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Li Y, Wang W, Zhou D, Lu Q, Li L, Zhang B. Mendelian randomization study shows a causal effect of asthma on chronic obstructive pulmonary disease risk. PLoS One 2023; 18:e0291102. [PMID: 37656706 PMCID: PMC10473539 DOI: 10.1371/journal.pone.0291102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND This study was performed to explore the causal association between asthma and chronic obstructive pulmonary disease(COPD). METHODS We obtained summary statistics for asthma from 408,442 Europeans in an open genome-wide association study (GWAS) from the UK Biobank to select strongly associated single nucleotide polymorphisms that could serve as instrumental variables for asthma (P < 5×10-8). Additional summary statistics for COPD were obtained from 193,638 individuals of European ancestry in the GWAS published by FinnGen. Univariable Mendelian randomization(UVMR) analysis was performed using inverse variance weighted (IVW) as the primary method of analysis. The reliability of the results was verified by multivariable MR(MVMR), reverse and replication MR analysis, and sensitivity analysis. RESULTS In the UVMR analysis, asthma increased the risk of COPD, with an odds ratio (OR) of 1.27 (95% confidence interval (CI) = 1.16-1.39, P = 5.44×10-7). Estimates were consistent in MVMR analyses by the adjustments of smoking initiation, age of smoking initiation, cigarettes per day, PM 2.5, and the combination of the above factors. In the reverse MR analysis, there was no evidence of a causal effect of COPD on asthma risk(OR = 1.02, 95% CI = 0.97-1.07, P = 0.3643). In the replication MR analysis, asthma still increased the risk of COPD. Sensitivity analyses validated the robustness of the above associations. CONCLUSIONS We found that genetically predicted asthma was positively associated with the risk of COPD. Additionally, there was no evidence that COPD increases the risk of asthma. Further clarification of this link and underlying mechanisms is needed to identify feasible measures to promote COPD prevention.
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Affiliation(s)
- Yuanyuan Li
- Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Weina Wang
- Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Dengfeng Zhou
- Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Qiaofa Lu
- Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Lili Li
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Bo Zhang
- Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
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Zeng S, Luo G, Lynch DA, Bowler RP, Arjomandi M. Lung volumes differentiate the predominance of emphysema versus airway disease phenotype in early COPD: an observational study of the COPDGene cohort. ERJ Open Res 2023; 9:00289-2023. [PMID: 37727675 PMCID: PMC10505951 DOI: 10.1183/23120541.00289-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 09/21/2023] Open
Abstract
Rationale Lung volumes identify the "susceptible smokers" who progress to develop spirometric COPD. However, among susceptible smokers, development of spirometric COPD seems to be heterogeneous, suggesting the presence of different pathological mechanisms during early establishment of spirometric COPD. The objective of the present study was to determine the differential patterns of radiographic pathologies among susceptible smokers. Methods We categorised smokers with preserved spirometry (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0) in the Genetic Epidemiology of COPD (COPDGene) cohort based on tertiles (low, intermediate and high) of lung volumes (either total lung capacity (TLC), functional residual capacity FRC or FRC/TLC) at baseline visit. We then examined the differential patterns of change in spirometry and the associated prevalence of computed tomography measured pathologies of emphysema and airway disease with those categories of lung volumes. Results The pattern of spirometric change differed when participants were categorised by TLC versus FRC/TLC: those in the high TLC tertile showed stable forced expiratory volume in 1 s (FEV1), but enlarging forced vital capacity (FVC), while those in the high FRC/TLC tertile showed decline in both FEV1 and FVC. When participants from the high TLC and high FRC/TLC tertiles were partitioned into mutually exclusive groups, compared to those with high TLC, those with high FRC/TLC had lesser emphysema, but greater air trapping, more self-reported respiratory symptoms and exacerbation episodes and higher likelihood of progressing to more severe spirometric disease (GOLD stages 2-4 versus GOLD stage 1). Conclusions Lung volumes identify distinct physiological and radiographic phenotypes in early disease among susceptible smokers and predict the rate of spirometric disease progression and the severity of symptoms in early COPD.
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Affiliation(s)
- Siyang Zeng
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Gang Luo
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | | | | | - Mehrdad Arjomandi
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
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3
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Deolmi M, Decarolis NM, Motta M, Makrinioti H, Fainardi V, Pisi G, Esposito S. Early Origins of Chronic Obstructive Pulmonary Disease: Prenatal and Early Life Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2294. [PMID: 36767660 PMCID: PMC9915555 DOI: 10.3390/ijerph20032294] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
The main risk factor for chronic obstructive pulmonary disease (COPD) is active smoking. However, a considerable amount of people with COPD never smoked, and increasing evidence suggests that adult lung disease can have its origins in prenatal and early life. This article reviews some of the factors that can potentially affect lung development and lung function trajectories throughout the lifespan from genetics and prematurity to respiratory tract infections and childhood asthma. Maternal smoking and air pollution exposure were also analyzed among the environmental factors. The adoption of preventive strategies to avoid these risk factors since the prenatal period may be crucial to prevent, delay the onset or modify the progression of COPD lung disease throughout life.
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Affiliation(s)
- Michela Deolmi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Matteo Motta
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Heidi Makrinioti
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 01451, USA
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Giovanna Pisi
- Cystic Fibrosis Unit, Pediatric Clinic, Az. Ospedaliera-Universitaria di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
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Novel Lung Growth Strategy with Biological Therapy Targeting Airway Remodeling in Childhood Bronchial Asthma. CHILDREN 2022; 9:children9081253. [PMID: 36010143 PMCID: PMC9406359 DOI: 10.3390/children9081253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022]
Abstract
Anti-inflammatory therapy, centered on inhaled steroids, suppresses airway inflammation in asthma, reduces asthma mortality and hospitalization rates, and achieves clinical remission in many pediatric patients. However, the spontaneous remission rate of childhood asthma in adulthood is not high, and airway inflammation and airway remodeling persist after remission of asthma symptoms. Childhood asthma impairs normal lung maturation, interferes with peak lung function in adolescence, reduces lung function in adulthood, and increases the risk of developing chronic obstructive pulmonary disease (COPD). Early suppression of airway inflammation in childhood and prevention of asthma exacerbations may improve lung maturation, leading to good lung function and prevention of adult COPD. Biological drugs that target T-helper 2 (Th2) cytokines are used in patients with severe pediatric asthma to reduce exacerbations and airway inflammation and improve respiratory function. They may also suppress airway remodeling in childhood and prevent respiratory deterioration in adulthood, reducing the risk of COPD and improving long-term prognosis. No studies have demonstrated a suppressive effect on airway remodeling in childhood severe asthma, and further clinical trials using airway imaging analysis are needed to ascertain the inhibitory effect of biological drugs on airway remodeling in severe childhood asthma. In this review, we describe the natural prognosis of lung function in childhood asthma and the risk of developing adult COPD, the pathophysiology of allergic airway inflammation and airway remodeling via Th2 cytokines, and the inhibitory effect of biological drugs on airway remodeling in childhood asthma.
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Fuhlbrigge AL. Epidemiology of Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:533-547. [PMID: 35965043 DOI: 10.1016/j.iac.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma COPD Overlap has consistently reported to be associated with an increase burden of disease but the impact on lung function decline and mortality varies by study. The prevalence increases with age but the relationship with gender also varies with the study population. The variability in the prevalence and clinical characteristics of ACO is linked to differences in how chronic obstructive pulmonary disease (COPD) and asthma are defined, including diagnostic criteria (spirometry-based vs. clinical or symptom-based diagnoses vs. claims data), the population studied, the geographic region and environment and a consensus approach to the diagnosis of ACO is needed to allow meaningful and consistent epidemiologic information to be generated about this condition.
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Affiliation(s)
- Anne L Fuhlbrigge
- Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Fitzsimons Building | 13001 East 17th Place, Aurora, CO 80045, USA.
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Yang W, Li F, Li C, Meng J, Wang Y. Focus on Early COPD: Definition and Early Lung Development. Int J Chron Obstruct Pulmon Dis 2021; 16:3217-3228. [PMID: 34858022 PMCID: PMC8629909 DOI: 10.2147/copd.s338359] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease with high incidence rate and mortality rates worldwide. It is the third leading cause of death in the world. Nevertheless, little progress has been made in treating and preventing the disease. Under these circumstances, the concept of “early COPD” was proposed. Although this concept is not new, most health-care workers do not fully understand early COPD and tend to confuse it with mild COPD. In this review, we mainly discuss the definition of early COPD and the developmental trajectory of lung function. Although patients with early COPD have no symptoms, their lung function is already lower than that of normal people. A relatively complete definition is needed to identify this group of people. Reduced lung function is the diagnostic criterion for COPD, but lung development is a long-term dynamic process. In addition to smoking and air pollution, we should pay more attention to prenatal and childhood risk factors, for example, parents smoking, birth weight, preterm birth, mode of delivery, childhood respiratory infections and childhood asthma. Health-care workers need to be fully aware of early COPD, to reduce the morbidity of COPD and take effective measures to prevent these risk factors.
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Affiliation(s)
- Weichang Yang
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Fengyuan Li
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Can Li
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Jiaqi Meng
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Ying Wang
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
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Duan P, Wang Y, Lin R, Zeng Y, Chen C, Yang L, Yue M, Zhong S, Wang Y, Zhang Q. Impact of early life exposures on COPD in adulthood: A systematic review and meta-analysis. Respirology 2021; 26:1131-1151. [PMID: 34541740 DOI: 10.1111/resp.14144] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/16/2021] [Accepted: 08/29/2021] [Indexed: 02/06/2023]
Abstract
Early life represents a critical period for the development and growth of the lungs. Adverse exposures in this stage may drive the development of chronic obstructive pulmonary disease (COPD). Thus, we quantitatively evaluated the impact of different early life exposures on COPD in adulthood. The PubMed, Embase and Cochrane Library electronic databases were searched for articles published from January 2001 to October 2020. A total of 30 studies (795,935 participants) met the criteria and were included in the review. We found a significant association of COPD with childhood serious respiratory infections, pneumonia or bronchitis (pooled adjusted OR [aOR], 2.23 [95% CI, 1.63-3.07]). The probability of COPD was increased 3.45-fold for children with than without asthma (pooled aOR, 3.45 [95% CI, 2.37-5.02]). In addition, the probability of COPD was associated with maternal smoking (pooled aOR, 1.42 [95% CI, 1.17-1.72]), any child maltreatment (pooled aOR, 1.30 [95% CI, 1.18-1.42]) and low birth weight (pooled aOR, 1.58 [95% CI, 1.08-2.32]) but not childhood environmental tobacco smoke exposure (pooled aOR, 1.15 [0.83-1.61]) or premature birth (pooled aOR, 1.17 [95% CI, 0.87-1.58]). Furthermore, subgroup analyses revealed that probability was increased for only women with childhood physical abuse, sexual abuse and exposure to intimate partner violence. Factors resulting in COPD in adults could trace back to early life. Childhood respiratory disease, maltreatment, maternal smoking and low birth weight increase the risk of COPD. Promising advances in prevention strategies for early life exposures could markedly decrease the risk of COPD.
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Affiliation(s)
- Pengfei Duan
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
- Department of Infectious Disease Prevention and Control, The Zhongshan Second People's Hospital, Zhongshan, China
| | - Yao Wang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Rongqing Lin
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Yiming Zeng
- Department of Pulmonary and Critical Care Medicine, Respiratory Medicine Center of Fujian Province, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Chengshui Chen
- Respiratory Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li Yang
- Respiratory Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minghui Yue
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Shan Zhong
- Center for Research and Technology of Precision Medicine, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen, China
| | - Yun Wang
- Center for Research and Technology of Precision Medicine, College of Life Sciences and Oceanography, Shenzhen University, Shenzhen, China
| | - Qingying Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, China
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Odimba U, Senthilselvan A, Farrell J, Gao Z. Current Knowledge of Asthma-COPD Overlap (ACO) Genetic Risk Factors, Characteristics, and Prognosis. COPD 2021; 18:585-595. [PMID: 34555990 DOI: 10.1080/15412555.2021.1980870] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Asthma-COPD overlap (ACO) is a newly identified phenotype of chronic obstructive airway diseases with shared asthma and COPD features. Patients with ACO are poorly defined, and some evidence suggests that they have worse health outcomes and greater disease burden than patients with COPD or asthma. Generally, there is no evidence-based and universal definition for ACO; several consensus documents have provided various descriptions of the phenotype. In addition, the mechanisms underlying the development of ACO are not fully understood. Whether ACO is a distinct clinical entity with its particular discrete genetic determinant different from asthma and COPD alone or an intermediate phenotype with overlapping genetic markers within asthma and COPD spectrum of obstructive airway disease remains unproven. This review summarizes the current knowledge of the genetic risk factors, characteristics, and prognosis of ACO.
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Affiliation(s)
- Ugochukwu Odimba
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Jamie Farrell
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Faculty of Medicine, Health Sciences Centre (Respirology Department), Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Zhiwei Gao
- Clinical Epidemiology Unit, Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Ghosh N, Choudhury P, Joshi M, Bhattacharyya P, Roychowdhury S, Banerjee R, Chaudhury K. Global metabolome profiling of exhaled breath condensates in male smokers with asthma COPD overlap and prediction of the disease. Sci Rep 2021; 11:16664. [PMID: 34404870 PMCID: PMC8370999 DOI: 10.1038/s41598-021-96128-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 07/30/2021] [Indexed: 02/07/2023] Open
Abstract
Asthma-chronic obstructive pulmonary disease (COPD) overlap, termed as ACO, is a complex heterogeneous disease characterised by persistent airflow limitation, which manifests features of both asthma and COPD. These patients have a worse prognosis, in terms of more frequent and severe exacerbations, more frequent symptoms, worse quality of life, increased comorbidities and a faster lung function decline. In absence of clear diagnostic or therapeutic guidelines, ACO presents as a challenge to clinicians. The present study aims to investigate whether ACO patients have a distinct exhaled breath condensate (EBC) metabolic profile in comparison to asthma and COPD. A total of 132 age and BMI matched male smokers were recruited in the exploratory phase which consisted of (i) controls = 33 (ii) asthma = 34 (iii) COPD = 30 and (iv) ACO = 35. Using nuclear magnetic resonance (NMR) metabolomics, 8 metabolites (fatty acid, propionate, isopropanol, lactate, acetone, valine, methanol and formate) were identified to be significantly dysregulated in ACO subjects when compared to both, asthma and COPD. The expression of these dysregulated metabolites were further validated in a fresh patient cohort consisting of (i) asthma = 32 (ii) COPD = 32 and (iii) ACO = 40, which exhibited a similar expression pattern. Multivariate receiver operating characteristic (ROC) curves generated using these metabolites provided a robust ACO classification model. The findings were also integrated with previously identified serum metabolites and inflammatory markers to develop a robust predictive model for differentiation of ACO. Our findings suggest that NMR metabolomics of EBC holds potential as a platform to identify robust, non-invasive biomarkers for differentiating ACO from asthma and COPD.
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Affiliation(s)
- Nilanjana Ghosh
- grid.429017.90000 0001 0153 2859School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302 India
| | - Priyanka Choudhury
- grid.429017.90000 0001 0153 2859School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302 India
| | - Mamata Joshi
- grid.22401.350000 0004 0502 9283National Facility for High-Field NMR, Tata Institute of Fundamental Research, Mumbai, India
| | | | | | - Rintu Banerjee
- grid.429017.90000 0001 0153 2859Department of Agricultural and Food Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Koel Chaudhury
- grid.429017.90000 0001 0153 2859School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, 721302 India
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10
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Ali KM. Childhood asthma as a risk factor for adult chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 16:461-467. [PMID: 33317352 DOI: 10.1080/17476348.2021.1864328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Due to the disagreement in studies, the present study performed a systematic review and meta-analysis to investigate the relationship between childhood asthma and the development of chronic obstructive pulmonary disease (COPD) in adulthood.Methods: Literature search was performed in Medline and Embase databases until the end of 2019. Data were recorded as adjusted odds ratio (OR) and 95% confidence interval (95%CI). Analyses were performed on STATA 14.0 and an overall OR was reported. Subgroup analysis was performed to determine the source of heterogeneity.Results: Data from 11 articles were included in the meta-analysis. Overall, the odds of developing adulthood COPD in children with asthma were 3.0 times higher than that in non-asthmatic children (OR = 3.00; 95%CI: 2.25-4.00; p < 0.001). The relationship between childhood asthma and COPD in adulthood was reported somewhat greater in random sampling method studies than consecutive sampling method studies (OR = 2.89; 95% CI: 1.72-4.86; p = 0.001).Conclusion: Asthma in childhood could be considered as an independent risk factor for COPD in adulthood. Since type of study, sampling method, sample size of study and COPD prevalence are the main sources of heterogeneity, further prospective high-quality studies assessing the relationship of childhood asthma and adulthood COPD are recommended to be performed.
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11
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Tautolo ES, Wong C, Vandal A, Jalili-Moghaddam S, Griffiths E, Iusitini L, Trenholme A, Byrnes C. Respiratory Health of Pacific Youth: An Observational Study of Associated Risk and Protective Factors Throughout Childhood. JMIR Res Protoc 2020; 9:e18916. [PMID: 33084587 PMCID: PMC7641786 DOI: 10.2196/18916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Respiratory disease is the third most common cause of death in New Zealand, with Pacific people living in New Zealand bearing the greatest burden of this type of disease. Although some epidemiological outcomes are known, we lack the specifics required to formulate targeted and effective public health interventions. The Pacific Islands Families (PIF) birth cohort study is a study that provides a unique source of data to assess lung function and current respiratory health among participants entering early adulthood and to examine associations with early life events during critical periods of growth. OBJECTIVE This paper aims to provide an overview of the design, methods, and scope of the Respiratory Health of Pacific Youth Study, which uses the overall PIF study cohort aged 18-19 years. METHODS From 2000-2019, the PIF study has followed, from birth, the growth, and the development of 1398 Pacific children born in Auckland, New Zealand. Participants were nested within the overall PIF study (at ages 18-19 years) from June 2018, and assessments were undertaken until mid-November 2019. The assessments included respiratory and general medical histories, a general physical examination, assessment of lung function (forced expiratory volume and forced vital capacity), self-completed questionnaires (St George's Respiratory Questionnaire, European Quality of Life 5 Dimensions-3 Level, Epworth Sleepiness Scale for Children and Adolescents, and Leicester Cough Questionnaire), blood tests (eosinophils, Immunoglobulin E, Immunoglobulin G, Immunoglobulin A, Immunoglobulin M, and C-reactive protein), and chest x-rays. Noninferential analyses will be carried out on dimensionally reduced risk and protective factors and confounders. RESULTS Data collection began in June 2018 and ended in November 2019, with a total of 466 participants recruited for submission of the paper. Collection and collation of chest x-ray data is still underway, and data analysis and expected results will be published by November 2020. CONCLUSIONS This is the first longitudinal observational study to address the burden of respiratory disease among Pacific youth by determining factors in early life that impose long-term detriments in lung function and are associated with the presence of respiratory illness. Identifying risk factors and the magnitude of their effects will help in adopting preventative measures, establishing whether any avoidable risks can be modified by later resilient behaviors, and provide baseline measurements for the development of respiratory disease in later adult life. The study results can be translated into practice guidelines and inform health strategies with immediate national and international impact. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18916.
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Affiliation(s)
- El-Shadan Tautolo
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Conroy Wong
- Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Alain Vandal
- Department of Biostatistics, University of Auckland, Auckland, New Zealand
| | - Shabnam Jalili-Moghaddam
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Emily Griffiths
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Leon Iusitini
- AUT Pacific Health Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Adrian Trenholme
- Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Catherine Byrnes
- Paediatric Department, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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12
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Asamoah-Boaheng M, Acheampong L, Tenkorang EY, Farrell J, Oyet A, Midodzi WK. Association between early history of asthma and COPD diagnosis in later life: a systematic review and meta-analysis. Int J Epidemiol 2019; 47:1865-1876. [PMID: 30277533 DOI: 10.1093/ije/dyy207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 11/14/2022] Open
Abstract
Background Whereas most studies have reported prior history/diagnosis of asthma as an independent risk factor for chronic obstructive pulmonary disease (COPD) development in later life, no systematic review and meta-analysis has been conducted to synthesize these observational studies. The aim of this review is to investigate associations between prior history of asthma and later development of COPD. Methods We conducted a comprehensive search in PubMed, CINAHL and EMBASE for studies related to prior history of asthma and COPD diagnosis. Articles were screened for relevance by two independent reviewers. Methodological quality was independently assessed and data extracted for qualitative and quantitative review. We explored heterogeneity and performed a publication bias check. Results From the 1260 articles retrieved, 9 were included in the qualitative review and 7 in the meta-analysis. History of asthma was associated with developing COPD in later life (Inverse Variance Random-effects model, odds ratio: 7.87, 95% confidence interval: 5.40-11.45, p < 0.00001). Conclusions Studies with high methodological quality provided sufficient evidence to suggest that individuals with previous history of asthma have an increasing likelihood of developing COPD in later life.
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Affiliation(s)
- Michael Asamoah-Boaheng
- Department of Medicine, Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Lily Acheampong
- Department of Medicine, Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St. John's, Canada
| | - Jamie Farrell
- Department of Medicine, Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Alwell Oyet
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, Canada
| | - William K Midodzi
- Department of Medicine, Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
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Owens L, Laing IA, Zhang G, Turner S, Le Souëf PN. Airway function in infancy is linked to airflow measurements and respiratory symptoms from childhood into adulthood. Pediatr Pulmonol 2018; 53:1082-1088. [PMID: 29806178 DOI: 10.1002/ppul.24062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/10/2018] [Accepted: 05/08/2018] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Increasing evidence suggests that poor lung function in adulthood is determined very early in life. Our study aims were: (1) identify factors associated with early infant lung function; (2) quantify the link between early infant lung function and early adult lung function; and (3) identify environmental and inherited factors which predict lung function throughout the post-natal growth period. METHODS In this longitudinal study, 253 individuals were recruited antenatally. Lung function and allergy testing occurred at 1, 6, 12 months, 6, 11, 18, and 24 years of age. The relationship between lung function at 1 month (V'maxFRC) and spirometry variables at each follow-up was evaluated. Early life predictors of spirometry were assessed longitudinally using linear mixed models. RESULTS V'maxFRC correlated positively with FEF25-75% at every assessment from 6 to 24 years and FEV1 /FVC at 11 and 24 years and inversely with airway responsiveness at 6 and 18 years. Maternal asthma and smoking in pregnancy were associated with lower FEV1 from 6 to 24 years (-99 mL, P = 0.03; -77 mL, P = 0.045 respectively). Lower V'maxFRC at 1 month was associated with asthma and wheeze through to 24 years. CONCLUSION Lung airflow measurements track from birth into early adulthood, suggesting a permanent and stable airway framework is laid down in the antenatal period. Lower infant airway function is associated with respiratory symptoms into adulthood, indicating the link is clinically important. Antenatal and early life exposures must be addressed in order to maximize airway growth and reduce lifelong respiratory compromise.
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Affiliation(s)
- Louisa Owens
- School of Medicine University of Western Australia, Perth, Australia
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Ingrid A Laing
- Telethon Kids Institute, Subiaco, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Guicheng Zhang
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Centre for Genetic Origins of Health and Disease, University of Western Australia and Curtin University
| | - Steve Turner
- School of Medical Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Peter N Le Souëf
- School of Medicine University of Western Australia, Perth, Australia
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Uchida A, Sakaue K, Inoue H. Epidemiology of asthma-chronic obstructive pulmonary disease overlap (ACO). Allergol Int 2018; 67:165-171. [PMID: 29551279 DOI: 10.1016/j.alit.2018.02.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/27/2022] Open
Abstract
The term "asthma-COPD overlap" (ACO) has been applied to the condition in which a person has persistent airflow limitation with clinical features of both asthma and COPD. The certain definition and diagnostic criteria for ACO have not yet been established, and ACO prevalence has varied widely in studies: from 0.9% to 11.1% in the general population, from 11.1% to 61.0% in asthma patients, and from 4.2% to 66.0% in COPD patients. Furthermore, the frequency of exacerbations and prognosis in ACO patients have not been clearly demonstrated. Although ACO consists with several subgroups of patients with distinct clinical and pathophysiological features, it would be important to propose a standardized definition of and/or diagnostic criteria for ACO based on biomarkers and objective measures, even if it is tentative. It may lead cohort studies with large population or clinical trials around the world.
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15
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Savran O, Ulrik CS. Early life insults as determinants of chronic obstructive pulmonary disease in adult life. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29520136 PMCID: PMC5834168 DOI: 10.2147/copd.s153555] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Early life events may predispose to the development of chronic lung disease in adulthood. Aim To provide an update on current knowledge of early nongenetic origins of COPD. Materials and methods Systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results A total of 16 studies, comprising 69,365 individuals, met the predefined criteria and were included in the present review. Studies have shown that in utero tobacco exposure, low birth weight, preterm birth, and respiratory diseases, primarily asthma and pneumonia, in early childhood are associated with lung function impairment later in childhood, and by that predispose to subsequent development of COPD, although the causal association between childhood respiratory diseases and COPD has been questioned in one study. Environmental tobacco exposure has also been shown to have negative impact on lung function in childhood possibly leading to COPD in adulthood, although it is at present not possible to clearly distinguish between the impact of active and the environmental tobacco exposure on subsequent development of COPD. Conclusion Tobacco exposure in utero and early life is a risk factor for subsequent development of COPD. Furthermore, low birth weight, lower respiratory tract infections and asthma, including wheezy bronchitis, in childhood also seem to be important determinants for later development of COPD. Early life insults may, therefore, be crucial to COPD development.
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Affiliation(s)
- Osman Savran
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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16
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Ma H, Li Y, Tang L, Peng X, Jiang L, Wan J, Suo F, Zhang G, Luo Z. Impact of childhood wheezing on lung function in adulthood: A meta-analysis. PLoS One 2018; 13:e0192390. [PMID: 29394280 PMCID: PMC5796725 DOI: 10.1371/journal.pone.0192390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/23/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A growing body of evidence shows that childhood wheezing may lead to recurrent or persistent symptoms in adulthood, such that persistent wheezing associated with lung function deficits often have their roots in the first few years of life. OBJECTIVES We summarized information from several prospective cohort studies following children with or without wheezing into adulthood, to estimate the effect of childhood wheezing on adulthood lung function. METHODS Medical literatures were searched in the Medline, PubMed, ScienceDirect, Web of Science and Embase databases up to October 31, 2016. The adulthood lung function was selected as primary outcome, and chronic obstructive pulmonary disease (COPD) prevalence was selected as secondary outcome. The meta-analysis was performed with the Stata Version 14.0. A random-effects model was applied to estimate standardized mean difference (SMD) of lung function, and relative risk (RR) of COPD. RESULTS Six articles enrolling 1141 and 1005 children with and without wheezing, respectively. Meta-analysis showed that childhood wheezing decreased adulthood lung function as compared with no-wheezing subjects (SMD = -0.365, 95% confidence interval (CI): -0.569~-0.161, P = 0.000). Subgroup analyses indicated that childhood atopic wheezing reduced adulthood FEV1/FVC and FEV1%pred when compared with no-wheezing subjects. In addition, childhood atopic wheezing was significantly associated with COPD prevalence (RR = 5.307, 95% CI:1.033~27.271, P = 0.046). CONCLUSIONS Our meta-analysis suggests that childhood wheezing may induce ongoing declined lung function that extends into adult life, as well as an increased risk of COPD prevalence when accompanied with atopy.
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Affiliation(s)
- Huan Ma
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yuanyuan Li
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lin Tang
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xin Peng
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lili Jiang
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Jiao Wan
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Fengtao Suo
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Guangli Zhang
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Zhengxiu Luo
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
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17
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Guevara-Rattray EM, Garden FL, James AL, Wood-Baker R, Abramson MJ, Johns DP, Sonia Buist A, Burney PGJ, Haydn Walters E, Toelle BG, Marks GB. Atopy in people aged 40 years and over: Relation to airflow limitation. Clin Exp Allergy 2017; 47:1625-1630. [PMID: 28972658 DOI: 10.1111/cea.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have reached conflicting conclusions about the role of atopy as a risk factor for COPD. In part, this is attributable to variation in the definitions of airflow limitation and the treatment of people with asthma. OBJECTIVE To establish whether there is any independent association between atopy and post-bronchodilator airflow limitation in the general population aged 40 years and over. METHODS A cross-sectional survey was conducted in a general population sample of 2415 people aged 40 years and over in Australia. A history of ever being diagnosed with asthma was elicited by questionnaire. Atopy was defined as any skin prick test weal to common aeroallergens ≥4 mm. Airflow limitation was defined as post-bronchodilator spirometric (FEV1 /FVC) ratio <lower limit of normal. Analyses were adjusted for potential confounding due to age, sex, smoking, race and socio-economic status. RESULTS The prevalence of atopy, ever diagnosed asthma and post-bronchodilator airflow obstruction was 44.8%, 19.3% and 7.5%, respectively. In the population as a whole, atopy was associated with lower FEV₁ (adjusted difference -0.068L, 95% confidence interval (CI) -0.104 to -0.032), FVC (adj. difference -0.043L, 95% CI -0.086 to -0.0009) and post-bronchodilator FEV₁/FVC ratio (adj. difference -0.011, 95% CI -0.017 to -0.0055). The effect of atopy on lung function was no longer apparent when participants who reported ever diagnosed asthma were excluded (FEV₁ -0.011L, [95% CI -0.05 to 0.028L], FVC -0.012L [95% CI -0.060 to 0.036] and FEV₁/FVC ratio -0.0012 [95% CI -0.0072 to 0.0047L]). CONCLUSION AND CLINICAL RELEVANCE The apparent association between atopy and post-bronchodilator airflow limitation in the general population appears to be explained by the association between atopy and having ever diagnosed asthma and the effect of asthma on lung function.
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Affiliation(s)
- E M Guevara-Rattray
- Respiratory Sleep and Environmental Health, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - F L Garden
- Respiratory Sleep and Environmental Health, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - A L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - R Wood-Baker
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - M J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D P Johns
- University of Tasmania, Hobart, TAS, Australia
| | - A Sonia Buist
- Pulmonary& Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - E Haydn Walters
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
| | - B G Toelle
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,Sydney Local Health District, NSW, Australia
| | - G B Marks
- Respiratory Sleep and Environmental Health, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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18
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Childhood asthma is a risk factor for the development of chronic obstructive pulmonary disease. Curr Opin Allergy Clin Immunol 2017; 17:104-109. [PMID: 28118239 PMCID: PMC5577926 DOI: 10.1097/aci.0000000000000348] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW This review will catalog the many recent longitudinal studies that have investigated the relationship between asthma and lung function, or the persistence and trajectories of lung function deficits. RECENT FINDINGS Recent work has reported on 50-year follow-ups of some prominent population cohorts. A history of asthma confers a 10-30-fold risk of chronic obstructive pulmonary disease. Individuals reaching a reduced maximum growth of forced expiratory volume in 1 s in early adulthood are at risk for early or more severe chronic obstructive pulmonary disease (COPD). SUMMARY Taken together, there is a wealth of overlapping cohort studies of lung function, asthma and COPD. These show that asthma is associated with reduced lung function, which may start in infancy or prenatally, persists through childhood and adulthood and predisposes for early or more severe COPD.
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19
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Sin DD. Asthma-COPD Overlap Syndrome: What We Know and What We Don't. Tuberc Respir Dis (Seoul) 2016; 80:11-20. [PMID: 28119742 PMCID: PMC5256349 DOI: 10.4046/trd.2017.80.1.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/05/2016] [Accepted: 10/22/2016] [Indexed: 12/11/2022] Open
Abstract
Approximately one in four patients with chronic obstructive pulmonary disease (COPD) have asthmatic features consisting of wheezing, airway hyper-responsiveness or atopy. The Global initiative for Asthma/Globalinitiative for chronic Obstructive Lung Disease committee recently labelled these patients as having asthma-COPD overlap syndrome or ACOS. ACOS also encompasses patients with asthma, ≥40 years of age, who have been cigarette smokers (more than 5–10 pack years) or have had significant biomass exposure, and demonstrate persistent airflow limitation defined as a post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity of <70%. Data over the past 30 years indicate that patients with ACOS have greater burden of symptoms including dyspnea and cough and show higher risk of COPD exacerbations and hospitalizations than those with pure COPD or pure asthma. Patients with ACOS also have increased risk of rapid FEV1 decline and COPD mortality. Paradoxically, experimental evidence to support therapeutic decisions in ACOS patients is lacking because traditionally, patients with ACOS have been systematically excluded from therapeutic COPD and asthma trials to maintain homogeneity of the study population. In this study, we summarize the current understanding of ACOS, focusing on definitions, epidemiology and patient prognosis.
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Affiliation(s)
- Don D Sin
- Division of Respiratory Medicine, Department of Medicine, The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia (UBC), Vancouver, BC, Canada
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20
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Omori K, Iwamoto H, Yamane T, Nakashima T, Haruta Y, Hattori N, Yokoyama A, Kohno N. Clinically remitted childhood asthma is associated with airflow obstruction in middle-aged adults. Respirology 2016; 22:86-92. [PMID: 27439943 DOI: 10.1111/resp.12860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/18/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE While adult asthma has been shown to be a risk factor for COPD, the effect of remitted childhood asthma on adult lung function has not been clarified. The aim of this study was to examine whether remitted childhood asthma is a risk factor for airflow obstruction in a middle-aged general population. METHODS A total of 9896 participants (range: 35-60 years) from five healthcare centres were included in the study. The participants were classified into four categories based on the presence or absence of physician-diagnosed childhood/adulthood asthma and asthma symptoms as follows: healthy controls (n = 9154), remitted childhood asthma (n = 287), adulthood-onset asthma (n = 354) and childhood-adulthood asthma (n = 101). RESULTS The prevalence of respiratory symptoms was similar in both the participants with remitted childhood asthma and healthy controls. The prevalence of airflow obstruction (forced expiratory volume in 1 s (FEV1 )/forced vital capacity (FVC) < 0.7) was significantly higher in the participants with remitted childhood asthma, those with adult-onset asthma and those with childhood-adulthood asthma (5.2%, 14.4% and 16.8%, respectively) compared with healthy controls (2.2%). Multivariate logistic regression showed that remitted childhood asthma was independently associated with airflow obstruction. Among the participants with remitted childhood asthma, ever-smokers had significantly lower FEV1 /FVC than never-smokers. CONCLUSION Clinically remitted childhood asthma is associated with airflow obstruction in middle-aged adults. Smoking and remitted childhood asthma may be additive factors for the development of airflow obstruction.
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Affiliation(s)
- Keitaro Omori
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Yamane
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Haruta
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akihito Yokoyama
- Department of Hematology and Respiratory Medicine, Kochi University, Kochi, Japan
| | - Nobuoki Kohno
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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21
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Bell MC, Busse WW. Is It Asthma or Is It COPD: The Overlap Syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:641-2; quiz 643. [PMID: 26164580 DOI: 10.1016/j.jaip.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew C Bell
- Division of Allergy and Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - William W Busse
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
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22
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Childhood asthma and chronic obstructive pulmonary disease: outcomes until the age of 50. Curr Opin Allergy Clin Immunol 2016; 15:169-74. [PMID: 25961391 DOI: 10.1097/aci.0000000000000146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW There has been recent interest in understanding the origins of chronic obstructive pulmonary disease. Epidemiological studies suggest that chronic obstructive pulmonary disease clearly has other causes apart from tobacco smoke. RECENT FINDINGS Cross-sectional studies of adult cohorts with chronic obstructive pulmonary disease highlight that childhood asthma is a risk factor. A recent longitudinal childhood cohort study of children from childhood to the age of 50 years describes that children with severe asthma are at increased risk of chronic obstructive pulmonary disease and that the deficit in lung function can be tracked back to early years. SUMMARY Children with severe asthma are at increased risk of developing chronic obstructive pulmonary disease.
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Miele CH, Jaganath D, Miranda JJ, Bernabe-Ortiz A, Gilman RH, Johnson CM, Diette GB, Wise RA, Checkley W. Urbanization and Daily Exposure to Biomass Fuel Smoke Both Contribute to Chronic Bronchitis Risk in a Population with Low Prevalence of Daily Tobacco Smoking. COPD 2015; 13:186-95. [PMID: 26552585 DOI: 10.3109/15412555.2015.1067765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Risk factors beyond tobacco smoking associated with chronic bronchitis are not well understood. We sought to describe the prevalence and risk factors of chronic bronchitis across four distinct settings in Peru with overall low prevalence of tobacco smoking yet varying degrees of urbanization, daily exposure to biomass fuel smoke and living at high altitude. METHODS We analyzed data of 2,947 participants from rural and urban Puno, Lima and Tumbes including spirometry, blood samples, anthropometry and administered questionnaires about respiratory symptoms. We used multivariable Poisson regression to assess biologic, socioeconomic and environmental risk factors associated with chronic bronchitis. RESULTS Overall prevalence of chronic bronchitis was 5.9% (95%CI 5.1%-6.9%) with variation by setting: prevalence was lower in semi-urban Tumbes (1.3%) vs. highly urbanized Lima (8.9%), urban Puno (7.0%) and rural Puno (7.8%; p < 0.001). Chronic bronchitis was more common among participants with vs. without COPD based on FEV1/FVC< LLN (12.1% vs 5.6%, p < 0.01) and it was associated with increased reporting of dyspnea on exertion (p < 0.001), hospitalization (p = 0.003) and workdays missed due to respiratory symptoms (p < 0.001). Older age (Prevalence ratio [PR] = 1.23 for each 10-years of age, 95%CI 1.09-1.40) past history of asthma (PR = 2.87, 95%CI 1.80-4.56), urbanization (PR = 3.34, 95%CI 2.18-5.11) and daily exposure to biomass fuel smoke (PR = 2.00, 95%CI 1.30-3.07) were all associated with chronic bronchitis. CONCLUSIONS We found important variations in the prevalence of chronic bronchitis across settings. Prevalence increased with both urbanization and with daily exposure to biomass fuel smoke. Having chronic bronchitis was also associated with worse patient-centered outcomes including dyspnea, hospitalization and missed workdays.
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Affiliation(s)
- Catherine H Miele
- a Division of Pulmonary and Critical Care, School of Medicine , Johns Hopkins University , Baltimore , Maryland , USA
| | - Devan Jaganath
- a Division of Pulmonary and Critical Care, School of Medicine , Johns Hopkins University , Baltimore , Maryland , USA.,b Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| | - J Jaime Miranda
- c CRONICAS Center of Excellence for Chronic Diseases , Universidad Peruana Cayetano Heredia , Lima , Peru.,d Departamento de Medicina, Escuela de Medicina , Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Antonio Bernabe-Ortiz
- c CRONICAS Center of Excellence for Chronic Diseases , Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Robert H Gilman
- b Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| | - Caroline M Johnson
- b Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| | - Gregory B Diette
- a Division of Pulmonary and Critical Care, School of Medicine , Johns Hopkins University , Baltimore , Maryland , USA
| | - Robert A Wise
- a Division of Pulmonary and Critical Care, School of Medicine , Johns Hopkins University , Baltimore , Maryland , USA
| | - William Checkley
- a Division of Pulmonary and Critical Care, School of Medicine , Johns Hopkins University , Baltimore , Maryland , USA.,b Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
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Tho NV, Park HY, Nakano Y. Asthma-COPD overlap syndrome (ACOS): A diagnostic challenge. Respirology 2015; 21:410-8. [PMID: 26450153 DOI: 10.1111/resp.12653] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022]
Abstract
Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD. ACOS may be a special phenotype of a spectrum of chronic obstructive airway diseases, in which asthma and COPD are at the two opposite ends. The prevalence of ACOS varies considerably due to differing criteria being applied for diagnosis. Patients with ACOS utilize a large proportion of medical resources. They are associated with more frequent adverse outcomes than those with asthma or COPD alone. ACOS is currently a diagnostic challenge for physicians because there are no specific biomarkers to differentiate ACOS from asthma or COPD. The approach to diagnosing ACOS depends on the population from which the patient originated. The management of ACOS should be individualized to ensure the most effective treatment with minimal side effects. In this paper, we review the diagnostic criteria of ACOS used in previous studies, propose practical approaches to diagnosing and managing ACOS and raise some research questions related to ACOS.
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Affiliation(s)
- Nguyen Van Tho
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Shiga, Japan
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25
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Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis. PLoS One 2015; 10:e0136065. [PMID: 26336076 PMCID: PMC4559416 DOI: 10.1371/journal.pone.0136065] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/30/2015] [Indexed: 12/04/2022] Open
Abstract
Background The combination of asthma and chronic obstructive pulmonary disease (COPD), or ACOS is a recently defined syndrome. The epidemiology of the condition is poorly described and previous research has suggested ACOS is associated with worse outcomes than either condition alone. We therefore decided to complete a systematic review of the published literature. Methods This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. A structured search was performed in the PubMed, Embase, and Medline databases up to Feb 2015 to identify studies reporting incidence, prevalence, health care utilization, morbidity, or mortality in COPD and asthma. Results A total of 19 studies were included in the present study. The pooled prevalence of overlap among COPD was 27% (95% CI: 0.16–0.38, p<0.0001) and 28% (95% CI: 0.09–0.47, p = 0.0032) in the population and hospital-based studies, respectively. We found no significant difference between ACOS and COPD in terms of gender, smoking status, lung function and 6mWD. However, in comparison to subject with only COPD, ACOS subjects were significantly younger, had higher BMI, healthcare utilization, and lower HRQoL. Conclusion ACOS is a common condition that exists in a substantial proportion of subjects with COPD. ACOS represents a distinct clinical phenotype with more frequent exacerbations, hospitalization, worse health-related quality of life, and higher healthcare costs than either disease alone. There is a critical need to better define the management and treatment of this syndrome.
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Bateman ED, Reddel HK, van Zyl-Smit RN, Agusti A. The asthma-COPD overlap syndrome: towards a revised taxonomy of chronic airways diseases? THE LANCET RESPIRATORY MEDICINE 2015; 3:719-728. [PMID: 26255108 DOI: 10.1016/s2213-2600(15)00254-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 01/03/2023]
Abstract
Most research of treatments for airways diseases has been restricted to patients who meet standard definitions of either chronic obstructive pulmonary disease (COPD) or asthma, yet to distinguish COPD from asthma in adult patients who have clinical features of both can be challenging. Treatment guidelines provide scant advice on how such patients should be managed. With increasing recognition that asthma and COPD are heterogeneous diseases, attention has been directed to the needs of a group of patients with what is now termed asthma-COPD overlap syndrome (ACOS), particularly in view of the high morbidity in this population. This Review considers the epidemiology, mechanisms of disease, current attempts to define and diagnose ACOS, existing and potential treatment options, and new approaches to the phenotyping and taxonomy of airway diseases.
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Affiliation(s)
- Eric D Bateman
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Richard N van Zyl-Smit
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alvar Agusti
- Thorax Institute, Hospital Clinic, IDIBAPS, CIBERES, University of Barcelona, Spain
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Li M, Chen Y. The updates of overlapping syndrome: asthma and COPD. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Aanerud M, Carsin AE, Sunyer J, Dratva J, Gislason T, Jarvis D, deMarco R, Raherison C, Wjst M, Dharmage SC, Svanes C. Interaction between asthma and smoking increases the risk of adult airway obstruction. Eur Respir J 2014; 45:635-43. [PMID: 25431272 DOI: 10.1183/09031936.00055514] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of the present study was to analyse the interaction between asthma and smoking in the risk of adult airway obstruction, accounting for atopy. In the European Community Respiratory Health Survey, 15 668 persons aged 20-56 years underwent spirometry in 1991-1993 and 9 years later (n=8916). Risk of airway obstruction and lung function decline associated with smoking and early-onset (<10 years of age) and late-onset (>10 years of age) asthma were analysed with generalised estimating equation models and random-effect linear models, adjusting for covariates. Interaction of asthma with smoking was expressed as relative excess risk due to interaction (RERI). A 20-fold increase in adult airway obstruction was found among those with early-onset asthma independently of smoking status (never-smokers: OR 21.0, 95% CI 12.7-35; current smokers: OR 23.7, 95% CI 13.9-40.6). Late-onset asthma was associated with airway obstruction, with a stronger association among current smokers (OR 25.6, 95% CI 15.6-41.9) than among never-smokers (OR 11.2, 95% CI 6.8-18.6) (RERI 12.02, 95% CI 1.96-22.07). Stratifying by atopy, the association between smoking and asthma was most pronounced among nonatopics. Early- and late-onset asthma were associated with 10-20-fold increased risk of adult airway obstruction. Smoking increased the risk of adult airway obstruction in subjects with asthma onset after age 10 years. Investigation of measures potentially preventive of chronic obstructive pulmonary disease development following asthma is urgently needed.
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Affiliation(s)
| | - Anne-Elie Carsin
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Universitat Pompeu Fabra, Barcelona, Spain
| | - Julia Dratva
- Institute of Social and Preventive Medicine at the Swiss Tropical Institute, Basel, Switzerland
| | - Thorarinn Gislason
- Dept of Respiratory Medicine and Sleep, Landspitali University Hospital (E7) and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Deborah Jarvis
- Dept of Public Health Sciences, Imperial College, London, UK
| | - Roberto deMarco
- Dept of Medicine and Public Health/Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | | | - Matthias Wjst
- Helmholtz Center Munich, National Research Centre for Environmental Health, Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Munich, Germany
| | - Shyamali C Dharmage
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Melbourne, Australia
| | - Cecilie Svanes
- Dept of Occupational Medicine, Haukeland University Hospital, Bergen, Norway Centre for International Health, University of Bergen, Bergen, Norway
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Obaseki D, Potts J, Joos G, Baelum J, Haahtela T, Ahlström M, Matricardi P, Kramer U, Gjomarkaj M, Fokkens W, Makowska J, Todo‐Bom A, Toren K, Janson C, Dahlen S, Forsberg B, Jarvis D, Howarth P, Brozek G, Minov J, Bachert C, Burney P. The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults. Allergy 2014; 69:1205-14. [PMID: 24841074 PMCID: PMC4233404 DOI: 10.1111/all.12447] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample. METHODS In 17 centers in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function. RESULTS A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1 /FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1 /FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls. CONCLUSIONS People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.
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Affiliation(s)
- D. Obaseki
- Department of Medicine Obafemi Awolowo University Ile‐Ife Nigeria
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - J. Potts
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - G. Joos
- Department of Respiratory Medicine Ghent University Hospital Ghent Belgium
| | - J. Baelum
- Odense University Hospital Odense University Odense Denmark
| | - T. Haahtela
- Skin and Allergy Hospital Helsinki University Helsinki Finland
| | - M. Ahlström
- Skin and Allergy Hospital Helsinki University Helsinki Finland
| | - P. Matricardi
- Department of Pediatric Pneumonology and Immunology Charité‐Universitätsmedizin Berlin Berlin Germany
| | - U. Kramer
- IUF – Leibniz Research Institute for Environmental Medicine Düsseldorf Germany
- Department of Dermatology and Allergy am Biederstein Technical University Munich Munich Germany
| | - M. Gjomarkaj
- Institute of Biomedicine and Molecular Immunology National Research Council Palermo Italy
| | - W. Fokkens
- Department of Otorhinolaryngology Academic Medical Center Amsterdam the Netherlands
| | - J. Makowska
- Department of Immunology Rheumatology and Allergy Medical University of Lodz Lodz Poland
| | - A. Todo‐Bom
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | - K. Toren
- Section of Occupational and Environmental Medicine University of Gothenburg Gothenburg Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology University of Uppsala Uppsala Sweden
| | - S.‐E. Dahlen
- CfA ‐ The Centre for Allergy Research Karolinska Institute Stockholm Sweden
| | - B. Forsberg
- Occupational and Environmental Medicine Umeå University Umeå Sweden
| | - D. Jarvis
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
| | - P. Howarth
- Clinical and Experimental Sciences Faculty of Medicine Southampton General Hospital Southampton UK
| | - G. Brozek
- Department of Epidemiology Medical University of Silesia in Katowice Katowice Poland
| | - J. Minov
- Institute for Occupational Health of Republic of Macedonia Skopje Republic of Macedonia
| | - C. Bachert
- Upper Airway Research Laboratory University of Ghent Ghent Belgium
- Division of Ear, Nose, and Throat Diseases Clintec Karolinska Institute Stockholm Sweden
| | - P. Burney
- Respiratory Epidemiology and Public Health Group National Heart and Lung Institute Imperial College London London UK
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Perret JL, Walters EH, Abramson MJ, McDonald CF, Dharmage SC. The independent and combined effects of lifetime smoke exposures and asthma as they relate to COPD. Expert Rev Respir Med 2014; 8:503-14. [PMID: 24834459 DOI: 10.1586/17476348.2014.905913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is part of a worldwide tobacco-related disease epidemic, and is associated with progressive airflow obstruction and varying degrees of emphysema and/or hyperinflation. Greater focus has been placed recently on the potential for early life factors to influence the development of COPD, based on the premise that delayed lung growth during childhood and adolescence might predispose to lung disease in later life. For most people, the adverse effects on lung function of adult and early childhood factors are additive, which provides no additional incentive for current smokers to quit. However, if there is a (synergistic) interaction between active smoking and asthma, smoking cessation is likely to have a greater lung function benefit for the smoker who is also asthmatic, especially if quitting occurs at an early age. This article critically evaluates the evidence for the independent associations of lifetime asthma, smoking and smoke exposures with airflow obstruction, plus their interaction when multiple factors are present.
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Affiliation(s)
- Jennifer L Perret
- Unit for Allergy and Lung Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne 3010, Victoria, Australia
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Hansell A, Ghosh RE, Poole S, Zock JP, Weatherall M, Vermeulen R, Kromhout H, Travers J, Beasley R. Occupational risk factors for chronic respiratory disease in a New Zealand population using lifetime occupational history. J Occup Environ Med 2014; 56:270-80. [PMID: 24327054 DOI: 10.1097/01.jom.0000438382.33221.dc] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate associations between respiratory disease and occupational exposures in a New Zealand urban population, the Wellington Respiratory Survey. METHODS Multiple regression analyses in a population sample of 1017 individuals aged 25 to 74 years with spirometry and questionnaire information, including a lifetime occupational history. RESULTS Chronic bronchitis symptoms were associated with self-reported exposure to hairdressing, paint manufacturing, insecticides, welding, detergents and with ALOHA Job Exposure Matrix-assessed gases/fumes exposure. The strongest association was for hairdressing (odds ratio 6.91; 95% confidence interval: 2.02 to 23.70). Cumulative exposure to mineral dust and gases/fumes was associated with higher FEV₁% (forced expiratory volume in the first second of expiration) predicted. Analyses were limited by relatively small numbers of cases. CONCLUSIONS Increased risks of objectively defined respiratory disease, which have been previously documented, were not seen. Nevertheless, the study suggested increased risk of respiratory symptoms with various occupational exposures as well as likely healthy worker effect.
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Affiliation(s)
- Anna Hansell
- From the MRC-PHE Centre for Environment and Health (Drs Hansell and Ghosh), Imperial College London, London, the United Kingdom; Imperial College Healthcare NHS Trust (Dr Hansell), London, the United Kingdom; Tauranga Hospital (Dr Poole), Tauranga, New Zealand; Centre for Research in Environmental Epidemiology (CREAL) (Dr Zock), Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM) (Dr Zock), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP) (Dr Zock), Spain; University of Otago Wellington (Prof Weatherall), Wellington, New Zealand; Institute for Risk Assessment Sciences (Profs Vermeulen and Kromhout), Utrecht University, Utrecht, The Netherlands; Medical Research Institute of New Zealand (Dr Travers), Wellington, New Zealand; and University of Otago, North Dunedin, New Zealand (Prof Beasley)
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Chen YS, Li XQ, Li HR, Miao Y, Lian SQ, Lu FF, Yu XL, Lin YH, Liu T. Risk factors for small airway obstruction among Chinese island residents: a case-control study. PLoS One 2013; 8:e68556. [PMID: 23874670 PMCID: PMC3715483 DOI: 10.1371/journal.pone.0068556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/29/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the prevalence of and risk factors for small airway obstruction (SAO) among Chinese island residents to establish means to prevent and treat SAO. METHODS From October 17, 2011 to November 1, 2011, a total of 2,873 residents aged >20 years who lived on the Huangqi Peninsula of Fujian were recruited by random cluster sampling. They were asked to complete a Burden of Obstructive Lung Disease (BOLD) questionnaire and underwent physical examinations and lung function evaluations. SAO was defined as a forced expiratory flow at 50% of vital capacity, Vmax50%, of less than 70% of predicted. Risk factors for SAO were assessed from among demographic and anthropometric variables, blood chemistry results, and questionnaire response items. RESULTS A total of 216 (7.52%) Chinese island residents were identified as having SAO (95 males; 121 females). Their survey and test results were compared with 432 age and sex-matched healthy controls (192 males; 240 females) for SAO risk factors. Among numerous factors investigated, only diabetes mellitus (p = 0.039), smoking index (SI, p<0.001 for SI>600), second hand smoke (p = 0.002), and lack of regular exercise (p<0.001) were significant risk factors for SAO. CONCLUSIONS The risk factors for SAO among Chinese island residents appeared to be similar to those among people who live in high-density urban environments and impoverished rural areas. Public health policies and medical practices directed toward improving respiratory health for island residents should be comparable to those used for urban and rural dwellers.
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Affiliation(s)
- Yu-sheng Chen
- Department of Respiratory Medicine, Fujian Provincial Hospital, Provincial Clinic College of Fujian Medical University, Fuzhou, Fujian Province, PR China.
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Stocks J, Sonnappa S. Early life influences on the development of chronic obstructive pulmonary disease. Ther Adv Respir Dis 2013; 7:161-73. [PMID: 23439689 PMCID: PMC4107852 DOI: 10.1177/1753465813479428] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
There is increasing evidence that chronic obstructive pulmonary disease (COPD) is not simply a disease of old age that is largely restricted to heavy smokers, but may be associated with insults to the developing lung during foetal life and the first few years of postnatal life, when lung growth and development are rapid. A better understanding of the long-term effects of early life factors, such as intrauterine growth restriction, prenatal and postnatal exposure to tobacco smoke and other pollutants, preterm delivery and childhood respiratory illnesses, on the subsequent development of chronic respiratory disease is imperative if appropriate preventive and management strategies to reduce the burden of COPD are to be developed. The extent to which insults to the developing lung are associated with increased risk of COPD in later life depends on the underlying cause, timing and severity of such derangements. Suboptimal conditions in utero result in aberrations of lung development such that affected individuals are born with reduced lung function, which tends to remain diminished throughout life, thereby increasing the risk both of wheezing disorders during childhood and subsequent COPD in genetically susceptible individuals. If the current trend towards the ever-increasing incidence of COPD is to be reversed, it is essential to minimize risks to the developing lung by improvements in antenatal and neonatal care, and to reduce prenatal and postnatal exposures to environmental pollutants, including passive tobacco smoke. Furthermore, adult physicians need to recognize that lung disease is potentially associated with early life insults and provide better education regarding diet, exercise and avoidance of smoking to preserve precious reserves of lung function in susceptible adults. This review focuses on factors that adversely influence lung development in utero and during the first 5 years of life, thereby predisposing to subsequent COPD.
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Affiliation(s)
- Janet Stocks
- Portex Unit, University College London Institute of Child Health, 30, Guilford Street, London WC1N 1EH, UK.
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Perret JL, Dharmage SC, Matheson MC, Johns DP, Gurrin LC, Burgess JA, Marrone J, Markos J, Morrison S, Feather I, Thomas PS, McDonald CF, Giles GG, Hopper JL, Wood-Baker R, Abramson MJ, Walters EH. The interplay between the effects of lifetime asthma, smoking, and atopy on fixed airflow obstruction in middle age. Am J Respir Crit Care Med 2012; 187:42-8. [PMID: 23155143 DOI: 10.1164/rccm.201205-0788oc] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The contribution by asthma to the development of fixed airflow obstruction (AO) and the nature of its effect combined with active smoking and atopy remain unclear. OBJECTIVES To investigate the prevalence and relative influence of lifetime asthma, active smoking, and atopy on fixed AO in middle age. METHODS The population-based Tasmanian Longitudinal Health Study cohort born in 1961 (n = 8,583) and studied with prebronchodilator spirometry in 1968 was retraced (n = 7,312) and resurveyed (n = 5,729 responses) from 2002 to 2005. A sample enriched for asthma and chronic bronchitis underwent a further questionnaire, pre- and post-bronchodilator spirometry (n = 1,389), skin prick testing, lung volumes, and diffusing capacity measurements. Prevalence estimates were reweighted for sampling fractions. Multiple linear and logistic regression were used to assess the relevant associations. MEASUREMENTS AND MAIN RESULTS Main effects and interactions between lifetime asthma, active smoking, and atopy as they relate to fixed AO were measured. The prevalence of fixed AO was 6.0% (95% confidence interval [CI], 4.5-7.5%). Its association with early-onset current clinical asthma was equivalent to a 33 pack-year history of smoking (odds ratio, 3.7; 95% CI, 1.5-9.3; P = 0.005), compared with a 24 pack-year history for late-onset current clinical asthma (odds ratio, 2.6; 95% CI, 1.03-6.5; P = 0.042). An interaction (multiplicative effect) was present between asthma and active smoking as it relates to the ratio of post-bronchodilator FEV(1)/FVC, but only among those with atopic sensitization. CONCLUSIONS Active smoking and current clinical asthma both contribute substantially to fixed AO in middle age, especially among those with atopy. The interaction between these factors provides another compelling reason for atopic individuals with current asthma who smoke to quit.
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Affiliation(s)
- Jennifer L Perret
- Centre for Molecular, Environmental, Genetic, and Analytical Epidemiology, University of Melbourne, Victoria, Australia.
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Hirayama F, Lee AH. Association between childhood asthma and chronic obstructive pulmonary disease in later life. Asia Pac J Public Health 2012; 27:NP1273-9. [PMID: 23000796 DOI: 10.1177/1010539512458953] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent chronic inflammation and impaired lung growth due to asthma in childhood may have long-term impact on pulmonary function and increase susceptibility to chronic obstructive pulmonary disease (COPD) in later life. To investigate whether childhood asthma is associated with adult lung function and the risk of developing COPD among Japanese older adults, a case-control study was conducted in central Japan. A total of 300 patients with COPD aged 50 to 75 years were referred by respiratory physicians, while 400 controls were recruited from the community. All participants underwent spirometric measurements of lung function. Information on childhood asthma, demographic characteristics, and lifestyle characteristics was obtained by face-to-face interview using a structured questionnaire. The prevalence of childhood asthma was higher (P = .015) among the cases (6.3%) than among the control group (2.4%). Childhood asthma was significantly associated with the risk of COPD (adjusted odds ratio 3.32, 95% confidence interval 1.05-10.45). Participants with childhood asthma had lower (P = .010) forced expiratory volume in 1 second (mean 1.63 L, standard deviation [SD] 0.64 L) than those without (mean 2.04 L, SD 0.75 L). However, the adjusted lung function difference did not attain statistical significance after controlling for confounding variables such as age and cumulative smoking exposure. The epidemiological evidence suggested a positive association between childhood asthma and COPD in later life. Further study of the effect of adequate childhood asthma treatment on future risk of COPD should be undertaken.
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Affiliation(s)
| | - Andy H Lee
- Curtin University, Perth, Western Australia, Australia
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