Santiago C. Arce

Prevalencia de enfermedad pulmonar obstructiva crónica en 6 aglomerados urbanos de Argentina: el estudio EPOC.AR

INTRODUCTION The prevalence of chronic obstructive pulmonary disease (COPD) has not been studied in Argentina. OBJECTIVES To determine the prevalence and relevant clinical characteristics of COPD in a representative sample. MATERIAL AND METHODS We performed a cross-sectional study in a population of adults aged ≥ 40 years randomly selected by cluster sampling in 6 urban locations. Subjects answered a structured survey and performed pre- and post-bronchodilator spirometry (PBD). COPD was defined as FEV1/FVC ratio < 0.7 predicted value. The total prevalence was estimated for each cluster with its 95% confidence interval (CI). RESULTS Of 4,599 surveys and 3,999 spirometries, 3,469 were considered of adequate quality (86.8%) for our study. The prevalence of COPD was 14.5% (CI: 13.4-15.7). The distribution of COPD cases according to FEV1 (GOLD 2017) was stage 1: 38% (CI: 34-43); stage 2: 52% (CI: 47-56); stage 3: 10% (CI: 7-13); and stage 4: 1% (CI: 0-2), and according to the refined ABCD (GOLD 2017) assessment: A: 52% (CI: 47-56); B: 43% (CI: 39-48); C: 1% (CI: 0-2); D: 4% (CI: 2-6). The rate of underdiagnosis was 77.4% (CI 73.7-81.1%) and diagnostic error 60.7% (CI 55.1-66.3%). A significant association was found between COPD and age (OR 3.77 in individuals 50-59 years of age and 19.23 in those > 80 years), male gender (OR 1.62; CI 1.31-2), smoking (OR 1.95; CI 1.49-2.54), low socioeconomic status (OR 1.33; CI 1.02-1.73), and previous tuberculosis (OR 3.3; CI 1.43-7.62). CONCLUSIONS We estimate that more than 2.3 million Argentineans have COPD, with high rates of underdiagnosis and diagnostic error.

Spirometry Reference Values for an Andean High-Altitude Population

We compared the spirometric values of people living at High Altitude at the Andean Plateau with those predicted for lowland population. RATIONALE Spirometry reference values are not yet available for the millions of people living at high altitude in the Andean High Plateau. OBJECTIVE To obtain spirometric prediction equations from a healthy subset of adults living in Argentina at 3440m above sea level. METHODS We randomly recruited 172 healthy men and 235 healthy women, ages 20-70. Spirometry was done according to ATS/ERS standards. Reference equations were computed using regression analysis. RESULTS The resulting prediction equations: For men: FVC=0.0407*height (cm)-0.0250*age(years)-0.81;SEE 0.518. FEV1=0.0327*height (cm)-0.0282*age(years)-0.25;SEE 0.414. For women: FVC(liters)=0.0464*height(cm)-0.0222*age(years)-2.62;SEE 0.396. FEV1(liters)=0.0343*height(cm)-0.0218*age(years)-1.40;SEE 0.316. CONCLUSIONS These results establish spirometric-prediction equations for the population studied and further demonstrate: (1) a linear decline of FVC and FEV1 with age for both genders, (2) age and height satisfactorily predict both parameters, (3) supra-normal values for this population were found when compared to those predicted by lowland Caucasian equations.

More Breathing, Less Fitness: Lessons from Exercise Physiology in Chronic Obstructive Pulmonary Disease–Heart Failure Overlap

Author contributions: both authors contributed equally in manuscript ́s conception and writing. Conflict of interests: none to declare Financing: none Running head: Lessons from exercise physiology in COPD-heart failure overlap Subject descriptor number: 8.13 Exercise in health and disease Word count: 997 Page 1 of 7 AJRCCM Articles in Press. Published on 01-August-2017 as 10.1164/rccm.201707-1430ED