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      Health-related quality of life in current smokers with COPD: factors associated with current smoking and new insights into sex differences

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          Abstract

          Findings from studies that examined the association between health-related quality of life (HRQOL) and smoking status among COPD patients have been mixed. Moreover, factors associated with current smoking in COPD patients and differences by sex have not been fully elucidated. Data from the 2011 and 2012 Behavioral Risk Factor Surveillance System was used in this study. Four HRQOL indicators were examined in this study: general health, physical health, mental health, and activity limitations. General health was dichotomized into two groups: “excellent/very good/good” and “fair/poor”, and the other three HRQOL indicators were dichotomized into <14 (infrequent) and ≥14 (frequent) unhealthy days in the past 30 days. To examine HRQOL indicators in association with current versus former smoking and identify factors associated with current smoking, logistic regression models were used. Sex differences were explored. In COPD patients, current smokers compared to former smokers had significantly poor HRQOL on all subdomains: “fair/poor” general health (adjusted odds ratio [AOR]: 1.2 [95% confidence interval {CI}: 1.1–1.5]); poor physical health (AOR: 1.3 [CI: 1.1–1.5]); poor mental health (AOR: 1.8 [CI: 1.4–2.2]); and poor activity limitations (AOR: 1.5 [CI: 1.3–1.9]). HRQOL subdomains affected by current smoking differed by sex except activity limitations. General health (AOR: 1.5 [CI: 1.1–2.0]) and activity limitations (AOR: 1.6 [95% CI: 1.2–2.2]) in males and physical health (AOR: 1.3 [CI: 1.0–1.6]), mental health (AOR: 2.1 [CI: 1.7–2.6]), and activity limitations (AOR: 1.5 [CI: 1.2–1.9]) in females were significantly impaired due to current smoking. Factors associated with current smoking differed by sex except being unmarried and having less than a college degree, which were associated with current smoking in both males and females. These findings have important implications for health care providers in designing more effective interventions which tailor to and target specific subgroups for smoking cessation.

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          Most cited references 32

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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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            COPD in Never Smokers

            Background: Never smokers comprise a substantial proportion of patients with COPD. Their characteristics and possible risk factors in this population are not yet well defined. Methods: We analyzed data from 14 countries that participated in the international, population-based Burden of Obstructive Lung Disease (BOLD) study. Participants were aged ≥ 40 years and completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. A diagnosis of COPD was based on the postbronchodilator FEV1/FVC ratio, according to current GOLD (Global Initiative for Obstructive Lung Disease) guidelines. In addition to this, the lower limit of normal (LLN) was evaluated as an alternative threshold for the FEV1/FVC ratio. Results: Among 4,291 never smokers, 6.6% met criteria for mild (GOLD stage I) COPD, and 5.6% met criteria for moderate to very severe (GOLD stage II+) COPD. Although never smokers were less likely to have COPD and had less severe COPD than ever smokers, never smokers nonetheless comprised 23.3% (240/1,031) of those classified with GOLD stage II+ COPD. This proportion was similar, 20.5% (171/832), even when the LLN was used as a threshold for the FEV1/FVC ratio. Predictors of COPD in never smokers include age, education, occupational exposure, childhood respiratory diseases, and BMI alterations. Conclusion: This multicenter international study confirms previous evidence that never smokers comprise a substantial proportion of individuals with COPD. Our data suggest that, in addition to increased age, a prior diagnosis of asthma and, among women, lower education levels are associated with an increased risk for COPD among never smokers.
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              The Centers for Disease Control and Prevention's Healthy Days Measures – Population tracking of perceived physical and mental health over time

              To promote the health and quality of life of United States residents, the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) – with 54 state and territorial health agencies – has supported population surveillance of health-related quality of life (HRQOL). HRQOL was defined as "perceived physical and mental health over time." Commonly-used measures of health status and activity limitation were identified and a set of "Healthy Days" HRQOL measures was developed and validated. A core set of these measures (the CDC HRQOL-4) asks about self-rated general health and the number of recent days when a person was physically unhealthy, mentally unhealthy, or limited in usual activities. A summary measure combines physically and mentally unhealthy days. From 1993 to 2001, more than 1.2 million adults responded to the CDC HRQOL-4 in each state-based Behavioral Risk Factor Surveillance System (BRFSS) telephone interview. More than one fifth of all BRFSS respondents also responded to a set of related questions – including five items that assess the presence, main cause and duration of a current activity limitation, and the need for activity-related personal and routine care; as well as five items that ask about recent days of pain, depression, anxiety, sleeplessness, and vitality. The Healthy Days surveillance data are particularly useful for finding unmet health needs, identifying disparities among demographic and socioeconomic subpopulations, characterizing the symptom burden of disabilities and chronic diseases, and tracking population patterns and trends. The full set of 14 Healthy Days Measures (the CDC HRQOL-14) has shown good measurement properties in several populations, languages, and settings. The brief standard CDC HRQOL-4 is now often used in surveys, surveillance systems, prevention research, and population health report cards.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2016
                15 September 2016
                : 11
                : 2211-2219
                Affiliations
                [1 ]Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH
                [2 ]Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
                Author notes
                Correspondence: Vinay K Cheruvu, Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Hilltop Drive, 320 Lowry Hall, Kent State University, Kent, OH 44242, USA, Tel +1 330 672 6518, Fax +1 330 672 6505, Email vcheruvu@ 123456kent.edu
                Article
                copd-11-2211
                10.2147/COPD.S106207
                5029840
                © 2016 Cheruvu et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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