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Am J Respir Crit Care Med. 2011 Apr 1;183(7):891-7. doi: 10.1164/rccm.201007-1125OC. Epub 2010 Oct 8.

Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults.

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1
Department of Public Health and Community Medicine, University of Verona, Istituti Biologici II, Verona, Italy. roberto.demarco@univr.it

Abstract

RATIONALE:

Few studies have investigated the factors associated with the early inception of chronic obstructive pulmonary disease (COPD).

OBJECTIVES:

We investigated COPD risk factors in an international cohort of young adults using different spirometric definitions of the disease.

METHODS:

We studied 4,636 subjects without asthma who had prebronchodilator FEV(1)/FVC measured in the European Community Respiratory Health Survey both in 1991 to 1993 (when they were 20-44 yr old) and in 1999 to 2002. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease fixed cut-off criterion (FEV(1)/FVC < 0.70), and two criteria based on the Quanjer and LuftiBus reference equations (FEV(1)/FVC less than lower limit of normal). COPD determinants were studied using two-level Poisson regression models.

MEASUREMENTS AND MAIN RESULTS:

COPD incidence ranged from 1.85 (lower limit of normal [Quanjer]) to 2.88 (Global Initiative for Chronic Obstructive Lung Disease) cases/1,000/yr. Although about half of the cases had smoked less than 20 pack-years, smoking was the main risk factor for COPD, and it accounted for 29 to 39% of the new cases during the follow-up. Airway hyperresponsiveness was the second strongest risk factor (15-17% of new cases). Other determinants were respiratory infections in childhood and a family history of asthma, whereas the role of sex, age, and of being underweight largely depended on the definition of COPD used.

CONCLUSIONS:

COPD may start early in life. Smoking prevention should be given the highest priority to reduce COPD occurrence. Airway hyperresponsiveness, a family history of asthma, and respiratory infections in childhood are other important determinants of COPD. We suggest the need for a definition of COPD that is not exclusively based on spirometry.

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PMID:
20935112
DOI:
10.1164/rccm.201007-1125OC
[Indexed for MEDLINE]
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