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Association of Nonobstructive Chronic Bronchitis With Respiratory Health Outcomes in Adults.
Monday,2021-01-25 15:55 America/Los_Angeles — ecterry
| Title | Association of Nonobstructive Chronic Bronchitis With Respiratory Health Outcomes in Adults. |
| Publication Type | Journal Article |
| Year of Publication | 2020 |
| Authors | Balte, PP, Chaves, PHM, Couper, DJ, Enright, P, Jacobs, DR, Kalhan, R, Kronmal, RA, Loehr, LR, London, SJ, Newman, AB, O'Connor, GT, Schwartz, JE, Smith, BM, Smith, LJ, White, WB, Yende, S, Oelsner, EC |
| Journal | JAMA Intern Med |
| Volume | 180 |
| Issue | 5 |
| Pagination | 676-686 |
| Date Published | 2020 05 01 |
| ISSN | 2168-6114 |
| Keywords | Adolescent, Adult, Aged, Aged, 80 and over, Asthma, Bronchitis, Chronic, Female, Humans, Lung, Male, Middle Aged, Prospective Studies, Respiratory Function Tests, Smokers, Smoking, Young Adult |
| Abstract | <p><b>Importance: </b>Chronic bronchitis has been associated with cigarette smoking as well as with e-cigarette use among young adults, but the association of chronic bronchitis in persons without airflow obstruction or clinical asthma, described as nonobstructive chronic bronchitis, with respiratory health outcomes remains uncertain.</p><p><b>Objective: </b>To assess whether nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes in adult ever smokers and never smokers.</p><p><b>Design, Setting, and Participants: </b>This prospective cohort study included 22 325 adults without initial airflow obstruction (defined as the ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity [FVC] of <0.70) or clinical asthma at baseline. The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 9 US general population-based cohorts. Thus present study is based on data from 5 of these cohorts. Participants were enrolled from August 1971 through May 2007 and were followed up through December 2018.</p><p><b>Exposures: </b>Nonobstructive chronic bronchitis was defined by questionnaire at baseline as both cough and phlegm for at least 3 months for at least 2 consecutive years.</p><p><b>Main Outcomes and Measures: </b>Lung function was measured by prebronchodilator spirometry. Hospitalizations and deaths due to chronic lower respiratory disease and respiratory disease-related mortality were defined by events adjudication and administrative criteria. Models were stratified by smoking status and adjusted for anthropometric, sociodemographic, and smoking-related factors. The comparison group was participants without nonobstructive chronic bronchitis.</p><p><b>Results: </b>Among 22 325 adults included in the analysis, mean (SD) age was 53.0 (16.3) years (range, 18.0-95.0 years), 58.2% were female, 65.9% were non-Hispanic white, and 49.6% were ever smokers. Among 11 082 ever smokers with 99 869 person-years of follow-up, participants with nonobstructive chronic bronchitis (300 [2.7%]) had accelerated decreases in FEV1 (4.1 mL/y; 95% CI, 2.1-6.1 mL/y) and FVC (4.7 mL/y; 95% CI, 2.2-7.2 mL/y), increased risks of chronic lower respiratory disease-related hospitalization or mortality (hazard ratio [HR], 2.2; 95% CI, 1.7-2.7), and greater respiratory disease-related (HR, 2.0; 95% CI, 1.1-3.8) and all-cause mortality (HR, 1.5; 95% CI, 1.3-1.8) compared with ever smokers without nonobstructive chronic bronchitis. Among 11 243 never smokers with 120 004 person-years of follow-up, participants with nonobstructive chronic bronchitis (151 [1.3%]) had greater rates of chronic lower respiratory disease-related hospitalization or mortality (HR, 3.1; 95% CI, 2.1-4.5) compared with never smokers without nonobstructive chronic bronchitis. Nonobstructive chronic bronchitis was not associated with FEV1:FVC decline or incident airflow obstruction. The presence of at least 1 of the component symptoms of nonobstructive chronic bronchitis (ie, chronic cough or phlegm), which was common in both ever smokers (11.0%) and never smokers (6.7%), was associated with adverse respiratory health outcomes.</p><p><b>Conclusions and Relevance: </b>The findings suggest that nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes, particularly in ever smokers, and may be a high-risk phenotype suitable for risk stratification and targeted therapies.</p> |
| DOI | 10.1001/jamainternmed.2020.0104 |
| Alternate Journal | JAMA Intern Med |
| PubMed ID | 32119036 |
| PubMed Central ID | PMC7052787 |
| Grant List | HHSN268201800003I / HL / NHLBI NIH HHS / United States HHSN268201800006I / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States HHSN268201700001I / HL / NHLBI NIH HHS / United States N01HC95168 / HL / NHLBI NIH HHS / United States R01 HL077612 / HL / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States HHSN268201800005I / HL / NHLBI NIH HHS / United States N01HC25195 / HL / NHLBI NIH HHS / United States HHSN268201700003I / HL / NHLBI NIH HHS / United States N01HC95164 / HL / NHLBI NIH HHS / United States R01 HL130506 / HL / NHLBI NIH HHS / United States HHSN268200800007C / HL / NHLBI NIH HHS / United States N01HC95160 / HL / NHLBI NIH HHS / United States R01 HL122477 / HL / NHLBI NIH HHS / United States HHSN268201800004I / HL / NHLBI NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States RC1 HL100543 / HL / NHLBI NIH HHS / United States N01HC95169 / HL / NHLBI NIH HHS / United States HHSN268201800001C / HL / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01HC95161 / HL / NHLBI NIH HHS / United States HHSN268201700004I / HL / NHLBI NIH HHS / United States N01HC95162 / HL / NHLBI NIH HHS / United States R01 HL093081 / HL / NHLBI NIH HHS / United States HHSN268201500001I / HL / NHLBI NIH HHS / United States HHSN268201800007I / HL / NHLBI NIH HHS / United States N01HC95165 / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01HC95167 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States HHSN268201700002I / HL / NHLBI NIH HHS / United States N01HC95159 / HL / NHLBI NIH HHS / United States N01HC95163 / HL / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States R21 HL129924 / HL / NHLBI NIH HHS / United States HHSN268201700005I / HL / NHLBI NIH HHS / United States U01 HL130114 / HL / NHLBI NIH HHS / United States N01HC95166 / HL / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States K23 HL130627 / HL / NHLBI NIH HHS / United States |
ePub date:
20/05