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      Prevalence and characteristics of COPD among pneumoconiosis patients at an occupational disease prevention institute: a cross-sectional study

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          Abstract

          Background

          Pneumoconiosis may play an important role in the development of chronic obstructive pulmonary disease (COPD), and the complication of COPD may impose a heavy burden of illness.

          Methods

          The study was conducted in Hunan Province in China from December 1, 2015, to December 1, 2016. Consecutive underground male pneumoconiosis patients employed for at least 1 year were recruited from the Hunan Occupational Disease Prevention Institute. Patient information, respiratory symptoms and clinical data were collected using a structured questionnaire. The diagnosis of COPD were assessed using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Logistic regression analyses were conducted to examine the clinical and demographic risk factors of COPD among pneumoconiosis patients.

          Results

          The prevalence of COPD in our sample of pneumoconiosis patients was 18.65% (119/638). In pneumoconiosis patients with and without smoking history, the prevalence of COPD was 19.32 and 16.77%. Compared with non-COPD patients, those with COPD are older in age, have longer exposure time, have lower body mass index (BMI), have a higher smoking index and have worse pulmonary function (all p < 0.05). For the five respiratory symptoms (cough, sputum, wheeze, dyspnea, and chest tightness), only the presence of wheeze and the severity scores for wheeze or dyspnea showed significant differences between the COPD and non-COPD groups ( p < 0.01). Multivariate logistic regression analysis revealed that advanced pneumoconiosis category, older age and the presence of wheeze symptoms were significant risk factors for the development of COPD among pneumoconiosis patients.

          Conclusion

          Pneumoconiosis patients are at a high risk of COPD, and pneumoconiosis patients with COPD may suffer more severe respiratory symptoms, such as wheeze and dyspnea, than patients without COPD. Advanced pneumoconiosis category, older age and the presence of wheeze symptoms are associated with an increased risk of COPD in pneumoconiosis. We proposed that a routine assessment of lung function is necessary for timely and adequate clinical management.

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          Most cited references31

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          Chronic obstructive pulmonary disease in non-smokers.

          Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests that other risk factors are important, especially in developing countries. An estimated 25-45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1.01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.
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            An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease.

            Although cigarette smoking is the most important cause of chronic obstructive pulmonary disease (COPD), a substantial proportion of COPD cases cannot be explained by smoking alone. To evaluate the risk factors for COPD besides personal cigarette smoking. We constituted an ad hoc subcommittee of the American Thoracic Society Environmental and Occupational Health Assembly. An international group of members was invited, based on their scientific expertise in a specific risk factor for COPD. For each risk factor area, the committee reviewed the literature, summarized the evidence, and developed conclusions about the likelihood of it causing COPD. All conclusions were based on unanimous consensus. The population-attributable fraction for smoking as a cause of COPD ranged from 9.7 to 97.9%, but was less than 80% in most studies, indicating a substantial burden of disease attributable to nonsmoking risk factors. On the basis of our review, we concluded that specific genetic syndromes and occupational exposures were causally related to the development of COPD. Traffic and other outdoor pollution, secondhand smoke, biomass smoke, and dietary factors are associated with COPD, but sufficient criteria for causation were not met. Chronic asthma and tuberculosis are associated with irreversible loss of lung function, but there remains uncertainty about whether there are important phenotypic differences compared with COPD as it is typically encountered in clinical settings. In public health terms, a substantive burden of COPD is attributable to risk factors other than smoking. To prevent COPD-related disability and mortality, efforts must focus on prevention and cessation of exposure to smoking and these other, less well-recognized risk factors.
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              The COPD assessment test: a systematic review.

              The COPD assessment test (CAT) is a self-administered questionnaire that measures health-related quality of life. We aimed to systematically evaluate the literature for reliability, validity, responsiveness and minimum clinically important difference (MCID) of the CAT. Multiple databases were searched for studies analysing the psychometric properties of the CAT in adults with chronic obstructive pulmonary disease. Two reviewers independently screened, selected and extracted data, and assessed methodological quality of relevant studies using the COSMIN checklist. From 792 records identified, 36 studies were included. The number of participants ranged from 45 to 6469, mean age from 56 to 73 years, and mean forced expiratory volume in 1 s from 39% to 98% predicted. Internal consistency (reliability) was 0.85-0.98, and test-retest reliability was 0.80-0.96. Convergent and longitudinal validity using Pearson's correlation coefficient were: SGRQ-C 0.69-0.82 and 0.63, CCQ 0.68-0.78 and 0.60, and mMRC 0.29-0.61 and 0.20, respectively. Scores differed with GOLD stages, exacerbation and mMRC grades. Mean scores decreased with pulmonary rehabilitation (2.2-3 units) and increased at exacerbation onset (4.7 units). Only one study with adequate methodology reported an MCID of 2 units and 3.3-3.8 units using the anchor-based approach and distribution-based approach, respectively. Most studies had fair methodological quality. We conclude that the studies support the reliability and validity of the CAT and that the tool is responsive to interventions, although the MCID remains debatable.
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                Author and article information

                Contributors
                pengyating2011@126.com
                40707074@qq.com
                caishan70@sina.com
                chenyan99727@163.com
                40404814@qq.com
                31409568@qq.com
                zhouzijing1114@126.com
                duancrystal@126.com
                pingchen0731@csu.edu.cn
                Journal
                BMC Pulm Med
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central (London )
                1471-2466
                29 January 2018
                29 January 2018
                2018
                : 18
                : 22
                Affiliations
                [1 ]ISNI 0000 0004 1803 0208, GRID grid.452708.c, Department of Respiratory Medicine, , The Second Xiangya Hospital, Central South University, ; Changsha, Hunan 410011 China
                [2 ]ISNI 0000 0001 0379 7164, GRID grid.216417.7, Research Unit of Respiratory Diseases, Central South University, ; Changsha, Hunan 410011 China
                [3 ]ISNI 0000 0001 0379 7164, GRID grid.216417.7, Diagnosis and Treatment Center of Respiratory Disease, Central South University, ; Changsha, Hunan 410011 China
                [4 ]Hunan Institute of Occupational Disease Prevention, Hunan Provincial Center for Disease Control and Prevention, 410011 Changsha, People’s Republic of China
                Article
                581
                10.1186/s12890-018-0581-0
                5789671
                29378587
                00be3854-2cb9-46b4-a3cb-5cf873342c37
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 16 October 2017
                : 9 January 2018
                Funding
                Funded by: National Key Clinical Specialist Construction Projects
                Award ID: (2012)No. 650
                Funded by: National Natural Science Foundation of China (CN)
                Award ID: 81370143,81170036
                Funded by: Explore and Innovative Projects of doctoral students in Central South University
                Award ID: 2015zzts118
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Respiratory medicine
                pneumoconiosis,copd,prevalence,risk factors
                Respiratory medicine
                pneumoconiosis, copd, prevalence, risk factors

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