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Chest. 2018 Feb;153(2):368-377. doi: 10.1016/j.chest.2017.11.038. Epub 2017 Dec 15.

Asthma Is a Risk Factor for Respiratory Exacerbations Without Increased Rate of Lung Function Decline: Five-Year Follow-up in Adult Smokers From the COPDGene Study.

Author information

1
Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: lystra.hayden@childrens.harvard.edu.
2
Clinical Discovery Unit, Early Clinical Discovery, AstraZeneca, Waltham, MA.
3
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA.
4
Department of Radiology, National Jewish Health, Denver, CO.
5
Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO.
6
Department of Radiology, University of Edinburgh, Edinburgh, Scotland.
7
Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO.
8
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA.

Abstract

BACKGROUND:

Previous investigations in adult smokers from the COPDGene Study have shown that early-life respiratory disease is associated with reduced lung function, COPD, and airway thickening. Using 5-year follow-up data, we assessed disease progression in subjects who had experienced early-life respiratory disease. We hypothesized that there are alternative pathways to reaching reduced FEV1 and that subjects who had childhood pneumonia, childhood asthma, or asthma-COPD overlap (ACO) would have less lung function decline than subjects without these conditions.

METHODS:

Subjects returning for 5-year follow-up were assessed. Childhood pneumonia was defined by self-reported pneumonia at < 16 years. Childhood asthma was defined as self-reported asthma diagnosed by a health professional at < 16 years. ACO was defined as subjects with COPD who self-reported asthma diagnosed by a health-professional at ≤ 40 years. Smokers with and those without these early-life respiratory diseases were compared on measures of disease progression.

RESULTS:

Follow-up data from 4,915 subjects were examined, including 407 subjects who had childhood pneumonia, 323 subjects who had childhood asthma, and 242 subjects with ACO. History of childhood asthma or ACO was associated with an increased exacerbation frequency (childhood asthma, P < .001; ACO, P = .006) and odds of severe exacerbations (childhood asthma, OR, 1.41; ACO, OR, 1.42). History of childhood pneumonia was associated with increased exacerbations in subjects with COPD (absolute difference [β], 0.17; P = .04). None of these early-life respiratory diseases were associated with an increased rate of lung function decline or progression on CT scans.

CONCLUSIONS:

Subjects who had early-life asthma are at increased risk of developing COPD and of having more active disease with more frequent and severe respiratory exacerbations without an increased rate of lung function decline over a 5-year period.

TRIAL REGISTRY:

ClinicalTrials.gov; No. NCT00608764; https://clinicaltrials.gov.

KEYWORDS:

COPD; asthma-COPD overlap; childhood asthma; childhood pneumonia; respiratory exacerbations

PMID:
29248621
PMCID:
PMC5815872
[Available on 2019-02-01]
DOI:
10.1016/j.chest.2017.11.038

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