Airway responsiveness to methacholine and incidence of COPD: an international prospective cohort study.
- Marcon A Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
- Locatelli F Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
- Keidel D Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- Beckmeyer-Borowko AB Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- Cerveri I Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
- Dharmage SC Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
- Fuertes E Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
- Garcia-Aymerich J Institute for Global Health (ISGlobal), Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.
- Heinrich J Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Ludwig Maximilians University, Munich, Germany.
- Imboden M Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- Janson C Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
- Johannessen A Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
- Leynaert B Inserm UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, University Paris Diderot Paris 7, Paris, France.
- Pascual Erquicia S Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain.
- Pesce G Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
- Schaffner E Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- Svanes C Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
- Urrutia I Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain.
- Jarvis D MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.
- Probst-Hensch NM Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
- Accordini S Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
- 2018-05-04
Published in:
- Thorax. - 2018
asthma
clinical epidemiology
copd epidemiology
Adult
Bronchial Provocation Tests
Female
Forced Expiratory Volume
Humans
Incidence
Male
Methacholine Chloride
Middle Aged
Prospective Studies
Pulmonary Disease, Chronic Obstructive
Young Adult
English
BACKGROUND
It has been debated, but not yet established, whether increased airway responsiveness can predict COPD. Recognising this link may help in identifying subjects at risk.
OBJECTIVE
We studied prospectively whether airway responsiveness is associated with the risk of developing COPD.
METHODS
We pooled data from two multicentre cohort studies that collected data from three time points using similar methods (European Community Respiratory Health Survey and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). We classified subjects (median age 37 years, 1st-3rd quartiles: 29-44) by their level of airway responsiveness using quintiles of methacholine dose-response slope at the first examination (1991-1994). Then, we excluded subjects with airflow obstruction at the second examination (1999-2003) and analysed incidence of COPD (postbronchodilator FEV1/FVC below the lower limit of normal) at the third examination (2010-2014) as a function of responsiveness, adjusting for sex, age, education, body mass index, history of asthma, smoking, occupational exposures and indicators of airway calibre.
RESULTS
We observed 108 new cases of COPD among 4205 subjects during a median time of 9 years. Compared with the least responsive group (incidence rate 0.6 per 1000/year), adjusted incidence rate ratios for COPD ranged from 1.79 (95% CI 0.52 to 6.13) to 8.91 (95% CI 3.67 to 21.66) for increasing airway responsiveness. Similar dose-response associations were observed between smokers and non-smokers, and stronger associations were found among subjects without a history of asthma or asthma-like symptoms.
CONCLUSIONS
Our study suggests that increased airway responsiveness is an independent risk factor for COPD. Further research should clarify whether early treatment in patients with high responsiveness can slow down disease progression.
It has been debated, but not yet established, whether increased airway responsiveness can predict COPD. Recognising this link may help in identifying subjects at risk.
OBJECTIVE
We studied prospectively whether airway responsiveness is associated with the risk of developing COPD.
METHODS
We pooled data from two multicentre cohort studies that collected data from three time points using similar methods (European Community Respiratory Health Survey and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). We classified subjects (median age 37 years, 1st-3rd quartiles: 29-44) by their level of airway responsiveness using quintiles of methacholine dose-response slope at the first examination (1991-1994). Then, we excluded subjects with airflow obstruction at the second examination (1999-2003) and analysed incidence of COPD (postbronchodilator FEV1/FVC below the lower limit of normal) at the third examination (2010-2014) as a function of responsiveness, adjusting for sex, age, education, body mass index, history of asthma, smoking, occupational exposures and indicators of airway calibre.
RESULTS
We observed 108 new cases of COPD among 4205 subjects during a median time of 9 years. Compared with the least responsive group (incidence rate 0.6 per 1000/year), adjusted incidence rate ratios for COPD ranged from 1.79 (95% CI 0.52 to 6.13) to 8.91 (95% CI 3.67 to 21.66) for increasing airway responsiveness. Similar dose-response associations were observed between smokers and non-smokers, and stronger associations were found among subjects without a history of asthma or asthma-like symptoms.
CONCLUSIONS
Our study suggests that increased airway responsiveness is an independent risk factor for COPD. Further research should clarify whether early treatment in patients with high responsiveness can slow down disease progression.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1136/thoraxjnl-2017-211289
- PMID 29720562
- Persistent URL
- https://sonar.ch/global/documents/185878
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