Mesa 1. Epidemiología y Diagnóstico en EPOC

1. Mesa 1. EPOC epidemiología y diagnóstico
Dr. Borja García-
Cosío Piqueras
Hospital Universitario Son Espases.
Mallorca

2. Mesa 1. EPOC epidemiología y diagnóstico
[ATS] Alpha 1 - Antitrypsin
Deficiency And
Abdominal Aortic
Aneurysms: Does This
Association Really Exist?
Pini L, Bonardelli S,
Ferrarotti I, et al.

3. Mesa 1. EPOC epidemiología y diagnóstico
Hipothesis
• A1AT is one of the major protease
inhibitors present in human plasma
• An underlying structural defect of
the extracellular matrix (ECM) is
always present and the loss of
elastic fibers is an early step in AAA
formation.
Therefore, AATD seems to be a reasonable risk factor for AAA because it is related to
protease/anti-protease imbalance and enhanced degradation of ECM of the vessel wall.

4. Mesa 1. EPOC epidemiología y diagnóstico
Objectives
• To investigate the distribution of AATD genotypes in
138 consecutive patients hospitalized for non-
traumatic rupture of AAA.
• The second purpose was to observe the distribution
of the main non genetic risk factors for AAA
between patients: with and without AATD.

5. Mesa 1. EPOC epidemiología y diagnóstico
Results
AAA patients with and without AATD we found no differences in terms of age, gender,
hypertension, diabetes and smoke habits, but hyperlipidemia was significantly less frequent in the
group of patients with AATD (46.4 vs 12.5 % respectively, P<0.05).
Out of 138 patients, 20 were found with A1ATD: 16 MS, 1 SS, 3MZ and 2 with new rare
normal variants of AAT
%ofpatients
P<0.01
NS

6. Mesa 1. EPOC epidemiología y diagnóstico
Discussion
• CONCLUSION: In AAA patients the frequency of S allele was
higher than in the general Italian population. Our preliminary
results support the hypothesis that AATD might represent a
risk factor for AAA.
• Previous reports:
J Surg Research 1990

7. Mesa 1. EPOC epidemiología y diagnóstico
[ATS] Risk Factors For
COPD Exacerbations In
Inhaled Medication Users:
COPDGene Study
Biannual Longitudinal
Follow-Up
Busch R, Bowler RP, Han MK;
COPDgene Investigators

8. Mesa 1. EPOC epidemiología y diagnóstico
Background and objectives
• Despite inhaled medications that decrease
exacerbation risk, some COPD patients continue
to have frequent exacerbations.
• Aim: to determine prospective risk factors for
acute exacerbations of COPD (AECOPD)
among subjects in the COPDGene study taking
inhaled respiratory medications.

9. Mesa 1. EPOC epidemiología y diagnóstico
Methods
• Retrospective data from the COPDGene study and prospective
data from the telephone- and web-based biannual Longitudinal
Follow-Up program (LFU).
• Medication use groups (TIO/LABA/ICS, TIO, LABA/ICS, and SAB)
were defined by subject self-report.
• Exacerbators and nonexacerbators were identified by the
frequency of AECOPD (exacerbators had one or more AECOPD
per year, non-exacerbators had zero AECOPD per year).
• Associations between AECOPD occurrence and demographics,
spirometry, chest CT data, and comorbidities were tested.

10. Mesa 1. EPOC epidemiología y diagnóstico
Results
GERD
Female gender
Higher total SGRQ scores

11. Mesa 1. EPOC epidemiología y diagnóstico
Results
• Subjects taking either LABA/ICS or TIO had similar
characteristics such as FEV1, 6-minute walk distance,
percent emphysema by CT scan, and pack-years of
smoking.
• Comparing subjects taking tiotropium vs. long-acting beta-
agonist/inhaled corticosteroid, tiotropium subjects showed
a trend towards statistically significantly lower rates of
exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p= 0.09),
especially in subjects without a doctor's diagnosis of
asthma (OR =0.56 [95 % CI 0.31, 1.00], p=0.05).

12. Mesa 1. EPOC epidemiología y diagnóstico
Discussion
• Conclusion: Characteristic risk factor profiles for exacerbators may
help identify subjects at risk for AECOPD

13. Mesa 1. EPOC epidemiología y diagnóstico
[ERS] Distribution of
COPD phenotypes
according to the Spanish
COPD guidelines
in clinical practice
Miravitlles M, Calle M, Rodríguez
JL, Murio C, On Behalf of the
FENEPOC Study Group

14. Mesa 1. EPOC epidemiología y diagnóstico
Background and aims
Aims. To determine the frequency of COPD phenotypes in Spanish clinical practice
and the availability of diagnostic tools.

15. Mesa 1. EPOC epidemiología y diagnóstico
Methods
• Epidemiological, cross-sectional and multicentre study.
• Patients >40 years with COPD, (FEV₁/FVC<0.7 post-bronchodilator
[post-BC], and >10 pack-years) were included.
• The availability of diagnostic tools to classify COPD phenotypes was
assessed by an ad-hoc questionnaire.

16. Mesa 1. EPOC epidemiología y diagnóstico
Results
• 647 patients [294 Primary Care and 353 Pulmonology]
• Investigators reported that>80 % of DT were available, with exception of computed
tomography (26.9 %) and carbon monoxide transfer test (13.5 %) in PC, and
sputum eosinophilia (40.4 % PC and 49.4 % P).
ACOS (42, 6.5 %) ECB (188, 29.1 %) EE (110, 17.0 %) NE (307, 47.5 %)
Age(years), mean(SD) 64.2(9.0) 69.5(8.6) 70.0(9.1) 67.2(9.3)
Sex(male), n( %) 21(50.0) 157(83.5) 90(81.8) 255(83.1)
Pack-years, mean(SD) 39.4(17.7) 42.8(21.2) 48.5(25.5) 42.9(23.6)
FEV₁ post-BD( %), mean(SD) 61.5(28.1) 54.8(21.0) 47.9(16.4) 53.0(16.2)
m-MRC scale, mean(SD) 1.8(0.8) 2.1(0.8) 2.2(1.0) 1.5(0.8)
N exacerbations, mean(SD) 3.2(2.5) 3.6(1.7) 3.7(1.9) 0.7(0.7)

17. Mesa 1. EPOC epidemiología y diagnóstico
Discussion
• Conclusion: In clinical practice, most COPD patients were
predominantly NE. In general, investigators have the required tools
for diagnosing COPD phenotypes.

18. Mesa 1. EPOC epidemiología y diagnóstico
Muchas gracias
por su atención