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Original Research: COPD |

Prediction of Acute Respiratory Disease in Current and Former Smokers With and Without COPDAcute Respiratory Disease in Smokers

Russell P. Bowler, MD, PhD; Victor Kim, MD; Elizabeth Regan, MD; André A. A. Williams, PhD; Stephanie A. Santorico, PhD; Barry J. Make, MD, FCCP; David A. Lynch, MD; John E. Hokanson, PhD; George R. Washko, MD; Peter Bercz, MD; Xavier Soler, MD; Nathaniel Marchetti, MD, FCCP; Gerard J. Criner, MD, FCCP; Joe Ramsdell, MD, FCCP; MeiLan K. Han, MD; Dawn Demeo, MD; Antonio Anzueto, MD; Alejandro Comellas, MD; James D. Crapo, MD, FCCP; Mark Dransfield, MD; J. Michael Wells, MD; Craig P. Hersh, MD; Neil MacIntyre, MD, FCCP; Fernando Martinez, MD, FCCP; Hrudaya P. Nath, MD, FCCP; Dennis Niewoehner, MD, FCCP; Frank Sciurba, MD, FCCP; Amir Sharafkhaneh, MD, FCCP; Edwin K. Silverman, MD, PhD; Edwin J. R. van Beek, MD; Carla Wilson; Christine Wendt, MD; Robert A. Wise, MD, FCCP; for the COPDGene investigators
Author and Funding Information

From the Department of Medicine (Drs Bowler, Regan, Williams, Make, Lynch, and Crapo) and the Division of Biostatistics and Bioinformatics (Ms Wilson), National Jewish Health, Denver, CO; the Department of Mathematical and Statistical Sciences (Dr Santorico), University of Colorado Denver, Denver, CO; the Department of Medicine (Drs Kim, Bercz, Marchetti, and Criner), Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA; the Department of Medicine and the Department of Epidemiology (Dr Hokanson), University of Colorado Anschutz Medical Campus, Aurora, CO; Channing Division of Network Medicine (Drs Washko, Demeo, Hersh, and Silverman), Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; the Department of Medicine (Drs Soler and Ramsdell), Division of Pulmonary and Critical Care Medicine, University of California at San Diego, La Jolla, CA; the Department of Internal Medicine (Drs Han and Martinez), University of Michigan, Ann Arbor, MI; the Department of Medicine (Dr Anzueto), Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, TX; University of Iowa (Dr Comellas), Iowa City, IA; University of Alabama at Birmingham (Drs Dransfield, Wells, and Nath), Birmingham, AL; Duke University Medical Center (Dr MacIntyre), Durham, NC; University of Minnesota (Drs Niewoehner and Wendt), Minneapolis, MN; University of Pittsburgh Medical Center (Dr Sciurba), Pittsburgh, PA; Baylor College of Medicine (Dr Sharafkhaneh), Houston, TX; Clinical Research Imaging Centre (Dr van Beek), University of Edinburgh, Edinburgh, Scotland; and Johns Hopkins University (Dr Wise), Baltimore, MD.

CORRESPONDENCE TO: Russell P. Bowler, MD, PhD, Department of Medicine, National Jewish Health, 1400 Jackson St, Room K715a, Denver, CO 80206; e-mail: Bowlerr@njhealth.org


FUNDING/SUPPORT: This study was supported by the National Heart, Lung and Blood Institute [Grants R01 HL 08 9856 and R01 HL 08 9897], National Center for Research Resources/National Institutes of Health [Grant UL1 RR025780], and National Institute of Nursing Research [NR013377].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):941-950. doi:10.1378/chest.13-2946
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BACKGROUND:  The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown.

METHODS:  Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score.

RESULTS:  At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV1), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George’s Respiratory Questionnaire score). Risks were similar for those with and without COPD.

CONCLUSIONS:  Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.

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