Effects of Allergic Phenotype on Respiratory Symptoms and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) guidelines make no recommendations for allergy diagnosis or treatment. Objectives: To determine whether an allergic phenotype contributes to respiratory symptoms and exacerbations in patients with COPD. Methods: Two separate cohorts were analyzed: National Health and Nutrition Survey III (NHANES III) and the COPD and domestic endotoxin (CODE) cohort. Subjects from NHANES III with COPD (n ¼ 1,381) defined as age . 40 years, history of smoking, FEV 1 /FVC , 0.70, and no diagnosis of asthma were identified. The presence of an allergic phenotype (n ¼ 296) was defined as self-reported doctor diagnosed hay fever or allergic upper respiratory symptoms. In CODE, former smokers with COPD (n ¼ 77) were evaluated for allergic sensitization defined as a detectable specific IgE to perennial allergens. Bivariate and multivariate models were used to determine whether an allergic phenotype was associated with respiratory symptoms and exacerbations. Measurements and Main Results: In NHANES III, multivariate analysis revealed that individuals with allergic phenotype were more likely to wheeze (odds ratio [OR], 2.1; P , 0.01), to have chronic cough (OR, 1.9; P ¼ 0.01) and chronic phlegm (OR, 1.5; P , 0.05), and to have increased risk of COPD exacerbation requiring an acute doctor visit (OR, 1.7; P ¼ 0.04). In the CODE cohort, multivariate analysis revealed that sensitized subjects reported more wheeze (OR, 5.91; P , 0.01), more nighttime awakening due to cough (OR, 4.20; P ¼ 0.03), increased risk of COPD exacerbations requiring treatment with antibiotics (OR, 3.79; P ¼ 0.02), and acute health visits (OR, 11.05; P , 0.01). An increasing number of sensitizations was associated with a higher risk for adverse health outcomes. Conclusions: Among individuals with COPD, evidence of an allergic phenotype is associated with increased respiratory symptoms and risk of COPD exacerbations.Keywords: atopy; allergic sensitization; allergy; chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD), a chronic disease of the airways, is caused by tobacco smoke and other air pollutant exposures (1). In the United States, COPD affects 14% of the adult population and is the third leading cause of death (2). Annually, COPD is responsible for 726,000 hospitalizations and over $32 billion in estimated cost, reflecting a large public health burden (3). Patients with COPD suffer significant morbidity, including respiratory symptoms that adversely affect quality of life and limit activity (4). Given the significant morbidity, understanding the different factors that contribute to symptom burden in COPD is an important focus of research.Allergic sensitization, assessed by allergen-specific IgE or skin prick testing, is a known risk factor for asthma (5, 6), and exposure to specific allergens in sensitized patients with asthma is known to worsen pulmonary symptoms (7,8). National and international guidelines recommend assessment of allergic sensitization and environmental exposur...

The Prevalence of Increased Serum IgE and Aspergillus Sensitization in Patients With COPD and Their Association With Symptoms and Lung Function

“…However, the cause of about one-third of severe exacerbations of COPD cannot be identified [37]. Because the allergic phenotype of COPD was shown to have an increased risk of exacerbations [2], whether airway allergy plays a role in the susceptibility to, or is an unidentified trigger for exacerbation is worth further speculating. Finally, longitudinal studies may also be needed to examine the potential role of allergy in disease expression or progression of COPD.…”

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O Perfil Clínico e a Qualidade de Vida de Homens e Mulheres com Tosse Crônica

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