Bronchial hyperresponsiveness and the development of asthma and COPD in asysmptomatic individuals - SAPALDIA cohort study

Martin H Brutsche ^1*, Sara H Downs ², Christian Schindler ², Margaret W Gerbase ³, Joel Schwartz ⁴, Martin Frey ⁵, Erich W Russi ⁶, Ursula Ackermann-Liebrich ², Philippe Leuenberger ⁷ and SAPALDIA Team ⁸

¹ Pneumology, University Hospital of Basel, Switzerland
² Institute for Social and Preventive Medicine, University of Basel, Switzerland
³ Pneumology, Hôpital Cantonal Universitaire, Geneva, Switzerland
⁴ Harvard School of Public Health, Boston, United States
⁵ Klinik Barmelweid, Switzerland
⁶ Pneumology, University Hospital Zürich, Switzerland
⁷ Pneumology, Centre Hôpitalier Universitaire Vaudois, Lausanne, Switzerland
⁸ *, Switzerland

^* To whom correspondence should be addressed. E-mail: mbrutsche{at}uhbs.ch.

Accepted 18 April 2006

Abstract

Background: Bronchial hyperresponsiveness (BHR) is a common feature of asthma. However, BHR is also present in asymptomatic individuals and its clinical and prognostic significance is unclear. We hypothesized that BHR might play a role in the development of COPD as well as asthma.

Methods: In 1991, respiratory symptoms and BHR to methacholine were evaluated in 7,126 of the 9,651 SAPALDIA cohort study participants. Eleven years later, 5,825 of these participants were re-evaluated of whom 4,852 had spirometry. COPD was defined as FEV1/FVC <0.70.

Results: In 1991, 17% of participants had BHR, of whom 51% were asymptomatic. Eleven years later the prevalence of asthma, wheeze and shortness of breath in formerly asymptomatic subjects with or without BHR were respectively 5.7% vs. 2.0%, 8.3% vs. 3.4% and 19.1% vs. 11.9% (all p<0.001). Similar differences were observed for chronic cough (5.9% vs. 2.3%; p=0.002), and COPD (37.9% vs. 14.3%; p<0.001). BHR conferred an adjusted OR of 2.9 (95%Cl 1.8-4.5) for wheezing at follow-up among asymptomatic participants. The adjusted ORs for COPD was 4.5 (95%Cl 3.3- 6.0). Silent BHR was associated with a significantly accelerated decline in FEV1 by 12 (5-18) mL/y, 11 (5-16) mL/y and 4 (2-8) mL/y in current smokers, former smokers and never smokers at SAPALDIA 2, respectively.

Conclusions: BHR is a risk factor for an accelerated decline in FEV1 and the development of asthma and COPD irrespective of atopic status. Current smokers with BHR have a particularly high loss of FEV1.

Keywords: airflow obstruction, bronchial challenge, chronic cough, epidemiologic study, methacholine

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