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Comparative Study
. 2009 Oct;64(10):894-900.
doi: 10.1136/thx.2008.110619. Epub 2009 Jul 5.

Chronic bronchitis before age 50 years predicts incident airflow limitation and mortality risk

S Guerra  1 , D L Sherrill, C Venker, C M Ceccato, M Halonen, F D Martinez
Affiliations
Comparative Study

Chronic bronchitis before age 50 years predicts incident airflow limitation and mortality risk

S Guerra et al. Thorax. 2009 Oct.

Abstract

Background: Previous studies on the relationship of chronic bronchitis to incident airflow limitation and all-cause mortality have provided conflicting results, with positive findings reported mainly by studies that included populations of young adults. This study sought to determine whether having chronic cough and sputum production in the absence of airflow limitation is associated with onset of airflow limitation, all-cause mortality and serum levels of C-reactive protein (CRP) and interleukin-8 (IL-8), and whether subjects' age influences these relationships.

Methods: 1412 participants in the long-term Tucson Epidemiological Study of Airway Obstructive Disease who at enrolment (1972-1973) were 21-80 years old and had FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) > or = 70% and no asthma were identified. Chronic bronchitis was defined as cough and phlegm production on most days for > or = 3 months in two or more consecutive years. Incidence of airflow limitation was defined as the first follow-up survey with FEV(1)/FVC <70%. Serum IL-8 and CRP levels were measured in cryopreserved samples from the enrolment survey.

Results: After adjusting for covariates, chronic bronchitis at enrolment significantly increased the risk for incident airflow limitation and all-cause mortality among subjects <50 years old (HR 2.2, 95% CI 1.3 to 3.8; and HR 2.2, 95% CI 1.3 to 3.8; respectively), but not among subjects > or = 50 years old (HR 0.9, 95% CI 0.6 to 1.4; and HR 1.0, 95% CI 0.7 to 1.3). Chronic bronchitis was associated with increased IL-8 and CRP serum levels only among subjects <50 years old.

Conclusions: Among adults <50 years old, chronic bronchitis unaccompanied by airflow limitation may represent an early marker of susceptibility to the effects of cigarette smoking on systemic inflammation and long-term risk for chronic obstructive pulmonary disease and all-cause mortality.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for incident airflow limitation. Figure 1a shows survival curves for the four groups generated by the combination of smoking status (ever smoked at least one pack-year versus never smoked one pack-year) and chronic bronchitis at enrollment. Figure 1b shows survival curves for the four groups generated by the combination of age (< 50 years versus ≥ 50 years) and chronic bronchitis at enrollment.
Figure 2
Figure 2
Kaplan-Meier survival curves for all-cause mortality. Figure 2a shows survival curves for the four groups generated by the combination of smoking status (ever smoked at least one pack-year versus never smoked one pack-year) and chronic bronchitis at enrollment. Figure 2b shows survival curves for the four groups generated by the combination of age (< 50 years versus ≥ 50 years) and chronic bronchitis at enrollment.
Figure 3
Figure 3
Proportion (and 95% CIs) of subjects with elevated IL-8 levels – defined as IL-8 levels above median – (Figures 3a and 3b) and geometric means (and 95% CIs) of serum CRP levels (Figures 3c and 3d) in each of the combinatorial groups generated by the combination of smoking status and chronic bronchitis, and by the combination of age and chronic bronchitis. * CB = Chronic Bronchitis. ^ P value refers to the statistical comparison across the four groups
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