Dan Xiao1, Zhengming Chen2, Sinan Wu3, Kewu Huang4, Jianying Xu5, Lan Yang6, Yongjian Xu7, Xiangyan Zhang8, Chunxue Bai9, Jian Kang10, Pixin Ran11, Huahao Shen12, Fuqiang Wen13, Wanzhen Yao14, Tieying Sun15, Guangliang Shan16, Ting Yang17, Yingxiang Lin4, Jianguo Zhu18, Ruiying Wang5, Zhihong Shi6, Jianping Zhao7, Xianwei Ye8, Yuanlin Song9, Qiuyue Wang10, Gang Hou10, Yumin Zhou11, Wen Li12, Liren Ding12, Hao Wang13, Yahong Chen14, Yanfei Guo15, Fei Xiao18, Yong Lu4, Xiaoxia Peng19, Biao Zhang16, Zuomin Wang20, Hong Zhang4, Xiaoning Bu4, Xiaolei Zhang17, Li An4, Shu Zhang4, Zhixin Cao4, Qingyuan Zhan17, Yuanhua Yang4, Lirong Liang21, Zhao Liu1, Xinran Zhang3, Anqi Cheng1, Bin Cao17, Huaping Dai17, Kian Fan Chung22, Jiang He23, Chen Wang24. 1. Tobacco Medicine and Tobacco Cessation Center, China-Japan Friendship Hospital, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. 2. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 3. Data and Project Management Unit, China-Japan Friendship Hospital, Beijing, China; Center of Respiratory Medicine, and Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. 4. Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China. 5. Department of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China. 6. Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 7. Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 8. Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, China. 9. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China. 10. Department of Pulmonary and Critical Care Medicine, First Hospital of China Medical University, Shenyang, China. 11. State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China. 12. Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China. 13. State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China. 14. Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China. 15. Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China; National Center of Gerontology, Beijing, China. 16. Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. 17. Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China. 18. National Center of Gerontology, Beijing, China. 19. Clinical Epidemiology and Evidence-based Medicine, Capital Medical University, Beijing, China; Beijing Children's Hospital, National Center for Children's Health, Beijing, China. 20. Department of Stomatology, Capital Medical University, Beijing, China. 21. Department of Epidemiology, Capital Medical University, Beijing, China; Beijing Institute of Respiratory Medicine, Beijing, China. 22. National Heart and Lung Institute, Imperial College London and Royal Brompton and Harefield NHS Trust, London, UK. 23. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. 24. Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Beijing Chao-Yang Hospital, Department of Respiratory Medicine, Capital Medical University, Beijing, China. Electronic address: wangchen@pumc.edu.cn.
Abstract
BACKGROUND: Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China. METHODS: From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV1 and FEV1/forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV1 and FEV1/FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data. FINDINGS: Overall the prevalence of small airway dysfunction was 43·5% (95% CI 40·7-46·3), pre-small airway dysfunction was 25·5% (23·6-27·5), and post-small airway dysfunction was 11·3% (10·3-12·5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2·5 μm (PM2·5) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m2. The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or pre-small airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM2·5, and increase of BMI by 5 kg/m2 were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China. INTERPRETATION: In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM2·5 exposure and increase of BMI by 5 kg/m2. Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population. FUNDING: Ministry of Science and Technology of China; National Natural Science Foundation of China; National Health Commission of China.
BACKGROUND: Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China. METHODS: From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV1 and FEV1/forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV1 and FEV1/FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data. FINDINGS: Overall the prevalence of small airway dysfunction was 43·5% (95% CI 40·7-46·3), pre-small airway dysfunction was 25·5% (23·6-27·5), and post-small airway dysfunction was 11·3% (10·3-12·5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2·5 μm (PM2·5) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m2. The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or pre-small airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM2·5, and increase of BMI by 5 kg/m2 were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China. INTERPRETATION: In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM2·5 exposure and increase of BMI by 5 kg/m2. Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population. FUNDING: Ministry of Science and Technology of China; National Natural Science Foundation of China; National Health Commission of China.
Authors: Lauren Prisco; Matthew Moll; Jiaqi Wang; Brian D Hobbs; Weixing Huang; Lily W Martin; Vanessa L Kronzer; Sicong Huang; Edwin K Silverman; Tracy J Doyle; Michael H Cho; Jeffrey A Sparks Journal: Arthritis Rheumatol Date: 2021-09-26 Impact factor: 10.995
Authors: G Talamonti; Davide Colistra; Francesco Crisà; Marco Cenzato; Pietro Giorgi; Giuseppe D'Aliberti Journal: J Neurol Date: 2020-09-10 Impact factor: 4.849
Authors: Arnav Agarwal; John Basmaji; Fiona Muttalib; David Granton; Dipayan Chaudhuri; Devin Chetan; Malini Hu; Shannon M Fernando; Kimia Honarmand; Layla Bakaa; Sonia Brar; Bram Rochwerg; Neill K Adhikari; Francois Lamontagne; Srinivas Murthy; David S C Hui; Charles Gomersall; Samira Mubareka; Janet V Diaz; Karen E A Burns; Rachel Couban; Quazi Ibrahim; Gordon H Guyatt; Per O Vandvik Journal: Can J Anaesth Date: 2020-06-15 Impact factor: 6.713