Publications by authors named "Emily Wan"

Background: Preserved ratio impaired spirometry (PRISm) findings are heterogeneous and include restrictive lung disease. Interstitial lung abnormalities (ILAs) may represent early interstitial lung disease. The relationship between PRISm findings and ILAs is not well understood.

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Rationale: The impact of respiratory exacerbation on chronic obstructive pulmonary disease (COPD) is well established. The effects of respiratory exacerbations in people with cigarette smoking but normal spirometry are unknown.

Objective: To assess the association of respiratory exacerbations with lung function decline and mortality in people with normal spirometry and current or former cigarette smoking history.

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Background: It remains unclear whether supplementation with vitamin D reduces risk of acute exacerbations of chronic obstructive lung disease (COPD) or asthma, major contributors to the world-wide burden of disease.

Objectives: To compare effects of vitamin D with placebo supplementation for the prespecified primary endpoints 1) acute exacerbations of COPD and 2) decline in pulmonary function measures of airflow obstruction. Prespecified secondary endpoints included asthma exacerbations and control.

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Background: Post-9/11 veterans were exposed to environmental and occupational pollutants during deployment.

Objective: Our aim was to determine associations between deployment-related exposures and sinusitis and rhinitis.

Methods: Between April 2018 and March 2020, veterans with land-based deployment after 9/11 who were living within 25 miles of 6 Department of Veteran Affairs medical centers were randomly chosen by using a Defense Manpower Data Center roster.

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Purpose Of Review: Recent recognition of the importance of abnormal spirometry without obstruction has generated interest in its epidemiology, risk factors, longitudinal outcomes, and clinical implications.

Recent Findings: Preserved ratio impaired spirometry (PRISm), defined as an forced expiratory volume in 1 s (FEV 1 )/ forced vital capacity (FVC) ≥0.7 with an FEV 1 <80% predicted, has a high prevalence globally (2.

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Unlabelled: Rationale/Objective: Acute exacerbations (AEs) of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality. Whether mucus plugs are associated with prospective exacerbations has not been examined extensively.

Methods: Mucus plugs were visually-identified on baseline chest computed tomography (CT) scans from smokers with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 2-4 COPD enrolled in two multicenter cohort studies: Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and COPDGene.

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Background: The relationships between physical activity (PA) and exercise performance and systemic biomarkers in persons with chronic obstructive pulmonary disease (COPD) have not been well characterized. The impact of PA promotion on biomarkers reflecting myocardial stress, systemic inflammation, and muscle injury is unclear.

Methods: This secondary analysis used 3 previously published studies in persons with COPD (2 examined a PA intervention that promoted community-based walking for 3 months) to explore these relationships.

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Article Synopsis
  • The study investigates the impact of smoking on lung function among post-9/11 Veterans, particularly those deployed in areas with high levels of particulate matter.
  • Data was collected from 1,836 Veterans, revealing that 44.8% were ever-smokers, with most starting before deployment and smoking more during deployment.
  • Results showed a negative correlation between the number of pack-years smoked and lung function measurements, indicating that higher smoking intensity, regardless of deployment status, adversely affects lung health.
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Background: Preserved ratio impaired spirometry (PRISm) is defined as a forced expiratory volume in 1 s (FEV) <80% predicted and FEV/forced vital capacity ≥0.70. PRISm is associated with respiratory symptoms and comorbidities.

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Article Synopsis
  • This study focused on analyzing inhalational exposures of US Veterans during their deployments to Afghanistan and Southwest Asia, examining their effects on respiratory health.
  • It involved nearly 2000 participants who reported their exposure to various harmful substances, such as burn pit smoke and other combustion-related pollutants, with results indicating significant exposure levels.
  • The findings revealed that exposure to burn pit smoke and military job-related vapors was linked to higher rates of respiratory symptoms, like dyspnoea and chronic bronchitis, among the Veterans.
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Hyper-secretion and/or hyper-concentration of mucus is a defining feature of multiple obstructive lung diseases, including chronic obstructive pulmonary disease (COPD). Mucus itself is composed of a mixture of water, ions, salt and proteins, of which the gel-forming mucins, MUC5AC and MUC5B, are the most abundant. Recent studies have linked the concentrations of these proteins in sputum to COPD phenotypes, including chronic bronchitis (CB) and acute exacerbations (AE).

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Background: Depression is known to limit physical activity (PA) among individuals with chronic obstructive pulmonary disease (COPD). However, whether and how depression influences the effectiveness of PA interventions is unknown.

Purpose: The study examined the association between baseline depression symptoms and change in daily step count and whether group assignment to a web-based, pedometer-mediated PA intervention moderated the association between baseline depression symptoms and change in daily step count.

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Cigarette smoking contributes to the risk of death through different mechanisms. To determine how causes of and clinical features associated with death vary in tobacco cigarette users by lung function impairment. We stratified current and former tobacco cigarette users enrolled in Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) into normal spirometry, PRISm (Preserved Ratio Impaired Spirometry), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-2 COPD, and GOLD 3-4 COPD.

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Article Synopsis
  • Recent studies indicate a significant number of people have undiagnosed chronic obstructive pulmonary disease (COPD), which could lead to complications and missed treatment opportunities.
  • The research analyzed data from smokers with at least 10 pack-years of history, excluding those already diagnosed with COPD or related conditions, and identified various risk factors related to abnormal spirometry results.
  • The findings revealed that 21% of participants had undiagnosed airflow obstruction, with factors like age, smoking history, and certain health conditions being key indicators, highlighting the need for early diagnosis and treatment.
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Article Synopsis
  • - The study looked at COPD patients with mild-to-moderate lung function and smokers whose lung function is preserved, categorizing them based on how often they experienced respiratory exacerbations, which are serious episodes needing medication.
  • - Among 2,099 COPD patients, those who had frequent exacerbations (1.8 or more yearly) faced a significantly higher risk of death compared to those with no exacerbations, showing a clear link between exacerbation frequency and mortality rates.
  • - In a separate group of 3,143 smokeless individuals with good lung function, frequent exacerbators were also found to have increased mortality risk, reinforcing that even with preserved lung function, frequent episodes can be serious.
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Article Synopsis
  • Researchers studied the rs35705950-T genetic variant to see how it affects the risk of severe outcomes in COVID-19 patients, particularly in the Million Veteran Program (MVP) participants.
  • The study found that those with the rs35705950-T allele had fewer hospitalizations due to COVID-19 but did not show significant differences in overall positivity rates for the virus.
  • The variant was linked to reduced rates of post-COVID-19 pneumonia among individuals of European ancestry, suggesting potential protective effects against certain complications of the disease.
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Article Synopsis
  • Sickle cell trait (SCT) affects millions in the US, especially among African and Hispanic populations, but its link to COVID-19 remains uncertain.* -
  • The study analyzed data from the Million Veteran Program, comparing 2,729 SCT-positive individuals, 353 of whom had COVID-19, to SCT-negative individuals to understand COVID-19 outcomes.* -
  • Results showed that SCT is associated with higher COVID-19 mortality among individuals of African ancestry and linked to various chronic health conditions before the pandemic.*
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The Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States (US) providing healthcare to an increasing number of middle-aged and older adults who remain at greater risk for chronic obstructive pulmonary disease (COPD) compared to their civilian counterparts. The VHA has obligated research funds, drafted clinical guidelines, and built programmatic infrastructure to support the diagnosis, treatment, and care management of Veterans with COPD. Despite these efforts, COPD remains a leading cause of morbidity and mortality in Veterans.

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Differences in body composition may contribute to variability in exercise capacity (EC) and physical activity (PA) in individuals with chronic obstructive pulmonary disease (COPD). Most studies have used bioimpedance-based surrogates of muscle (lean) mass; relatively few studies have included consideration of fat mass, and limited studies have been performed using dual X-ray absorptiometry (DXA) to assess body composition. To determine whether DXA-assessed muscle (lean) and fat mass exhibit differential correlations with EC and PA in subjects with COPD.

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We examined the performance of a commercially-available handheld bioimpedance (BIA) device relative to dual X-ray absorptiometry (DXA) to assess body composition differences among Veterans with chronic obstructive pulmonary disease (COPD). Body composition was measured using DXA and BIA (Omron HBF-306C) at a single time point. Correlations between BIA- and DXA-assessed percent fat, fat mass, and fat-free mass were analyzed using Spearman (ρ) and Lin Concordance Correlation Coefficients (ρ).

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