Association of chronic mucus hypersecretion with FEV1 decline and chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group.

Abstract

The aim of this study was to examine the association between chronic mucus hypersecretion, and FEV1 decline, and subsequent hospitalization from chronic obstructive pulmonary disease (COPD). We used data from The Copenhagen City Heart Study on 5,354 women and 4,081 men 30 to 79 yr of age with assessment of smoking habits, respiratory symptoms, and spirometry at two surveys 5 yr apart. Information on COPD hospitalization during 8 to 10 yr of subsequent follow-up was obtained from a nationwide register. Chronic mucus hypersecretion was significantly associated with FEV1 decline; the effect was most prominent among men, where chronic mucus hypersecretion at both surveys was associated with an excess FEV1 decline of 22.8 ml/yr (95% confidence interval, 8.2 to 37.4) compared with men without mucus hypersecretion, after adjusting for age, height, weight change, and smoking; in women, the excess decline was 12.6 ml/yr (0.7-24.6). Chronic mucus hypersecretion was associated with subsequent hospitalization due to COPD after adjusting for age and smoking; relative risk was 5.3 (2.9 to 9.6) among men and 5.1 (2.5 to 10.3) among women. After further adjusting for FEV1 at the second survey, the relative risk was reduced to 2.4 (1.3 to 4.5) for men and 2.6 (1.2 to 5.3) for women. Chronic mucus hypersecretion was significantly and consistently associated with both an excess FEV1 decline and an increased risk of subsequent hospitalization because of COPD.

Prevalence of self-reported chronic diseases in individuals over the age of 40 in São Paulo, Brazil: the Platino study

“…Other surveys undertaken in Brazil and other countries have evaluated large samples focusing on specific diseases 15,16,17 . However, few studies have analyzed the characteristics of the surveyed individuals associated with these diseases.…”

COPD: problems in diagnosis and measurement

“…Respiratory symptoms have been associated with lower levels of pulmonary function [44][45][46][47], although patients may underestimate the morbidity associated with their disease. In a large international telephone screening of 201,921 households (in the USA, Canada, France, Italy, Germany, the Netherlands, Spain and the UK), 3,265 individuals with probable obstructive lung disease were identified.…”

“…For example, among individuals with the most severe breathlessness and limitation (unable to leave home secondary to dyspnoea), 35.8% described their disease as mild; of those unable to ambulate for a few minutes on level ground, 60.3% described their disease as mild [48]. Although the impairment associated with chronic cough was observed predominantly in males [44], it has been reported that females and males with chronic cough and chronic mucus hypersecretion have an accelerated decline in FEV1 [45,46] and greater mortality from COPD [47]. Whether these symptoms are markers of pathological alteration of the airways is not known.…”

From COPD epidemiology to studies of pathophysiological disease mechanisms: challenges with regard to study design and recruitment process

“…Still, the chosen levels of defining rate of decline in FEV 1 may be discussed. Normal rate of decline in FEV 1 among middle-aged adults is described as 25–30 ml/year [26]. Here, we chose an even stricter criterion for groups C and D, having normal lung function at recruitment and follow-up as well as an annual decline in FEV 1 within the range of <20 ml.…”