TY  - JOUR
AB  - BACKGROUND: Lung function impairment in COPD is known to be related to reductions of left heart size, while short-term interventional trials with bronchodilators showed positive effects on cardiac parameters. We investigated whether COPD maintenance therapy has analogous long-term effects. METHODS: Pooled data of GOLD grade 1-4 patients from visits 1 and 3 (1.5 y apart) of the COSYCONET cohort were used. Medication was categorized as use of ICS, LABA + ICS, LABA + LAMA and triple therapy (LABA + LAMA + ICS), contrasting "always" versus "never". Echocardiographic parameters comprised left ventricular end-diastolic and -systolic diameter (LVEDD, LVESD), ejection fraction (LVEF) and left atrial diameter (LA). Associations were identified by multiple regression analysis, as well as propensity score analysis. RESULTS: Overall, 846 patients (mean age 64.5 y; 41% female) were included, 53% using ICS at both visits, 51% LABA + ICS, 56% LABA + LAMA, 40% LABA + LAMA + ICS (triple) therapy. Conversely, 30%, 32%, 28% and 42% had no ICS, LABA + ICS, LABA + LAMA or triple therapy, respectively, at both visits. Among echocardiographic measures, only LA showed statistically significant associations (increases) with medication, whereby significant effects were linked to ICS, LABA + ICS and LABA + LAMA (p < 0.05 each, "always" versus "never") and propensity score analyses underlined the role of LABA + LAMA. CONCLUSIONS: In this observational study, COPD maintenance therapy, especially LABA + LAMA, was linked to left atrial size, consistent with the results of short-term interventional trials. These findings suggest that maintenance medication for COPD does not only improve lung function and patient reported outcomes but may also have an impact on the cardiovascular system. TRIAL REGISTRATION: NCT01245933.
AU  - Kellerer, C.*
AU  - Kahnert, K.*
AU  - Trudzinski, F.C.*
AU  - Lutter, J.
AU  - Berschneider, K.*
AU  - Speicher, T.*
AU  - Watz, H.*
AU  - Bals, R.*
AU  - Welte, T.*
AU  - Vogelmeier, C.F.*
AU  - Jörres, R.A.*
AU  - Alter, P.*
C1  - 62345
C2  - 50798
CY  - 32 Jamestown Rd, London Nw1 7by, England
TI  - COPD maintenance medication is linked to left atrial size: Results from the COSYCONET cohort.
JO  - Respir. Med.
VL  - 185
PB  - W B Saunders Co Ltd
PY  - 2021
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity.Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: <= 50%, 2: >50% BE-involvement for each lobe).1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians' diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby <= 50% BE occurred in 18.6% in <= 2 lobes, in 10.0% in 3-4 lobes, in 15.9% in 5-6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores >= 4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally >= 5.In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.
AU  - Kahnert, K.*
AU  - Jörres, R.A.*
AU  - Kauczor, H.U.*
AU  - Biederer, J.*
AU  - Jobst, B.*
AU  - Alter, P.*
AU  - Biertz, F.*
AU  - Mertsch, P.*
AU  - Lucke, T.*
AU  - Lutter, J.
AU  - Trudzinski, F.C.*
AU  - Behr, J.*
AU  - Bals, R.*
AU  - Watz, H.*
AU  - Vogelmeier, C.F.*
AU  - Welte, T.*
C1  - 60013
C2  - 49167
CY  - 32 Jamestown Rd, London Nw1 7by, England
TI  - Relationship between clinical and radiological signs of bronchiectasis in COPD patients: Results from COSYCONET.
JO  - Respir. Med.
VL  - 172
PB  - W B Saunders Co Ltd
PY  - 2020
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Background: Pulmonary embolism (PE) is the third most common cause of cardiovascular death. However, comprehensive knowledge on the lived experience of patients with PE is lacking so far. The objective of this study was to fill this gap using a qualitative research approach.Methods: A qualitative study using focus group methodology was conducted. Sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The patients were presented eight questions, which asked for their experiences in terms of prodromal and acute symptoms, changes of physical and mental well-being, daily life and social life, and experiences with PE medication and treatment. The focus group discussions were digitally recorded and transcribed verbatim. The constant comparative method was used for data analysis.Results: Five focus groups with n = 18 participants (50% female, median age 56 years) in total were performed. Major identified themes were: (1) progressing dyspnea and pain as major prodromal and acute symptoms, (2) persisting dyspnea and loss of physical fitness, (3) depression, fears and threat monitoring, (4) exhaustion which improves over time, (5) social contacts ranging between ignorance and overprotection, (6) anticoagulants as lifesavers and threat, (7) quick versus delayed diagnosis, (8) left alone by health care providers, and (9) unsupportive health care system.Conclusion: PE may be associated with considerable mental health problems and the existing health care system is experienced as not supportive by a number of patients. Further results from larger, quantitative studies are needed to estimate the extent of the identified problems.
AU  - Kirchberger, I.
AU  - Ruile, S.*
AU  - Linseisen, J.
AU  - Haberl, S.*
AU  - Meisinger, C.
AU  - Berghaus, T.M.*
C1  - 58966
C2  - 48643
CY  - 32 Jamestown Rd, London Nw1 7by, England
TI  - The lived experience with pulmonary embolism: A qualitative study using focus groups.
JO  - Respir. Med.
VL  - 167
PB  - W B Saunders Co Ltd
PY  - 2020
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation, which is progressive and not fully reversible. In patients with COPD, body mass index (BMI) is an important parameter associated with health outcomes, e.g. mortality and health-related quality of life. However, so far no study evaluated the association of BMI and health care expenditures across different COPD severity grades. We used claims data and documentation data of a Disease Management Program (DMP) from a statutory health insurance fund (AOK Bayern). Patients were excluded if they had less than 4 observations in the 8 years observational period. Generalized additive mixed models with smooth functions were used to evaluate the association between BMI and health care expenditures, stratified by severity of COPD, indicated by GOLD grades 1–4. We included 30,682 patients with overall 188,725 observations. In GOLD grades 1–3 we found an u-shaped relation of BMI and expenditures, where patients with a BMI of 30 or slightly above had the lowest and underweight and obese patients had the highest health care expenditures. Contrarily, in GOLD grade 4 we found an almost linear decline of health care expenditures with increasing BMI. In terms of expenditures, the often reported obesity paradox in patients with COPD was clearly reflected in GOLD grade 4, while in all other severity grades underweight as well as severely obese patients caused the highest health care expenditures. Reduction of obesity may thus reduce health care expenditures in GOLD grades 1–3.
AU  - Kirsch, F.
AU  - Schramm, A.*
AU  - Kurz, C.F.
AU  - Schwarzkopf, L.
AU  - Lutter, J.
AU  - Huber, M.B.
AU  - Leidl, R.
C1  - 60526
C2  - 49335
CY  - 32 Jamestown Rd, London Nw1 7by, England
TI  - Effect of BMI on health care expenditures stratified by COPD GOLD severity grades: Results from the LQ-DMP study.
JO  - Respir. Med.
VL  - 175
PB  - W B Saunders Co Ltd
PY  - 2020
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Background: Guidelines for chronic obstructive pulmonary disease (COPD) recommend supplementing pharmacotherapy with non-pharmacological interventions. Little is known about the use of such interventions by patients. We analyzed the utilization of a number of non-pharmacological interventions and identified potential determinants of use.Methods: Based on self-reports, use of interventions (smoking cessation, influenza vaccination, physiotherapy, sports program, patient education, pulmonary rehabilitation) and recommendation to use were assessed in 1410 patients with COPD. The utilization was analyzed according to sex and severity of disease. Potential determinants of utilization included demographic variables and disease characteristics and were analyzed using logistic regression models.Results: Influenza vaccination in the previous autumn/winter was reported by 73% of patients. About 19% were currently participating in a reimbursed sports program, 10% received physiotherapy, 38% were ever enrolled in an educational program, and 34% had ever participated in an outpatient or inpatient pulmonary rehabilitation program. Out of 553 current or former smokers, 24% had participated in a smoking cessation program. While reports of having received a recommendation to use mainly did not differ according to sex, women showed significantly (p < 0.05) higher utilization rates than men for all interventions except influenza vaccination. Smoking was a predictor for not having received a recommendation for utilization and also significantly associated with a reduced odds of utilization. We found a correlation between recommendation to use and utilization.Conclusions: Utilization of non-pharmacological interventions was lower in men and smokers. A recommendation or offer to use by the physician could help to increase uptake.
AU  - Lutter, J.
AU  - Lukas, M.
AU  - Schwarzkopf, L.
AU  - Jörres, R.A.*
AU  - Studnicka, M.*
AU  - Kahnert, K.*
AU  - Karrasch, S.
AU  - Bewig, B.*
AU  - Vogelmeier, C.F.*
AU  - Holle, R.
C1  - 59763
C2  - 48999
CY  - 32 Jamestown Rd, London Nw1 7by, England
TI  - Utilization and determinants of use of non-pharmacological interventions in COPD: Results of the COSYCONET cohort.
JO  - Respir. Med.
VL  - 171
PB  - W B Saunders Co Ltd
PY  - 2020
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Introduction: Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry.Methods: Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC >= Lower Limit of Normal and a FVC< 80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (< 1st study-specific tertile) was evaluated using adjusted logistic regression models.Results: Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET.min/week in ECRHS, and 3519 vs 3945 MET.min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95% CI 1.07-1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding.Conclusion: Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.
AU  - Carsin, A.E.*
AU  - Fuertes, E.*
AU  - Schaffner, E.*
AU  - Jarvis, D.*
AU  - Antò, J.M.*
AU  - Heinrich, J.
AU  - Bellisario, V.*
AU  - Svanes, C.*
AU  - Keidel, D.*
AU  - Imboden, M.*
AU  - Weyler, J.*
AU  - Nowak, D.*
AU  - Martinez-Moratalla, J.*
AU  - Gullón, J.A.*
AU  - Sanchez Ramos, J.L.*
AU  - Caviezel, S.*
AU  - Beckmeyer-Borowko, A.*
AU  - Raherison, C.*
AU  - Pin, I.*
AU  - Demoly, P.*
AU  - Cerveri, I.*
AU  - Accordini, S.*
AU  - Gislason, T.*
AU  - Toren, K.*
AU  - Forsberg, B.*
AU  - Janson, C.*
AU  - Jogi, R.*
AU  - Emtner, M.*
AU  - Gómez Real, F.*
AU  - Raza, W.*
AU  - Leynaert, B.*
AU  - Pascual, S.*
AU  - Guerra, S.*
AU  - Dharmage, S.C.*
AU  - Probst-Hensch, N.*
AU  - Garcia-Aymerich, J.*
C1  - 55067
C2  - 46034
CY  - 32 Jamestown Rd, London Nw1 7by, England
SP  - 116-123
TI  - Restrictive spirometry pattern is associated with low physical activity levels. A population based international study.
JO  - Respir. Med.
VL  - 146
PB  - W B Saunders Co Ltd
PY  - 2019
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - INTRODUCTION: Evidence about the economic burden related to interstitial lung diseases (ILDs) and the cost-driving factors is sparse. In the knowledge that distinct comorbidities affect the clinical course of ILDs, our study investigates their impact on costs of care within first year after diagnosis. METHODS: Using claims data of individuals diagnosed with Idiopathic Interstitial Pneumonia (IIP) (n = 14 453) or sarcoidosis (n = 9106) between 2010 and 2013, we calculated total and ILD-associated mean annual per capita costs adjusted by age, sex and comorbidity burden via Generalized Linear Gamma models. Then, we assessed the cost impact of chronic obstructive pulmonary disease (COPD), diabetes, coronary artery disease, depression, gastro-esophageal reflux disease, pulmonary hypertension (PH), obstructive sleep apnoea syndrome (OSAS) and lung cancer using the model-based parameter estimates. RESULTS: Total mean annual per capita costs were €11 131 in the pooled cohort, €12 111 in IIP and €8793 in sarcoidosis, each with a 1/3 share of ILD-associated cost. Most comorbidities had a significant cost-driving effect, which was most pronounced for lung cancer in total (1.989 pooled, 2.491 sarcoidosis, 1.696 IIP) and for PH in ILD-associated costs (2.606 pooled, 2.347 IIP, 3.648 sarcoidosis). The lung-associated comorbidities COPD, PH, OSAS more strongly affected ILD-associated than total costs. CONCLUSION: Comorbidities increase the already substantial costs of care in ILDs. To support patient-centred ILD care, not only highly cost-driving conditions that are inherent with high mortality themselves require systematic management. Moreover, conditions that are more rather restricting the patient's activities of daily living should be addressed - despite a low-cost impact.
AU  - Frank, A.L.
AU  - Kreuter, M.*
AU  - Schwarzkopf, L.
C1  - 55935
C2  - 46649
SP  - 25-31
TI  - Economic burden of incident interstitial lung disease (ILD) and the impact of comorbidity on costs of care.
JO  - Respir. Med.
VL  - 152
PY  - 2019
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - The COPD Assessment Test (CAT) is in widespread use for the evaluation of patients with chronic obstructive pulmonary disease (COPD). We assessed whether the CAT items carry additional information beyond the sum score regarding COPD characteristics including emphysema. Patients of GOLD grades 1 to 4 from the COPD cohort COSYCONET (German COPD and Systemic Consequences - Comorbidities Network) with complete CAT data were included (n = 2270), of whom 493 had chest CT evaluated for the presence of emphysema. Comorbidities and lung function were assessed following standardised procedures. Cross-sectional data analysis was based on multiple regression analysis of the single CAT items against a panel of comorbidities, lung function, or CT characteristics (qualitative score, 15th percentile of mean lung density), with age, BMI and gender as covariates. This was supported by exploratory factor analysis. Regarding the relationship to comorbidities and emphysema, there were marked differences between CAT items, especially items 1 and 2 versus 3 to 8. This grouping was basically confirmed by factor analysis. Items 4 and 5, and to a lower degree 1, 2 and 6, appeared to be informative regarding the presence of emphysema, whereas the total score was not or less informative. Regarding comorbidities, similar findings as for the total CAT score were obtained for the modified Medical Research Council scale (mMRC) which was also informative regarding emphysema. Our findings suggest that the usefulness of the CAT can be increased if evaluated on the basis of single items which may be indicating the presence of comorbidities and emphysema.
AU  - Marietta von Siemens, S.*
AU  - Alter, P.*
AU  - Lutter, J.
AU  - Kauczor, H.U.*
AU  - Jobst, B.*
AU  - Bals, R.*
AU  - Trudzinski, F.C.*
AU  - Söhler, S.*
AU  - Behr, J.*
AU  - Watz, H.*
AU  - Waschki, B.*
AU  - Bewig, B.*
AU  - Jones, P.W.*
AU  - Welte, T.*
AU  - Vogelmeier, C.F.*
AU  - Jörres, R.A.*
AU  - Kahnert, K.*
C1  - 57361
C2  - 47665
TI  - CAT score single item analysis in patients with COPD: Results from COSYCONET.
JO  - Respir. Med.
VL  - 159
PY  - 2019
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Aims: Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases are thought to be linked through various factors. We aimed to assess the relationship between airway obstruction, lung hyperinflation and diastolic filling in COPD. Methods: The study population was a subset of the COPD cohort COSYCONET. Echocardiographic parameters included the left atrial diameter (LA), early (E) and late (A) transmitral flow, mitral annulus velocity (e'), E wave deceleration time (E[dt]), and isovolumic relaxation time (IVRT). We quantified the effect of various predictors including forced expiratory volume in 1 s (FEV1) and intrathoracic gas volume (ITGV) on the echocardiographic parameters by multiple linear regression and integrated the relationships into a path analysis model. Results: A total of 615 COPD patients were included (mean FEV1 52.6% predicted). In addition to influences of age, BMI and blood pressure, ITGV was positively related to e'-septal and negatively to LA, FEV1 positively to E(dt) (p < 0.05 each). The effect of predictors was most pronounced for LA, e'-septal and E(dt), and less for E/A, IVRT and E/e'. Path analysis was used to take into account the additional relationships between the echocardiographic parameters themselves, demonstrating that their associations with the predictors were maintained and robust. Conclusions: Airway obstruction and lung hyperinflation were significantly associated with cardiac diastolic filling in patients with COPD, suggesting a decreased preload rather than an inherently impaired myocardial relaxation itself. This suggests that a reduction in obstruction and hyperinflation could help to improve cardiac filling.
AU  - Alter, P.*
AU  - Watz, H.*
AU  - Kahnert, K.*
AU  - Pfeifer, M.*
AU  - Randerath, W.J.*
AU  - Andreas, S.*
AU  - Waschki, B.*
AU  - Kleibrink, B.E.*
AU  - Welte, T.*
AU  - Bals, R.*
AU  - Schulz, H.
AU  - Biertz, F.*
AU  - Young, D.M.*
AU  - Vogelmeier, C.F.*
AU  - Jörres, R.A.*
C1  - 53073
C2  - 44609
CY  - London
SP  - 14-22
TI  - Airway obstruction and lung hyperinflation in COPD are linked to an impaired left ventricular diastolic filling.
JO  - Respir. Med.
VL  - 137
PB  - W B Saunders Co Ltd
PY  - 2018
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Introduction: The COPD classification proposed by the Global Initiative for Obstructive Lung Disease was recently revised, and the A to D grouping is now based on symptoms and exacerbations only. Potential associations with comorbidities have not been assessed so far. Thus the aim of the present study was to determine the relationship between the revised (2017) GOLD groups A-D and major comorbidities. Methods: We used baseline data from the COPD cohort COSYCONET. Comorbidities were identified from patient self-reports and disease-specific medication: gastrointestinal disorders, asthma, sleep apnea, hyperuricemia, hyperlipidemia, diabetes, osteoporosis, mental disorders, heart failure, hypertension, coronary artery disease. The A-D groups were based on either the COPD Assessment Test or the modified Medical Research Council scale. Exacerbations were also categorized as per GOLD recommendations. Results: Data from 2228 patients were analyzed. Using GOLD group A as a reference, group D was associated with nearly all comorbidities, followed by group B and C. When groups A-D were dichotomized as AC vs. BD (symptoms) and AB vs. CD (exacerbations), all comorbidities correlated with symptoms and/or exacerbations. This was true for both mMRC- and CAT-based categorizations. Conclusions: These findings suggest that the recently modified GOLD categorization is clinically relevant beyond being purely an assessment of symptoms and exacerbations. As the A-D groups correlated with the risk of important comorbidities, with some differences in terms of the correlation with symptoms and exacerbations, the findings underline the importance of identifying comorbidities in COPD, particularly in non-responders to therapy who have high symptoms and/or exacerbation rates.
AU  - Kahnert, K.*
AU  - Alter, P.*
AU  - Young, D.M.*
AU  - Lucke, T.*
AU  - Heinrich, J.*
AU  - Huber, R.M.*
AU  - Behr, J.*
AU  - Wacker, M.
AU  - Biertz, F.*
AU  - Watz, H.*
AU  - Bals, R.*
AU  - Welte, T.*
AU  - Wirtz, H.*
AU  - Herth, F.*
AU  - Vestbo, J.*
AU  - Wouters, E.F.*
AU  - Vogelmeier, C.F.*
AU  - Jörres, R.A.*
C1  - 52906
C2  - 44247
CY  - London
SP  - 79-85
TI  - The revised GOLD 2017 COPD categorization in relation to comorbidities.
JO  - Respir. Med.
VL  - 134
PB  - W B Saunders Co Ltd
PY  - 2018
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Aim: Biological therapies developed for severe asthma may have a role in COPD patients with asthma features.Method: We carried out a prospective, consecutive, cross-sectional analysis of 80 patients with severe COPD GOLD IV/D.Results: We studied 80 patients (48.8% female), aged 57.6 +/- 5.1 years, ex-smokers with 35.7 +/- 21.2 pack years, BMI 22.3 +/- 3.5 kg/m(2), FEV1 of 0.61 +/- 0.2 L (21.1 +/- 5.6% pred), pO(2) 52.4 +/- 8.4 mmHg, and BODE 6.9 +/- 1.7. 68% had > 2 moderate or severe exacerbations annually. 16.1% (5/31) patients showed FEV1 reversibility of > 12% and > 200 ml despite maximal therapy, 33% (15/45) had FENO >= 22.5 ppb, 33% (24/73) had serum IgE >= 100 I.E./ml and there was positive allergen sensitization in 51.5% (35/68). Blood eosinophilia of >= 150 cells/mu l was seen in 47% (35/74). Induced sputum showed eosinophilia of >= 2% in 56% (14/24) with respiratory pathogens in 63.8% (30/47). We identified 12 (15%) patients with asthma-COPD overlap. Of these, 10 (83.3%) had frequent exacerbations and these patients had significantly more severe exacerbations requiring NIV or ICU than those without asthma features (p < 0.005).Conclusion: We detected asthma features in a substantial subset of stable patients with severe COPD. Asthma features were associated with more severe exacerbation despite optimal COPD therapy, representing potential candidates for targeted therapy with anti- IgE or anti-IL5.
AU  - Matthes, S.*
AU  - Stadler, J.*
AU  - Barton, J.*
AU  - Leuschner, G.*
AU  - Munker, D.*
AU  - Arnold, P.*
AU  - Villena-Hermoza, H.*
AU  - Frankenberger, M.
AU  - Probst, P.*
AU  - Koch, A.*
AU  - Kneidinger, N.*
AU  - Milger, K.*
AU  - Behr, J.*
AU  - Neurohr, C.*
C1  - 54660
C2  - 45755
CY  - 32 Jamestown Rd, London Nw1 7by, England
SP  - 89-94
TI  - Asthma features in severe COPD: Identifying treatable traits.
JO  - Respir. Med.
VL  - 145
PB  - W B Saunders Co Ltd
PY  - 2018
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Background The German COPD cohort study COSYCONET ("COPD and SYstemic consequences-COmorbidities NETwork") investigates the interaction of lung disease, comorbidities and systemic inflammation. Recruitment took place from 2010 to 2013 in 31 study centers. In addition to the baseline visit, follow-up visits are scheduled at 6, 18, 36 and 54 months after baseline. The study also comprises a biobank, image bank, and includes health economic data. Here we describe the study design of COSYCONET and present baseline data of our COPD cohort. Methods Inclusion criteria were broad in order to cover a wide range of patterns of the disease. In each visit, patients undergo a large panel of assessments including e.g. clinical history, spirometry, body plethysmography, diffusing capacity, blood samples, 6-min walk-distance, electrocardiogram and echocardiography. Chest CTs are collected if available and CTs and MRIs are performed in a subcohort. Data are entered into eCRFs and subjected to several stages of quality control. Results Overall, 2741 subjects with a clinical diagnosis of COPD were included (59% male; mean age 65 ± 8.6 years (range 40-90)). Of these, 8/35/32/9% presented with GOLD stages I-IV; 16% were uncategorized, including the former GOLD-0 category. 24% were active smokers, 68% ex-smokers and 8% never-smokers. Data completeness was 96% for the baseline items. Conclusion The German COPD cohort comprises patients with advanced and less advanced COPD. This is particularly useful for studying the time course of COPD in relation to comorbidities. Baseline data indicate that COSYCONET offers the opportunity to investigate our research questions in a large-scale, high-quality dataset.
AU  - Karch, A.*
AU  - Vogelmeier, C.*
AU  - Welte, T.*
AU  - Bals, R.*
AU  - Kauczor, H.U.*
AU  - Biederer, J.*
AU  - Heinrich, J.
AU  - Schulz, H.
AU  - Gläser, S.*
AU  - Holle, R.
AU  - Watz, H.*
AU  - Korn, S.*
AU  - Adaskina, N.*
AU  - Biertz, F.*
AU  - Vogel, C.*
AU  - Vestbo, J.*
AU  - Wouters, E.F.M.*
AU  - Rabe, K.F.*
AU  - Söhler, S.*
AU  - Koch, A.*
AU  - Jörres, R.A.*
C1  - 48299
C2  - 39996
CY  - London
SP  - 27-37
TI  - The German COPD cohort COSYCONET: Aims, methods and descriptive analysis of the study population at baseline.
JO  - Respir. Med.
VL  - 114
PB  - W B Saunders Co Ltd
PY  - 2016
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Objectives Chronic Obstructive Pulmonary Disease (COPD) has a substantial impact on health care systems worldwide. Particularly, cardiovascular diseases such as ischemic heart disease (IHD) are frequent in individuals with COPD, but the economic consequences of combined COPD and IHD are by large unknown. Therefore, our study has the objective to investigate excess costs of IHD in COPD patients. Methods Out of German Statutory Health Insurance claims data we identified 26,318 COPD patients with and 10,287 COPD patients without IHD based on ICD-10 codes (COPD J44; IHD I2[0,1,2,5]) of the year 2011 and matched 9986 of them in a 1:1 ratio based on age and gender. Then, we investigated health care service expenditures in 2012 via Generalized Linear Models. Moreover, we evaluated a potential non-linear association between health care expenditures and age in a gender-stratified Generalized Additive Model. Results The prevalence of IHD in individuals with COPD increases with rising age up to a share of 50%. COPD patients with IHD cause adjusted mean annual per capita health care service expenditures of ca. €7400 compared with ca. €5800 in COPD patients without IHD. Moreover, excess costs of IHD have an inverse u-shape, peaking in the early (men) respectively late seventies (women). Conclusions IHD in COPD patients is associated with excess costs of ca. € 1,500, with the exact amount varying age- and gender-dependently. Subgroups with high excess costs indicate medical need that calls for efficient care strategies, considering COPD and IHD together particularly between 70 and 80 years of age.
AU  - Schwarzkopf, L.
AU  - Wacker, M.
AU  - Ertl, J.*
AU  - Hapfelmeier, J.*
AU  - Larisch, K.*
AU  - Leidl, R.
C1  - 49258
C2  - 31205
CY  - London
SP  - 112-118
TI  - Impact of chronic ischemic heart disease on the health care costs of COPD patients – An analysis of German claims data.
JO  - Respir. Med.
VL  - 118
PB  - W B Saunders Co Ltd
PY  - 2016
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Background: Reliable up-to-date estimates regarding the economic impact of chronic obstructive pulmonary disease (COPD) are lacking. This study investigates COPD excess healthcare utilization, work absenteeism, and resulting costs within the German COPD cohort COSYCONET. Methods: Data from 2139 COPD patients in GOLD grade 1-4 from COSYCONET were compared with 1537 lung-healthy control subjects from the population-based KORA platform. Multiple generalized linear models analyzed the association of COPD grades with healthcare utilization, work absence, and costs from a societal perspective while adjusting for sex, age, education, smoking status, body mass index (BMI), and several comorbidities. Results: COPD was significantly associated with excess healthcare utilization, work absence, and premature retirement. Adjusted annual excess cost of COPD in 2012 for GOLD grade 1-4 amounted to €2595 [1770-3678], €3475 [2966-4102], €5955 [5191-6843], and €8924 [7190-10,853] for direct costs, and €8621 [4104-13,857], €9871 [7692-12,777], €16,550 [13,743-20,457], and €27,658 [22,275-35,777] for indirect costs respectively. Comorbidities contributed to the primary effect of COPD on direct costs only. An additional history of cancer or stroke had the largest effect on direct costs, but the effects were smaller than those of COPD grade 3/4. Conclusions: COPD is associated with substantially higher costs than previously reported.
AU  - Wacker, M.
AU  - Jörres, R.A.*
AU  - Schulz, H.
AU  - Heinrich, J.
AU  - Karrasch, S.
AU  - Karch, A.*
AU  - Koch, A.*
AU  - Peters, A.
AU  - Leidl, R.
AU  - Vogelmeier, C.*
AU  - Holle, R.
C1  - 47619
C2  - 39442
CY  - London
SP  - 39-46
TI  - Direct and indirect costs of COPD and its comorbidities: Results from the German COSYCONET study.
JO  - Respir. Med.
VL  - 111
PB  - W B Saunders Co Ltd
PY  - 2016
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - BACKGROUND: Some studies have shown a higher prevalence of asthma in elite athletes as compared to the general population. It is inconclusive to what extent certain sport categories are especially affected. The present study offered a unique opportunity to assess these differences in asthma prevalence in the general population and elite summer athletes from a wide range of sport disciplines across various geographical areas. METHODS: Cross-sectional data for 1568 general population participants from the European Community Respiratory Health Survey II and 546 elite athletes from the Global Allergy and Asthma European Network Olympic study from three European countries were analyzed. Using logistic regression, the asthma risks associated with athlete sport practice, endurance level and aquatic sport practice, respectively, were investigated. RESULTS: Athletes in the highest endurance category had increased risk of doctor-diagnosed asthma (OR 3.5; 95% CI 1.7-7.5), asthma symptoms (OR 3.0; CI 1.5-6.0) and asthma symptoms or medication use (OR 3.5; CI 1.8-6.7) compared to the general population. Aquatic athletes were at increased risk of doctor-diagnosed asthma (OR 2.0; CI 1.1-3.9), asthma symptoms (OR 2.6; CI 1.3-5.0) and asthma symptoms or medication use (OR 2.3; CI 1.2-4.4) when compared to individuals not involved in aquatic sports. Regarding the entire athlete population, no increase in asthma was found when compared to the general population. CONCLUSIONS: Practice of very high endurance and aquatic sports may be associated with increased asthma risks. Athlete participation as such showed no association with asthma risk.
AU  - Burns, J.*
AU  - Mason, C.*
AU  - Müller, N.*
AU  - Ohlander, J.*
AU  - Zock, J.P.*
AU  - Drobnic, F.*
AU  - Wolfarth, B.*
AU  - Heinrich, J.
AU  - Omenaas, E.*
AU  - Stensrud, T.*
AU  - Nowak, D.*
AU  - Radon, K.*
C1  - 45037
C2  - 37144
CY  - London
SP  - 813-820
TI  - Asthma prevalence in Olympic summer athletes and the general population: An analysis of three European countries.
JO  - Respir. Med.
VL  - 109
IS  - 7
PB  - W B Saunders Co Ltd
PY  - 2015
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - OBJECTIVE: Empirical results indicate an increased risk for cardiovascular (CV) adverse drug events (ADE) in chronic obstructive pulmonary disease (COPD) patients treated with beta-2-agonists (B2A) and muscarinic antagonists (MA). A systematic review (including a meta-analysis for drug classes with sufficient sample size) was conducted assessing the association between B2A or MA and acute myocardial infarctions (MI) in COPD patients. METHODS: Comprehensive literature search in electronic databases (MEDLINE, Cochrane database) was performed (January 1, 1946-April 1, 2013). Results were presented by narrative synthesis including a comprehensive quality assessment. In the meta-analysis, a random effects model was used for estimating relative risk estimates for acute MI. RESULTS: Eight studies (two systematic reviews, two randomized controlled trials, and four observational studies) were comprised. Most studies comparing tiotropium vs. placebo showed a decreased MI risk for tiotropium, whereas for studies with active control arms no clear tendency was revealed. For short-acting B2A, an increased MI risk was shown after first treatment initiation. For all studies, a good quality was found despite some shortcomings in ADE-specific criteria. A meta-analysis could be conducted for tiotropium vs. placebo only, showing a relative risk reduction of MI (0.74 [0.61-0.90]) with no evidence of statistical heterogeneity among the included trials (I(2) = 0%; p = 0.8090). CONCLUSIONS: An MI-protective effect of tiotropium compared to placebo was found, which might be attributable to an effective COPD treatment leading to a decrease in COPD-related cardiovascular events. Further studies with effective control arms and minimal CV risk are required determining precisely tiotropium's cardiovascular risk.
AU  - Rottenkolber, M.*
AU  - Rottenkolber, D.
AU  - Fischer, R.*
AU  - Ibáñez, L.*
AU  - Fortuny, J.*
AU  - Ballarin, E.*
AU  - Sabaté, M.*
AU  - Ferrer, P.*
AU  - Thürmann, P.*
AU  - Hasford, J.*
AU  - Schmiedl, S.*
C1  - 31658
C2  - 34605
SP  - 1075-1090
TI  - Inhaled beta-2-agonists/muscarinic antagonists and acute myocardial infarction in COPD patients.
JO  - Respir. Med.
VL  - 108
IS  - 8
PY  - 2014
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - AIM: While it is known that severe COPD has substantial economic consequences, evidence on resource use and costs in mild disease is scarce. The objective of this study was to investigate excess costs of early stages of COPD. METHODS: Using data from two population-based studies in Southern Germany, current GOLD criteria were applied to pre-bronchodilator spirometry for COPD diagnosis and staging in 2255 participants aged 41 to 89. Utilization of physician visits, hospital stays and medication was compared between participants with COPD stage I, stage II+ (II or higher) and controls. Costs per year were calculated by applying national unit costs. In controlling for confounders, two-part generalized regression analyses were used to account for the skewed distribution of costs and the high proportion of subjects without costs. RESULTS: Utilization in all categories was significantly higher in COPD patients than in controls. After adjusting for confounders, these differences remained present in physician visits and medication, but not in hospital days. Adjusted annual costs did not differ between stage I (€ 1830) and controls (€ 1822), but increased by about 54% to € 2812 in stage II+. CONCLUSION: The finding that utilization and costs are considerably higher in moderate but not in mild COPD highlights the economic importance of prevention and of interventions aiming at early diagnosis and delayed disease progression.
AU  - Menn, P.
AU  - Heinrich, J.
AU  - Huber, R.M.*
AU  - Jörres, R.A.*
AU  - John, J.
AU  - Karrasch, S.
AU  - Peters, A.
AU  - Schulz, H.
AU  - Holle, R.
C1  - 6803
C2  - 29287
SP  - 540-548
TI  - Direct medical costs of COPD - an excess cost approach based on two population-based studies.
JO  - Respir. Med.
VL  - 106
IS  - 4
PB  - Elsevier
PY  - 2012
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - The aim of the current study was to determine the impact and interaction of important influencing factors on the fraction of exhaled nitric oxide (FeNO). FeNO was measured in a population-based sample of 1250 middle-aged subjects from the KORA F4 cohort (Augsburg, Germany). Analysis of covariance models was performed including the factors age, height, FVC, FEV(1), sex, current smoking status, recent respiratory tract infection, and respiratory allergy. Geometric mean (SD as factor; 95% confidence interval as factor) FeNO was 13.9 (1.9; 1.033) ppb. FeNO significantly depended on age, height, smoking, infection and allergy. Smoking reduced FeNO by 21%, while infection and allergy led to increases by 9 and 11%, respectively. Increases in age by 10 years and in height by 10 cm were associated with increases of FeNO by 15 and 10%, respectively. Non-smokers demonstrated independent multiplicative superposition of factors affecting FeNO while the effect of allergy was virtually eliminated in smokers without infection. We conclude that in middle-aged non-smokers the effects of infection, age and height can be easily taken into account and do not significantly disturb the effect of respiratory tract allergies on FeNO. In current smokers, however, effects were heterogeneous and information on smoking intensity seems to be useful for better adjustment.
AU  - Karrasch, S.*
AU  - Ernst, K.*
AU  - Behr, J.*
AU  - Heinrich, J.
AU  - Huber, R.M.*
AU  - Nowak, D.*
AU  - Wichmann, H.-E.
AU  - Baumeister, S.E.
AU  - Meisinger, C.
AU  - Ladwig, K.-H.
AU  - Holle, R.
AU  - Jörres, R.A.*
AU  - Schulz, S.
AU  - KORA Study Group (Wichmann, H.-E.
AU  - Holle, R.
AU  - John, J.
AU  - Illig, T.
AU  - Peters, A.
AU  - Meisinger, C.
AU  - Ladwig, K.-H.)
C1  - 2870
C2  - 27852
SP  - 713-718
TI  - Exhaled nitric oxide and influencing factors in a random population sample.
JO  - Respir. Med.
VL  - 105
IS  - 5
PB  - Elsevier
PY  - 2011
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Spirometry is a frequently performed lung function test and an important tool in medical surveillance examinations of pulmonary diseases. The interpretation of lung function relies on the comparison to reference values derived from a healthy population. The study aim was to compare the lung function data of three representative population-based German studies (Study of Health in Pomerania [SHIP-1], Cooperative Health Research in the Region of Augsburg [KORA-S3] and European Community Respiratory Health Survey Erfurt [ECRHS-I Erfurt]) with existing European spirometry reference values and to establish a new set of comprehensive German prediction equations. METHODS:Spirometry was performed in 4133 participants of three population-based surveys using almost identical standardised methods. Current and former smokers, subjects with cardiopulmonary disorders or on medication with potential influence on lung function were excluded. Sex specific prediction equations were established by quantile regression analyses. Comparison was performed to existing European reference values. RESULTS: The healthy reference sample consisted of 1302 (516 male) individuals, aged 20-80 years. Sex specific comprehensive prediction equations adjusted for age and height are provided. Significant differences were found in comparison to previous studies with pronounced lower values of the current population if applying historic prediction equations. CONCLUSION: The results contribute to the interpretation of lung function examination in providing a comprehensive set of spirometry reference values obtained in a large number of healthy volunteers. Whereas the differences in between the investigated studies are negligible, striking divergence was detected in comparison to historic and recent European spirometry prediction values.
AU  - Koch, B.*
AU  - Schäper, C.*
AU  - Ewert, R.*
AU  - Völzke, H.*
AU  - Obst, A.*
AU  - Friedrich, N.*
AU  - Felix, S.B.*
AU  - Vogelmeier, C.F.*
AU  - Schnabel, E.
AU  - Karrasch, S.
AU  - Wichmann, H.-E.
AU  - Schäfer, T.*
AU  - Schulz, S.
AU  - Heinrich, J.
AU  - Gläser, S.*
C1  - 6132
C2  - 28352
SP  - 352-362
TI  - Lung function reference values in different German populations.
JO  - Respir. Med.
VL  - 105
IS  - 3
PB  - Elsevier
PY  - 2011
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - BACKGROUND: Lung mucociliary clearance is impaired in patients with chronic obstructive pulmonary disease (COPD). Treatment guidelines recommend that patients with COPD receive maintenance therapy with long-acting beta-agonists and anticholinergic agents. METHODS: Twenty-four patients with mild to moderate COPD received formoterol (12 μg, twice daily from Turbuhaler® dry powder inhaler (DPI)) or tiotropium (18 μg, once daily from Handihaler® DPI) for 14 days. They also received single doses of formoterol, tiotropium, salbutamol (200 μg) and placebo. A radioaerosol technique was used to assess the effects on mucus clearance of 14 days treatment with formoterol or tiotropium, as well as single doses of these drugs. RESULTS: The 4 h whole lung retention of radioaerosol was significantly higher after 14 days treatment with tiotropium (P = 0.016), but not after 14 days treatment with formoterol. However, patients bronchodilated after 14 days treatment with both drugs, so that the deposited radioaerosol may have had an increased distance to travel in order to be cleared by mucociliary action. A single dose of formoterol enhanced radioaerosol clearance significantly compared to other single dose treatments (P < 0.05). CONCLUSION: Formoterol (12 μg) enhances mucus clearance in patients with mild to moderate COPD when given as a single dose, and may do so when given for 14 days. Studies of longer duration would be needed in order to assess the effects of the study drugs on mucus clearance when they are used for long-term maintenance therapy.
AU  - Meyer, T.*
AU  - Reitmeir, P.
AU  - Brand, P.*
AU  - Herpich, C.*
AU  - Sommerer, K.*
AU  - Schulze, A.*
AU  - Scheuch, G.*
AU  - Newman, S.*
C1  - 6538
C2  - 28921
SP  - 900-906
TI  - Effects of formoterol and tiotropium bromide on mucus clearance in patients with COPD.
JO  - Respir. Med.
VL  - 105
IS  - 6
PB  - Elsevier
PY  - 2011
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Several studies showed an association between lung function and hypertension. However, it must be considered that antihypertensive treatment might have an effect on lung function, too. So far, this potential effect of antihypertensive medication on lung function has been investigated mainly in patients with already existing pulmonary diseases. Thus, the aim of this analysis was to determine whether hypertension and its medical treatment are associated with lung function impairment in a general adult population. Within the cross-sectional study ECRHS-I Erfurt 1158 adults aged between 20 and 65 years performed lung function tests and blood pressure measurements. Additionally, information on anthropometric measurements, sociodemographic characteristics and medical history was available. Multivariate regression models were applied to study the association between lung function, blood pressure and antihypertensive treatment. RESULTS: The combination of high blood pressure and the use of antihypertensive medication had the strongest negative effect on lung function. Thus, it was associated with a deterioration in FEV(1) of -150 ml (p=0.01) and in FVC of -190 ml (p<0.01). When using both high blood pressure and antihypertensive medication as individual variables in one regression model, only medication decreased FEV(1) and FVC significantly (each p<0.01).We speculate that high blood pressure in combination with antihypertensive treatment and not HBP itself might be associated with reduced lung function in a general adult population. Nevertheless, it must be considered that antihypertensive medication might just be an indicator for very high blood pressure.
AU  - Schnabel, E.
AU  - Nowak, D.*
AU  - Brasche, S.*
AU  - Wichmann, H.-E.
AU  - Heinrich, J.
C1  - 6323
C2  - 28505
CY  - London, England
SP  - 727-733
TI  - Association between lung function, hypertension and blood pressure medication.
JO  - Respir. Med.
VL  - 105
IS  - 5
PB  - W.B. Saunders Co. Ltd.
PY  - 2011
SN  - 0954-6111
ER  - 

TY  - JOUR
AB  - Classically, the development of emphysema in chronic obstructive pulmonary disease is believed to involve inflammation induced by cigarette smoke and leukocyte activation, including oxidant-antioxidant and protease-antiprotease imbalances. While there is substantial evidence for this, additional aspects have been suggested by a number of clinical and experimental observations. Smokers exhibit signs of premature aging, particularly obvious in the skin. The link between aging and chronic disease is well-known, e.g., for the brain and musculoskeletal or cardiovascular system, as well as the clinical link between malnutrition and emphysema, and the experimental link to caloric restriction. Interestingly, this intervention also increases lifespan, in parallel with alterations in metabolism, oxidant burden and endocrine signaling. Of special interest is the observation that, even in the absence of an inflammatory environment, lung fibroblasts from patients with emphysema show persistent alterations, possibly based on epigenetic mechanisms. The importance of these mechanisms for cellular reprogramming and response patterns, individual risk profile and therapeutic options is becoming increasingly recognized. The same applies to cellular senescence. Recent findings from patients and experimental models open novel views into the arena of gene-environment interactions, including the role of systemic alterations, cellular stress, telomeres, CDK inhibitors such as p16, p21, pRb, PI3K, mTOR, FOXO transcription factors, histone modifications, and sirtuins. This article aims to outline this emerging picture and to stimulate the identification of challenging questions. Such insights also bear implications for the long-term course of the disease in relation to existing or future therapies and the exploration of potential lung regeneration.
AU  - Karrasch, S.
AU  - Holz, C.*
AU  - Jörres, R.A.*
C1  - 3017
C2  - 25451
SP  - 1215-1230
TI  - Aging and induced senescence as factors in the pathogenesis of lung emphysema.
JO  - Respir. Med.
VL  - 102
IS  - 9
PB  - Elsevier
PY  - 2008
SN  - 0954-6111
ER  - 

TY  - JOUR
AU  - Sausenthaler, S.
AU  - Kompauer, I.
AU  - Brasche, S.*
AU  - Linseisen, J.*
AU  - Heinrich, J.
C1  - 265
C2  - 23083
SP  - 864-870
TI  - Sodium intake and bronchial hyperresponsiveness in adults.
JO  - Respir. Med.
VL  - 99
PY  - 2005
SN  - 0954-6111
ER  - 

TY  - JOUR
AU  - Lenz, A.-G.
AU  - Hinze-Heyn, H.
AU  - Schneider, A.E.
AU  - Behr, J.*
AU  - Häußinger, K.*
AU  - Heindl, S.*
AU  - Stanzel, F.*
AU  - Maier, K.L.
C1  - 2885
C2  - 22058
SP  - 737-745
TI  - Influence of inflammatory mechanisms on the redox balance in interstitial lung diseases.
JO  - Respir. Med.
VL  - 98
PY  - 2004
SN  - 0954-6111
ER  - 

TY  - JOUR
AU  - Mueller, J.E.
AU  - Frye, C.
AU  - Brasche, S.*
AU  - Heinrich, J.
C1  - 9873
C2  - 21105
SP  - 990-992
TI  - Association of hormone replacement therapy with bronchial hyper-responsiveness. 
JO  - Respir. Med.
VL  - 97
PY  - 2003
SN  - 0954-6111
ER  - 

TY  - JOUR
AU  - Richter, K.*
AU  - Heinrich, J.
AU  - Jörres, R.A.*
AU  - Magnussen, H.*
AU  - Wichmann, H.-E.
C1  - 21582
C2  - 19708
SP  - 668-677
TI  - Trends in bronchial hyperresponsiveness, respiratory symptoms and lung function among adults: West and East West Germany.
JO  - Respir. Med.
VL  - 94
PY  - 2000
SN  - 0954-6111
ER  -