TY - JOUR
T1 - Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults
AU - De Marco, Roberto
AU - Accordini, Simone
AU - Marcon, Alessandro
AU - Cerveri, Isa
AU - Antó, Josep M.
AU - Gislason, Thorarinn
AU - Heinrich, Joachim
AU - Janson, Christer
AU - Jarvis, Deborah
AU - Kuenzli, Nino
AU - Leynaert, Bénédicte
AU - Sunyer, Jordi
AU - Svanes, Cecilie
AU - Wjst, Matthias
AU - Burney, Peter
PY - 2011/4/1
Y1 - 2011/4/1
N2 - Rationale: Few studies have investigated the factors associated with the early inception of chronic obstructive pulmonary disease (COPD). Objectives: We investigated COPD risk factors in an international cohort of young adults using different spirometric definitions of the disease. Methods: We studied 4,636 subjects without asthma who had prebronchodilator FEV1/FVC measured in the European Community Respiratory Health Survey both in 1991 to 1993 (when theywere 20-44 yr old) and in 1999 to 2002. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease fixed cut-off criterion (FEV1/FVC<0.70), and two criteria based on the Quanjer and LuftiBus reference equations (FEV1/FVC less than lower limit of normal). COPD determinantswere studied using two-level Poisson regression models. Measurements and Main Results: COPD incidence ranged from 1.85 (lower limit of normal [Quanjer]) to 2.88 (Global Initiative for Chronic Obstructive Lung Disease) cases/1,000/yr. Although about half of the cases had smoked less than 20 pack-years, smoking was the main risk factor for COPD, and it accounted for 29 to 39% of the new cases during the follow-up. Airway hyperresponsiveness was the second strongest risk factor (15-17% of new cases). Other determinants were respiratory infections in childhood and a family history of asthma, whereas the role of sex, age, and of being underweight largely depended on the definition of COPD used. Conclusions: COPD may start early in life. Smoking prevention should be given the highest priority to reduce COPD occurrence. Airway hyperresponsiveness, a family history of asthma, and respiratory infections in childhoodare other important determinants of COPD. We suggest the need for a definition of COPD that is not exclusively based on spirometry.
AB - Rationale: Few studies have investigated the factors associated with the early inception of chronic obstructive pulmonary disease (COPD). Objectives: We investigated COPD risk factors in an international cohort of young adults using different spirometric definitions of the disease. Methods: We studied 4,636 subjects without asthma who had prebronchodilator FEV1/FVC measured in the European Community Respiratory Health Survey both in 1991 to 1993 (when theywere 20-44 yr old) and in 1999 to 2002. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease fixed cut-off criterion (FEV1/FVC<0.70), and two criteria based on the Quanjer and LuftiBus reference equations (FEV1/FVC less than lower limit of normal). COPD determinantswere studied using two-level Poisson regression models. Measurements and Main Results: COPD incidence ranged from 1.85 (lower limit of normal [Quanjer]) to 2.88 (Global Initiative for Chronic Obstructive Lung Disease) cases/1,000/yr. Although about half of the cases had smoked less than 20 pack-years, smoking was the main risk factor for COPD, and it accounted for 29 to 39% of the new cases during the follow-up. Airway hyperresponsiveness was the second strongest risk factor (15-17% of new cases). Other determinants were respiratory infections in childhood and a family history of asthma, whereas the role of sex, age, and of being underweight largely depended on the definition of COPD used. Conclusions: COPD may start early in life. Smoking prevention should be given the highest priority to reduce COPD occurrence. Airway hyperresponsiveness, a family history of asthma, and respiratory infections in childhoodare other important determinants of COPD. We suggest the need for a definition of COPD that is not exclusively based on spirometry.
KW - Bronchial hyperreactivity
KW - Chronic obstructive pulmonary disease
KW - Epidemiology
KW - Reference values
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=79953305304&partnerID=8YFLogxK
U2 - 10.1164/rccm.201007-1125OC
DO - 10.1164/rccm.201007-1125OC
M3 - Article
C2 - 20935112
AN - SCOPUS:79953305304
SN - 1073-449X
VL - 183
SP - 891
EP - 897
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 7
ER -