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- Title
Association of Nonobstructive Chronic Bronchitis With Respiratory Health Outcomes in Adults.
- Authors
Balte, Pallavi P.; Chaves, Paulo H.M.; Couper, David J.; Enright, Paul; Jacobs, David R.; Kalhan, Ravi; Kronmal, Richard A.; Loehr, Laura R.; London, Stephanie J.; Newman, Anne B.; O'Connor, George T.; Schwartz, Joseph E.; Smith, Benjamin M.; Smith, Lewis J.; White, Wendy B.; Yende, Sachin; Oelsner, Elizabeth C.; Jacobs, David R Jr
- Abstract
<bold>Importance: </bold>Chronic bronchitis has been associated with cigarette smoking as well as with e-cigarette use among young adults, but the association of chronic bronchitis in persons without airflow obstruction or clinical asthma, described as nonobstructive chronic bronchitis, with respiratory health outcomes remains uncertain.<bold>Objective: </bold>To assess whether nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes in adult ever smokers and never smokers.<bold>Design, Setting, and Participants: </bold>This prospective cohort study included 22 325 adults without initial airflow obstruction (defined as the ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity [FVC] of <0.70) or clinical asthma at baseline. The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 9 US general population-based cohorts. Thus present study is based on data from 5 of these cohorts. Participants were enrolled from August 1971 through May 2007 and were followed up through December 2018.<bold>Exposures: </bold>Nonobstructive chronic bronchitis was defined by questionnaire at baseline as both cough and phlegm for at least 3 months for at least 2 consecutive years.<bold>Main Outcomes and Measures: </bold>Lung function was measured by prebronchodilator spirometry. Hospitalizations and deaths due to chronic lower respiratory disease and respiratory disease-related mortality were defined by events adjudication and administrative criteria. Models were stratified by smoking status and adjusted for anthropometric, sociodemographic, and smoking-related factors. The comparison group was participants without nonobstructive chronic bronchitis.<bold>Results: </bold>Among 22 325 adults included in the analysis, mean (SD) age was 53.0 (16.3) years (range, 18.0-95.0 years), 58.2% were female, 65.9% were non-Hispanic white, and 49.6% were ever smokers. Among 11 082 ever smokers with 99 869 person-years of follow-up, participants with nonobstructive chronic bronchitis (300 [2.7%]) had accelerated decreases in FEV1 (4.1 mL/y; 95% CI, 2.1-6.1 mL/y) and FVC (4.7 mL/y; 95% CI, 2.2-7.2 mL/y), increased risks of chronic lower respiratory disease-related hospitalization or mortality (hazard ratio [HR], 2.2; 95% CI, 1.7-2.7), and greater respiratory disease-related (HR, 2.0; 95% CI, 1.1-3.8) and all-cause mortality (HR, 1.5; 95% CI, 1.3-1.8) compared with ever smokers without nonobstructive chronic bronchitis. Among 11 243 never smokers with 120 004 person-years of follow-up, participants with nonobstructive chronic bronchitis (151 [1.3%]) had greater rates of chronic lower respiratory disease-related hospitalization or mortality (HR, 3.1; 95% CI, 2.1-4.5) compared with never smokers without nonobstructive chronic bronchitis. Nonobstructive chronic bronchitis was not associated with FEV1:FVC decline or incident airflow obstruction. The presence of at least 1 of the component symptoms of nonobstructive chronic bronchitis (ie, chronic cough or phlegm), which was common in both ever smokers (11.0%) and never smokers (6.7%), was associated with adverse respiratory health outcomes.<bold>Conclusions and Relevance: </bold>The findings suggest that nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes, particularly in ever smokers, and may be a high-risk phenotype suitable for risk stratification and targeted therapies.
- Subjects
RESEARCH; ASTHMA; LUNGS; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; PULMONARY function tests; RESEARCH funding; SMOKING; CHRONIC bronchitis; LONGITUDINAL method
- Publication
JAMA Internal Medicine, 2020, Vol 180, Issue 5, p676
- ISSN
2168-6106
- Publication type
journal article
- DOI
10.1001/jamainternmed.2020.0104