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Related Articles Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with chronic obstructive pulmonary disease. Chest. 2007 May 15; Authors: Laurin C, Lavoie KL, Bacon SL, Dupuis G, Lacoste G, Cartier A, Labrecque M Background Psychiatric disorders are highly prevalent in patients with chronic obstructive pulmonary disease (COPD). In general, psychiatric disorders are more common in women than in men. The extent to which women with COPD suffer from greater psychiatric and psychological morbidity is not known. The present cross-sectional study evaluated the prevalence of mood and anxiety disorders, levels of psychological distress, and quality of life in 62 women and 54 men with documented, stable COPD. METHODS: All patients (n=116) underwent a sociodemographic and medical history interview, followed by a structured psychiatric interview and standard spirometry. Patients also completed a battery of questionnaires measuring psychological distress and quality of life. RESULTS: The overall prevalence of psychiatric disorders was 49%. Significantly more women than men met diagnostic criteria for anxiety disorders (56% vs. 35%) and a trend for greater levels of major depression in women was found (18% vs. 7%). Women had significantly higher anxiety sensitivity and depressive symptoms compared to men, but did not report more limitations in psychological functioning. Women also reported being less confident in their ability to control respiratory symptoms, and more daily physical limitations compared to men, despite having comparable COPD severity, dyspnoea scores, and exacerbation rates. CONCLUSIONS: Results indicate that psychiatric disorders are at least three times higher in COPD patients compared to the general population, and nearly two times higher in women than in men. Women also have greater psychological distress, worse perceived control of symptoms and greater functional impairment. Greater efforts should be made to identify and treat psychiatric disorders in COPD patients, particularly in women.
Related Articles Comparison of Peak-Expiratory Flow Variability Between Workers with Work-Exacerbated Asthma and Occupational Asthma. Chest. 2007 May 15; Authors: Chiry S, Cartier A, Malo JL, Tarlo SM, Lemière C Background Peak-expiratory flow (PEF) monitoring is frequently used to diagnose occupational asthma (OA). The variability of PEF between periods at and away from work has not been described in workers with work-exacerbated asthma (WEA).We sought to assess and compare the diurnal variability of PEF during periods at and away from work between subjects with OA and WEA. Methods Workers referred for work-related asthma underwent PEF monitoring for 2 weeks at and away from work. The diagnostic of OA or WEA was subsequently made according to the respective positivity or negativity of the specific-inhalation challenges. The PEF's mean diurnal variability was calculated during periods at and away from work. PEF graphs were also interpreted using direct visual analysis by five observers and by using the Oasys-2 expert system. Results Thirty-four subjects were investigated (WEA: 15; OA: 19). There was a greater variability of PEF at work than away from work in both OA (19.8 +/- 8.7% vs. 10.7 +/- 6.3% p <0.001) and WEA (14.2 +/- 4.8% vs. 10.6 +/- 5.6% p = 0.02). However, the magnitude of the variability was higher in OA than in WEA (p = 0.02). The visual interpretation of PEF or Oasys-2 failed to distinguish WEA from OA. Conclusion Although workers with OA showed a higher PEF variability than workers with WEA when at work, clinicians were unable to reliably differentiate OA from WEA using the visual interpretation of PEF graphs or the computerized analysis.
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Related Articles Diisocyanate asthma and gene-environment interactions with IL4RA, CD-14, and IL-13 genes. Ann Allergy Asthma Immunol. 2006 Dec;97(6):800-6 Authors: Bernstein DI, Wang N, Campo P, Chakraborty R, Smith A, Cartier A, Boulet LP, Malo JL, Yucesoy B, Luster M, Tarlo SM, Hershey GK BACKGROUND: Diisocyanate asthma (DA) affects 2% to 10% of exposed workers, yet the pathogenetic mechanisms underlying this disorder remain ill defined. OBJECTIVE: To determine if specific single nucleotide polymorphisms (SNPs) of interleukin 4 receptor alpha (IL4RA), IL-13, and CD14 promoter genes are associated with DA. METHODS: Sixty-two workers with DA confirmed by specific inhalation challenge (SIC) and 75 diisocyanate-exposed, SIC-negative workers were analyzed for SNPs associated with IL4RA, IL-13, and CD14 promoter genes. RESULTS: No associations were found with individual SNPs and DA. When stratified according to specific diisocyanate exposure, a significant association was found between IL4RA (I50V) II and DA among individuals exposed to hexamethylene diisocyanate (HDI) (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.33-8.14; P = .01) only. Similarly, the IL4RA (I50V) II and IL-13 (R110Q) RR combination was significantly associated with DA in HDI-exposed workers (OR, 4.13; 95% CI, 1.35-12.68; P = .01), as was the IL4RA (I50V) II and CD14 (C159T) CT genotype combination (OR, 5.2; 95% CI, 1.82-14.88; P = .002) and the triple genotype combination IL4RA (I50V) II, IL-13 (R110Q) RR, and CD14 (C159T) CT (OR, 6.4; 95% CI, 1.57-26.12; P = .01). CONCLUSIONS: Gene-environmental interactions may contribute to the pathogenesis of DA, and gene-gene interactions may modulate this relationship.
Related Articles Can access to spirometry in asthma education centres influence the referral rate by primary physicians for education? Can Respir J. 2006 Dec;13(8):427-31 Authors: Labrecque M, Lavallée M, Beauchesne MF, Cartier A, Boulet LP BACKGROUND AND OBJECTIVES: Asthma remains uncontrolled in a large number of asthmatic patients. Recent surveys have shown that a minority of asthmatic patients are referred to asthma educators.The objective of the present study was to assess the influence of increased access to spirometry in asthma education centres (AECs) on the rate of patient referrals to these centres by general practitioners. METHODS: A one-year, prospective, randomized, multicentric, parallel group study was conducted over two consecutive periods of six months each, with added spirometry being offered in the second six-month period to the experimental group. Ten AECs were enrolled in the project. An advertisement describing the AECs' services was sent by mail to a total of 303 general practitioners at the start of each period, inviting them to refer their patients. Measures of the frequency of medical referrals to the AECs were assessed for each period. RESULTS: The group of AECs randomly selected for spirometry in the second six-month period received 48 medical referrals during the first period and 32 during the second one, following proposed spirometry. AECs that had not offered spirometry received five referrals during the first period and seven during the second period. One AEC withdrew a few weeks after the study began and others encountered administrative problems, reducing their ability to provide interventions. CONCLUSIONS: Referral to AECs is not yet integrated into the primary care of asthma and offering more rapid access to spirometry in the AECs does not seem to be a significant incentive for such referrals.
Related Articles What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both? Chest. 2006 Oct;130(4):1039-47
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