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The early origins of COPD in severe asthma: the one thing that leads to another or the two things that come together?
  1. Joerg Mattes1,2,
  2. Peter G Gibson2
  1. 1 Experimental & Translational Respiratory Medicine, University of Newcastle, Newcastle, New South Wales, Australia
  2. 2 Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Professor Joerg Mattes, HMRI, Newcastle Children's Hospital, Locked Bag 1, Newcastle, NSW 2305, Australia; joerg.mattes{at}newcastle.edu.au

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Chronic obstructive pulmonary disease (COPD) is diagnosed during middle to late adult life, when significant airflow limitation has already developed by the time the disease is recognised. What if the origins of COPD occurred much earlier? If this were true, it would have major implications for detection (screening) and prevention of COPD. Convincing evidence is hard to obtain, because it requires exceptionally long follow-up, such as half a life span, a period that is often longer than the average career of a researcher! Williams and McNichol established such a longitudinal asthma study from a 1957 birth cohort, and now Tai et al 1 evaluate for an association between childhood asthma and adult COPD. They followed-up a cohort of 6–7-year-old children over more than four decades, of whom 197 survivors completed lung function testing and questionnaires at age 50 years. The most important result reported by the authors was that children with more severe asthma were at increased risk (OR 32; 95% CI, 3 to 269) of developing adult COPD. Specifically, of those who had more severe asthma in childhood, 44% (15/34) were diagnosed with adult COPD and 41% (14/34) with adult asthma, while 15% (5/34) showed asthma remission at age 50 years. By contrast, adult COPD affected only 8% (13/163) of those who had intermittent or no childhood asthma. Thus, adults who suffered from more severe asthma in childhood have more commonly COPD.

Several other results reported here are of interest. First, previous or current tobacco …

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