Thirty-Year Cumulative Incidence of Chronic Bronchitis and COPD in Relation to 30-Year Pulmonary Function and 40-Year Mortality: A Follow-up in Middle-Aged Rural Men

doi:10.1378/chest.130.4.1129

Chest

Volume 130, Issue 4, October 2006, Pages 1129-1137

https://doi.org/10.1378/chest.130.4.1129 Get rights and content

Purpose

To describe the 30-year cumulative incidence of chronic bronchitis and COPD in relation to smoking habits. The effect of chronic bronchitis on pulmonary function and mortality was also examined.

Methods

Middle-aged men belonging to two rural Finnish cohorts of the Seven Countries Study (n = 1,711 in 1959) were followed up for up to 40 years until 2000. Standard questionnaires were used to measure chronic bronchitis, and repeated spirometry was used to evaluate pulmonary function during the 30 years. Forty-year mortality data were examined.

Results

The cumulative incidence of chronic bronchitis and COPD was 42% and 32%, respectively, in continuous smokers, compared to 26% and 14% in ex-smokers and 22% and 12% in never-smokers. During the follow-up, subjects with chronic bronchitis had on average 252 mL (95% confidence interval, 211 to 293 mL) lower forced expiratory volume than those without it. The decrease in forced expiratory volume attributable to chronic bronchitis was most pronounced in those with persistent symptoms and in smokers. In subjects with chronic bronchitis, all-cause mortality was increased by a hazard ratio of 1.30 (95% confidence interval, 1.02 to 1.65). Smokers with chronic bronchitis who decreased their daily cigarette consumption increased their median life span by 2.4 years.

Conclusions

The lifetime risk of chronic bronchitis among smokers is approximately two in five, and almost one half of smokers who have chronic bronchitis also acquire COPD. Chronic bronchitis is related to earlier death, also in never-smokers, probably partly through a rapid decline in pulmonary function.

Section snippets

Subjects

In 1959, all men (n = 1,711) aged 40 to 59 years from two rural areas in Finland were invited to the international Seven Countries Study17, 18 (Fig 1). Re-examinations were performed in 1964, 1969, 1974, 1984, 1989, and 2000.

Definition of Chronic Bronchitis

At the baseline, chronic bronchitis was defined as productive cough for at least 3 months a year.¹⁹ From 1969 to 1989, chronic bronchitis was defined by a positive response to the question, “Do you bring up phlegm on most days for as much as three months each year” (British

Results

By 75 years of age, the cumulative incidence of chronic bronchitis was 42% (95% confidence interval, 38 to 47%) in continuous smokers, compared to 26% (95% confidence interval, 18 to 34%) in ex-smokers and 22% (95% confidence interval, 16 to 28%) in never-smokers (Fig 2). The cumulative incidence of chronic bronchitis leveled off after the age of 65 years. The cumulative incidence of persistent chronic bronchitis was 22% (95% confidence interval, 19 to 26%) in continuous smokers, compared to

Discussion

In our study, > 40% of smokers living in a rural environment acquired chronic bronchitis during their life; in most cases, chronic bronchitis was persistent and half of those subjects with chronic bronchitis also acquired chronic airflow obstruction (COPD). In ex-smokers and never-smokers, chronic bronchitis was mostly nonpersistent, and most of subjects with airflow obstruction did not have chronic bronchitis. Generally, chronic bronchitis was associated with lower pulmonary function and

References (33)

ThurlbeckWM
Pathophysiology of chronic obstructive pulmonary disease
Clin Chest Med
(1990)
SethiJM et al.
Smoking and chronic obstructive pulmonary disease
Clin Chest Med
(2000)
Ebi-KrystonKL
Respiratory symptoms and pulmonary function as predictors of 10-year mortality from respiratory disease, cardiovascular disease, and all causes in the Whitehall Study
J Clin Epidemiol
(1988)
ViegiG et al.
Prevalence of airways obstruction in a general population. European Respiratory vs American Thoracic Society Definition
Chest
(2000)
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease
Am J Respir Crit Care Med
(1995)
FletcherCM et al.
The natural history of chronic airflow obstruction
BMJ
(1977)
KrzyzanowskiM et al.
Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow study: risk of chronic obstructive pulmonary disease
Am Rev Respir Dis
(1986)
KauffmanF et al.
Twelve years spirometric changes among Paris area workers
Int J Epidemiol
(1979)
ShermanCB et al.
Longitudinal lung function decline in subjects with respiratory symptoms
Am Rev Respir Dis
(1992)
VestboJ et al.
Association of chronic mucus hypersecretion with FEV₁decline and chronic obstructive pulmonary disease morbidity: the Copenhagen City Heart Study Group
Am J Respir Crit Care Med
(1996)

GriffithKA et al.

Predictors of loss of lung function in the elderly: the Cardiovascular Health Study

Am J Respir Crit Care Med

(2001)

LangeP et al.

Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes

Thorax

(1990)

Ebi-KrystonKL et al.

Breathlessness, chronic bronchitis and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland and the United States

Int J Epidemiol

(1989)

MayneST et al.

Previous lung disease and risk of lung cancer among men and women nonsmokers

Am J Epidemiol

(1999)

TockmanMS et al.

Respiratory risk factors and mortality: longitudinal studies in Washington County, Maryland

Am Rev Respir Dis

(1989)

PetoR et al.

The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease

Am Rev Respir Dis

(1983)

Cited by (160)

Systems pharmacology-based dissection of potential mechanisms of Exocarpium Citri Grandis for the treatment of chronic bronchitis
2024, Arabian Journal of Chemistry
Exocarpium Citri Grandis (ECG), a precious traditional Chinese medicine (TCM), has been widely utilized to improve the symptoms of chronic bronchitis (CB) such as cough or sputum. However, its underlying pharmacological mechanisms remain unclear. To investigate the potential mechanisms of ECG for the treatment of CB, a comprehensive systems pharmacology strategy combining network pharmacology, molecular docking, molecular dynamics simulations, and molecular biology experiments in vitro was carried out. In this study, 46 potential targets of CB screened for 10 active ingredients of ECG were strongly linked to inflammatory responses, immune processes, and apoptosis. Molecular docking revealed that the active ingredients of ECG have high binding activity for MyD88, NF-κB p65, Caspase9, and Caspase3, respectively. Meanwhile, MD simulations confirmed that neohesperidin and naringenin have high stability and low binding free energy with NF-κB p65 and Caspase3 in the binding pocket. In the LPS-induced RAW264.7 cell inflammatory model, ECG markedly reduced the secretion of IL1β, IL6, TNF-α, and NO. Transcriptomics showed a total of 337 differential expression genes (DEGs) were screened after ECG treatment, of which 233 down-regulated DEGs were closely associated with the NF-κ B signaling pathway, the Toll-like receptor signaling pathway, the IL-17 signaling pathway, and the TNF signaling pathway. Further analysis results revealed that ECG significantly down-regulated the expression of TLR4, MyD88, NF-κB p65, NF-κB p-p65 (S536), p-IκBα (S36), COX2, ICAM1, and iNOS, and up-regulated the expression of IκBα, inhibited NF-κB p65 entry into the nucleus, thereby suppressing NF-κB signaling transduction. Furthermore, ECG also significantly up-regulated the expression of Bcl-2 and down-regulated the expression of Bax, Caspase3, Caspase8, and Caspase9, inhibiting apoptosis in a dose-dependent manner. Our study reveals the potential pharmacological mechanisms of ECG for the treatment of CB and provides a scientific basis for its clinical application.
Explore bioactive ingredients and potential mechanism of Houpo Mahuang decoction for chronic bronchitis based on UHPLC-Q exactive orbitrap HRMS, network pharmacology, and experiment verification
2023, Journal of Ethnopharmacology
Chronic bronchitis (CB) affects a growing number of people and may be linked to lung function impairment. The traditional Chinese medicine formula Houpo Mahuang Decoction (HPMHD) has been used for clinical treatment of respiratory diseases for thousands of years. Until now, its bioactive ingredients, potential targets and molecular mechanism remain unclear.
To investigate the effect of HPMHD on the treatment of CB and explore the bioactive ingredients and possible mechanisms of HPMHD against CB.
UHPLC-Q Exactive Orbitrap HRMS was performed to analyze the chemical components of HPMHD. The mechanism of multiple components, targets and pathways of HPMHD in the treatment of chronic bronchitis were explored by network pharmacology. Additionally, CB mice model induced by lipopolysaccharide (LPS) and smoking was used to evaluate the anti-chronic bronchitis activity of HPMHD in vivo. Pulmonary pathology was determined by hematoxylin and eosin (H&E) measurement. The levels of TNF-α and IL-6 in lung were measured by ELISA. The immunofluorescence experiments were carried out for the expression of IL-1β, TNF-α, IL-6 and NF-κB p-P65/P65 in lung. Western blot assays were performed to quantify and visualize the protein expression of NF-κB p-P65/P65 in mice lung.
Data showed that 79 compounds were identified in HPMHD. The network pharmacology results showed 53 compounds were hinted their effectivity for the treatment of chronic bronchitis with HPMHD, such as ephedrine, schisantherin A, and honokiol. The main targets were predicted as 37 genes, including TNF, TP53, IL6 and so on. HPMHD ameliorated lung damages in mice and inhibited the NF-κB signaling pathway, one of the pathways plotted by KEGG pathway enrichment analysis, by reducing IL-1β, TNF-α and IL-6 expression and significantly downregulating the NF-κB p-P65/P65.
In summary, the complex chemical components of HPHMD was successfully elucidate by UHPLC-Q Exactive Orbitrap HRMS. The study based on network pharmacology and experiment verification indicated that HPMHD can decreased inflammatory response in lung to treat CB. The underlying mechanism may be related to the reduction of inflammation by down-regulated the NF-κB pathways.
Association of Nonobstructive Chronic Bronchitis With All-Cause Mortality: A Systematic Literature Review and Meta-analysis
2022, Chest
The effect of nonobstructive chronic bronchitis (CB) on mortality is unclear.
Is nonobstructive CB associated with increased all-cause mortality?
We conducted a systematic literature review and meta-analysis to assess the association of nonobstructive CB and all-cause mortality. We searched for articles that included both CB and mortality in the title, abstract, or both in PubMed and EMBASE. We excluded studies in which participants demonstrated obstructive spirometry findings and studies in which CB and mortality were not defined. We used the Newcastle-Ottawa Quality Assessment Scale to assess study quality. We pooled adjusted hazard ratios (HRs) using the random effects model and inverse variance weighting. We conducted stratified analysis by the definition of CB and smoking status. We used Cochran’s Q and I² to assess for heterogeneity. We assessed publication bias by visual inspection of a funnel plot.
Of 5,014 titles identified, eight fulfilled the inclusion and exclusion criteria. Overall nonobstructive CB was associated with all-cause mortality (HR, 1.37; 95% CI, 1.26-1.50) with no statistically significant heterogeneity (P = .14; I² = 29%). Nonobstructive CB was associated with increased mortality in studies that defined CB as any respiratory symptoms (broad definition; HR, 1.28; 95% CI, 1.10-1.48; I² = 0%) as well as in the rest of the studies (HR, 1.40; 95% CI, 1.26-1.56; I² = 37%). Nonobstructive CB was associated with increased mortality in ever smokers (HR, 1.49; 95% CI, 1.35-1.64; I² = 0%), but was not associated with increased mortality in never smokers (HR, 1.22; 95% CI, 0.90-1.66), and moderate heterogeneity was found (P = .10; I² = 49%). The funnel plot did not indicate evidence of a publication bias because it showed symmetrical distribution of studies.
Nonobstructive CB is associated with increased all-cause mortality, and this association seems to be present only in current and former smokers. Further research should investigate whether this high-risk population may benefit from early therapeutic intervention.
PROSPERO; No.: CRD42021253596; URL: www.crd.york.ac.uk/prospero
Chronic bronchitis revisited
2024, ERS Monograph
Bronchoscopic interventions for chronic bronchitis
2024, Current Opinion in Pulmonary Medicine
Contribution of smoking change to 45-year trend in prevalence of chronic bronchitis in Finland
2023, Scandinavian Journal of Public Health

View all citing articles on Scopus

Supported by the Finnish Academy, the Finnish Anti-Tuberculosis Association Foundation, the Finnish Lung Health Association, and the National Institute on Aging (United States) [grant EDC-1 1 RO1 AGO8762–01A1].

No author has any conflict of interest.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

View full text

Chest

Original ResearchThirty-Year Cumulative Incidence of Chronic Bronchitis and COPD in Relation to 30-Year Pulmonary Function and 40-Year Mortality: A Follow-up in Middle-Aged Rural Men

Purpose

Methods

Results

Conclusions

Section snippets

Subjects

Definition of Chronic Bronchitis

Results

Discussion

Clin Chest Med

Clin Chest Med

J Clin Epidemiol

Chest

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

The natural history of chronic airflow obstruction

BMJ

Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow study: risk of chronic obstructive pulmonary disease

Am Rev Respir Dis

Twelve years spirometric changes among Paris area workers

Int J Epidemiol

Longitudinal lung function decline in subjects with respiratory symptoms

Am Rev Respir Dis

Association of chronic mucus hypersecretion with FEV1decline and chronic obstructive pulmonary disease morbidity: the Copenhagen City Heart Study Group

Am J Respir Crit Care Med

Predictors of loss of lung function in the elderly: the Cardiovascular Health Study

Am J Respir Crit Care Med

Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes

Thorax

Breathlessness, chronic bronchitis and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland and the United States

Int J Epidemiol

Previous lung disease and risk of lung cancer among men and women nonsmokers

Am J Epidemiol

Respiratory risk factors and mortality: longitudinal studies in Washington County, Maryland

Am Rev Respir Dis

The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease

Am Rev Respir Dis

Original Research
Thirty-Year Cumulative Incidence of Chronic Bronchitis and COPD in Relation to 30-Year Pulmonary Function and 40-Year Mortality: A Follow-up in Middle-Aged Rural Men

Association of chronic mucus hypersecretion with FEV₁decline and chronic obstructive pulmonary disease morbidity: the Copenhagen City Heart Study Group