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      Prevalence and Risk Factors of ACO (Asthma-COPD Overlap) in Aboriginal People

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          Abstract

          Background and Objective

          Aboriginal peoples are at a higher risk of many chronic respiratory diseases compared to the general Canadian population. Patients with asthma-COPD overlap (ACO), a disease newly described in 2015, are associated with frequent exacerbations, rapid decline in lung function, poor quality of life, high mortality, and disproportionate utilization of health-care resources than patients with asthma and COPD alone. The objective was to investigate the prevalence and risk factors of ACO in Aboriginal peoples.

          Methods

          Data from the 2012 Aboriginal Peoples Survey (APS) were used for this study. The ACO definition was based on the respondent giving positive responses to both of the following questions “Do you/Does (name) have Asthma diagnosed by a health professional?” and “Do you/Does (name) have chronic bronchitis, emphysema or chronic pulmonary obstructive disease or COPD diagnosed by a health professional?” Results . Aboriginal peoples older than 45 years, women, widowed, separated, or divorced, having a total personal income below $20,000 were associated with a significant risk of ACO. Residing in Ontario, being a daily smoker, living in a rented dwelling, dwelling in need of major repairs, having diabetes, and working more than 40 hrs a week were also significantly associated with increased risk of ACO.

          Conclusion

          The results from this study will provide information to aid the development of prevention and intervention strategies for Aboriginal communities.

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          Most cited references35

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          The Asthma-COPD Overlap Syndrome.

          Although in textbooks asthma and chronic obstructive pulmonary disease (COPD) are viewed as distinct disorders, there is increasing awareness that many patients have features of both. This article reviews the asthma-COPD overlap syndrome.
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            Inhaled corticosteroids and the risks of diabetes onset and progression.

            Systemic corticosteroids are known to increase diabetes risk, but the effects of high-dose inhaled corticosteroids are unknown. We assessed whether the use and dose of inhaled corticosteroids increase the risk of diabetes onset and progression. We formed a new-user cohort of patients treated for respiratory disease during 1990-2005, identified using the Quebec health insurance databases and followed through 2007 or until diabetes onset. The subcohort treated with oral hypoglycemics was followed until diabetes progression. A nested case-control analysis was used to estimate the rate ratios of diabetes onset and progression associated with current inhaled corticosteroid use, adjusted for age, sex, respiratory disease severity, and co-morbidity. The cohort included 388,584 patients, of whom 30,167 had diabetes onset during 5.5 years of follow-up (incidence rate 14.2/1000/year), and 2099 subsequently progressed from oral hypoglycemic treatment to insulin (incidence rate 19.8/1000/year). Current use of inhaled corticosteroids was associated with a 34% increase in the rate of diabetes (rate ratio [RR] 1.34; 95% confidence interval [CI], 1.29-1.39) and in the rate of diabetes progression (RR 1.34; 95% CI, 1.17-1.53). The risk increases were greatest with the highest inhaled corticosteroid doses, equivalent to fluticasone 1000 μg per day or more (RR 1.64; 95% CI, 1.52-1.76 and RR 1.54; 95% CI, 1.18-2.02; respectively). In patients with respiratory disease, inhaled corticosteroid use is associated with modest increases in the risks of diabetes onset and diabetes progression. The risks are more pronounced at the higher doses currently prescribed in the treatment of chronic obstructive pulmonary disease. Copyright © 2010 Elsevier Inc. All rights reserved.
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              Overlap syndrome of asthma and COPD predicts low quality of life.

              In clinical practice, patients whose airway disease shares features of both asthma and chronic obstructive pulmonary disease (COPD) remain poorly recognized. The study population consisted of 1546 patients with a diagnosis of asthma or COPD or both. Based on patient-reported outcomes and retrospective medical record data, the study population was divided into three groups: ( 1 ) asthma only, ( 2 ) COPD only, and ( 3 ) both asthma and COPD (overlap syndrome group). We evaluated patient characteristics associated with health-related quality of life (HRQoL). In many respects, the overlap group fell between the asthma and COPD groups. In the overlap group, however, HRQoL was the poorest of all. In the logistic regression model, with the asthma group as the reference, both the overlap and the COPD group showed higher risk for low HRQoL [odd ratio (OR): 1.9; 95% confidence interval (CI): 1.2-3.2; and OR: 1.8, 95% CI: 1.0-3.2; respectively]. In addition, female gender, obesity, duration of disease, disability pension, and coexisting cardiovascular disease were associated with low HRQoL across the study population. Patients with overlapping asthma and COPD differed from those patients with asthma or COPD only. Overlap syndrome was associated with low HRQoL.
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                Author and article information

                Contributors
                Journal
                J Environ Public Health
                J Environ Public Health
                JEPH
                Journal of Environmental and Public Health
                Hindawi
                1687-9805
                1687-9813
                2018
                21 November 2018
                : 2018
                : 4657420
                Affiliations
                1Clinical Epidemiology Unit, Memorial University, Newfoundland and Labrador, Canada
                2Faculty of Medicine, Health Sciences Centre (Respirology Department), Memorial University, St John's, Newfoundland and Labrador, Canada
                Author notes

                Academic Editor: Tongzhang Zheng

                Author information
                http://orcid.org/0000-0002-1262-7826
                http://orcid.org/0000-0002-5313-4884
                Article
                10.1155/2018/4657420
                6280246
                30584428
                7165b88a-2faa-4e07-a843-b11e64f13678
                Copyright © 2018 Adetola Koleade et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 June 2018
                : 5 November 2018
                Funding
                Funded by: Memorial University of Newfoundland
                Categories
                Research Article

                Public health
                Public health

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