratory failure
admitted to respiratory intensive care unit (RICU).Design: Retrospective cohort         P2627
study of 107 COPD patients admitted to RICU between April 2001 and June 2003.           Declared work loss in active subjects with undiagnosed airflow obstruction
Method: Patients’ demografics, clinical and laboratory data were recorded from           from the general population
the hospital files. Patients were followed up 2 years after discharge from the           Nicolas Roche, François Dalmay, Thierry Perez, Claude Kuntz,
hospital by review of the clinical notes and telephone contacts to be informed their    Jean-Pierre Giordanella, Françoise Neukirch, Alain Vergnenègre, Gérard Huchon.
current status and survival time.                                                       on Behalf of the Scientific Committee and Investigators, CES2 Study, Paris,
Results: Mean age was 61,7±9 (39-80), F/M ratio 12/95. Seventy-eight patients           France
received NIMV, 25 received IMV. RICU and in-hospital mortality rates were
11,2% and 15,9%, respectively. Variables predictive for in-hospital mortality were      COPD is markedly under-diagnosed and may induce significant work loss even in
having lower baseline HCO3 (p:0.03,OR:0.717) and higher PaCO2 at the time               patients with mild disease. To explore that issue, data from a large French popu-
of discharge from RICU (p:0.013,OR:1.270). The mortality rates at 1, 3, 6,              lation survey were analyzed. 4764 subjects aged 40 years or more were recruited
12 and 24 months were 24.3%, 32.7%, 37.4%, 46.7% and 61.7%, respectively,               during systematic visits to national health prevention centres. A questionnaire in
following admission to the RICU. The median survival time was 13.5 months.              part derived from the European Community Respiratory Health Survey was used
Variables predictive for 1 month mortality were higher age (p:0.01,OR:1.119),           and spirometry was performed. Age was 60±10 years, male/female ratio was 1.08,
receiving IMV at RICU (p:0.03,OR:4.855), higher APACHE II score on admis-               31.8% were ex-smokers and 18.6% current smokers. 98.6% of the population was
sion of RICU (p:0.002,OR:1.241), and using long term oxygen therapy (LTOT)              active. 429 subjects declared current asthma (9.1%) and 534 reported a diagnosis of
(p:0.01,OR:8.774). Factors predictive for 1 year survival were using LTOT and           chronic bronchitis, chronic obstructive lung disease, bronchiectasis or heart failure.
NIMV at home (p:0.028, OR: 2.773 and p:0.026,OR:4.815, respectively), and for           In the 3748 remaining subjects, airflow obstruction (FEV1/FVC<0.70) was present
2 years using LTOT (p:0.026, OR:2.471).                                                 in 7%. Among these, FEV1 was ≥ 80% predicted in 59.0% and between 50% and
Conclusions: Although COPD patients with ARF treated in ICU have a good early           80% predicted in 36.1%. Chronic bronchitis was reported by 3.9% of subjects.
survival, their long-term prognosis is poor. Besides LTOT, we found that NIMV           The overall prevalence of COPD (including GOLD stage 0) was 10.2%. Duration
positively affected the long-term survival in such patients.                            of declared work loss during the previous year was highly variable (mean±SD:
                                                                                        1.8±17.3 days). It tended to be higher in subjects with chronic bronchitis (3.6±12.9
                                                                                        vs 1.8±17.4 days, p=NS) and was higher when airflow obstruction was present:
P2625                                                                                   6.7±39.1 vs 1.45±14.3 days (p=0.0015). It also tended to be higher when FEV1
Maximal inspiratory pressure predicts mortality in patients with chronic                was 50-80% predicted (5.38±36.2 days) than when it was normal (1.5±13.9 days,
obstructive pulmonary disease in five year follow-up period                              p=NS). In conclusion, in patients with no known respiratory disease, undiagnosed
Vladimir A. Hodzhev 1 , Stefan S. Kostianev 2 . 1 Pulmonology, Medical University,      mild-to-moderate COPD may be a significant cause of working time loss.
Plovdiv, Bulgaria; 2 Pathophisiology, Medical University, Plovdiv, Bulgaria             Institutional support: CETAF-CNAMTS, CNMR.
                                                                                        Financial support: Boehringer Ingelheim France, Pfizer.
The aim of this study was to assess the prognostic role of a large set of pa-


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         Thematic Poster Session                                                                                                        Hall B2-17 - 12:50-14:40
                                                               M ONDAY, S EPTEMBER 4 TH 2006

P2628                                                                                    Conclusion: Nutritional disorders are more frequent in COPD than healthy cases.
Comparative study about the permanent work capacity impairment in                        Obesity’s frequency is similar in both groups; malnutrition is more common in
COPD and asthma                                                                          COPD. As COPD stage progresses, incidence of malnutrition increases. Results
Olimpia I. Nicolaescu. Pneumology II Ward, “Dr. Victor Babes” Clinical                   indicate that airflow limitation and nutrition are related conditions.
Infectious Diseases Hospital, Bucharest, Romania

We retrospectively reviewed the medical records of 1247 adults patients, 460 with        P2631
asthma (180 men, 280 women, the mean age 48.8 years) and 787 with COPD                   Frequency of α-1 antitrypsin deficiency (AATD) in a population screening in
(504 men, 283 women, the mean age 62.8 years), hospitalised between January              an high risk area (Val Trompia, Italy)
2001 and December 2005. Asthma was associated with permanent work capacity               Nuccia Gatta 1 , Luciano Corda 2 , Daniela Medicina 3 , Giovanni Moretti 4 ,
impairment in 118 patients (51 men, 67 women), 45.5% for all retirements. In             Fabio Facchetti 3 , Enrica Bertella 5 , Valentina Pinelli 5 , Mirella Barbaglio 3 ,
COPD, 73.5% from retired patients were to retiring age, only 26.5% (108 men,             Bruno Balbi 6 . 1 Associazione Nazionale Alfa-1 AT, Italian Association AATD
60 women) do not work anymore for medical reasons. Considering that the re-              Patients, Sarezzo, Brescia, Italy; 2 Centro Riferimento AATD, Prima Medicina,
tired age is in Romania 57 years for women and 62 years for men, the asthma              Spedali Civili, Brescia, Italy; 3 Centro Riferimento AATD, Prima Anatomia
patients lose for their active life medium 13.4 years for men and 8.1 years for          Patologica, Spedali Civili, Brescia, Italy; 4 Laboratorio Analisi - Gardone Val
women, and COPD patients lose respectively 11 and 3.6 years. Reduced current             Trompia, Spedali Civili, Brescia, Italy; 5 Cattedra Malattie Apparato
employment in asthma and COPD was associated with severe and very severe                 Respiratorio, Universita di Brescia, Brescia, Italy; 6 Centro Riferimento AATD -
forms in 69.5% asthma patients and 81.8% in COPD patients, respiratory failure in        Pneumologia, Fondazione S Maugeri, Gussago, Brescia, Italy
13.5% respectively 23.6%, more comorbidity in 59.3% respectively 58.3%, use of
oral corticosteroids and their adverse reactions in 21.2% respectively 6.5% cases.       From 1996, at Brescia Hospital there is a hospital-based, case-finding program that
Work limitation appears to be more common among persons with asthma. The                 contributed with 63 cases to the Italian Registry (IR) of AATD. IR data shows a
medical retired asthma patients are younger than COPD patient. Men lose a longer         north-south gradient for Z frequency. Our records in Brescia show that many case
period of their active life in both affections. Oral corticosteroids adverse reactions   families originated from an Alp Valley (Val Trompia). Our aim was to determine
were associated with invalidity occurrences especially in asthma, when respiratory       the prevalence of AATD in Val Trompia by a population screening enhancing the
failure is more common in COPD. The comorbidity does not differentially affect           value of new molecular methods.
the work capacity in COPD and asthma.                                                    Methods: Blood was drawn to residents who consented. Serum levels of AAT
                                                                                         (nephelometric method), GOT and GPT were determined, PCR for Z and S alleles
                                                                                         was performed. MRC dyspnea score and European Community Respiratory Health
P2629                                                                                    Survey (ECRHS) questionnaires were administered.
Prevalence of comorbid cardiovascular conditions in Russian patients with                Results: Out of 1,236 adult residents, 815 (66%) consented and 71 (8,7%) had
chronic obstructive pulmonary disease                                                    AAT levels < 90 mg/dl, our threshold of normal range. We observed 1 PIZZ (AAT
Vasiliy Pyankov, Yulia Chuyasova. Department of Internal Diseases, Kirov State           23 mg/dL, GOT and GPT normal, MRC score 0, ECRHS normal), 1 PISS (AAT
Medical Academy, Kirov, Russia                                                           86, GOT and GPT abnormal, MRC score 1, ECRHS normal), 48 PIMZ (AAT
                                                                                         76, GOT and GPT abnormal in 6 and 5 subjects, MRC score 1.12+0.4, ECRHS
Purpose: The purpose of this study was to estimate the prevalence of comorbid            abnormal in 4 subjects), 53 PIMS (AAT 111.3+21, GOT and GPT abnormal in
cardiovascular conditions in Russian patients with COPD.                                 7 and 5 subjects, MRC score 1.5+1.1, ECRHS abnormal in 5 subjects). Further
Material and Methods: 134 hospitalized men (mean age was 64.0±10.2 years;                DNA analysis to rule out rare AATD alleles is ongoing. This Z and S frequency
mean smoking history was 41.4±9.7 pack-years) with exacerbation of COPD were             is significantly higher than the expected Italian one. A part from volunteers, each
included in this study. In all patients blood pressure and anthropometric measure-       subject test costed 75 Euros.
ments (BMI, abdominal circumference), laboratory tests (LDL-cholesterol, whole           Conclusions: This study confirms the high prevalence of AATD in Val Trompia
capillary blood glucose), instrumental investigations (spirometry, echocardiogra-        area; furthermore it indicates that population screening with genetic technology in
phy, duplex ultrasound) and questionnaire interviews were performed.                     selected areas with suspected high frequency of AATD may result cost-effective,
Results: Arterial hypertension was detected in 36.5% of cases (49 patients): grade       allowing early diagnosis of AATD.
2 hypertension - in 75.5% (37 patients), grade 3 hypertension – in 24.5% (12
patients). Coronary artery disease (CAD) (history of myocardial infarction and
angina) were revealed in 9.7% of cases (13 patients). Lower extremity peripheral         P2632
arterial disease was detected in 2.2% of cases (3 patients). Diabetes was detected       Alpha1 -antitrypsin deficiency-related PI*Z and PI*S alleles in a random
in 2.2% of cases (3 patients). Abdominal obesity (abdominal circumference ≥              sample of Polish population
102 cm, BMI > 30 kg/m2 ) was revealed in 2.9% of cases (4 patients). Secondary           Marcin Kaczor, Marek Sanak, Andrew Szczeklik. Internal Medicine, Jagiellonian
pulmonary arterial hypertension was detected in 38.7% of cases (19 patients).            University School of Medicine, Kraków, Poland
Conclusions: Our study confirmed high prevalence of comorbid cardiovascular
conditions in Russian COPD patients. Arterial hypertension was the most frequent         Alpha1 -antitrypsin (AAT) deficiency is a common hereditary disorder in Cau-
cardiovascular disease in this group of patients. Prognosis of these patients is         casians leading to an early onset COPD and/or liver diseases.
characterized by an increased risk for cardiovascular ischemic events. Physicians        Population-based cross-sectional study aimed to estimate the deficiency alleles
should detect these comorbid conditions in COPD patients. Patients should be             was conducted on representative sample of residents of Krakow, with a population
treated in view of concomitant cardiovascular disorders and COPD.                        of about 760000. A random, stratified sampling method selected 686 men and 814
                                                                                         women. Participants were invited for the study by a letter. The overall response rate
                                                                                         was 37% and was higher in older age groups than in work-active strata. A short
P2630                                                                                    health questionnaire and samples of blood were obtained upon informed consent.
Nutritional distribution in COPD                                                         AAT genotyping of was performed using a validated real-time qualitative PCR
Ayse Baccioglu, Turan Acican. Department of Pulmonary Medicine, Ankara                   based on 5’-nuclease assay and dual-labeled fluorescence, allele specific probes.
University Faculty of Medicine, Ankara, Turkey; Department of Pulmonary                  Among 550 individuals tested the PI*S allele frequency was 1.73% and PI*Z –
Medicine, Ankara University Faculty of Medicine, Ankara, Turkey                          1.09%. Because the results did not differed with a previously collected sample of
                                                                                         inner city district inhabitants, therefore we cumulated these data. In the total of 859
Introduction: In COPD, weight is a significant predictor of survival. Properties of       Krakow residents, the PI*S allele frequency was 1.75% (95% CI: 1.11 – 2.44%)
this relationship are unclear, but establishing nutritional composition may explain      and the PI*Z – 1.05 (95% CI: 0.58 – 1.57%). The studied population conforms to
the reason-result relation.                                                              the Hardy-Weinberg equilibrium.
Aim: To assess nutritional distribution in COPD and healthy cases.
Method: Stable 180 COPD and 50 healthy cases were compared by respi-                     Expected prevalence
ratory functions and nutritional aspects. We grouped FEV1 >80% as controls,              Population              MS            MZ              SZ            SS             ZZ
50%<FEV1 <80% as moderate, 30%<FEV1 <50% as severe, FEV1 <30% as very
severe COPD. Malnutrition BMI<20, obesity BMI> 25, ideal BMI=20-24.9 were                38 161 313            1 295 522     777 313         13 964         11 636        4 189
defined based on WHO.
Results: Prevalence of ideal BMI was 48.9% in COPD, 60% in controls. 51% of              Presented data are the first large-scale population-based molecular estimates of the
patients and 40% of controls had nutritional disorders (malnutrition and obesity).       AAT deficiency alleles in Poland, based on a representative sample. The previous
While 21.7% of patients and 12% of controls had malnutrition, 29.4% of patients          reports underestimated prevalence of PI*Z allele. The study proved real-time PCR
and 28% of controls had obesity (p>0.05). Frequency of ideal BMI and obe-                method to be a fast and inexpensive choice of screening for AAT deficiency.
sity were similar between groups (p>0.05), malnutrition’s frequency was 12.2%            Numbers of AAT deficiency carriers in Poland are high enough to consider a
in controls, 17.4% in moderate, 22.1% in severe, 25% in very severe COPD’s               nationwide screening.
(p<0.05). As COPD stage progressed, body weight decreased (r=0.35, p<0.05).
10% of patients and 4% of controls were thin, 5% of patients and 6% of controls
were mild PEM, 5.6% of patients and 2% of controls were moderate PEM, 1.1%
of patients (no controls) were very sever PEM. All the controls were mild obese,
3.9% of COPD was moderate and 0.6% of COPD was morbid obese. There was
no severe PEM, moderate and morbid obese in healthy cases.


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