Sex-related differences in COPD in five Latin American cities: the PLATINO study

There is evidence to suggest sex differences exists in chronic obstructive pulmonary disease (COPD) clinical expression. We investigated sex differences in health status perception, dyspnoea and physical activity, and factors that explain these differences using an epidemiological sample of subjects with and without COPD.PLATINO is a cross-sectional, population-based study. We defined COPD as post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio = 2 versus 35% of males. A similar trend was observed in females with COPD (63% versus 44%). in the entire study population, female sex was a factor explaining dyspnoea (OR 1.60, 95% CI 1.40-1.84) and SF-12 physical score (OR -1.13, 95% CI -1.56- -0.71). 40% of females versus 28% of males without COPD reported their general health status as fair-to-poor. Females with COPD showed a similar trend (41% versus 34%). Distribution of COPD severity was similar between sexes, but currently smoking females had more severe COPD than currently smoking males.There are important sex differences in the impact that COPD has on the perception of dyspnoea, health status and physical activity limitation.Boehringer Ingelheim GmbH (Ingelheim, Germany)Asociacion Latinoamericana de Torax (ALAT)Univ Republica, Fac Med, Montevideo, UruguayCent Univ Venezuela, Fac Med, Caracas, VenezuelaUniv Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90024 USAInst Resp Dis, Mexico City, DF, MexicoUniversidade Federal de São Paulo, São Paulo, BrazilUniv Fed Pelotas, Postgrad Program Epidemiol, Pelotas, BrazilPontificia Univ Catolica Chile, Santiago, ChileUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Altitude and COPD prevalence: analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study

Background COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors. Methods A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as >1500 m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD. Results Among 30,874 participants aged 56.1 ± 11.3 years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500 m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p < 0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude. Conclusion Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD

Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study

Background Both the prevalence and mortality attributable to chronic obstructive pulmonary disease (COPD) seem to be increasing in low-income and middle-income countries, but few data are available. the aim of the PLATINO study, launched in 2002, was to describe the epidemiology of COPD in five major Latin American cities: São Paulo (Brazil), Santiago (Chile), Mexico City (Mexico), Montevideo (Uruguay), and Caracas (Venezuela).Methods A two-stage sampling strategy was used in the five areas to obtain probability samples of adults aged 40 years or older. These individuals were invited to answer a questionnaire and undergo anthropometry, followed by prebronchodilator and postbronchodilator spirometry. We defined COPD as a ratio less than 0.7 of postbronchodilator forced expiratory volume in the first second over forced vital capacity.Findings Complete information, including spirometry, was obtained from 963 people in São Paulo, 1173 in Santiago, 1000 in Mexico City, 885 in Montevideo, and 1294 in Caracas. Crude rates of COPD ranged from 7.8% (78 of 1000; 95% CI 5.9-9.7) in Mexico City to 19.7% (174 of 885; 17.2-22.2) in Montevideo. After adjustment for key risk factors, the prevalence of COPD in Mexico City remained significantly lower than that in other cities.Interpretation These results suggest that COPD is a greater health problem in Latin America than previously realised. Altitude may explain part of the difference in prevalence. Given the high rates of tobacco use in the region, increasing public awareness of the burden of COPD is important.Univ Fed Pelotas, Fac Med, BR-96030002 Pelotas, RS, BrazilInst Nacl Enfermedades Resp, Mexico City, DF, MexicoUniversidade Federal de São Paulo, São Paulo, BrazilUniv Republica, Montevideo, UruguayPontificia Univ Catolica Chile, Santiago, ChileCent Univ Venezuela, Caracas, VenezuelaUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study

SETTING: Five Latin American cities: Sao Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; Caracas, Venezuela.OBJECTIVE: To describe the burden of chronic obstructive pulmonary disease (COPD) in Latin America.DESIGN: This is a multi Centre study. Post-bronchodilator spirometry was used and the main outcome measure was FEV1/FVC = 40 years in the five countries included in the study was approximately 85.3 million. Of these, it was estimated that 12.2 million have airflow obstruction, which corresponds to our prevalence estimate of 14.3%. The proportion of subjects in Stages II-IV of the GOLD classification was 5.6%. Risk factors presenting the highest actiological fractions for COPD were age, current smoking, indoor exposure to coal and exposure to dust in the workplace. Smoking, the modifiable factor with the strongest aetiological fraction for COPD, affects 29.2% of adults aged >= 40 years in these cities, corresponding to approximately 25 million smokers in this age group.CONCLUSION: Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD in Latin America. The information obtained by a collaborative study has been vast and encouraging for other similar studies

Acute bronchodilator responsiveness in subjects with and without airflow obstruction in five Latin American cities: The PLATINO study

Background: Acute bronchodilator responsiveness is an area of discussion in COPD. No information exists regarding this aspect of the disease from an unselected COPD population. We assessed acute bronchodilator responsiveness and factors influencing it in subjects with and without airway obstruction in an epidemiologic sample.Methods: COPD was defined by GOLD criteria (post-bronchodilator FEV1/FVC = 0.70 post-bronchodilator were considered to have reversible obstruction. Bronchodilator responsiveness after albuterol 200 mu g was assessed using three definitions: a) FVC and/or FEV1 increment >= 12% plus >= 200 mL over baseline; b) FEV1 >= 15% increase over baseline; and c) FEV1 increase >= 10% of predicted value.Results: There were 756 healthy respiratory subjects, 48 1 subjects with reversible obstruction and 759 COPD subjects. Depending on the criterion used the proportion of person with acute bronchodilator responsiveness ranged between 15.0-28.2% in COPD, 11.4-21.6% in reversible obstructed and 2.7-7.2% in respiratory healthy. FEV1 changes were lower (110.6 +/- 7.40 vs. 164.7 +/- 11.8 mL) and FVC higher (146.5 +/- 14.2 mL vs. -131.0 +/- 19.6 mL) in COPD subjects compared with reversible obstructed. Substantial overlap in FEV1 and FVC changes was observed among the groups. Acute bronchodilator responsiveness in COPD persons was associated with less obstruction and never smoking.Conclusions: Over two-thirds of persons with COPD did not demonstrate acute bronchodilator responsiveness. The overall response was small and less than that considered as significant by ATS criteria. The overlap in FEV1, and FVC changes after bronchodilator among the groups makes it difficult to determine a threshold for separating them. (C) 2009 Elsevier Ltd. All rights reserved.Asociacion Latinoamericana de Torax (ALAT)Boehringer Ingelheim Gmb

Increased Risk of Exacerbation and Hospitalization in Subjects With an Overlap Phenotype COPD-Asthma

Background: Several COPD phenotypes have been described; the COPD-asthma overlap is one of the most recognized. the aim of this study was to evaluate the prevalence of three subgroups (asthma, COPD, and COPD-asthma overlap) in the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) study population, to describe their main characteristics, and to determine the association of the COPD-asthma overlap group with exacerbations, hospitalizations, limitations due to physical health, and perception of general health status (GHS).Methods: the PLATINO study is a multicenter population-based survey carried out in five Latin American cities. Outcomes were self-reported exacerbations (defined by deterioration of breathing symptoms that affected usual daily activities or caused missed work), hospitalizations due to exacerbations, physical health limitations, and patients' perception of their GHS obtained by questionnaire. Subjects were classified in three specific groups: COPD-a postbronchodilator (post-BD) FEV1/FVC ratio of < 0.70; asthma-presence of wheezing in the last year and a minimum post-BD increase in FEV1 or FVC of 12% and 200 mL; and overlap COPD-asthma-the combination of the two.Results: Out of 5,044 subjects, 767 were classified as having COPD (12%), asthma (1.7%), and COPD-asthma overlap (1.8%). Subjects with COPD-asthma overlap had more respiratory symptoms, had worse lung function, used more respiratory medication, had more hospitalization and exacerbations, and had worse GHS. After adjusting for confounders, the COPD-asthma overlap was associated with higher risks for exacerbations (prevalence ratio [PR], 2.11; 95% CI, 1.08-4.12), hospitalizations (PR, 4.11; 95% CI, 1.45-11.67), and worse GHS (PR, 1.47; 95% CI, 1.18-1.85) compared with those with COPD.Conclusions: the coexisting COPD-asthma phenotype is possibly associated with increased disease severity.Boehringer Ingelheim GmbHGlaxoSmithKlineUniv Fed Pelotas, Postgrad Program Epidemiol, BR-96020220 Pelotas, RS, BrazilCent Univ Venezuela, Fac Med, Caracas, VenezuelaNatl Inst Resp Dis, Sleep Clin & Pulm Physiol, Mexico City, DF, MexicoGlaxoSmithKline, London, EnglandUniv Republica, Fac Med, Montevideo, UruguayCtr Hosp Pereira Rossell, Montevideo, UruguayUniversidade Federal de São Paulo, São Paulo, BrazilPontificia Univ Catolica Chile, Santiago, ChileUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study

SETTING: Five Latin American cities: Sao Paulo, Brazil; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; Caracas, Venezuela.OBJECTIVE: To describe the burden of chronic obstructive pulmonary disease (COPD) in Latin America.DESIGN: This is a multi Centre study. Post-bronchodilator spirometry was used and the main outcome measure was FEV(1)/FVC = 40 years in the five countries included in the study was approximately 85.3 million. Of these, it was estimated that 12.2 million have airflow obstruction, which corresponds to our prevalence estimate of 14.3%. The proportion of subjects in Stages II-IV of the GOLD classification was 5.6%. Risk factors presenting the highest actiological fractions for COPD were age, current smoking, indoor exposure to coal and exposure to dust in the workplace. Smoking, the modifiable factor with the strongest aetiological fraction for COPD, affects 29.2% of adults aged >= 40 years in these cities, corresponding to approximately 25 million smokers in this age group.CONCLUSION: Prevention of smoking and exposure to pollutants, such as coal and dust, are the interventions most likely to succeed against COPD in Latin America. The information obtained by a collaborative study has been vast and encouraging for other similar studies.Univ Fed Pelotas, Programa Posgrad Epidemiol, Pelotas, RS, BrazilInst Nacl Enfermedades Resp, Tialpan, MexicoUniv Fed Sao Paulo, Sao Paulo, BrazilUniv Republica, Montevideo, UruguayPontificia Univ Catolica Chile, Santiago, ChileCent Univ Venezuela, Caracas, VenezuelaUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc

Health status perception and airflow obstruction in five Latin American cities: The PLATINO study

SummaryBackgroundCOPD is a highly prevalent disease but underdiagnosed, undertreated and possibly under-recognized by patients. Limited information exists regarding patients' perception of COPD severity. We compared patients' general health status perception, degree of breathlessness and physical activity limitation with the severity of their respiratory condition measured by airway obstruction, in a population-based sample.MethodsWe used postbronchodilator FEV1/FVC<0.70 to define COPD. Patients' perception of their general health status was derived from the question “in general you would say that your health is: excellent, very good, good, fair or poor?”ResultsSpirometry was performed in 5314 subjects: an FEV1/FVC ratio below 0.70 was found in 759 subjects. In persons with COPD, general health status decreased with increasing GOLD stages. Over one-half of subjects with stage 2 and one third of those with stages 3 and 4 reported their health status as good to excellent. There was also a disparity between airway obstruction severity and breathlessness intensity. Although the more severe COPD stages were frequently associated with significant compromise of work and everyday activities, patients often tended to provide an optimistic self evaluation of their health status.ConclusionsThe discrepancy observed between general health status, dyspnea severity, physical activity limitation and airway obstruction most likely reflect patients' underperception of disease severity, emphasizing the need for improving case-finding measures and multi-component evaluation of COPD subjects

Diagnostic Labeling of COPD in five Latin American cities

Background: COPD is a major worldwide problem with a rising prevalence. Despite its importance, there is a lack of information regarding underdiagnosis and misdiagnosis of COPD in different countries. As part of the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar study, we examined the relationship between prior diagnostic label and airway obstruction in the metropolitan areas of five Latin American cities (S (a) over tildeo Paulo, Santiago, Mexico City, Montevideo, and Caracas).Methods: A two-stage sampling strategy was used in each of the five areas to obtain probability samples of adults aged 40 years. Participants completed a questionnaire that included questions on prior diagnoses, and prebronchodilator and postbronchodilator spirometry. A study diagnosis of COPD was based on airway obstruction, defined as a postbronchodilator FEV1/FVC < 0.70.Results: Valid spirometry and prior diagnosis information was obtained for 5,303 participants; 758 subjects had a study diagnosis of COPD, of which 672 cases (88.7%) had not been previously diagnosed. the prevalence of undiagnosed COPD was 12.7%, ranging from 6.9% in Mexico City to 18.2% in Montevideo. Among 237 subjects with a prior COPD diagnosis, only 86 subjects (36.3%) had postbronchodilator FEV1/FVC < 0.7, while 151 subjects (63.7%) had normal spirometric values. in the same group of 237 subjects, only 34% reported ever undergoing spirometry prior to our study.Conclusions: Inaccurate diagnostic labeling of COPD represents an important health problem in Latin America. One possible explanation is the low rate of spirometry for COPD diagnosis.Hosp Univ Caracas, Univ Cent Venezuela, Fac Med, Catedra Neumonol, Caracas 1040, VenezuelaUniv Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90024 USAInst Resp Dis, Mexico City, DF, MexicoUniversidade Federal de São Paulo, São Paulo, BrazilUniv Republica, Fac Med, Montevideo, UruguayPontificia Univ Catolica Chile, Santiago, ChileFed Univ Pelotas, Post Grad Program Epidemiol, Pelotas, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc