Abstract
Rationale Patients with concomitant features of asthma and chronic obstructive pulmonary disease (COPD) have a heavy disease burden.
Objectives Using data collected prospectively in the European Community Respiratory Health Survey, we compared the risk factors, clinical history, and lung function trajectories from early adulthood to the late sixties of middle aged subjects having asthma+COPD (n=179), past (n=263) or current (n=808) asthma alone, COPD alone (n=111), or none of these (n=3477).
Methods Interview data and prebronchodilator FEV1 and FVC were obtained during three clinical examinations in 1991–1993, 1999–2002, and 2010–2013. Disease status was classified in 2010–2013, when the subjects were aged 40–68, according to the presence of fixed airflow obstruction (postbronchodilator FEV1/FVC below the lower limit of normal), a lifetime history of asthma, and cumulative exposure to tobacco or occupational inhalants. Previous lung function trajectories, clinical characteristics, and risk factors of these phenotypes were estimated.
Main results Subjects with asthma+COPD reported maternal smoking (28.2%) and respiratory infections in childhood (19.1%) more frequently than subjects with COPD alone (20.9 and 14.0%, respectively). Subjects with asthma+COPD had an impairment of lung function at age 20 that tracked over adulthood, and more than half of them had asthma onset in childhood. Subjects with COPD alone had the highest lifelong exposure to tobacco smoking and occupational inhalants, and they showed accelerated lung function decline during adult life.
Conclusions The coexistence between asthma and COPD seems to have its origins earlier in life compared to COPD alone. These findings suggest that prevention of this severe condition, which is typical at older ages, should start in childhood.
Footnotes
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Conflict of interest: Dr. Marcon has nothing to disclose.
Conflict of interest: Dr. Locatelli has nothing to disclose.
Conflict of interest: Dr. Dharmage has nothing to disclose.
Conflict of interest: Dr. Svanes has nothing to disclose.
Conflict of interest: Dr. Heinrich has nothing to disclose.
Conflict of interest: Dr. Leynaert has nothing to disclose.
Conflict of interest: Dr. Burney has nothing to disclose.
Conflict of interest: Dr. Corsico has nothing to disclose.
Conflict of interest: Dr. Caliskan has nothing to disclose.
Conflict of interest: Dr. Calciano has nothing to disclose.
Conflict of interest: TG has no COI.
Conflict of interest: Dr. Janson has nothing to disclose.
Conflict of interest: Dr. Jarvis has nothing to disclose.
Conflict of interest: Dr. Jõgi reports grants from Estonian Research Council Personal Research Grant no 562, during the conduct of the study; personal fees from Consultancy, grants from Grants/grants pending, personal fees from Payment for lectures, personal fees from Travel/accommodations/meeting expenses, outside the submitted work.
Conflict of interest: Dr. Lytras has nothing to disclose.
Conflict of interest: Dr. Malinovschi has nothing to disclose.
Conflict of interest: Dr. Probst-Hensch has nothing to disclose.
Conflict of interest: Dr. Torén has nothing to disclose.
Conflict of interest: Dr. Casas has nothing to disclose.
Conflict of interest: Dr. Verlato has nothing to disclose.
Conflict of interest: Dr. Garcia-Aymerich has nothing to disclose.
Conflict of interest: Dr. Accordini has nothing to disclose.
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- Received December 30, 2020.
- Accepted April 6, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org