Vedel-Krogh Signe, Nielsen Sune Fallgaard, Nordestgaard Børge Grønne, Lange Peter, Vestbo Jørgen
Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Public Health, Section of Epidemiology, University of Copenhagen, Denmark; Medical Department, Respiratory Section, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
Respir Med. 2021 Sep;186:106529. doi: 10.1016/j.rmed.2021.106529. Epub 2021 Jul 7.
Asthma and COPD diagnoses are used to classify chronic airway diseases; however, both diseases are related to phenotypic traits like allergy, obesity, cough, sputum production, low-grade inflammation, smoking, elevated blood eosinophil count, comorbidities, and occupational exposures. Whether such traits can replace asthma and COPD diagnoses when assessing risk of exacerbation is unclear. We tested the hypothesis that individuals with either asthma or COPD diagnoses have similar risk of moderate and severe exacerbations when adjusted for differences in phenotypic traits.
From the Copenhagen General Population Study, a cohort study of the general population, we included 7190 individuals with chronic airway disease. Phenotypic traits were recorded at baseline and risk of exacerbations was assessed during follow-up from 2003 to 2013.
The incidence rate ratio (IRR) of moderate exacerbations in individuals with clinical COPD was 1.61 (95% Confidence Interval, 1.27-2.02) compared to individuals with asthma in a model only adjusted for age, sex, and education, but after the inclusion of phenotypic traits IRR was 1.05 (0.82-1.35). Corresponding IRRs of severe exacerbations in individuals with clinical COPD versus asthma were 3.82 (2.73-5.35) and 2.28 (1.63-3.20), respectively.
When taking phenotypic traits into account, individuals with asthma and COPD had comparable risk of moderate exacerbations; however, corresponding risk of severe exacerbations was higher in individuals with COPD than in those with asthma.
哮喘和慢性阻塞性肺疾病（COPD）的诊断用于对慢性气道疾病进行分类；然而，这两种疾病都与过敏、肥胖、咳嗽、咳痰、低度炎症、吸烟、血液嗜酸性粒细胞计数升高、合并症和职业暴露等表型特征有关。在评估病情加重风险时，这些特征是否可以取代哮喘和COPD的诊断尚不清楚。我们检验了这样一个假设，即调整表型特征差异后，患有哮喘或COPD诊断的个体发生中度和重度病情加重的风险相似。
从哥本哈根普通人群研究（一项针对普通人群的队列研究）中，我们纳入了7190名患有慢性气道疾病的个体。在基线时记录表型特征，并在2003年至2013年的随访期间评估病情加重的风险。
在仅根据年龄、性别和教育程度进行调整的模型中，临床COPD患者中度病情加重的发病率比（IRR）为1.61（95%置信区间，1.27 - 2.02），而哮喘患者为1.61；但纳入表型特征后，IRR为1.05（0.82 - 1.35）。临床COPD患者与哮喘患者重度病情加重的相应IRR分别为3.82（2.73 - 5.35）和2.28（1.63 - 3.20）。
考虑表型特征时，哮喘和COPD患者发生中度病情加重的风险相当；然而，COPD患者发生重度病情加重的相应风险高于哮喘患者。
