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Respiratory symptoms and their determinants in the general Spanish population: changes over 20 years

Marc Miravitlles, Juan José Soler-Cataluña, Joan B. Soriano, Francisco García-Río, Pilar de Lucas, Inmaculada Alfageme, Ciro Casanova, José Miguel Rodríguez González-Moro, Guadalupe Sánchez, Julio Ancochea, Borja G. Cosío
ERJ Open Research 2022 8: 00067-2022; DOI: 10.1183/23120541.00067-2022
Marc Miravitlles
1Pneumology Dept, Hospital Universitari Vall d'Hebron/Vall d'Hebron Institut de Recerca, Barcelona, Spain
2CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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  • For correspondence: marcm@separ.es
Juan José Soler-Cataluña
2CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
3Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, Spain
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Joan B. Soriano
2CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
4Servicio de Neumología, Hospital Universitario La Princesa, and Universidad Autónoma de Madrid, Madrid, Spain
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Francisco García-Río
2CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
5Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
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Pilar de Lucas
6Servicio de Neumología, Hospital General Gregorio Marañon, Madrid, Spain
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Inmaculada Alfageme
7Unidad de Gestión Clínica de Neumología, Hospital Universitario Virgen de Valme, Universidad de Sevilla, Seville, Spain
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Ciro Casanova
8Servicio de Neumología, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
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José Miguel Rodríguez González-Moro
9Servicio de Neumología, Hospital Universitario “Príncipe de Asturias”, Alcalá de Henares, Universidad de Alcalá, Madrid, Spain
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Guadalupe Sánchez
10Departamento Médico, GSK, Madrid, Spain
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Julio Ancochea
2CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
4Servicio de Neumología, Hospital Universitario La Princesa, and Universidad Autónoma de Madrid, Madrid, Spain
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Borja G. Cosío
2CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
11Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain
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  • FIGURE 1
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    FIGURE 1

    Prevalence of respiratory symptoms in the general population over 40 years of age by a) sex and b) smoking habit. CMH: chronic mucus hypersecretion; CAT: COPD Assessment Test.

  • FIGURE 2
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    FIGURE 2

    Prevalence of respiratory symptoms in three population-based epidemiological surveys conducted in Spain in 1999, 2009 and 2019. CMH: chronic mucus hypersecretion; CAO: chronic airflow obstruction.

Tables

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  • Supplementary Materials
  • TABLE 1

    Demographic and clinical characteristics of the study participants by sex and smoking

    GlobalMenWomenp-valueSmokersNever-smokersp-value
    Subjects n90924311478149104182
    Age years60.2±11.160.1±10.860.4±11.30.155359.4±10.261.2±12.0<0.0001
    BMI kg·m−227.5±5.028.1±4.427.01±5.4<0.000127.4±4.827.6±5.10.0706
    Active smoker %19.821.618.1<0.000136.6
    Ex-smoker %34.239.929.163.4
    Never-smoker %46.038.552.8100
    Pack-years26.3±22.930.0±24.821.9±19.6<0.000126.3±22.9
    FVC L3.7±1.04.32±0.93.1±0.7<0.00013.8±0.93.2±1.1<0.0001
    FVC %101.0±14.9100.5±14.9101.5±14.9<0.0001100.9±14.5101.2±15.40.2152
    FEV1 L2.9±0.83.34±0.82.4±0.6<0.00012.9±0.82.8±0.9<0.0001
    FEV1 % pred100.6±17.199.64±17.7101.5±16.5<0.000198.8±17.2102.7±16.8<0.0001
    FEV1/FVC78.2±7.877.08±8.579.12±7.04<0.000176.9±8.579.7±6.7<0.0001
    Charlson comorbidity index0.36±0.870.42±0.970.30±0.77<0.00010.40±0.940.30±0.78<0.0001
    COTE index1.01±2.250.64±1.721.34±2.59<0.00011.06±2.290.95±2.200.0256
    Possible depression %11.19.512.6<0.000111.011.20.9141
    Possible anxiety %26.619.732.8<0.000126.426.80.1447
    YPAS50.0±23.852.7±25.147.7±22.5<0.000150.0±23.950.1±14.00.8135

    Values are mean±sd, unless otherwise specified. BMI: body mass index; FVC: forced vital capacity; FEV1: forced expiratory volume in 1 s; COTE: COPD specific comorbidity test; YPAS: Yale Physical Activity Questionnaire.

    • TABLE 2

      Prevalence of respiratory symptoms and chronic airflow obstruction in the study participants by sex and smoking

      GlobalMenWomenp-valueSmokersNever-smokersp-value
      Subjects n90924311478149104182
      Chronic cough15.914.916.80.014619.511.6<0.0001
      CMH13.015.011.2<0.000117.08.3<0.0001
      Wheezing33.733.633.80.792741.424.7<0.0001
      Dyspnoea one floor13.18.317.5<0.000113.412.80.4333
      Any dyspnoea26.822.031.1<0.000127.026.50.6041
      Dyspnoea mMRC<0.00010.9011
       073.278.068.973.073.5
       I21.818.125.121.921.6
       II3.82.94.73.83.9
       III1.11.01.21.21.0
       IV0.10.10.10.10.1
      Chronic bronchitis4.75.04.30.13876.72.3<0.0001
      Any symptom47.545.549.40.000255.438.3<0.0001
      CAT score, mean±sd6.4±5.85.8±5.46.8±6.1<0.00016.8±5.85.9±5.7<0.0001
      CAT >1019.616.222.8<0.000121.517.5<0.0001
      Asthma7.96.29.4<0.00016.69.4<0.0001
      Chronic airflow limitation (FR)11.814.69.4<0.000116.07.0<0.0001
      Chronic airflow limitation (LLN)6.07.14.9<0.00018.82.7<0.0001
      • Values are % unless otherwise specified. CMH: chronic mucus hypersecretion; mMRC: Modified Medical Research Council dyspnoea scale; CAT: COPD Assessment Test; FR: fixed ratio; LLN: lower limit of normal.

    • TABLE 3

      Unadjusted and adjusted association between patients’ characteristics and the presence of dyspnoea and wheezing

      VariablesDyspnoeaWheezing
      Unadjusted analysisAdjusted analysisUnadjusted analysisAdjusted analysis
      OR (95% CI)p-valueOR (95% CI)p-valueOR (95% CI)p-valueOR (95% CI)p-value
      Sex
       MaleRefRefRef
       Female2.355 (2.062–2.691)<0.00013.056 2.597–3.597)<0.00011.012 (0.927–1.105)0.7928
      Age years1.039 (1.033–1.045)<0.00011.029 (1.022–1.036)<0.00010.997 (0.993–1.001)0.2092
      BMI kg·m−21.111 (1.098–1.124)<0.00011.093 (1.078–1.107)<0.00011.054 (1.045–1.064)<0.00011.043 (1.033–1.052)<0.0001
      Smoking pack-years
       0RefRefRefRef
       0–100.775 (0.632–0.951)0.01451.162 (0.919–1.470)0.21071.448 (1.263–1.661)<0.00011.627 (1.409–1.879)<0.0001
       10–200.748 (0.598–0.935)0.01071.076 (0.835–1.386)0.57041.818 (1.575–2.099)<0.00011.930 (1.659–2.245)<0.0001
       20–300.930 (0.748–1.158)0.51751.252 (0.972–1.612)0.08152.154 (1.857–2.499)<0.00012.138 (1.828–2.502)<0.0001
       >301.593 (1.362–1.864)<0.00011.529 (1.262–1.854)<0.00013.242 (2.870–3.662)<0.00012.659 (2.334–3.029)<0.0001
      FEV1 %0.966 (0.963–0.970)<0.00010.973 (0.969–0.977)<0.00010.972 (0.970–0.975)<0.00010.978 (0.975–0.981)<0.0001
      Charlson comorbidity index
       0RefRefRef
       12.503 (2.147–2.919)<0.00011.700 (1.420–2.036)<0.00011.780 (1.578–2.009)<0.00011.372 (1.203–1.566)<0.0001
       >13.409 (2.826–4.112)<0.00012.341 (1.873–2.926)<0.00011.665 (1.417–1.957)<0.00011.211 (1.015–1.446)0.0335
      Depression4.167 (3.582–4.847)<0.00011.945 (1.606–2.356)<0.00011.543 (1.349–1.765)<0.0001
      Anxiety3.050 (2.685–3.464)<0.00012.302 (1.956–2.709)<0.00011.762 (1.599–1.942)<0.00011.769 (1.595–1.963)<0.0001
      YPAS0.975 (0.972–0.978)<0.00010.986 (0.983–0.989)<0.00010.995 (0.993–0.997)<0.0001

      The analysis was adjusted for the following variables: body mass index (BMI); forced vital capacity (FVC); forced expiratory volume in 1 s (FEV1); Hospital Anxiety and Depression scale (HADS); Yale Physical Activity Questionnaire (YPAS). Ref: reference.

      • TABLE 4

        Unadjusted and adjusted association between patients’ characteristics and chronic bronchitis and the presence of “any symptom”

        VariablesChronic bronchitis“Any symptom”
        Unadjusted analysisAdjusted analysisUnadjusted analysisAdjusted analysis
        OR (95% CI)p-valueOR (95% CI)p-valueOR (95% CI)p-valueOR (95% CI)p-value
        Sex
         MaleRefRefRef
         Female0.859 (0.703–1.051)0.13911.171 (1.076–1.274)0.00021.435 (1.302–1.582)<0.0001
        Age years1.006 (0.997–1.015)0.18911.010 (1.006–1.014)<0.0001
        BMI kg·m−21.029 (1.010–1.049)0.00251.063 (1.054–1.073)<0.00011.051 (1.041–1.062)<0.0001
        Smoking pack-years
         0RefRefRefRef
         0–101.174 (0.784–1.757)0.43601.258 (0.828–1.911)0.28291.221 (1.073–1.389)0.00251.415 (1.232–1.625)<0.0001
         10–201.769 (1.222–2.582)0.00311.803 (1.223–2.657)0.00291.703 (1.484–1.955)<0.00011.916 (1.651–2.224)<0.0001
         20–303.097 (2.216–4.327)<0.00013.069 (2.174–4.333)<0.00012.038 (1.762–2.356)<0.00012.192 (1.872–2.566)<0.0001
         >305.726 (4.409–7.435)<0.00014.808 (3.655–6.324)<0.00013.377 (2.982–3.824)<0.00012.987 (2.605–3.426)<0.0001
        FEV1 %0.968 (0.963–0.973)<0.00010.977 (0.971–0.982)<0.00010.969 (0.966–0.971)<0.00010.975 (0.972–0.978)<0.0001
        Charlson comorbidity index
         0RefRefRef
         11.629 (1.257–3.113)0.00021.909 (1.690–2.156)<0.00011.457 (1.273–1.667)<0.0001
         >12.184 (1.607–2.968)<0.00012.119 (1.797–2.498)<0.00011.537 (1.280–1.845)<0.0001
        Depression2.774 (2.177–3.535)<0.00011.388 (1.040–1.852)0.02592.210 (1.923–2.541)<0.00011.240 (1.050–1.464)0.0113
        Anxiety2.723 (2.222–3.337)<0.00012.457 (1.940–3.110)<0.00012.029 (1.841–2.236)<0.00011.825 (1.626–2.048)<0.0001
        YPAS0.992 (0.987–0.996)0.00030.991 (0.989–0.993)<0.00010.996 (0.994–0.998)<0.0001

        The analysis was adjusted for the following variables: body mass index (BMI); forced vital capacity (FVC); forced expiratory volume in 1 s (FEV1); Hospital Anxiety and Depression scale (HADS); Yale Physical Activity Questionnaire (YPAS). Ref: reference.

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        Respiratory symptoms and their determinants in the general Spanish population: changes over 20 years
        Marc Miravitlles, Juan José Soler-Cataluña, Joan B. Soriano, Francisco García-Río, Pilar de Lucas, Inmaculada Alfageme, Ciro Casanova, José Miguel Rodríguez González-Moro, Guadalupe Sánchez, Julio Ancochea, Borja G. Cosío
        ERJ Open Research Oct 2022, 8 (4) 00067-2022; DOI: 10.1183/23120541.00067-2022

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        Respiratory symptoms and their determinants in the general Spanish population: changes over 20 years
        Marc Miravitlles, Juan José Soler-Cataluña, Joan B. Soriano, Francisco García-Río, Pilar de Lucas, Inmaculada Alfageme, Ciro Casanova, José Miguel Rodríguez González-Moro, Guadalupe Sánchez, Julio Ancochea, Borja G. Cosío
        ERJ Open Research Oct 2022, 8 (4) 00067-2022; DOI: 10.1183/23120541.00067-2022
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