Asthma, airflow limitation and mortality risk in the general population

Huang, Shuang; Vasquez, Monica M.; Halonen, Marilyn; Martínez, Fernando D.; Guerra, Stefano

doi:10.1183/09031936.00108514

Cited by 47 publications

(38 citation statements)

References 34 publications

(36 reference statements)

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“…Many of the risk factors we identified for reduced growth of lung function have been reported previously, including maternal smoking during gestation, 29 reduced lung function at enrollment, 30 and increased airway hyperresponsiveness. 31 Among these factors, reduced lung function at baseline was the strongest predictor of longitudinal lung-function impairment.…”

Section: Discussionsupporting

confidence: 55%

Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma

McGeachie¹,

Yates

Zhou³

et al. 2016

N Engl J Med

497

421

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BACKGROUND Tracking longitudinal measurements of growth and decline in lung function in patients with persistent childhood asthma may reveal links between asthma and subsequent chronic airflow obstruction. METHODS We classified children with asthma according to four characteristic patterns of lung-function growth and decline on the basis of graphs showing forced expiratory volume in 1 second (FEV1), representing spirometric measurements performed from childhood into adulthood. Risk factors associated with abnormal patterns were also examined. To define normal values, we used FEV1 values from participants in the National Health and Nutrition Examination Survey who did not have asthma. RESULTS Of the 684 study participants, 170 (25%) had a normal pattern of lung-function growth without early decline, and 514 (75%) had abnormal patterns: 176 (26%) had reduced growth and an early decline, 160 (23%) had reduced growth only, and 178 (26%) had normal growth and an early decline. Lower baseline values for FEV1, smaller bronchodilator response, airway hyperresponsiveness at baseline, and male sex were associated with reduced growth (P<0.001 for all comparisons). At the last spirometric measurement (mean [±SD] age, 26.0±1.8 years), 73 participants (11%) met Global Initiative for Chronic Obstructive Lung Disease spirometric criteria for lung-function impairment that was consistent with chronic obstructive pulmonary disease (COPD); these participants were more likely to have a reduced pattern of growth than a normal pattern (18% vs. 3%, P<0.001). CONCLUSIONS Childhood impairment of lung function and male sex were the most significant predictors of abnormal longitudinal patterns of lung-function growth and decline. Children with persistent asthma and reduced growth of lung function are at increased risk for fixed airflow obstruction and possibly COPD in early adulthood. (Funded by the Parker B. Francis Foundation and others; ClinicalTrials.gov number, NCT00000575.)

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Section: Discussionsupporting

confidence: 55%

Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma

McGeachie¹,

Yates

Zhou³

et al. 2016

N Engl J Med

497

421

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“…The presence of a linear trend across groups seems to confirm a linear relationship between FEV 1 /FVC reduction and mortality, as also shown by others [19] . The increased mortality in the F + /L -group, however, seems to be due to the confounding effect of age and sex.…”

Section: Discussionsupporting

confidence: 58%

Difference in Mortality Risk in Elderly People with Bronchial Obstruction Diagnosed Using a Fixed Cutoff or the Lower Limit of Normal of the FEV<sub>1</sub>/FVC Ratio

Pedone

Giua²,

Scichilone³

et al. 2017

Respiration

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Background: Whether a fixed cutoff or the lower limit of normal of the FEV₁/FVC ratio should be used to diagnose bronchial obstruction is still a matter of debate. This issue is particularly important for elderly people. Objectives: We used equations applicable up to 90 years of age to evaluate the mortality of elderly people diagnosed with bronchial obstruction using either a fixed cutoff of 0.7 or the lower limit of normal (LLN). Methods: Participants in the SaRA (Salute Respiratoria nell'Anziano, Italian for “Respiratory Health in the Elderly”) study were grouped as follows: FEV₁/FVC ≥0.7 and ≥ LLN (n = 535: F^-/L^-), FEV₁/FVC <0.7 but ≥ LLN (n = 118: F⁺/L^-), and FEV₁/FVC <0.7 and < LLN (n = 229: F⁺/L⁺). We estimated the mortality risk in the three groups over 15 years of follow-up. Results: The mean age was 73 years (58% men). The hazard ratio (HR) for mortality was 1.427 (95% CI: 1.09-1.868) in the F⁺/L− group and 2.143 (95% CI: 1.13-1.995) in the F⁺/L⁺ group. After adjustment for potential confounders, we found no increased mortality in the F⁺/L− group (HR: 1.007, 95% CI: 0.755-1.342), while the HR in the F⁺/L⁺ group was still sizeable (1.474, 95% CI: 1.136-1.911). Conclusions: As expected, using a fixed cutoff translates in a larger number of people to be classified as having bronchial obstruction. In our sample the increased mortality in the F⁺/L^- group is due to the confounding effect of age and sex. Our study lends support to the use of LLN in elderly people.

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“…Hence, the recent joint project of GINA and GOLD on the diagnosis of diseases of chronic airflow limitation describing the Asthma-COPD overlap syndrome (ACOS) emphasize that patients with obstructive airflow limitations who present features suggestive of asthma should be treated with inhaled corticosteroids (ICS) [12]. Furthermore, it has been repeatedly shown that airflow limitation in asthma is Lung function impairment increases with age 5 + MODEL associated with doubled risk of mortality, with respiratory failure as the most common cause of death [19,21]. An observational study based on the present cohort indicates that ICS treatment may reduce the annual loss of lung function by app.…”

Section: Discussionmentioning

confidence: 99%