Breathlessness and incidence of COPD, cardiac events and all-cause mortality: A 44-year follow-up from middle age throughout life

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Abstract

Background

Breathlessness is prevalent in the general population and may be associated with adverse health outcomes. This study aimed to evaluate the association of breathlessness with Chronic Obstructive Pulmonary Disease (COPD) events, cardiac events and all-cause mortality from middle-age throughout life.

Methods

Breathlessness was measured in 699, 55-year old men residing in Malmö, Sweden using modified Medical Research Council (mMRC). COPD events (hospitalisation, death or diagnosis) cardiac events and all-cause mortality was assessed using The Swedish Causes of Death Register and Hospital Discharge Register. Data was analyzed using Cox- and competing risks (Fine-Gray) regression analysis.

Results

695 (99%) of 699 participants died and four emigrated during follow up. Eighty-seven (12%) had mMRC = 1 and 19 (3%) had mMRC≥2. Breathlessness was associated with COPD events; adjusted Sub-Hazard Ratio 2.1 (95% CI, 1.2–3.6) for mMRC = 1 and 7.5 (2.6–21.7) for mMRC ≥ 2 but not associated with cardiac events when adjusting for competing events and confounding. Breathlessness was associated increased all- cause mortality (Hazard Ratios of 1.4 (1.1–1.7) (mMRC = 1) and 3.4 (2.1–5.6) (mMRC ≥ 2)).

Conclusion

Breathlessness is associated with increased risk of COPD events and increase in all-cause mortality from age 55 until death.

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Most cited references 5

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Lung function, respiratory symptoms, and mortality: results from the Busselton Health Study.

M Divitini, A William Musk, Eoin G. Ryan … (1999)

This study examines the association between lung function [percentage predicted FEV, (forced expiratory volume in 1 s)] and respiratory symptoms (asthma, bronchitis, wheeze, dyspnea) and mortality from all causes; coronary heart disease, stroke, cancer, and respiratory disease in a cohort of 2,100 men and 2,177 women in the Busselton Health Study followed for 20-26 years for mortality. A total of 840 men and 637 women died during the follow-up period, and Cox proportional hazards regression was used to assess the relationships between risk factors and mortality. Lung function was significantly and independently predictive of mortality from all causes, coronary heart disease, cancer, and respiratory disease in both men and women, and of mortality from stroke in women. There was evidence that, among men, the association was stronger in current and former smokers as compared to those who never smoked. After adjustment for age, smoking, lung function, coronary heart disease, blood pressure, treatment for hypertension, total cholesterol, body mass index, and alcohol consumption, dyspnea was significantly related to total mortality in men and women and to respiratory disease mortality in men, and asthma was significantly related to respiratory disease mortality in women. Lung function is associated with mortality from many diseases independent of smoking and respiratory symptoms. Although most respiratory symptoms are associated with smoking and lung function, after controlling for smoking and lung function, only dyspnea is associated with mortality from nonrespiratory causes.

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Validation of a COPD diagnosis from the Swedish Inpatient Registry.

Malin Inghammar, Gunnar Engström, Claes-Göran Löfdahl … (2012)

The Swedish National Inpatient Registry is an important source of data for numerous epidemiological studies, amongst them studies on chronic obstructive pulmonary disease (COPD). General validation studies indicate that in general 85-95% of diagnoses reported are correct, but this is not true for all groups of diseases, why specific validation studies are of great importance. Charts from 374 individuals discharged with a COPD diagnosis between 2000-07 from two central hospitals and two university hospitals in the county of Skåne were validated against the original medical files. Criteria for the degree of certainty of the COPD diagnosis were predefined and the association between predictors of diagnostic probability and the level of certainty was assessed using an ordinal logistic regression model. According to the Global Initiative for Chronic Obstructive Lung Disease criteria, 21.7% of the diagnosis were classified as proven COPD, 35.5% were classified as probable, another 34.0% as possible COPD, 2.1% were classified as having an uncertain diagnosis, and 7.0% as an unlikely COPD diagnosis. Age category (adjusted ORs: 60-79 years, 2.6, 95% CI 1.2-5.4; ≥80 years, 1.6, 95% CI 0.7-3.3) and discharge from a non-surgical department (adjusted OR: 1.7, 95% CI 1.1-2.8) were significantly associated with higher level of diagnostic certainty. A COPD diagnoses from the Swedish Inpatient Registry is of acceptable validity for epidemiological research. The degree of certainty of the diagnosis varies but less than 10% were considered as misclassified or having an uncertain COPD diagnosis.

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Hypertensive men who exercise regularly have lower rate of cardiovascular mortality.

L. Janzon, Pär G. Engström, B. Hedblad (1999)

Regular exercise has been associated in prospective studies with reduced incidence of cardiovascular disease (CVD) and death. To assess in a cohort study whether there is a similar protective effect of regular exercise among hypertensive individuals. Population-based prospective cohort study. Spare time physical activity was assessed by structured interview. Malmo, Sweden. Healthy men (n = 642) born in 1914. A baseline examination took place in 1969-1970. All-cause and cardiovascular mortality rates during 25 years of follow-up in relation to blood pressure and other risk factors for atherosclerosis. One-hundred (16%) men reported vigorous spare time physical activity. In this group, 31 had hypertension (blood pressure >160/95 mm Hg or treatment for hypertension), 47 were smokers and 39 had hyperlipidaemia. Among the 173 men with hypertension, vigorous physical activity was associated with markedly reduced rates of all-cause (17.3 versus 40.0 deaths per 1000 person-years) and cardiovascular mortality (6.3 versus 21.0 deaths per 1000 person-years). The risk reductions associated with exercise remained statistically significant after adjustment for smoking, systolic blood pressure and antihypertensive therapy. The relative risk was 0.43 (confidence interval 0.22-0.82) for total mortality and 0.33 (confidence interval 0.11 -0.94) for CVD mortality. People who regularly perform physical activity constitute a heterogeneous group with regard to their exposure to known cardiovascular risk factors. Our results support the view that regular physical activity is associated with a reduced incidence of cardiovascular disease and death and suggest that this protective effect may be enhanced among hypertensive individuals.

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Author and article information

Contributors

Jacob Sandberg:

ORCID: http://orcid.org/0000-0003-1863-2033

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Gunnar Engström: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing

Magnus Ekström: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing

Hajo Zeeb: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 18 March 2019

Publication date Collection: 2019

Volume: 14

Issue: 3

Electronic Location Identifier: e0214083

Affiliations

[1 ] Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden

[2 ] Dept of Clinical Sciences Malmö, Lund University, Malmö, Sweden

Leibniz Institute for Prevention Research and Epidemiology BIPS, GERMANY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: jacob.sandberg@ 123456med.lu.se

Author information

Jacob Sandberg http://orcid.org/0000-0003-1863-2033

Article

Publisher ID: PONE-D-18-30437

DOI: 10.1371/journal.pone.0214083

PMC ID: 6422305

PubMed ID: 30883602

SO-VID: 104d5038-7b02-4cb0-a805-74d3579e2336

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 21 October 2018

Date accepted : 6 March 2019

Page count

Figures: 3, Tables: 4, Pages: 11

Funding

JS was funded through an unrestricted grant from the Scientific Committee of Blekinge County Council.

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Data Availability Data cannot be made freely available as they are subject to secrecy in accordance with the Swedish Public Access to Information and Secrecy Act, but can be made available to researchers upon request (subject to a review of secrecy). Requests for data should be made to the corresponding author of this paper or to Medicinska fakulteten, Lunds universitet, Box 117, 221 00 LUND, Swedish Phone: +46-46-222 00 00, email: info@ 123456med.lu.se .

Breathlessness and incidence of COPD, cardiac events and all-cause mortality: A 44-year follow-up from middle age throughout life

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Abstract

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Conclusion

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Most cited references 5

Lung function, respiratory symptoms, and mortality: results from the Busselton Health Study.

Validation of a COPD diagnosis from the Swedish Inpatient Registry.

Hypertensive men who exercise regularly have lower rate of cardiovascular mortality.

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