AIR POLLUTION, HOMOCYSTEINE AND GLOBAL DNA METHYLATION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A POPULATION BASED STUDY FROM INDIA

Abstract

Background/Aim: Improving physical activity is important for better management of patients with COPD, but still challenging because it is affected by multiple factors including socioeconomic background. Given that patients with COPD seen in university hospital and community-based clinic might have different background and physical status, this study aimed to investigate whether physical activity level would differ among medical institutions independent of disease severity and symptom in COPD. Methods: This is a part of ongoing multi-centre observational study conducted at Kyoto University Hospital and Terada Clinic where a pulmonary physician offered general medical care in a local community. Patients with COPD at age of 40 or more who underwent medical interview, inspiratory and expiratory CT scans and spirometry were consecutively enrolled. Physical activity was assessed using Life space assessment (LSA) questionnaire in relation to symptom scores assessed with COPD assessment test (CAT) and modified MRC (mMRC). Results: There were no significant differences in age, LSA, CAT and mMRC between patients at the university hospital (n=80) and clinic (n=48), while patients at the clinic were more female and showed lower BMI, severe airflow limitations (lower percent forced expiratory volume in one second [%FEV1]) compared to those at the university hospital (P=0.002, 0.04, and 0.0004, respectively). Multivariable linear regression analysis showed that the medical institution that each patient chose to visit, age, and CAT score were significantly associated with the LSA score independently of sex, mMRC, and %FEV1. Conclusion: In addition to age and the CAT score, patient-reported physical activity would be affected by the difference in medical institution that might treat patients with distinct socioeconomic background. Impacts of different medical institutions should be incorporated in a multi-centre study to assess physical activity in COPD.