Environmental Public Health Commons^™

Occupational Chronic Obstructive Pulmonary Disease: An Update, Enrique Diaz-Guzman, David M. Mannino, Shambhu Aryal

David M. Mannino

Chronic obstructive pulmonary disease represents a major cause of morbidity and mortality in industrialized and nonindustrialized countries. Although tobacco use remains the main factor associated with development of the disease, occupational risk factors represent an important and preventable cause. The most common occupationally related factors include exposure to organic dusts, metallic fumes, and a variety of other mineral gases and/or vapors. This article summarizes the literature on the subject and provides an update of the most recent advances in the field.

Epidemiology Of Comorbidities In Chronic Obstructive Pulmonary Disease: Clusters, Phenotypes And Outcomes, Shambhu Aryal, Enrique Diaz-Guzman, David M. Mannino

David M. Mannino

COPD is a complex multisystem disease often accompanied by multiple co-morbidities that contribute to symptoms, exacerbations, hospital admissions and mortality. Individual comorbidities can be grouped into clusters of common human pathology: inflammation/immune response (e.g., ischemic heart disease, metabolic syndrome), thrombosis/hemorrhage (e.g., cerebrovascular diseases, pulmonary embolism), fibrosis/cell proliferation (e.g., lung cancer and other malignancies) and apoptosis/necrosis (e.g., osteoporosis, skeletal muscle dysfunction). While the prevalence of the co-morbidities has been described in a number of observational studies, there is considerable variability in results; moreover characterization of cluster of co-morbidities with the most clinical significance in terms of morbidity and mortality is still …

Investigation Of The Correlates And Effectiveness Of A Prison-Based Wellness Program, Monica L. Clouse, David M. Mannino, Philip R. Curd

David M. Mannino

In 2006, a comprehensive wellness intervention, titled Wellness Works, was implemented in an incarcerated male population at a 200-bed facility in LaGrange, Kentucky. The purpose of this study was to determine health risk factors and benefits of program participation by analyzing data from a pre-/post-participation health risk assessment (HRA). In total, 448 inmates completed the pre- HRA and 177 (40%) completed the post- HRA. Among program completers, two of the six measured domains (smoking and depression) showed significant improvement at the post- HRA while the other domains (exercise, nutrition, stress, and dental hygiene) did not show significant changes. Overall, this …

Blood Fibrinogen As A Biomarker Of Chronic Obstructive Pulmonary Disease, Annelyse Duvoix, Jenny Dickens, Imran Haq, David M. Mannino, Bruce Miller, Ruth Tal-Singer, David A. Lomas

David M. Mannino

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a multicomponent condition that is characterised by airflow obstruction that is not fully reversible and is a major global cause of morbidity and mortality. The most widely used marker of disease severity and progression is FEV(1). However, FEV(1) correlates poorly with both symptoms and other measures of disease progression and thus there is an urgent need for other biological markers to better characterise individuals with COPD. Fibrinogen is an acute phase plasma protein that has emerged as a promising biomarker in COPD. Here we review the current clinical evidence linking fibrinogen with COPD …

Worldwide Patterns Of Bronchodilator Responsiveness: Results From The Burden Of Obstructive Lung Disease Study, Wan C. Tan, William M. Vollmer, Berned Lamprecht, David M. Mannino, Anamika Jithoo, Ewa Nizankowska-Mogilnicka, Filip Mejza, Thorarinn Gislason, Peter Burney, A Sonia Buist

David M. Mannino

Rationale: Criteria for a clinically significant bronchodilator response (BDR) are mainly based on studies in patients with obstructive lung diseases. Little is known about the BDR in healthy general populations, and even less about the worldwide patterns.

Methods: 10 360 adults aged 40 years and older from 14 countries in North America, Europe, Africa and Asia participated in the Burden of Obstructive Lung Disease study. Spirometry was used before and after an inhaled bronchodilator to determine the distribution of the BDR in population-based samples of healthy non-smokers and individuals with airflow obstruction.

Results: In 3922 healthy never smokers, the weighted …

Fibrinogen, Copd And Mortality In A Nationally Representative U.S. Cohort, David M. Mannino, Deepa Valvi, Hana Mullerova, Ruth Tal-Singer

David M. Mannino

BACKGROUND:

Fibrinogen is a marker of systemic inflammation and may represent an important biomarker for the progression of chronic obstructive pulmonary disease (COPD).

METHODS:

We used baseline data from the Third National Health and Nutrition Examination Survey (NHANES III) and follow-up mortality data to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected long-term outcomes. Elevated fibrinogen was defined as the upper 10% of the fibrinogen level distribution.

RESULTS:

Our study sample included 8,507 subjects, including 245 with Stage 3 or 4 COPD and 826 with Stage 2 COPD. Then, 3,290 of …

Fibrinogen, Chronic Obstructive Pulmonary Disease (Copd) And Outcomes In Two United States Cohorts, Deepa Valvi, David M. Mannino, Hana Mullerova, Ruth Tal-Singer

David M. Mannino

Background

Fibrinogen is a marker of systemic inflammation and may be important in the pathogenesis and progression of chronic obstructive pulmonary disease (COPD).

Methods

We used baseline data from Atherosclerosis Risk in Communities and Cardiovascular Health Studies to determine the relation between fibrinogen levels and COPD and to examine how fibrinogen levels at baseline affected outcomes of death, development of COPD, lung function decline, and COPD-hospitalizations.

Results

Our study sample included 20,192 subjects, of whom 2995 died during the follow-up period. The mean fibrinogen level was 307.6 mg/dL and 10% of the sample had levels >393.0 mg/dL. Subjects with Stage …

Syllabus - Cph 911 Epidemiology Seminar I, David M. Mannino

David M. Mannino

No abstract provided.

Pre- And Post-Bronchodilator Lung Function As Predictors Of Mortality In The Lung Health Study, David M. Mannino, Enrique Diaz-Guzman, Sonia Buist

David M. Mannino

Background

Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of post-bronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-bronchodilator lung function available. We used pre-and post bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality.

Methods

We limited our analysis to subjects who were of black or white race, on whom we had complete data, and who participated at either the 1 year or the 5 year follow-up visit. We classified subjects based on their baseline lung function, according …

Race-Ethnicity As An Effect Modifier Of The Association Between Hbalc And Mortality In U.S. Adults Without Diagnosed Diabetes, Katharina G. Kehl, Hannes M. Findeisen, David W. Fardo, Dennis Bruemmer, David M. Mannino, Wayne T. Sanderson

David M. Mannino

Objective

HbAlc is increasingly appreciated as a risk factor for all-cause and cardiovascular disease (CVD) mortality in the non-diabetic population. In this study, we investigated the association between HbAlc and mortality with a particular focus on the impact of race–ethnicity.

Design

Cohort study.

Methods

We analyzed the association between HbAlc and all-cause and CVD mortality in 12 698 non-diabetic adults 20 years or older from the Third National Health and Nutrition Examination Survey using separate models for people of different race–ethnicity.

Results

In our stratified analyses, higher non-diabetic HbAlc levels were associated with all-cause and CVD mortality in non-Hispanic whites …

Copd In Never Smokers: Results From The Population-Based Burden Of Obstructive Lung Disease Study, Bernd Lamprecht, Mary Ann Mcburnie, William M. Vollmer, Gunnar Gudmundsson, Tobias Welte, Ewa Nizankowska-Mogilnicka, Michael Studnicka, Eric Bateman, Josep M. Anto, Peter Burney, David M. Mannino, Sonia A. Buist

David M. Mannino

Background: Never smokers comprise a substantial proportion of patients with COPD. Their characteristics and possible risk factors in this population are not yet well defined.

Methods: We analyzed data from 14 countries that participated in the international, population-based Burden of Obstructive Lung Disease (BOLD) study. Participants were aged ≥ 40 years and completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. A diagnosis of COPD was based on the postbronchodilator FEV1/FVC ratio, according to current GOLD (Global Initiative for Obstructive Lung Disease) guidelines. In addition to this, the lower limit of normal …

The Association Of Adverse Pregnancy Events And Cardiovascular Disease In Women 50 Years Of Age And Older, Sara M. Freibert, David M. Mannino, Heather Bush, Leslie J. Crofford

David M. Mannino

Objective: This study investigates the association between a prior history of pregnancy complications and cardiovascular disease (CVD) among Kentucky women aged ≥50 years.

Methods: Data were analyzed from participants (n = 3909) in the Kentucky Women's Health Registry (2006–2008). Primary outcomes were self-reported prevalence of CVD, including angina, heart attack, heart failure, and arrhythmia. Pregnancy complications used as predictors were preterm labor, preeclampsia, gestational diabetes mellitus (GDM), and third trimester bleeding. Logistic regression analyses were conducted to determine associations between prevalence of CVD and pregnancy complications, controlling for age, education, and smoking status.

Results: Overall, 199 (5.1%) women reported angina, …

Kriged And Modeled Ambient Air Levels Of Benzene In An Urban Environment: An Exposure Assessment Study, Kristina W. Whitworth, Elaine Symanski, Dejian Lai, Ann L. Coker

CRVAW Faculty Journal Articles

Background. There is increasing concern regarding the potential adverse health effects of air pollution, particularly hazardous air pollutants (HAPs). However, quantifying exposure to these pollutants is problematic. Objective. Our goal was to explore the utility of kriging, a spatial interpolation method, for exposure assessment in epidemiologic studies of HAPs. We used benzene as an example and compared census tract-level kriged predictions to estimates obtained from the 1999 U.S. EPA National Air Toxics Assessment (NATA), Assessment System for Population Exposure Nationwide (ASPEN) model. Methods. Kriged predictions were generated for 649 census tracts in Harris County, Texas using estimates of annual benzene …

Update On The Management Of Chronic Obstructive Pulmonary Disease, Andrea K. Maas, David M. Mannino

David M. Mannino

Chronic obstructive pulmonary disease is a highly prevalent, underdiagnosed, and undertreated chronic lung disease. Early and appropriate treatment may help modify the course of the disease with respect to exacerbation timing and frequency, quality of life, and mortality. Steady progress continues to be made in understanding the disease pathogenesis and treatment modalities, and there is some evidence that outcomes are improving.

Exposure To Indoor Biomass Fuel Pollutants And Asthma Prevalence In Southeastern Kentucky: Results From The Burden Of Lung Disease (Bold) Study, Anna C. Barry, David M. Mannino, Claudia Hopenhayn, Heather Bush

David M. Mannino

BACKGROUND:

Asthma is a chronic inflammatory respiratory disease, characterized by episodic and reversible airflow obstruction and airway hyperresponsiveness and is influenced by both genetic and environmental factors.

METHODS:

The Burden of Obstructive Lung Disease (BOLD) survey was used to determine the prevalence of self-reported asthma in a target population of 325,000 adults aged > or =40 in Southeastern Kentucky. Postbronchodilator spirometry was used to classify subjects based on lung function. Risk factors for asthma in this population, in particular indoor usage of biomass fuels, were evaluated.

RESULTS:

The overall study population was comprised of 508 individuals, with 15.5% reporting current asthma …

Recent Trends In Exposure To Secondhand Smoke In The United States Population, Chieh-I Chen, Tanya Burton, Christine L. Baker, Vera Mastey, David M. Mannino

David M. Mannino

Background Previous research using the National Health and Nutrition Examination Surveys (NHANES) data documented a significant downward trend in secondhand smoke (SHS) exposure between 1988 and 2002. The objective of this study was to assess whether the downward trend in exposure continued from 2001 through 2006.

Methods We analyzed data from the 2001-2006 NHANES to estimate exposure of nonsmokers to SHS. Geometric means of serum cotinine levels for all nonsmokers were computed.

Results Overall serum cotinine levels (95% Confidence Intervals) in 2001-2002, 2003-2004, and 2005-2006 were 0.06 ng/mL (0.05-0.07), 0.07 ng/mL (0.06-0.09), and 0.05 ng/mL (0.05-0.06), respectively. Subgroup analysis by …

Development Of The Lung Function Questionnaire (Lfq) To Identify Airflow Obstruction, Barbara P. Yawn, Douglas W. Mapel, David M. Mannino, Fernando J. Martinez, James F. Donohue, Nicola A. Hanania, Mark Kosinski, Regina Rendas-Baum, Matthew Mintz, Steven Samuels, Anand A. Dalal

David M. Mannino

Objective:

To describe the item-selection and item-reduction for the Lung Function Questionnaire (LFQ), being developed to help clinicians identify patients appropriate for diagnostic evaluation for chronic obstructive pulmonary disease (COPD) using spirometry.

Methods:

Item selection and reduction were based on information from 387 ≥40-year-old respondents to the third National Health and Nutrition Examination Survey who had self-reported chronic bronchitis. Item reduction involved stepwise logistic regression. The accuracy of the final subset of items for identifying individuals with airflow obstruction (forced expiratory volume in one second/forced vital capacity <0.70) versus those without it was assessed with receiver operating characteristic analysis. Content and face validity were assessed using focus groups of primary care physicians (n = 16) and interviews with COPD patients (n = 16).

Results:

The model with all five items (age; smoking history; the presence of …

Preventing Copd: Evidence Of Progress, David M. Mannino

David M. Mannino

Comment on

Trends in hospitalization with chronic obstructive pulmonary disease-United States, 1990-2005. [COPD. 2010]

Trends in mortality from COPD in selected U.S. States differing in tobacco control efforts. [COPD. 2010]

Prevalence Of Copd Among Symptomatic Patients In A Primary Care Setting, Barbara Yawn, David M. Mannino, Thomas Littlejohn, Gary Ruoff, Amanda Emmett, Ibrahim Raphiou, Glenn Crater

David M. Mannino

Objective: Spirometry is recognized as the gold standard assessment for the diagnosis of COPD. However, spirometry continues to be underused, perpetuating the underdiagnosis of COPD. The aim of this study was to evaluate the prevalence of COPD in a primary care setting in patients with a smoking history and self-reported chronic bronchitis symptoms.

Research design and methods: This was a multi-center, cross-sectional study. The primary assessment was the percentage of patients with airway obstruction (post-bronchodilator FEV1/FVC ratio ≤ 0.70) compared to those without obstruction (post-bronchodilator FEV1/FVC ratio > 0.70).

Results: Airflow obstruction consistent with COPD was confirmed in 26% of patients …

Association Of Ambient Ozone Exposure With Airway Inflammation And Allergy In Adults With Asthma, Sumita B. Khatri, Fernando C. Holguin, P. Barry Ryan, David M. Mannino, Serpil C. Erzurum, W. Gerald Teague

David M. Mannino

Rationale

Previous studies have demonstrated associations of high ozone levels with increased epidemiologic as well as lung function measures of asthma activity.

Objectives

In an observational study during the summer months, we hypothesized that higher ambient ozone levels are associated with more frequent symptoms, higher airway and systemic inflammation, as well as worse lung function in asthmatics as compared with non-asthmatic individuals.

Methods

Thirty-eight asthmatics and thirteen healthy control subjects residing in metropolitan Atlanta were enrolled during peak ozone season. Medical histories, quality-of-life questionnaires, spirometry, serum immunoglobulin (IgE), peripheral eosinophil counts, and exhaled nitric oxide (NO) were obtained during study …

Life Expectancy And Years Of Life Lost In Chronic Obstructive Pulmonary Disease: Findings From The Nhanes Iii Follow-Up Study, Robert M. Shavelle, David R. Paculdo, Scott J. Kush, David M. Mannino, David J. Strauss

David M. Mannino

Rationale

Previous studies have demonstrated that chronic obstructive pulmonary disease (COPD) causes increased mortality in the general population. But life expectancy and the years of life lost have not been reported.

Objectives

To quantify mortality, examine how it varies with age, sex, and other risk factors, and determine how life expectancy is affected.

Methods

We constructed mortality models using the Third National Health and Nutrition Examination Survey, adjusting for age, sex, race, and major medical conditions. We used these to compute life expectancy and the years of life lost.

Measurements and main results

Pulmonary function testing classified patients as having …

The Effect Of Sex On Asthma Control From The National Asthma Survey, James Temprano, David M. Mannino

David M. Mannino

Background Previous studies have demonstrated conflicting results with regard to differences in asthma control between the sexes.

Objective We sought to identify sex differences in short-term and long-term measures of asthma control in adults from the National Asthma Survey.

Methods This study analyzed data from the National Asthma Survey (Four-State sample) sponsored by the National Center for Environmental Health, Centers for Disease Control and Prevention. Asthma control was compared between the sexes based on short-term (recent symptoms, asthma attacks, and albuterol use) and long-term (asthma attacks, work days lost, and urgent-care visits and hospitalizations in the prior year) measures. Composite …

Gender Specific Differences In The Pros And Cons Of Smoking Among Current Smokers In Eastern Kentucky: Implications For Future Smoking Cessation Interventions, Dana A. Hazen, David M. Mannino, Richard Clayton

David M. Mannino

This study investigated gender differences in the perceived “pros” and “cons” of smoking using the constructs of decisional balance (DB) and stage of change from the Transtheoretical Model. The population distribution for stage of change among a population-based, cross-sectional survey of 155 current smokers over 40 years was: precontemplation (22.6%), contemplation (41.9%), preparation (35.5%). Results of stepwise regression models indicated significant gender differences in DB were in the preparation stage of change; scores on the DB measure increased 3.94 points (95% CI: 1.94, 5.93) for male smokers. Interventions targeting the “pros” and “cons” of smoking may need to be gender …

Obstructive Lung Disease Models: What Is Valid, Jill M. Ferdinands, David M. Mannino

David M. Mannino

Use of disease simulation models has led to scrutiny of model methods and demand for evidence that models credibly simulate health outcomes. We sought to describe recent obstructive lung disease simulation models and their validation. Medline and EMBASE were used to identify obstructive lung disease simulation models published from January 2000 to June 2006. Publications were reviewed to assess model attributes and four types of validation: first-order (verification/debugging), second-order (comparison with studies used in model development), third-order (comparison with studies not used in model development), and predictive validity. Six asthma and seven chronic obstructive pulmonary disease models were identified. Seven …

Epidemiology Of Copd Exacerbations, Andrea K. Johnston, David M. Mannino

David M. Mannino

Chapter Opening

Chronic obstructive pulmonary disease (COPD) is expected to be the third cause of death worldwide by the year 2020, behind only cardiovascular disease and cerebrovascular disease (1), and the fifth leading cause of disability-adjusted life years lost (2). In the United States, COPD accounted for 8 million outpatient visits, 1.5 millions emergency department (ED) visits, 726,000 hospitalizations, and 119,000 deaths in 2000, with the number of women dying from COPD surpassing the number of men for the first time (3). In the United Kingdom, COPD exacerbations are now the most common cause of hospital admission (4). Acute exacerbations …

Respiratory Diseases Research At Niosh: Reviews Of Research Programs Of The National Institute For Occupational Safety And Health, Mark Utell, John Balmes, Paul Blanc, Elizabeth Chamberlin, Rogene Henderson, David M. Mannino, James Merchant, Jacqueline Nowell, Charles Poole, Richard Schlesinger, Noah Seixas, Ira Tager, David Wegman

David M. Mannino

See attached file for Executive Summary Full Text Link http://www.nap.edu/openbook.php?record_id=12171&page=R1

The Epidemiology And Economics Of Chronic Obstructive Pulmonary Disease, David M. Mannino, S. Braman

David M. Mannino

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease responsible for a large human and economic burden around the world. Cigarette smoking is the main risk factor for COPD in the developed world, although other important risk factors include occupational exposures, air pollution, airway hyperresponsiveness, asthma, and genetic predisposition. In most of the world, COPD prevalence and mortality continue to rise in response to increases in smoking, particularly by women and adolescents. COPD is also an important cause of disability, and is linked to comorbid diseases, such as depression and cardiovascular disease, which adds to the large economic …

Adrb2 Arg16gly Polymorphism, Lung Function, And Mortality: Results From The Atherosclerosis Risk In Community Study, Jill M. Ferdinands, David M. Mannino, Marta L. Gwinn, Molly S. Bray

David M. Mannino

Background

Growing evidence suggests that the Arg16Arg genotype of the beta-2 adrenergic receptor gene may be associated with adverse effects of beta-agonist therapy. We sought to examine the association of beta-agonist use and the Arg16Gly polymorphism with lung function and mortality among participants in the Atherosclerosis Risk in Communities study.

Methodology and Principal Findings

We genotyped study participants and analyzed the association of the Arg16Gly polymorphism and beta-agonist use with lung function at baseline and clinical examination three years later and with all-cause mortality during 10 years of follow-up. Lung function was characterized by percent-predicted forced expiratory volume in 1 …

What Is The Cost To Employers Of Direct Medical Care For Chronic Obstructive Pulmonary Disease?, Tursynbek Nurmagambetov, Adam Atherly, Seymour Williams, Fernando Holguin, David M. Mannino, Stephen C. Redd

David M. Mannino

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the United States. In 2000, an estimated 10.5 million people had COPD, of which more than 7.2 million were from the under-age 65 employed population. The prevalence of COPD in the workforce population was substantial with 46.5% of current employment among adults having the disease. However, the cost burden in the employed population is unknown. We examined COPD prevalence and costs in a large employment-based population. Using claims data from 1999 to 2003, we estimated the cost associated with COPD-related hospitalizations, emergency department visits, outpatient services, …

Changing The Burden Of Copd Mortality, David M. Mannino, Victor A. Kiri

David M. Mannino

COPD is a major cause of mortality and morbidity worldwide with an estimated 2.75 million deaths in 2000 (fourth leading cause of death). In addition to the considerable morbidity and mortality associated with COPD, this disease incurs significant healthcare and societal costs. Current COPD guidelines acknowledge that the following can improve COPD mortality: smoking cessation; long-term oxygen therapy; and lung volume reduction surgery in small subsets of COPD patients. To date, no randomized controlled trials have demonstrated an effect of pharmacological treatment on mortality, although several observational studies suggest that both long-acting bronchodilators and inhaled corticosteroids may provide a survival …