Published ahead of print on July 14, 2005, doi:10.1164/rccm.200503-323OC Am. J. Respir. Crit. Care Med., Volume 172, Number 8, October 2005, 956-961 A more recent version of this article appeared on October 15, 2005
Submitted on March 1, 2005 An Increase in Bronchial Responsiveness is Associated with Continuing or Restarting SmokingSusan Chinn1*,1 Department of Public Health Sciences, King's College London, London, United Kingdom, 2 Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland, 3 Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain, 4 Division of Respiratory Diseases, University of Pavia, San Matteo Hospital, Pavia, Italy, 5 Department of Medicine and Public Health, Division of Epidemiology and Statistics, University of Verona, Verona, Italy, 6 Department of Allergy, Respiratory Medicine and Sleep, University Hospital, Reykjavik, Iceland, 7 Institute of Epidemiology, National Research Center for Environment and Health, Neuherberg, Germany, 8 Respiratory Medicine and Allergology, University of Uppsala, Uppsala, Sweden, 9 Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, 10 Unit 408, Epidemiology, Faculty of Medicine, INSERM - The French Institute of Health and Medical Research, Paris, France, 11 Department of Epidemilogy and Bioinformatics, University of Groningen, Groningen, The Netherlands, 12 Department of Thoracic Medicine, Haukeland Hospital, Bergen, Norway * To whom correspondence should be addressed. E-mail: sue.chinn{at}kcl.ac.uk.
Rationale: Bronchial responsiveness has been found to be associated with smoking, atopy and lower lung function in cross-sectional studies, but there is little information on determinants of change in adults. Objectives: To analyze change in bronchial responsiveness in an international longitudinal community study. Methods: The study was carried out in 3993 participants in the European Community Respiratory Health Survey who had bronchial responsiveness measured in 1991-1993, when aged 20 to 44 years, and in 1998-2002. Measurements: Bronchial responsiveness was assessed by methacholine challenge. Serum samples were tested for total IgE, and for specific IgE to four common allergens. Smoking information was obtained from detailed administered questionnaires. Change in bronchial responsiveness was analyzed by change in IgE-sensitization, smoking and lung function, with tests of interaction terms with age and gender. Main Results: Continuing and restarting smokers had increasing bronchial responsiveness, approximately equivalent to a mean reduction in PD20 of 0.68 and 0.75 doubling doses, respectively, over 10 years, in addition to a small increase explained by decline in FEV1. No other risk factor for change in bronchial responsiveness was identified. Conclusions: Smoking is a risk factor for increasing bronchial responsiveness over and above the effect of decreasing lung function. Neither baseline IgE-sensitization nor change in sensitization was shown to be a risk factor for increasing BHR, the latter possibly due to little overall increase or decrease in sensitization. Key words: bronchial hyperreactivity, asthma, chronic obstructive pulmonary disease, immunoglobulin E, atopy
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