Explore the vast range of titles available.

The aim of this study was to analyse the relationship between exposure to residential radon and chronic obstructive pulmonary disease (COPD) by means of a systematic review. A search was conducted in PubMed and OVID for papers making reference to the radon-COPD relationship. No search filters were applied, whether by date of publication, study type or sample size. All studies not written in English or Spanish were discarded. A total of 174 and 57 papers were found in PubMed and OVID, respectively: of these, 13 (11 on miners and 2 on the general population) fulfilled the inclusion criteria. Only four of the studies on cohorts of miners analysed COPD as a specific disease, and only one reported statistically significant results. In addition, many of these studies lacked information on tobacco use among miners. In contrast, studies conducted on the general public showed an association between mortality and hospital admissions, on the one hand, and residential radon on the other. There are not enough studies to provide a basis for confirming or ruling out an association between radon exposure and COPD. Nonetheless, the most recent general population studies point to evidence of a possible association. In view of the heterogeneity of available studies, it is impossible to say whether this gas may or may not affect COPD morbidity and mortality, until such a time as further studies are carried out.

Abstract Objective To determine the risk of lung cancer associated with exposure at home to the radioactive disintegration products of naturally occurring radon gas Design Collaborative analysis of individual data from 13 case-control studies of residential radon and lung cancer. Setting Nine European countries. Subjects 7148 cases of lung cancer and 14 208 controls. Main outcome measures Relative risks of lung cancer and radon gas concentrations in homes inhabited during the previous 5-34 years measured in becquerels (radon disintegrations per second) per cubic metre (Bq/m3) of household air. Results The mean measured radon concentration in homes of people in the control group was 97 Bq/m3, with 11% measuring > 200 and 4% measuring > 400 Bq/m3. For cases of lung cancer the mean concentration was 104 Bq/m3. The risk of lung cancer increased by 8.4% (95% confidence interval 3.0% to 15.8%) per 100 Bq/m3 increase in measured radon (P = 0.0007). This corresponds to an increase of 16% (5% to 31%) per 100 Bq/m3 increase in usual radon—that is, after correction for the dilution caused by random uncertainties in measuring radon concentrations. The dose-response relation seemed to be linear with no threshold and remained significant (P = 0.04) in analyses limited to individuals from homes with measured radon < 200 Bq/m3. The proportionate excess risk did not differ significantly with study, age, sex, or smoking. In the absence of other causes of death, the absolute risks of lung cancer by age 75 years at usual radon concentrations of 0, 100, and 400 Bq/m3 would be about 0.4%, 0.5%, and 0.7%, respectively, for lifelong non-smokers, and about 25 times greater (10%, 12%, and 16%) for cigarette smokers. Conclusions Collectively, though not separately, these studies show appreciable hazards from residential radon, particularly for smokers and recent ex-smokers, and indicate that it is responsible for about 2% of all deaths from cancer in Europe.

The rising trend in hospital admissions among patients with chronic obstructive pulmonary disease (COPD) is worrying, not only because of the increasing costs, but also because of the worsening quality of life. We aimed to identify the predictive factors of hospital admission, re-admission and mortality of COPD patients through using information exclusively registered in electronic clinical records. We conducted a population-based case-control study. All data were sourced from the different information systems comprising the Galician Health Service electronic record database. We included in the study patients diagnosed with COPD (code R95 in the medical record), ≥35 years old and with at least one spirometry performed ≤3 years prior inclusion. We fitted three logistic regression models, each one to ascertain the factors that influence the probability of admission, re-admission, and mortality, and calculated odds ratios (OR) with their 95% confidence intervals (95% CI). COPD patients were admitted due to respiratory causes a mean of 1.51 times across the period December 2016-December 2017, with 55% requiring re-admission in the next 90 days. The factor most closely associated with the re-admission profile was home oxygen therapy (OR 3.06 95% CI 2.42-3.87), followed by male gender (OR 2.01 95% CI 1.48-2.72), a CHA2D-VASc scale score >2 (OR 1.28 95% CI 1.16-1.42), and severity by clinical risk group stratification (OR 1.14 95% CI 1.04-1.26). Male sex (OR 1.47 CI 95% 1.04-2.09), having been readmitted ≥2 times (OR 1.34 CI 95% 1.11-1.61) and being ≥70 years old (OR 1.05 CI 95% 1.03-1.08) increase the probability of dying from COPD during the study period. These results confirm the complexity of management of COPD exacerbations, and indicate the need to establish strategies that would ensure continuity of care after hospital admission, with the aim of preventing re-admissions and death.

To plan end-of-life care it is essential to ascertain where patients die. There is very little information on the place of death of chronic obstructive pulmonary disease (COPD) patients. Accordingly, this study set out to describe the place of death of all COPD-related deaths in a Spanish region across the period 2009-2017, taking into account the sex and age of the deceased. We analyzed COPD deaths, codes J41-44 of the International Classification of Diseases-10th revision, in the Galician Autonomous Region from 2009 to 2017. Using death certificate data furnished by the Galician Mortality Registry, information was extracted on place of death, categorized as \"hospital\", \"nursing home\", \"patient's home\", \"other\" or \"not shown\". There were 10,274 deaths, with a male:female ratio of 2.52; 39.0% of deaths occurred in hospital and 41.4% at home, with these data varying according to sex and age. Across the study period, no reduction was observed in the number of deaths that occurred in hospital. For all the period analyzed, deaths among women occurred mostly at home, with an increase being seen in the number of deaths in nursing homes over the course of the study. Patients aged under 70 years tended to die more frequently in hospital, and those over this age died more frequently at home or in nursing homes. A very high percentage of COPD patients still die in hospital, a trend that has shown no decline in recent years. Even so, there are important variations by sex and age on the place of death of these patients.

Tobacco use is the leading risk factor for lung cancer, yet in addition to smoking habit, diet may also play a role in the diseases appearance. While there are reports to indicate that antioxidant vitamins and carotenoids may decrease the risk of lung cancer, results to date have been somewhat ambiguous. This review aimed to describe the results yielded by different studies, which have addressed antioxidant vitamin intake and lung cancer, and to indicate the mechanisms whereby these nutrients might be exercising their activity. Antioxidant vitamins were observed to have no clear protective effect, though there was some evidence pointing to a protective role for vitamins C and E. Vitamin A, in contrast, evinced no clear effect. Insofar as provitamin A carotenoids were concerned, lutein/zeaxanthin, lycopene and alpha-carotene displayed a certain protective trend, yet beta-carotene exhibited no protective effect whatsoever; and indeed, there was speculation as to whether it might even be pernicious in smokers. Beta-criptoxanthin, on the other hand, showed a more consistent protective effect. The study highlighted the need to conduct further research on smokers and non-smokers alike, and in particular, to investigate the effect, if any, on lung cancer of carotenoids or vitamins when ingested in differing dosages.

The purpose of this work is to model the relationship between smoking-related variables and the risk of lung cancer by using parametric and non-parametric models. A hospital-based case-control study was conducted to ascertain the influence of smoking on risk of lung cancer. We used parametric logistic regression with a series of categorized independent variables and non-parametric logistic regression models. Such models allow for variables to be treated as continuous, since they avoid arbitrariness in the selection of cut-offs and furnish information on the dose-risk relationship. The results point to the possible existence of a saturation effect for a lifetime tobacco consumption of around 25000-30000 packets. Duration of habit and years of abstinence show a linear relationship marked by opposite, though similar, slopes, which would seem to indicate that for every year of smoking, risk rises by an amount (8.00%, 95% confidence interval (CI) 5.94-10.06) equal to the decline in risk for every year of abstinence (6.98%, 95% CI 2.53-11.84). Lastly, a lower age of smoking initiation appears to have an influence, although non-significant, on the appearance of the disease. The risk of lung cancer due to duration of the habit would seem to be proportional to years of abstinence, and there could be a saturation effect with respect to lifetime tobacco consumption.

To increase our knowledge of the patient variables related to the overburden of the caregivers of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). This was a cross-sectional study of patients with severe COPD who have informal caregivers. We performed a multivariate analysis of sociodemographic (economic situation, care, dependence, social risk, and use of social services) and clinical (degree of dyspnea, previous hospitalizations, disease impact, pulmonary function, and comorbidity) factors and related these to the burden of informal caregivers, as evaluated using the Zarit scale. The study included 91 patients, age 72.6±8.7 years and 80 were male (89.7%); the mean modified Medical Research Council dyspnea scale (mMRC) score was 2.5±0.8; mean FEV was 39.5 ± 13.2%; and 70 patients (76.9%) were dependent for basic activities. Of the informal caregivers, 90 (90.9%) were women, 49 (49.4%) were partners or spouses, and 29 (29.6%) were daughters. The mean Zarit questionnaire score was 51.4±14.2, with 63 of carers (69.2%) perceiving some overburden, and 34 (37.4%) describing the overburden as mild-moderate. The variables related to informal caregiver overburden in the multivariate study were the previous use of social resources [OR = 8.1 (95% CI = 1.03-69.9); = 0.04], degree of mMRC dyspnea 3-4 [OR =4.7 (95% CI = 1.7-13.2); = 0.003], and two or more admissions for AEPOC in the previous year [OR = 4.5 (95% CI = 1.7-13.2); = 0.003]. Of the informal caregivers of patients who had presented two or more of these variables, 92.3% perceived an overburden. The variables associated with overburden are easily accessible in patient medical records, or can be obtained by interviewing patients or their relatives. This information would allow to detect and assess the overburden of informal caregivers to provide an early warning of this problem.

Background: Few epidemiological studies have examined the effect of wine on the risk of lung cancer. A study was therefore undertaken to estimate the effect of wine consumption, both overall and by type of wine, on the risk of developing lung cancer. Methods: A hospital based case-control study was conducted on 319 subjects (132 cases, 187 controls) in 1999–2000. All subjects were interviewed about their lifestyles with particular reference to alcohol consumption and tobacco use. The results were analysed using non-parametric logistic regression. The main outcome measure was the risk of lung cancer associated with consumption of wine and its individual types. Results: A very slight but significant association was observed between the risk of lung cancer and white wine consumption (odds ratio (OR) 1.20 for each daily glass). Red wine consumption, on the other hand, had an OR of 0.43 (95% CI 0.19 to 0.96), with each daily glass of red wine having an inverse association with the development of lung cancer (OR 0.87 (95% CI 0.77 to 0.99)). There was no apparent association between lung cancer and consumption of beer or spirits. Conclusions: These results suggest that the consumption of red wine is negatively associated with the development of lung cancer. Further studies are needed to test this finding in cancer induced laboratory animals.

There are no studies analyzing the relationship between emphysema and lung cancer (LC). With this aim and in order to make some comparisons between different clinical variables, we carried out the present study. This is a case-control study, patients with COPD and LC being the cases and subjects with stable COPD being the controls. Clinical and functional parameters, as well as the existence of radiological emphysema, were evaluated in a qualitative and quantitative way, using a radiological density of -950 Hounsfield units as a cutoff point in the images. The existence of several different types of emphysema (centrilobular, paraseptal, panacinar, or bullae) was analyzed, allowing patients to have more than one simultaneously. The extent to which lobes were involved was evaluated and the extension of emphysema was graduated for each type and location, following a quantitative scale. Differences between cases and controls were compared by using bivariate and multivariate analyzes with results expressed as OR and 95% CI. We included 169 cases and 74 controls, 84% men with a FEV (%) of 61.7±18.5, with 90.1% non-exacerbators. Most of them (50%) were active smokers and 47.2% were ex-smokers. Emphysema was found in 80.2% of the subjects, the most frequent type being centrilobular (34.4%). The only significantly different factor was the presence of paraseptal emphysema (alone or combined; OR =2.2 [95% CI =1.1-4.3, = 0.03]), with adenocarcinoma being significantly more frequent in paraseptal emphysema with respect to other types (67.2% vs 32.8%, =0.03). Patients with COPD and paraseptal emphysema could be a risk group for the development of LC, especially adenocarcinoma subtype.

Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis. Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the \"data warehouse of the Galician Healthcare Service\" using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0. A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA DS -VASc (4.21 vs 3.46; =0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; <0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; =0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; =0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality. AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect.