Published ahead of print on September 28, 2006, doi:10.1164/rccm.200603-381OC
Am. J. Respir. Crit. Care Med., Volume 175, Number 1, January 2007, 32-39
A more recent version of this article appeared on January 1, 2007
Submitted on March 15, 2006
Accepted on September 28, 2006
Incidence of COPD in a Cohort of Young Adults According to the Presence of Chronic Cough and Phlegm
Roberto de Marco1*, Simone Accordini1, Isa Cerveri2, Angelo Corsico2, Josep M Anto3, Nino Kunzli4, Christer Janson5, Jordi Sunyer3, Deborah Jarvis6, Susan Chinn7, Paul Vermeire8, Cecilie Svanes9, Ursula Ackermann-Liebrich10, Thorarinn Gislason11, Joachim Heinrich12, Benedicte Leynaert13, Francoise Neukirch13, Jan P Schouten14, Matthias Wjst15, and Peter Burney6
1 Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy,
2 Division of Respiratory Diseases, IRCCS "San Matteo" Hospital, University of Pavia, Pavia, Italy,
3 Institut Municipal d'Investigacio Medica (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, Spain,
4 Institut Municipal d'Investigacio Medica (IMIM), Universitat Pompeu Fabra (UPF), Barcelona, Spain; Keck School of Medicine, University of Southern California, Los Angeles, California, USA,
5 Department of Medical Sciences, Respiratory Medicine and Allergology, University of Uppsala, Uppsala, Sweden,
6 Respiratory Epidemiology and Public Health Group, National Heart and Lung Institute, Imperial College, London, United Kingdom,
7 Department of Public Health Sciences, King's College London, London, United Kingdom,
8 Campus Drie Eiken, University of Antwerp, Antwerp, Belgium,
9 Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway,
10 Institute of Social and Preventive Medicine, University of Basel, Basel, Switzerland,
11 Department of Allergy, Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland,
12 Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany,
13 INSERM-The French Institute of Health and Medical Research, Unit 408 - Epidemiology, Faculty of Medicine X Bichat, Paris, France,
14 Department of Epidemiology and Bioinformatics, University Medical Center, University of Groningen, Groningen, The Netherlands,
15 Institute of Epidemiology, GSF-National Research Center for Environment and Health, Neuherberg, Germany; Institute of Epidemiology, Ludwig-Maximilians-University of Munich, Neuherberg, Germany
* To whom correspondence should be addressed. E-mail: roberto.demarco{at}univr.it.
RATIONALE: The few prospective studies aimed at assessing the incidence of COPD in relation to the presence of chronic cough / phlegm have given contrasting results.
OBJECTIVES: To assess the incidence of COPD in a cohort of young adults, in order to test whether chronic cough / phlegm and dyspnoea are independent predictors of COPD.
METHODS: An international cohort of 5,002 non-asthmatic subjects (20-44 years) with normal lung function (FEV1/FVC ratio  70%) from 12 countries was followed from 1991-1993 to 1999-2002 in the frame of the European Community Respiratory Health Survey II. Incident cases of COPD were those who had a FEV1/FVC ratio <70% at the end of the follow-up, but did not report having had a doctor diagnosis of asthma during the follow-up.
MAIN RESULTS: The incidence rate of COPD was 2.8 cases/1,000/year (95%CI: 2.3 to 3.3). Chronic cough / phlegm was an independent and statistically significant predictor of COPD (IRR=1.85; 95%CI: 1.17 to 2.93) after adjusting for smoking habits and other potential confounders, whereas dyspnoea was not associated with the disease (IRR=0.98; 95%CI: 0.64 to 1.50). Subjects who reported chronic cough / phlegm both at baseline and at the follow-up had a nearly three-fold increased risk of developing COPD with respect to asymptomatic subjects (IRR=2.88; 95%CI: 1.44 to 5.79).
CONCLUSIONS: The incidence of COPD is substantial also in young adults. The presence of chronic cough / phlegm identifies a sub-group of subjects with a high risk of developing COPD, independently of smoking habits.
Key words: COPD, chronic cough and phlegm, incidence, epidemiology
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