Kroniskt Obstruktiv Lungsjukdom Höjdpunkter från ERS

Docent Ann Lindberg, överläkare Institutionen för Folkhälsa och Klinisk medicin,

Enheten för Medicin, Umeå Universitet Lung- och Allergimottagningen

Sunderby sjukhus, Luleå

Global and regional trends in mortality from chronic obstructive pulmonary disease:

Their relation to poverty, smoking and population change

Jämförde KOL-mortalitet 1990 och 2010

Individer > 40 års ålder (BOLD)

Ålder, kön, inkomst/capita, kumulativt ’rökindex’

Total antal dödsfall sjönk något;

2,995,058 (1990) 2,837,877 (2010)

J. Patel, P. G. J. Burney, R. B. Newson, C. Minelli, M. Naghavi

Global and regional trends in mortality from chronic obstructive pulmonary disease:

Their relation to poverty, smoking and population change

Jämförde KOL-mortalitet 1990 och 2010

Individer > 40 års ålder (BOLD) Ålder, kön, inkomst/capita, kumulativt ’rökindex’

Total antal dödsfall sjönk något;

2,995,058 (1990) 2,837,877 (2010)

Förändring i åldersdistribution ökad mortalitet

Förbättrade ekonomiska förhållanden minskade mortalitet

J. Patel, P. G. J. Burney, R. B. Newson, C. Minelli, M. Naghavi

Distribution and outcomes of the new Spanish phenotype-based guideline for COPD

Syfte: - att kartlägga distribution av fenotyper vid KOL och skillnader med avseende på demografi och kliniskt förlopp Metod: - multicenter poliklinisk KOL-kohort i Spanien, n=831 - stabila vid base-line - ett års uppföljning

B. G. Cosio et al, poster

Distribution and outcomes of the new Spanish phenotype-based guideline for COPD

NE non-exacerbator phenotype

ACOS asthma-COPD overlap syndrome

EE frequent exacerbator phenotype with emphysema

ECB frequent exacerbator phenotype with bronchitis

Fördelning: NE 66.2%, ACOS 15.0%, EE 4.6%, ECB 11.9%

2.3% var freq exacerbators utan att vara EE el ECB

B. G. Cosio et al, poster

Distribution and outcomes of the new Spanish phenotype-based guideline for COPD

Signifikanta skillnader mellan grupperna

ålder, kön, symtom, FEV1 och BODE-index

ECB signifikant mest symtom (CAT-score)

EE och ECB hade oftare farmakologisk behandling hade signifikant mer exacerbationer vid uppföljn

B. G. Cosio et al, poster

The BODE index predicts mortality better than 2007 GOLD and GOLD ABCD

N= 96 (55 män, 41 kvinnor), uppföljning efter 5 år

At baseline: spirometri, 6MWT, mMRC, exacerbationer

Mean FEV1 27 pp+5%, 50% mortalitet

Manligt kön och BODE index predikterade död

BODE index är en bättre prediktor för död än GOLD-klass

J. Bertó Botella et al. E-poster

Cause-specific mortality in mild COPD: The Rotterdam Study

L. Lahousse, et al. poster

Cause of death in 257 subjects who had performed spirometry during 2002-2010

LATE-BREAKING ABSTRACT: beta-blockers are associated with a reduction

in COPD exacerbations in COPDGene

COPDGene : 45-80 års ålder, GOLD 2-4, ca 3500 individer

• β-blocker use in moderate to very severe COPD is associated with a significant reduction in exacerbations

• Benefit persists after adjustment for underlying CVD and propensity to receive these drugs

• Use of other cardiac medications not associated with a reduction in exacerbation risk

Bhatt et al, oral presentation

LATE-BREAKING ABSTRACT: beta-blockers are associated with a reduction

in COPD exacerbations in COPDGene

COPDGene : 45-80 års ålder, GOLD 2-4, ca 3500 individer

• β-blocker use in moderate to very severe COPD is associated with a significant reduction in exacerbations

• Benefit persists after adjustment for underlying CVD and propensity to receive these drugs

• Use of other cardiac medications not associated with a reduction in exacerbation risk

Mortalitet påverkades ej

Bhatt et al, oral presentation

LATE-BREAKING ABSTRACT: beta-blockers are associated with a reduction

in COPD exacerbations in COPDGene

Mekanism? Bhatt SP. Transl Res. 2013;162(4):237-51

• Chronic blockade of β-receptors may up-regulate receptor density

• Prevention of β-agonist toxicity

• Reduction in airway inflammation and mucus secretion

• Anti-ischemic

• Alleviate diastolic dysfunction

• Decrease resting tachycardia and prevent arrhythmias

Bhatt et al, oral presentation

Statin use and risk of exacerbations in individuals with COPD:

The Copenhagen general population study

N=5798, >40 års ålder med KOL (FEV1/FVC<0.70) 3-års uppföljning; exacerbationer moderat/severe case-control design, matchning för kön, ålder, svårighetsgrad av KOL, komorbiditet, rökning Värdera association mellan statinanvändning före exacerbation och risk för exacerbationer statiner och högt crp (>3 mg/L) hög crp och framtida risk för exacerbationer

Ingebrigtsen et al. Thorax Oct 2014

Statin use and risk of exacerbations in individuals with COPD:

The Copenhagen general population study

Statiner minskade risken för exacerbationer univariat analys OR 0.68 (95% CI 0.51-0.91) multivariat analys OR 0.67 (95% CI 0.48-0.92)

Statiner minskade risken för högt crp OR 0.69 (95% CI 0.56-0.85)

Högt crp ökade risken för exacerbationer HR 1.64 (95% CI 1.37-1.97)

Ingebrigtsen et al. Thorax Oct 2014

Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden

Syfte:

kartlägga tillgång av rehabiliteringsresurser för KOL i primärvården

Metod:

frågeformulär till 683 primärvårdsenheter i 12 regioner

Rehabiliteringsresurs:

fysisk träning + ett av följande: utbildning, nutritionråd, energibesparande teknik, psykosocial stöd

M Arne et al, poster

Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden

Syfte:

kartlägga tillgång av rehabiliteringsresurser för KOL i primärvården

Metod:

frågeformulär till 683 primärvårdsenheter i 12 regioner

Rehabiliteringsresurs:

fysisk träning + ett av följande: utbildning, nutritionråd, energibesparande teknik, psykosocial stöd

M Arne et al, poster

Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden

Resultat (56 % svarsfrekvens)

Tillgång: 92% fysioterapeut

92% arabetsterapeut

84% dietist

98% psykolog/motsvarande

M Arne et al, poster

Availability of pulmonary rehabilitation in primary care for patients with COPD in Sweden

Resultat (56 % svarsfrekvens)

Tillgång: 92% fysioterapeut

92% arabetsterapeut

84% dietist

98% psykolog/motsvarande

KOL-patienterna hade tillgång till PR på 49% av enheterna

M Arne et al, poster

Joan B Soriano FISIB-IdISPa, Hospital Universitari Son Espases

Population screening

initiatives and future

strategies

ERS 2014 Munich; Session 147; Room 14b Sunday, September 7, 14:45-16:45 Symposium: Finding patients with COPD: how, when and where Chairs: F. Burgos, J. Vestbo, D. Marciniuk

° COPD underdiagnosis is universally high

° A variety of screening and case-finding COPD options are already available: when, where and how

° A wider implementation of quality spirometry might/should help to reduce the future COPD burden.

CONCLUSIONS

Presentationer från OLIN-studierna

• OLIN’s KOL-studie

– Tre muntliga presentationer

– Tre posters

• Poolade data från populationsbaserade kohorter

– En muntlig presentation

Physical activity and fatigue in subjects with COPD

Mikael Andersson,PhD1,2, Caroline Stridsman,PhD3 , Eva Rönmark, Prof.3,4, Anne Lindberg, Ass. Prof.3,5, Margareta Emtner, Ass.Prof.1,2

A population-based study

1 Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden 2 Department of Medical Science, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden 3 The OLIN studies, Sunderby Hospital, Luleå, Sweden 4 Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden 5 Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden

Andersson et al, submitted, under review

Results

Physical activity (continuous outcome)

Non- COPD

COPD

p = 0.029

p = 0.047

p = 0.046

p = 0.043

GOLD III-IV

(n = 13)

GOLD II

(n = 148)

GOLD I

(n = 309) (n = 470) (n = 659)

MET-minutes/week

Andersson et al, submitted, under review

0.0 0.1 0.1 0.2 0.2 0.3 0.3 0.4 0.4 0.5 0.5 0.6 0.6

Age

Gender (female = 1)

FEV1

Underweight

Overweight

Obese

Heart disease (yes = 1)

Ex-smoker

Current smoker

Fatigue (yes = 1)

Factors associated with LOW physical activity Non-COPD subjects

Variables included

0.91 (0.18 – 4.47)

1.29 (0.99 - 1.67)

0.92 (0.57 – 1.49)

0.94 (0.80 – 1.10)

0.87 (0.47 – 1.60)

2.26 (1.17 – 4.35)

0.89 (0.47 – 1.66)

0.76 (0.46 – 1.26)

1.21 (0.51 – 2.89)

1.28 (0.79 – 2.07)

Odds ratio (95% CI)

Andersson et al, submitted, under review

Age

Gender (female = 1)

FEV1

Underweight

Overweight

Obese

Heart disease (yes = 1)

Ex-smoker

Current smoker

Fatigue (yes = 1)

0.0 0.1 0.1 0.2 0.2 0.3 0.3 0.4 0.4 0.5 0.5 0.6 0.6

Variables included Odds ratio (95% CI)

0.21 (0.02 – 2.08)

1.52 (1.12 – 2.06)

1.22 (0.69 – 2.14)

0.90 (0.77 – 1.05)

1.15 (0.63 – 2.12)

0.44 (0.18 – 1.07)

2.11 (1.10 – 4.08)

0.85 (0.41 – 1.75)

1.62 (0.72 – 3.65)

2.33 (1.31 – 4.13)

Factors associated with LOW physical activity COPD subjects

Andersson et al, submitted, under review

CO-MORBIDITY IS THE MAIN COST

DRIVER AMONG COPD-SUBJECTS

Sven-Arne Jansson, Helena Backman, Eva

Rönmark, Bo Lundbäck, Anne Lindberg

DISTRIBUTION OF HEALTH-CARE COSTS AMONG SUBJECTS WITH AND WITHOUT COPD

5.2 5.3

27.8

61.8

Outpatient care resp

Hospitalization resp

Outpatient care non-resp

Hospitalization non-resp

4.6 3.4

47.8

44.2

Non-COPD Total costs EUR 931 COPD Total costs EUR 1,561

Hospitalization due to non-respiratory diseases was the main cost driver in COPD.

Jansson et al. COPD 2014, in print

Experiences of well-being when living with COPD

Caroline Stridsman,PhD1,2 Karin Zingmark, Ass. Prof.1, Anne Lindberg, Ass. Prof.2,3, Lisa Skär, Ass. Prof1

1Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden. 2The OLIN studies, Sunderby Hospital, Luleå, Sweden 3Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden

Stridsman et al. Prim Health Care Res Dev. 2014 Feb 14:1-11

LTU-logga?

Factors that may contribute

to increased well-being

Acceptance but not capitulating - Replacement of activities

Engaging in meaningful activities - Family, friends, work

Taking advantage of good days

Learning emotional adaption strategies

Ceasing smoking

Physical activities - Being outdoor/fresh air

Continuity in care

Cardiovascular comorbidities among never smokers with COPD

Stig Hagstad1,2 Helena Backman2,3, Linda Ekerljung, PhD1, Anne Lindberg, Ass. Prof.2,4, Anders Bjerg, PhD1,2

1Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden 2The OLIN studies, Sunderby Hospital, Luleå, Sweden 3Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, The OLIN unit, Umeå University, Sweden 4Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden

Hagstad et al, submitted

Prevalence of any cardiovascular disease by smoking status and lung function

0

10

20

30

40

50

60

70

80

Neversmokers Eversmokers

No COPD

GOLD I

GOLD ≥II

%

p <0.001 p <0.001

Association of comorbidities and COPD among never-smokers

Any cardiovascular diseaseA

Crude OR Adjusted OR*

OR 95% CI OR 95% CI

No COPD 1 1

GOLD I 1.78 1.12-2.82 1.30 0.80-2.09

GOLD ≥II 2.84 1.70-4.75 1.90 1.12-3.24

* Adjusted for age and sex

Posters

Fatigue is related to decreased health status in COPD Caroline Stridsman, Lisa Skär, Linnea Hedman, Anne Lindberg

Arterial stiffness is increased in subjects with COPD stage 3-4

Ulf Nilsson, Linnea Qvist, Viktor Johansson, Kjell Larsson, Eva Rönmark, Jeremy Langrish, Anders Blomberg, Anne Lindberg

The outcome of broncho-dilation among subjects with airway obstruction in the general population

Sami Sawalha, Linnea Hedman, Eva Rönmark, Bo Lundbäck, Anne Lindberg

Tack!