Browsing by Author "Malinovschi, Andrei"
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- Bronchodilator responsiveness and future chronic airflow obstruction: a multinational longitudinal studyPublication . Knox-Brown, Ben; Algharbi, Fahad; Mulhern, Octavia; Potts, James; Harrabi, Imed; Janson, Christer; Nielsen, Rune; Agarwal, Dhiraj; Malinovschi, Andrei; Juvekar, Sanjay; Denguezli, Miriam; Gíslason, Thorarinn; Ahmed, Rana; Nafees, Asaad; Koul, Parvaiz A.; Obaseki, Daniel; Anand, Mahesh Padukudru; Loh, Li Cher; Hermínia Brites Dias; Rodrigues, Fátima; Mannino, David; Elbiaze, Mohammed; El Rhazi, Karima; Mejza, Filip; Devereux, Graham; Franssen, Frits; El Sony, Asma; Wouters, Emiel; Al Ghobain, Mohammed; Mortimer, Kevin; Rashid, Abdul; Osman, Rashid; Studnicka, Michael; Cardoso, João; Burney, Peter; Amaral, André; BOLD Collaborative Research GroupBackground: Bronchodilator responsiveness testing is mainly used for diagnosing asthma. We aimed to investigate whether it is associated with progression to chronic airflow obstruction over time. Methods: The multinational Burden of Obstructive Lung Disease cohort study surveyed adults, aged 40 years and above, at baseline and followed them up after a mean of 9.1 years. Recruitment took place between January 2, 2003, and December 26, 2016. Follow-up measurements were collected between January 29, 2019, and October 24, 2021. On both occasions, study participants provided information on respiratory symptoms, health status, and several environmental and lifestyle exposures. They also underwent pre- and post-bronchodilator spirometry. We defined bronchodilator responsiveness at baseline using the American Thoracic Society and European Respiratory Society (ATS/ERS) 2022 definition, and the presence of chronic airflow obstruction at follow-up as a post-bronchodilator forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) less than the lower limit of normal. We used multi-level regression models to estimate the association between baseline bronchodilator responsiveness and incident chronic airflow obstruction. We stratified analyses by gender and performed a sensitivity analysis in never smokers. Findings: We analysed data from 3701 adults with 56% being women. Compared to those without bronchodilator responsiveness at baseline, those with bronchodilator responsiveness had a 36% increased risk of developing chronic airflow obstruction (RR: 1.36, 95%CI 1.04, 1.80). This effect was stronger in women (RR: 1.45, 95%CI 1.09, 1.91) than in men (RR: 1.07, 95%CI 0.51, 2.24). Never smokers with bronchodilator responsiveness also were at greater risk of incident chronic airflow obstruction (RR: 1.48, 95%CI 1.01, 2.20). Interpretation: Bronchodilator responsiveness appears to be a risk factor for incident chronic airflow obstruction. It is important that future studies in other large population-based cohorts replicate these findings.
- Concordance between FVC and FEV6 for identifying chronic airflow obstruction and spirometric restriction in the Burden of Obstructive Lung Disease (BOLD) studyPublication . Knox-Brown, Ben; Potts, James; Franssen, Frits M. E.; Nielsen, Rune; Denguezli, Meriem; Rotevatn, Anders Ørskov; Juvekar, Sanjay K.; Cherkaski, Hamid Hacene; Studnicka, Michael; Sylvester, Karl Peter; Mortimer, Kevin; Bateman, Eric D.; Janson, Christer; Malinovschi, Andrei; Seemungal, Terence; Koul, Parvaiz; Mannino, David; Mahesh, Padukudru Anand; Jogi, Rain; Mejza, Filip; Al Ghobain, Mohammed; Paraguas, Stefanni Nonna M.; Welte, Tobias; Wouters, Eliel; Gislason, Thorarinn; Harrabi, Imed; Dias, Maria Hermínia Monteiro Brites; Obaseki, Daniel O.; Kocabas, Ali; Barbara, Cristina; Cardoso, João; Agarwal, Dhiraj; Nafees, Asaad Ahmed; Rodrigues, Fatima; Garcia-Larsen, Vanessa; Erhabor, Gregory E.; Loh, Li-Cher; Amaral, Andre F. S.Introduction: We investigated whether the forced expiratory volume in 6 s (FEV6) can be used as a surrogate for the forced vital capacity (FVC). Methods: The Burden of Obstructive Lung Disease is a multinational cohort study. At baseline, data were collected from adults aged 40 years or older, from 41 sites across 34 countries. Participants from 18 sites were followed up after a median of 8.3 years. Participants who completed the study core questionnaire and had acceptable post-bronchodilator spirometry were included. We performed receiver operating characteristic analyses to measure the ability of FEV1/FEV6 less than the lower limit of normal (LLN) to correctly classify FEV1/FVC less than the LLN, and FEV6 less than the LLN to correctly classify FVC less than the LLN. We used multilevel regression analyses to assess the association of discordant measurements with respiratory symptoms, quality of life, and lung function decline. Results: At baseline, 28,604 participants were included. 53% were female (15,060). 10% (2876) had chronic airflow obstruction for FEV1/FVC, compared with 9% (2704) for FEV1/FEV6. 37% (10,637) had spirometric restriction for FVC, compared with 35% (9978) for FEV6. The FEV1/FEV6 had excellent accuracy in identifying FEV1/FVC less than the LLN (area under the curve (AUC): 0.90, 95% CI, 0.89 to 0.91, κ coefficient 0.82). The FEV6 also had excellent agreement in identifying FVC less than the LLN (AUC: 0.95, 95% CI, 0.94 to 0.95, κ coefficient 0.90). Discordant reductions in FEV1/FEV6 (1%, 345) and FEV6 (1%, 309) were associated with greater odds of having respiratory symptoms and a lower physical quality of life. 3870 participants were followed up with. Those with discordant reductions in FEV1/FEV6 and FEV6 were more likely to have chronic airflow obstruction and spirometric restriction at follow-up. Conclusions: There is strong agreement between the FVC and FEV6 in the identification of chronic airflow obstruction and spirometric restriction.