Chest
Volume 137, Issue 3, March 2010, Pages 593-600
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Original Research
COPD
Prior TB, Smoking, and Airflow Obstruction: A Cross-Sectional Analysis of the Guangzhou Biobank Cohort Study

https://doi.org/10.1378/chest.09-1435Get rights and content

Background

Prior pulmonary TB has been shown to be associated with a higher risk of airflow obstruction, which is the hallmark of COPD, but whether smoking modifies this relationship is unclear. We investigated the relationships between prior TB, smoking, and airflow obstruction in a Chinese population sample.

Methods

Participants in the Guangzhou Biobank Cohort Study underwent spirometry, chest radiography, and a structured interview on lifestyle and exposures. Prior TB was defined as the presence of radiologic evidence suggestive of inactive TB. Airflow obstruction was based on spirometric criteria.

Results

The prevalence of prior TB in this sample (N = 8,066, mean age: 61.9 years) was 24.2%. After controlling for sex, age, and smoking exposure, prior TB remained independently associated with an increased risk of airflow obstruction (odds ratio = 1.37; 95% CI, 1.13-1.67). Further adjustment for exposure to passive smoking, biomass fuel, and dust did not alter the relationship. Smoking did not modify the relationship between prior TB and airflow obstruction.

Conclusions

Prior TB is an independent risk factor for airflow obstruction, which may partly explain the higher prevalence of COPD in China. Clinicians should be aware of this long-term risk in individuals with prior TB, irrespective of smoking status, particularly in patients from countries with a high TB burden.

Section snippets

Participants

The Guangzhou Biobank Cohort Study, a collaboration between the Guangzhou Number 12 People's Hospital and the Universities of Birmingham and Hong Kong, has been described in detail previously.19, 20 Recruitment of participants drew from the Guangzhou Health and Happiness Association for the Respectable Elders, a community social and welfare association unofficially aligned with the municipal government whose membership is open to older persons for a monthly fee of 4 yuan (50 US cents). About 7%

Results

Of the 20,431 participants, 8,145 had available information on relevant variables and valid spirometric data (Fig 1). Among them, 79 participants were removed because of radiologic evidence suggestive of active TB. Thus, the final study sample included 8,066 participants, of whom 5,933 (73.6%) were women and 2,133 (26.4%) were men, with an overall mean age of 61.9 years (SD 6.9). Participants who were included for analysis were similar to those who were excluded because of insufficient

Discussion

In a sample of older people from a TB-prevalent region in Asia, we found that radiologic evidence suggestive of inactive TB was associated with a higher risk of airflow obstruction. Furthermore, we did not find evidence to suggest the relationship was modified by smoking.

Our finding is in accordance with a previous study conducted in TB patients6 and two small-scale case-control studies.7, 11 Snider and colleagues6 found that heavy smoking (≥20 cigarettes per day) and more severe TB

Acknowledgments

Author contributions: Dr K.-b. H. Lam: contributed to the quality control of spirometry data in the Guangzhou Biobank Cohort Study, conceived the idea for the paper and developed the approach, analyzed the data, drafted the paper, contributed to the development of the paper, and commented on and approved the final version.

Dr Jiang: helped to conceive the Guangzhou Biobank Cohort Study, contributed to the development of the paper, and commented on and approved the final version.

Dr Jordan:

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Funding/Support: The Guangzhou Biobank Cohort Study was funded by The University of Hong Kong Foundation for Educational Development and Research, the Guangzhou Public Health Bureau, the Guangzhou Science and Technology Bureau, and The University of Birmingham.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).

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