Atopy is a risk factor for respiratory symptoms in COPD patients: results from the EUROSCOP study

Respiratory Research

Judith M Vonk³  Dirkje S Postma²  Wim Timens²  Machteld N Hylkema²  Claes-Göran Löfdahl¹  Nick H T ten Hacken²  Fatemeh Fattahi² 

[1] Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden;Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

关键词: Respiratory symptoms;    Lung function;    Gender;    Corticosteroid;    Chronic obstructive pulmonary disease;    Allergy;   

Others  :  796546
DOI  :  10.1186/1465-9921-14-10

 received in 2012-08-13, accepted in 2013-01-11,  发布年份 2013

【 摘 要 】

Background

The pathogenesis of COPD is complex and remains poorly understood. The European Respiratory Society Study on Chronic Obstructive Pulmonary Disease (EUROSCOP) investigated long-term effects of budesonide; 18% of the COPD participants were atopic. So far effects of atopy on the long-term course of COPD have not been elucidated.

Methods

Factors related to the presence of atopy (positive phadiatop) in 1277 mild-to-moderate COPD patients participating in EUROSCOP were analysed using regression analysis. Incidence and remission of respiratory symptoms during 3-year follow-up were analysed using generalised estimating equations models, and association of atopy with lung function decline using linear mixed effects models.

Results

Independent predisposing factors associated with the presence of atopy were: male gender (OR: 2.21; 95% CI: 1.47–3.34), overweight/obese (OR: 1.41; 95% CI: 1.04–1.92) and lower age (OR: 0.98; 95% CI: 0.96–0.99). Atopy was associated with a higher prevalence of cough (OR: 1.71; 95% CI: 1.26–2.34) and phlegm (OR: 1.50; 95% CI: 1.10–2.03), but not with lung function levels or FEV₁ decline. Atopic COPD patients not treated with budesonide had an increased incidence of cough over time (OR: 1.79, 95% CI: 1.03–3.08, p = 0.038), while those treated with budesonide had increased remission of cough (OR: 1.93, 95% CI: 1.11–3.37, p = 0.02) compared to non-atopic COPD patients.

Conclusions

Atopic COPD patients are more likely male, have overweight/obesity and are younger as compared with non-atopic COPD patients. Atopy in COPD is associated with an increased incidence and prevalence of respiratory symptoms. If atopic COPD patients are treated with budesonide, they more often show remission of symptoms compared to non-atopic COPD patients who are treated with budesonide. We recommend including atopy in the diagnostic work-up and management of COPD.

【 授权许可】

   
2013 Fattahi et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Kay AB: Overview of ‘allergy and allergic diseases: with a view to the future’. Br Med Bull 2000, 56:843-864.
• [2]Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, Williams H: Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006, 368:733-743.
• [3]Platts-Mills TA, Erwin E, Heymann P, Woodfolk J: Is the hygiene hypothesis still a viable explanation for the increased prevalence of asthma? Allergy 2005, 60(Suppl 79):25-31.
• [4]Romanet-Manent S, Charpin D, Magnan A, Lanteaume A, Vervloet D: Allergic vs nonallergic asthma: what makes the difference? Allergy 2002, 57:607-613.
• [5]Berry M, Morgan A, Shaw DE, Parker D, Green R, Brightling C, Bradding P, Wardlaw AJ, Pavord ID: Pathological features and inhaled corticosteroid response of eosinophilic and non-eosinophilic asthma. Thorax 2007, 62:1043-1049.
• [6]Pavord ID, Brightling CE, Woltmann G, Wardlaw AJ: Non-eosinophilic corticosteroid unresponsive asthma. Lancet 1999, 353:2213-2214.
• [7]Hurd S: The impact of COPD on lung health worldwide: epidemiology and incidence. Chest 2000, 117:1S-4S.
• [8]Pauwels RA, Lofdahl CG, Laitinen LA, Schouten JP, Postma DS, Pride NB, Ohlsson SV: Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European respiratory society study on chronic obstructive pulmonary disease. N Engl J Med 1999, 340:1948-1953.
• [9]Watson L, Schouten JP, Lofdahl CG, Pride NB, Laitinen LA, Postma DS: Predictors of COPD symptoms: does the sex of the patient matter? Eur Respir J 2006, 28:311-318.
• [10]Burrows B, Lebowitz MD, Barbee RA: Respiratory disorders and allergy skin-test reactions. Ann Intern Med 1976, 84:134-139.
• [11]Sparrow D, O’Connor G, Weiss ST: The relation of airways responsiveness and atopy to the development of chronic obstructive lung disease. Epidemiol Rev 1988, 10:29-47.
• [12]Viegi G, Scognamiglio A, Baldacci S, Pistelli F, Carrozzi L: Epidemiology of chronic obstructive pulmonary disease (COPD). Respiration 2001, 68:4-19.
• [13]Weiss ST: Atopy as a risk factor for chronic obstructive pulmonary disease: epidemiological evidence. Am J Respir Crit Care Med 2000, 162:S134-S136.
• [14]Watson L, Vonk JM, Lofdahl CG, Pride NB, Pauwels RA, Laitinen LA, Schouten JP, Postma DS: Predictors of lung function and its decline in mild to moderate COPD in association with gender: results from the Euroscop study. Respir Med 2006, 100:746-753.
• [15]Physical status: the use and interpretation of anthropometry: Report of a WHO expert committee. World Health Organ Tech Rep Ser 1995, 854:1-452.
• [16]Standardization of Spirometry, 1994 Update: American thoracic society. Am J Respir Crit Care Med 1995, 152:1107-1136.
• [17]Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC: Lung volumes and forced ventilatory flows. Report working party standardization of lung function tests, European community for steel and coal. Official statement of the European respiratory society. Eur Respir J Suppl 1993, 16:5-40.
• [18]Govaere E, Van GD, Massa G, Verhamme KM, Doli E, De BF: The influence of age and gender on sensitization to aero-allergens. Pediatr Allergy Immunol 2007, 18:671-678.
• [19]Siroux V, Curt F, Oryszczyn MP, Maccario J, Kauffmann F: Role of gender and hormone-related events on IgE, atopy, and eosinophils in the epidemiological study on the genetics and environment of asthma, bronchial hyperresponsiveness and atopy. J Allergy Clin Immunol 2004, 114:491-498.
• [20]Zauli D, Bortolotti R, Grassi A, Tiberio D, Bianchi FB: Changes in atopy over 25 years: atopy now affects wider age range. BMJ 2005, 331:352.
• [21]Sears MR, Burrows B, Flannery EM, Herbison GP, Holdaway MD: Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma. Clin Exp Allergy 1993, 23:941-948.
• [22]Barbee RA, Halonen M, Kaltenborn W, Lebowitz M, Burrows B: A longitudinal study of serum IgE in a community cohort: correlations with age, sex, smoking, and atopic status. J Allergy Clin Immunol 1987, 79:919-927.
• [23]Barbee RA, Brown WG, Kaltenborn W, Halonen M: Allergen skin-test reactivity in a community population sample: correlation with age, histamine skin reactions and total serum immunoglobulin E. J Allergy Clin Immunol 1981, 68:15-19.
• [24]Chen Y, Rennie D, Cormier Y, Dosman J: Association between obesity and atopy in adults. Int Arch Allergy Immunol 2010, 153:372-377.
• [25]Wuthrich B, Schindler C, Medici TC, Zellweger JP, Leuenberger P: IgE levels, atopy markers and hay fever in relation to age, sex and smoking status in a normal adult Swiss population. SAPALDIA (Swiss study on Air pollution and lung diseases in adults) team. Int Arch Allergy Immunol 1996, 111:396-402.
• [26]Yoo S, Kim HB, Lee SY, Kim BS, Kim JH, Yu JH, Kim BJ, Hong SJ: Association between obesity and the prevalence of allergic diseases, atopy, and bronchial hyperresponsiveness in Korean adolescents. Int Arch Allergy Immunol 2011, 154:42-48.
• [27]Sutherland TJ, Cowan JO, Young S, Goulding A, Grant AM, Williamson A, Brassett K, Herbison GP, Taylor DR: The association between obesity and asthma: interactions between systemic and airway inflammation. Am J Respir Crit Care Med 2008, 178:469-475.
• [28]Mensinga TT, Schouten JP, Rijcken B, Weiss ST, Speizer FE, van der Lende R: The relationship of eosinophilia and positive skin test reactivity to respiratory symptom prevalence in a community-based population study. J Allergy Clin Immunol 1990, 86:99-107.
• [29]Jansen DF, Rijcken B, Schouten JP, Kraan J, Weiss ST, Timens W, Postma DS: The relationship of skin test positivity, high serum total IgE levels, and peripheral blood eosinophilia to symptomatic and asymptomatic airway hyperresponsiveness. Am J Respir Crit Care Med 1999, 159:924-931.
• [30]Jamieson DB, Diette GB, Curtin-Brosnan J, Matsui EC, McCormack MC, Breysse P, Hansel N: Allergic status May worsen respiratory symptoms in patients with COPD [abstract]. Am J Respir Crit Care Med 2011, 183:A1735.
• [31]Miravitlles M: Cough and sputum production as risk factors for poor outcomes in patients with COPD. Respir Med 2011, 105:1118-1128.
• [32]Kauffmann F, Neukirch F, Korobaeff M, Marne MJ, Claude JR, Lellouch J: Eosinophils, smoking, and lung function. An epidemiologic survey among 912 working men. Am Rev Respir Dis 1986, 134:1172-1175.
• [33]Sherrill DL, Lebowitz MD, Halonen M, Barbee RA, Burrows B: Longitudinal evaluation of the association between pulmonary function and total serum IgE. Am J Respir Crit Care Med 1995, 152:98-102.
• [34]Gottlieb DJ, Sparrow D, O’Connor GT, Weiss ST: Skin test reactivity to common aeroallergens and decline of lung function. The Normative Aging Study. Am J Respir Crit Care Med 1996, 153:561-566.
• [35]Tracey M, Villar A, Dow L, Coggon D, Lampe FC, Holgate ST: The influence of increased bronchial responsiveness, atopy, and serum IgE on decline in FEV1. A longitudinal study in the elderly. Am J Respir Crit Care Med 1995, 151:656-662.
• [36]Sahn SA: Corticosteroids in chronic bronchitis and pulmonary emphysema. Chest 1978, 73:389-396.
• [37]Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: Global initiative for chronic obstructive lung disease. 2011. (revised 2011). http://www.goldcopd.com webcite
• [38]Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007, 176:532-555.