Women and COPD: do we need more evidence? Gut-Gobert, Christophe; Cavaillès, Arnaud; Dixmier, Adrien ...
European respiratory review,
03/2019, Volume:
28, Issue:
151
Journal Article
Peer reviewed
Open access
The increasingly female face of chronic obstructive pulmonary disease (COPD) prevalence among women has equalled that of men since 2008, due in part to increased tobacco use among women worldwide and ...exposure to biomass fuels. This finding is supported by a number of characteristics. There is evidence of susceptibility to smoking and other airborne contaminants, along with epidemiological and phenotypic manifestations. COPD has thus become the leading cause of death in women in the USA. The clinical presentation is characterised by increasingly pronounced dyspnoea with a marked tendency towards anxiety and depression, undernutrition, nonsmall cell lung cancer (especially adenocarcinoma) and osteoporosis. Quality of life is also more significantly impacted. The theories advanced to explain these differences involve the role played by oestrogens, impaired gas exchange in the lungs and smoking habits. While these differences require appropriate therapeutic responses (smoking cessation, pulmonary rehabilitation, long-term oxygen therapy), barriers to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. Faced with this serious public health problem, we need to update and adapt our knowledge to the epidemiological changes.
There are conflicting data regarding the magnitude and determinants of chronic obstructive pulmonary disease (COPD) risk in farmers.In a cross-sectional study of 917 nonfarming working controls and ...3787 farmers aged 40-75 years, we assessed respiratory symptoms, tobacco exposure, job history (without direct exposure measurement) and lung function. COPD was defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.70) and by the Quanjer reference equation (post-bronchodilator FEV1/FVC <lower limit of normal (LLN)).The prevalence (95% CI) of COPD according to the GOLD criterion was 5.1% (4.4-5.8%) and 2.9% (1.8-4.0%) in farmers and controls, respectively (p=0.005), and 3.1% (2.5-3.6%) and 1.5% (0.7-2.3%), respectively, for the LLN criterion (p<0.01). For both COPD criteria after adjustment for age, sex and smoking status, COPD prevalence was similar in controls and crop farmers. Compared to controls, four job categories had a higher prevalence of COPD according to the GOLD criterion, namely, cattle breeders, swine breeders, poultry breeders and breeders of two or more livestock types. Among cattle breeders, only those from Franche-Comté had higher prevalence of COPD according to both GOLD and LLN criteria.The prevalence of COPD in farmers is higher than in nonfarming working controls, and depends on the farming activity, the region and the criterion used to define COPD.
Prolonged occupational agricultural exposure is associated with an increase in asthma diagnosis. This study aimed to identify the prevalence and risk factors for asthma in dairy farmers.
AIRBAg was a ...cross-sectional study including 1203 representative dairy farmers. They completed a self-administered questionnaire and underwent a health respiratory check-up. Referral to a pulmonologist was made for any participant with wheezing, dyspnoea, chronic bronchitis, a chronic cough or a FEV1/FEV6 ratio<80%. They underwent further examinations such as spirometry with a reversibility test. Controls (non-asthmatic dairy farmers and non-farm employees) were matched to each asthma case for sex and age (±5 years). The odds ratios (OR) between asthma and different risk factors were estimated using conditional multivariate logistic regression models.
Active asthma was diagnosed in 107 (8.9%) farmers. Compared with control dairy farmers, there was a positive association with family history of allergy (OR = 8.68; 95% CI 4.26–17.69), personal history of eczema (OR = 3.39; 95% CI 1.61–7.13), hay manipulation (OR = 5.36, 95% CI 1.59–18.01), and a negative association with farm area (OR = 0.92; 95% CI 0.85–0.99) and handling treated seeds (OR = 0.47; 95% CI 0.23–0.95). Compared with control non-farm employees, there was a positive association between asthma and family history of allergy (OR = 95.82, 95% CI 12.55–731.47).
The prevalence of active asthma in dairy farmers was somewhat higher than the rate observed in the general population but may be controlled by reducing exposure to airborne organic contaminants through occupational adaptions on farms.
•There is a high prevalence of asthma in dairy farmers in France.•Family history of allergy is positively associated with asthma.•Personal history of eczema is positively associated with asthma.•Hay handling is positively associated with asthma.•Asthmatic farmers run smaller farms and handle less treated seeds.
The AIRBAg study was designed to assess the prevalence of chronic obstructive pulmonary disease (COPD) in dairy farmers and to define its associated risk factors.
Between March 2012 and February 2017 ...randomly selected dairy farmers in the French region of Brittany were asked to complete a self-administered questionnaire and undergo an occupational health check-up with electronic mini-spirometry and standard spirometry. Those having one or more of the following features: chronic cough, chronic bronchitis, wheezing, dyspnea and/or a ratio FEV1/FEV6 < 80% were then referred to a pulmonologist for further check-up including spirometry with a reversibility test. Each COPD case was matched with three controls (dairy farmers and non-farm employees), for sex and age ( ± 5 years). Conditional multivariate logistic regression models were used to estimate the odds ratios between COPD occurrence and various risk factors.
The 1203 farmers examined included 525 (43.6%) who were "at risk of bronchial obstruction" and 432 (35.9%) of these saw the pulmonologist. This screening identified 16 (1.3%) cases of COPD, including eight non-smokers and five with an FEV1 < 80% of predicted values. Their average age was 54.6 ( ± 7.7) years and 10 of them were men. None complained of illness before the study. Multivariate analyses revealed no significant occupational risk factors for COPD.
This unexpected result may be because Breton dairy farms began to modernize early (1950s), giving rise to conditions with much lower exposure to airborne contaminants.
•Occupational exposure could be involved in the pathophysiology of COPD.•A total of 1203 dairy farmers (Brittany, France) were screened for COPD.•Risk factors were identified by comparing COPD cases with two control populations.•Multivariate analyses revealed no significant occupational risk factors for COPD.•Farm modernization from 1950 onwards could explain this unexpected result.
Objectives
People at risk of chronic obstructive pulmonary disease (COPD) can benefit from appropriate medical management before severe symptoms appear. This study assesses the value of the COPD ...Assessment Test (CAT) questionnaire for screening dairy farmers, who tend to be slow or reluctant to seek health care.
Methods
During the time period 2012‐2017, 2089 randomly selected dairy farmers in Brittany (France) were invited to complete self‐administered questionnaires (including the CAT) and to undergo an occupational health check‐up using an electronic mini‐spirometer and conventional spirometry. Those showing symptoms suggestive of COPD and/or a ratio FEV1/FEV6 < 80% were sent to a pulmonologist for a further check‐up, including spirometry with a reversibility test. Multivariate logistic models based on CAT scores and socio‐demographic or work‐related factors were developed to predict COPD.
Results
The 1231 farmers who underwent the occupational health check‐up included 1203 who met the inclusion/exclusion criteria. Pulmonologist identified 16 (1.3%) cases of COPD. A multivariate logistic regression model (covariates: CAT sum score, on‐farm time, BMI, smoking status, free‐stall mulching) provided an area under the receiver‐operating characteristic curve (AUC) of 0.87 (95% CI: 0.75‐0.98). Using a cut‐off of 0.007 gave a sensitivity of 93.8% and a specificity of 62.4%. Another model that included CAT breathlessness and the same covariates performed marginally better (AUC = 0.88, 95% CI: 0.77‐0.98).
Conclusion
Our predictive models can both benefit dairy farmers by providing early diagnosis and management of their COPD and avoid unnecessary, costly spirometry during the screening process.
Bronchogenic carcinoma (BC) is a worldwide health public problem with a parallel but delayed development to smoking. The prognosis of BC in young patients is poorly known mainly because of few ...studies that have looked at this group of patients. The hypothesis of our study is that ‘young’ patients with BC have a better prognosis than others.
We conducted a retrospective epidemiologic study of all patients aged 45 and under (n=73) followed for BC between 2002 and 2007 in two hospitals in the central region in France, compared with patients over 45years random (n=73). We evaluated the clinical characteristics (sex, smoking habits, WHO status, clinical presentation, histology, TNM stage), the management and prognosis of these patients.
The median survival of patients aged 45 and under was 13.4months against 8.9months for patients over 45years. In multivariate analysis, age is not an independent prognostic factor (P=0.41) in contrast to the WHO status (P=0.002) and initial TNM stage (P<0.001). There was no significant difference for other clinical characteristics between the two patient populations.
In our study, the better prognosis of the “young” patient group is not directly related to age but in good condition and lower TNM stage of these patients.
Le pronostic du carcinome bronchopulmonaire (CBP) chez les sujets jeunes est mal connu en raison du faible nombre d’études. L’hypothèse de notre étude était que les patients « jeunes » atteints de CBP auraient un meilleur pronostic que les autres.
Nous avons réalisé une étude épidémiologique rétrospective sur tous les patients de 45ans et moins suivis pour un CBP entre 2002 et 2007 dans deux centres hospitaliers de la région Centre, en les comparant avec des patients de plus de 45ans tirés au sort. Les caractéristiques cliniques, la prise en charge et le pronostic de ces patients ont été évalués.
Nous avons analysé les dossiers de 73 patients de 45ans et moins, et de 73 patients de références de plus de 45ans. La médiane de survie des patients de 45ans et moins était de 13,4 mois contre 8,9 mois pour les autres patients. En analyse multivariée, l’âge n’était pas un facteur pronostique (p=0,41). Le statut OMS (p=0,002) et le stade TNM initial (p<0,001) étaient des facteurs pronostiques.
Le meilleur pronostic du groupe de patients « jeunes » n’est pas directement lié à l’âge mais plutôt au bon état général et au stade TNM plus faible de ces patients.
Bronchogenic carcinoma (BC) is a worldwide health public problem with a parallel but delayed development to smoking. The prognosis of BC in young patients is poorly known mainly because of few ...studies that have looked at this group of patients. The hypothesis of our study is that 'young' patients with BC have a better prognosis than others.
We conducted a retrospective epidemiologic study of all patients aged 45 and under (n=73) followed for BC between 2002 and 2007 in two hospitals in the central region in France, compared with patients over 45 years random (n=73). We evaluated the clinical characteristics (sex, smoking habits, WHO status, clinical presentation, histology, TNM stage), the management and prognosis of these patients.
The median survival of patients aged 45 and under was 13.4 months against 8.9 months for patients over 45 years. In multivariate analysis, age is not an independent prognostic factor (P=0.41) in contrast to the WHO status (P=0.002) and initial TNM stage (P<0.001). There was no significant difference for other clinical characteristics between the two patient populations.
In our study, the better prognosis of the "young" patient group is not directly related to age but in good condition and lower TNM stage of these patients.
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