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Incidence of Chronic Obstructive Pulmonary Disease in a Cohort of Young Adults According to the Presence of Chronic Cough and Phlegm

Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona; Division of Respiratory Diseases, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico "San Matteo" Hospital, University of Pavia, Pavia, Italy; Institut Municipal d'Investigaciò Mèdica, Universitat Pompeu Fabra, Barcelona, Spain; Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Medical Sciences, Respiratory Medicine, and Allergology, University of Uppsala, Uppsala, Sweden; Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London; Department of Public Health Sciences, King's College London, London, United Kingdom; Campus Drie Eiken, University of Antwerp, Antwerp, Belgium; Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland; Department of Allergy, Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland; Institute of Epidemiology, Gesellschaft für Strahlen Forschung–National Research Center for Environment and Health, Neuherberg; Institute of Epidemiology, Ludwig-Maximilians-University of Munich, Neuherberg, Germany; Institut National de la Santé et de la Recherche Médicale, Unit 408—Epidemiology, Faculty of Medicine X Bichat, Paris, France; and Department of Epidemiology and Bioinformatics, University Medical Center, University of Groningen, Groningen, The Netherlands

Correspondence and requests for reprints should be addressed to Roberto de Marco, Ph.D., Sezione di Epidemiologia & Statistica Medica, Dipartimento di Medicina e Sanità Pubblica, Università degli Studi di Verona, c/o Istituti Biologici II, Strada Le Grazie 8 37134, Verona, Italy. E-mail: roberto.demarco{at}univr.it

Rationale: The few prospective studies aimed at assessing the incidence of chronic obstructive pulmonary disease (COPD) in relation to the presence of chronic cough/phlegm have produced contrasting results.

Objectives: To assess the incidence of COPD in a cohort of young adults and to test whether chronic cough/phlegm and dyspnea are independent predictors of COPD.

Methods: An international cohort of 5,002 subjects without asthma (ages 20–44 yr) with normal lung function (FEV₁/FVC ratio 70%) from 12 countries was followed from 1991–2002 in the frame of the European Community Respiratory Health Survey II. Incident cases of COPD were those who had an FEV₁/FVC ratio less than 70% at the end of the follow-up, but did not report having had a doctor diagnose asthma during the follow-up.

Main Results: The incidence rate of COPD was 2.8 cases/1,000/yr (95% confidence interval [CI], 2.3–3.3). Chronic cough/phlegm was an independent and statistically significant predictor of COPD (incidence rate ratio [IRR], 1.85; 95% CI, 1.17–2.93) after adjusting for smoking habits and other potential confounders, whereas dyspnea was not associated with the disease (IRR = 0.98; 95% CI, 0.64–1.50). Subjects who reported chronic cough/phlegm both at baseline and at the follow-up had a nearly threefold-increased risk of developing COPD with respect to asymptomatic subjects (IRR = 2.88; 95% CI, 1.44–5.79).

Conclusions: The incidence of COPD is substantial even in young adults. The presence of chronic cough/phlegm identifies a subgroup of subjects with a high risk of developing COPD, independently of smoking habits.

Key Words: chronic cough and phlegm • chronic obstructive pulmonary disease • incidence • epidemiology

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The few prospective studies aimed at verifying the prognostic value of chronic cough/phlegm for chronic obstructive pulmonary disease (COPD) have given contrasting results. Therefore, it remains an open question whether the presence of these symptoms may predict the future occurrence of COPD. What This Study Adds to the Field The presence of chronic cough/phlegm is an early marker of COPD independent of smoking habits.

 

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