The coexistence of asthma and COPD: risk factors, clinical history and lung function trajectories

on behalf of The Ageing Lungs in European Cohorts (ALEC) study

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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=3,477). 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.

Original languageEnglish
JournalEuropean Respiratory Journal
Issue number5
Publication statusPublished - 1 Nov 2021
Externally publishedYes

Bibliographical note

Funding Information:
Financial Support for ECRHS III: Australia: National Health and Medical Research Council; Belgium: Antwerp South and Antwerp City: Research Foundation Flanders (FWO), grant code G.0.410.08.N.10; Estonia: Tartu: SF0180060s09 from the Estonian Ministry of Education; France: (All) Ministère de la Santé, Programme Hospitalier de Recherche Clinique (PHRC) national 2010, Bordeaux: INSERM U897 Université Bordeaux segalen, Grenoble: Comite ScientifiTue $*IRadom 2011 Paris $gence 1ationale de la Santp Rpgion Ile de )rance domaine d¶intprrt maMeur (DIM); Germany: Erfurt: German Research Foundation HE 3294/10-1, Hamburg: German Research Foundation MA 711/6-1, NO 262/7-1; Iceland: Reykjavik: The Landspitali University Hospital Research Fund, University of Iceland Research Fund, ResMed Foundation, California, USA, Orkuveita Reykjavikur (Geothermal plant), Vegagerðin (The Icelandic Road Administration (ICERA); Italy: All Italian centers were funded by the Italian Ministry of Health, Chiesi Farmaceutici SpA, in addition Verona was funded by Cariverona foundation, Education Ministry (MIUR); Norway: Norwegian Research council grant no 214123, Western Norway Regional Health Authorities grant no 911631, Bergen Medical Research Foundation; Spain: Fondo de Investigación Sanitaria (PS09/02457, PS09/00716, PS09/01511, PS09/02185, PS09/03190), Servicio Andaluz de Salud, Sociedad Española de Neumología y Cirurgía Torácica (SEPAR 1001/2010), Fondo de Investigación Sanitaria (PS09/02457), Barcelona: Fondo de Investigación Sanitaria (FIS PS09/00716), Galdakao: Fondo de Investigación Sanitaria (FIS 09/01511), Huelva: Fondo de Investigación Sanitaria (FIS PS09/02185) and Servicio Andaluz de Salud, Oviedo: Fondo de Investigación Sanitaria (FIS PS09/03190); Sweden: All centers were funded by The Swedish Heart and Lung Foundation, The Swedish Asthma and Allergy Association, The Swedish Association against Lung and Heart Disease, Swedish Research Council for health, working life and welfare (FORTE), Göteborg: also received further funding from the Swedish Council for Working life and Social Research. Umea: also received funding from Vasterbotten Country Council ALF grant; Switzerland: The Swiss National Science Foundation (grants no 33CSCO-134276/1, 33CSCO-108796, 3247BO-104283, 3247BO-104288, 3247BO-104284, 3247-065896, 3100-059302, 3200-052720, 3200-042532, 4026-028099), The Federal office for forest, environment and landscape, The Federal Office of Public Health, The Federal Office of Roads and Transport, the canton¶s goYernment of $argan %ase-Sl tadt, Basel-Land, Geneva, Luzern, Ticino, Valais and Zürich, the Swiss Lung League, the canton's Lung League of Basel Stadt/ Basel, Landschaft, Geneva, Ticino, Valais and Zurich, SUVA, Freiwillige Akademische Gesellschaft, UBS Wealth Foundation, Talecris Biotherapeutics GmbH, Abbott Diagnostics, European Commission 018996 (GABRIEL), Wellcome Trust WT 084703MA; UK: Medical Research Council (Grant Number 92091), support also provided by the National Institute for Health Research through the Primary Care Research Network.

Funding Information:
Financial support for ECRHS I: The co-ordination of this work was supported by the European Commission and the authors and participants are grateful to the late C. Baya and M. Hallen for their help during the study and K. Vuylsteek and the members of the COMAC for their support. The following grants helped to fund the local studies: Australia: $sthma )oundation of 9ictoria $llen and Hanbury¶s %elgium %elgian Science Policy Office 1ational )und for Scientific Research; Estonia: Estonian Science Foundation, grant no 1088; France: Ministère de la Santé, Glaxo France, Institut Pneumologique d'Aquitaine, Contrat de Plan Etat-Région Languedoc-Rousillon, CNMATS, CNMRT (90MR/10, 91AF/6), Ministre delegué de la santé, RNSP, France, GSF; Germany: Bundesminister für Forschung und Technologie; Italy: Ministero dell'Università e della Ricerca Scientifica e Tecnologica, CNR, Regione Veneto grant RSF n. 381/05.93; Norway: Norwegian Research Council project no. 101422/310; Portugal: Glaxo Farmacêutica Lda, Sandoz Portugesa; Spain: Fondo de Investigación Sanitaria (#91/0016-060-05/E, 92/0319 and #93/0393), Hospital General de Albacete, Hospital General Juan Ramón Jiménez, Dirección Regional de Salud Pública (Consejería de Sanidad del Principado de Asturias), CIRIT (1997 SGR 00079) and Servicio Andaluz de Salud; Sweden: The Swedish Medical Research Council, the Swedish Heart Lung Foundation, the Swedish Association against Asthma and Allergy; Switzerland: Swiss National Science Foundation grant 4026-28099; UK: National Asthma Campaign, British Lung Foundation, Department of Health, South Thames Regional Health Authority.

Funding Information:
The ALEC Study was funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No. 633212. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. National funders who supported data collection in the original studies are listed in Appendix E1. The funders had no role in the design of the study, in the collection, analysis, and interpretation of data, in writing of the manuscript and in the decision to submit it for publication. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication.

Funding Information:
RJ reports grants from the Estonian Research Council (Personal Research Grant n. 562), and personal fees for consultancy and lecturing from GSK, Boehringer, and Novartis, and for travels/accommodation/meetings from GSK and Boehringer. All the other authors report no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.

Funding Information:
Financial Support for ECRHS II: Australia: National Health and Medical Research Council; Belgium: Antwerp: Fund for Scientific Research (grant code, G.0402.00), University of Antwerp, Flemish Health Ministry; Estonia: Tartu Estonian Science Foundation grant no 4350, France: (All) Programme Hospitalier de Recherche Clinique²Direction de la Recherche CliniTue (DRC de *renoble 2000 number 2 10 0inistry of Health 0inistqre de l¶Emploi eet lda Solidarité, Direction Génerale de la Santé, Centre Hospitalier Universitaire (CHU) de Grenoble; Bordeaux: Institut PneumologiTue d¶$Tuitaine *renoble Comite des 0aladies Respiratoires de l¶Isere 0ontpellier $Yentis ()rance Direction Regionale des Affaires Sanitaires et Sociales Languedoc-Roussillon; Paris: Union Chimique Belge-Pharma (France), Aventis (France), Glaxo France, Germany: Erfurt: GSF²National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (grant code, FR1526/1-1); Hamburg: GSF²National Research Centre for Environment and Health, Deutsche Forschungsgemeinschaft (grant code, MA 711/4-1); Iceland: Reykjavik, Icelandic Research Council, Icelandic University Hospital Fund; Italy: Pavia: GlaxoSmithKline Italy, Italian Ministry of University and Scientific and Technological Research (MURST), Local University Funding for Research 1998 and 1999; Turin: Azienda Sanitaria Locale 4 Regione Piemonte (Italy), Azienda Ospedaliera Centro Traumatologico Ospedaliero/Centro Traumatologico Ortopedico²Istituto Clinico Ortopedico Regina Maria Adelaide Regione Piemonte 9erona 0inistero dell¶8niYersitj e della Ricerca Scientifica (08RS7 *laxo :ellcome s p a 1orway Bergen: Norwegian Research Council, Norwegian Asthma and Allergy Association, Glaxo Wellcome AS, Norway Research Fund; Spain: Fondo de Investigacion Santarias (grant codes, 97/0035-01, 99/0034-01 and 99/0034-02), Hospital Universitario de Albacete, Consejeria de Sanidad; Barcelona: Sociedad Espanola de Neumología y Cirugía Toracica, Public Health Service (grant code, R01 HL62633-01), Fondo de Investigaciones Santarias (grant codes, 97/0035-01, 99/0034-01, and 99/0034-02), Consell Interdepartamentalde Recerca i Innovació Tecnológica (grant code, 1999SGR 00241) Instituto de Salud Carlos III; Red de Centros de Epidemiología y Salud Pública, C03/09,Red de Bases moleculares y fisiológicas de las Enfermedades Respiratorias, C03/011and Red de Grupos Infancia y Medio Ambiente G03/176; Huelva: Fondo de Investigaciones Santarias (grant codes, 97/0035-01, 99/0034-01, and 99/0034-02); Galdakao: Basque Health Department; Oviedo: Fondo de Investigaciones Sanitaria (97/0035-02, 97/0035, 99/0034-01, 99/0034-02, 99/0034-04, 99/0034-06, 99/350, 99/0034--07), European Commission (EU-PEAL PL01237), Generalitat de Catalunya (CIRIT 1999 SGR 00214), Hospital Universitario de Albacete, Sociedad Española de Neumología y Cirugía Torácica (SEPAR R01 HL62633-01) Red de Centros de Epidemiología y Salud Pública (C03/09), Red de Bases moleculares y fisiológicas de las Enfermedades Respiratorias (C03/011) and Red de Grupos Infancia y Medio Ambiente (G03/176; 97/0035-01, 99/0034-01, and 99/0034-02); Sweden: Göteborg, Umea, Uppsala: Swedish Heart Lung Foundation, Swedish Foundation for Health Care Sciences and Allergy Research, Swedish Asthma and Allergy Foundation, Swedish Cancer and Allergy Foundation, Swedish Council for Working Life and Social Research (FAS); Switzerland: Basel Swiss National Science Foundation, Swiss Federal Office for Education and Science, Swiss National Accident Insurance Fund; UK: Ipswich and Norwich: Asthma UK (formerly known as National Asthma Campaign).

Publisher Copyright:
© 2021 European Respiratory Society. All rights reserved.


  • Asthma-COPD overlap
  • Health trajectories
  • Longitudinal studies
  • Lung function
  • Risk factors


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