The impact of a history of asthma on long-term outcomes of people with newly diagnosed chronic obstructive pulmonary disease: A population study - 19/04/17
, Teresa M. To, PhD a, c, e, Shawn D. Aaron, MD, MSc f, M. Diane Lougheed, MD, MSc a, g, Mohsen Sadatsafavi, MD, PhD h, J. Mark FitzGerald, MD h, Andrea S. Gershon, MD, MSc a, b, c, d, efor the
Canadian Respiratory Research Network
Abstract |
Background |
Little is known about the natural history of chronic obstructive pulmonary disease (COPD) that has developed from airway remodeling due to asthma, as compared with other COPD phenotypes.
Objective |
We compared long-term health outcomes of individuals with COPD with and without a history of asthma in a population-based cohort study.
Methods |
All individuals with physician-diagnosed COPD between the ages 40 and 55 years from 2009 and 2011 were identified and followed until March 2013 through provincial health administrative data (Ontario, Canada). The exposure was a history of asthma at least 2 years before the diagnosis of COPD to ensure it preceded COPD. The hazards of COPD-, respiratory-, and cardiovascular (CV)-related hospitalizations and all-cause mortality were compared between groups using a Cox regression model controlling for demographic characteristics, comorbidities, and level of health care.
Results |
Among 9053 patients with COPD, 2717 (30%) had a history of asthma. Over a median of 2.9 years, 712 (8%) individuals had a first COPD hospitalization, 964 (11%) a first respiratory-related and 342 (4%) a first CV-related hospitalization, and 556 (6%) died. Controlling for confounding, a history of asthma was significantly associated with COPD and respiratory-related hospitalizations (hazard ratio, 1.53 [95% CI, 1.29-1.82] and hazard ratio, 1.63 [95% CI, 1.14-1.88], respectively), but not with CV-related hospitalizations or all-cause mortality. Additional analyses confirmed that these findings were not likely a result of unmeasured confounding or misclassification.
Conclusions |
Middle-aged individuals with physician-diagnosed COPD and a history of asthma had a higher hazard of hospitalizations due to COPD and other respiratory diseases than did those without.
Le texte complet de cet article est disponible en PDF.Key words : COPD, asthma, mortality, hospitalization
Abbreviations used : COPD, CV
Plan
| This work was supported by the Canadian Respiratory Research Network (CRRN). The CRRN is supported by grants from the Canadian Institutes of Health Research (CIHR)- Institute of Circulatory and Respiratory Health; Canadian Lung Association/Canadian Thoracic Society; British Columbia Lung Association; and Industry Partners Boehringer-Ingelheim Canada Ltd, AstraZeneca Canada Inc, and Novartis Canada Ltd. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. |
|
| Disclosure of potential conflict of interest: T. Kendzerska is supported by the CRRN Fellowship Training Award. Funding for training of graduate students and new investigators within the network was supported by the above funding sponsors as well as by GlaxoSmithKline Inc. M. Diane Lougheed has received grants from Government of Ontario's Innovation Fund, AllerGen NCE, Ontario Lung Association/Ontario Thoracic Society, Queen's University William M. Spear/Start Memorial Fund, GlaxoSmithKlein, Ontario Lung Association/Canada Health Infoway, Janssen Pharmaceutical, and Ontario Lung Association (subcontract from the Ministry of Health and Long-Term Care of the Province of Ontario). M. Sadatsafavi has received a grant from AstraZeneca Canada. A. S. Gershon has received support from the Physicians' Services Incorporated Foundation and the Canadian Institutes of Health Research New Investigator Salary Award. J. M. FitzGerald is a member of the Global Initiative for Asthma Executive and its Science Committee. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 139 - N° 3
P. 835-843 - mars 2017 Retour au numéro
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