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Thorax 61:671-677 doi:10.1136/thx.2005.052241
  • Epidemiology

Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA Cohort Study

  1. M H Brutsche1,
  2. S H Downs2,
  3. C Schindler2,
  4. M W Gerbase3,
  5. J Schwartz4,
  6. M Frey5,
  7. E W Russi6,
  8. U Ackermann-Liebrich3,
  9. P Leuenberger7,
  10. for the SAPALDIA Team
  1. 1Pneumology, University Hospital Basel, Basel, Switzerland
  2. 2Institute for Social and Preventive Medicine, University of Basel, Switzerland
  3. 3Pneumology, Hôpital Cantonal Universitaire, Geneva, Switzerland
  4. 4Harvard School of Public Health, Boston, USA
  5. 5Klinik Barmelweid, Barmelweid, Switzerland
  6. 6Pneumology, University Hospital Zurich, Zurich, Switzerland
  7. 7Pneumology, Centre Hôpitalier Universitaire Vaudois, Lausanne, Switzerland
  1. Correspondence to:
    Dr M H Brutsche
    Pneumologie, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; mbrutsche{at}uhbs.ch
  • Received 4 October 2005
  • Accepted 18 April 2006
  • Published Online First 2 May 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 hypothesised that BHR might play a role in the development of chronic obstructive pulmonary disease (COPD) as well as asthma.

Methods: In 1991 respiratory symptoms and BHR to methacholine were evaluated in 7126 of the 9651 participants in the SAPALDIA cohort study. Eleven years later 5825 of these participants were re-evaluated, of whom 4852 performed spirometric tests. COPD was defined as an FEV1/FVC ratio of <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 was, respectively, 5.7% v 2.0%, 8.3% v 3.4%, and 19.1% v 11.9% (all p<0.001). Similar differences were observed for chronic cough (5.9% v 2.3%; p = 0.002) and COPD (37.9% v 14.3%; p<0.001). BHR conferred an adjusted odds ratio (OR) of 2.9 (95% CI 1.8 to 4.5) for wheezing at follow up among asymptomatic participants. The adjusted OR for COPD was 4.5 (95% CI 3.3 to 6.0). Silent BHR was associated with a significantly accelerated decline in FEV1 by 12 (5–18), 11 (5–16), and 4 (2–8) ml/year in current smokers, former smokers and never smokers, respectively, at SAPALDIA 2.

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.

Footnotes

  • Published Online First 2 May 2006

  • The following are members of the SAPALDIA Team. The letters in parentheses indicate their specialties, defined below.Senior scientific team: Ph Leuenberger and U Ackermann-Liebrich (e), Co-directors; J C Barthélémy (c), W Berger (g), R. Bettschart (p), A Bircher (a), K Blaser (a), G Bolognini (p), O Brändli (p), M Brutsche (p), L Burdet (p), S Downs (e/s), M Frey (p), J M Gaspoz (c), M W Gerbase (p), D Gold (e/c/p), W Karrer (p), R Keller (p), B Knöpfli (p), N Künzli (e/exp), A Morabia (e), U Neu (exp), L Nicod (p), A P Perruchoud (p), M Pons (p), N Probst Hensch (g/e), Th Rochat (p), E W Russi (p), C Schindler (s), P Schmid-Grendelmeyer (a), J Schwartz (e), F Schwarz (p), P Straehl (exp), J M Tschopp (p), A von Eckardstein, J P Zellweger (p), E Zemp Stutz (e).Scientific team at coordinating centers: L Bayer-Oglesby (exp), D Felber Dietrich (c), M Imboden (g), D Keidel (s), P Städele-Kessler (s), M W Gerbase (p), S Downs (e).Scientific team at local study sites: C Burrus, D Felber Dietrich, U Egermann, M Gerbase, R Gimmi, A Kick, N Lutz, R Keller.Specialities: (a) allergology, (c) cardiology, (cc) clinical chemistry, (e) epidemiology, (exp) exposure, (g) genetic and molecular biology, (m) meteorology, (p) pneumology, (s) statistics.

  • The SAPALDIA study was supported by the National Science Foundation of Switzerland (grant no 32-65896.01, NF 32-59302.99, 3247B0-102081), the Federal Office for Forest, Environment and Landscape, the Federal Office of Public Health, the Federal Office of Roads and Transport, the Cantons Basel-Stadt, Basel-Land, Geneva, Zurich, Ticino, Aargau, Luzern, the Swiss Lung League and the Lung League of Ticino, Zurich and Basel Stadt/Basel Landschaft. SAPALDIA Basel is part of the European Respiratory Health Survey.

  • Competing interests: none declared.