The GOLD 2007 guidelines stage COPD using FEV1. Clinical findings were added to GOLD 2011 to improve management. In a large study assessing data from 22 COPD cohorts (15632 patients; 70184 person-years), COPD was defined as mild in 16%, moderate in 46%, severe in 28% and very severe in 11% according to FEV1 alone. For 14660 patients, GOLD 2011 staging was applied, and 38% were grade A, 19% grade B, 13% grade C and 31% grade D. GOLD 2011 criteria shifted patients towards more severe COPD categorisation. Neither system showed enough discrimination power to predict 3 year mortality. Outcomes are not necessarily improved by more intense treatment due to GOLD 2011 staging.
Screening of 112,330 households in 9 Asia-Pacific territories yielded 4,289 patients with COPD out of 69,279 people aged >40. Subjects were interviewed and completed a questionnaire to assess the COPD burden. Overall COPD prevalence was 6.2%, and severe COPD prevalence was 19.1%. Exacerbations in the previous year were reported by 46% with 19% reporting hospitalization. Ability to work was reported as limited by 42% while 23% reported not working because of their COPD. 20% of those taking prescription drugs could not name their drugs. Inhaler use was low at 25% and 44% reported steroid use in the previous year. Of the 37% who had undergone spirometry, 89% did not know the result.
In 1990 the prevalence of asthma amongst preschool children in Shanghai was estimated as 2.1%. This had risen to 10.2% in a recently published study where 14884 parents/guardians completed questionnaires on the health of their children aged 3-7. Other prevalence reported included wheeze 28.1%, pneumonia (ever) 33.5%, otitis media 11%, rhinitis (ever) 54.1%, hay fever 12.2%, eczema (ever) 22.7% and food allergy 15.7%. Most morbidities were commoner in urban than suburban children and asthma was commoner in boys than girls. According to the authors the increasing prevalence over time of these common conditions may be attributed to alterations in environmental exposures.
According to a review of studies on asthma and COPD, asthma-COPD overlap affects around 20% of obstructive airways disease patients. Morbidity was greater in these patients than in those with just one of the conditions, and mortality and comorbidity were possibly also greater. Histology of airway inflammation was heterogeneous including eosinophilic, neutrophilic or mixed infiltrates. Patients with asthma-COPD overlap also had systemic inflammation similar to those with COPD. Much remains to be discovered about asthma-COPD overlap, including ways of identifying different subgroups and identification of clinical aspects that affect outcomes and personalised treatment strategies.
The 12 item RAND Negative Impact of Asthma on Quality of Life scale evaluates asthma specific quality of life (QoL). Before controlling for elements of asthma control, asthma severity and symptoms strongly predicted asthma specific QoL in 2032 adult asthmatics. When other aspects of asthma control were controlled in regression models, symptoms and severity emerged as poorer QoL predictors, and asthma control and social role/activity –related elements of QoL emerged with the strongest value predicting asthma specific QoL. The authors suggested that researchers into effects of asthma on QoL should recognize the impact of asthma control as evaluated by standardized scales.
In a Canadian study where 90% of women were on welfare, congenital malformation prevalence was increased in women with moderate-to-severe asthma exacerbations in early pregnancy. In a re-evaluation of the subject in 36587 asthmatic pregnancies by the same researchers, malformation prevalence for severe, moderate and no 1st trimester exacerbations was 19.1%, 11.7% and 12% respectively. Moderate exacerbations were not associated with malformations. Severe exacerbations had OR of 1.64 (95% CI 1.02-2.64) for malformations compared to no exacerbations. The authors stated that risk may have been overestimated in the prior study because most women were of low socioeconomic status.
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