• Frits M E Franssen, Joan B Soriano, Nicolas Roche, Paul H Bloomfield, Guy Brusselle, Leonardo M Fabbri, Francisco García-Rio, Mark T Kearney, Namhee Kwon, Bo Lundbäck, Klaus F Rabe, Alice Raillard, Hana Muellerova, and John R Cockcroft.
• 1 Department of Research and Education, CIRO+, Horn, the Netherlands.
• Am. J. Respir. Crit. Care Med. 2016 Sep 1; 194 (5): 568-76.

RationaleThe aim of the ALICE (Airflow Limitation in Cardiac Diseases in Europe) study was to investigate the prevalence of airflow limitation in patients with ischemic heart disease and the effects on quality of life, healthcare use, and future health risk.ObjectivesTo examine prebronchodilator and post-bronchodilator spirometry in outpatients aged greater than or equal to 40 years with clinically documented ischemic heart disease who were current or former smokers.MethodsThis multicenter, cross-sectional study was conducted in 15 cardiovascular outpatient clinics in nine European countries. Airflow limitation was defined as post-bronchodilator FEV1/FVC less than 0.70.Measurements And Main ResultsAmong the 3,103 patients with ischemic heart disease who were recruited, lung function was defined for 2,730 patients. Airflow limitation was observed in 30.5% of patients with ischemic heart disease: 11.3% had mild airflow limitation, 15.8% moderate airflow limitation, 3.3% severe airflow limitation, and 0.1% very severe airflow limitation. Most patients with airflow limitation (70.6%) had no previous spirometry testing or diagnosed pulmonary disease. Airflow limitation was associated with greater respiratory symptomatology, impaired health status, and more frequent emergency room visits (P < 0.05).ConclusionsAirflow limitation compatible with chronic obstructive pulmonary disease affects almost one-third of patients with ischemic heart disease. Although airflow limitation is associated with additional morbidity and societal burden, it is largely undiagnosed and untreated. Clinical trial registered with www.clinicaltrials.gov (NCT 01485159).

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