Characteristics and Prognosis of Never-Smokers and Smokers with Asthma in the Copenhagen General Population Study A Prospective Cohort Study
Characteristics and Prognosis of Never-Smokers and Smokers with Asthma in the Copenhagen General Population Study A Prospective Cohort Study
复制标题
DOI：
10.1164/rccm.201502-0302oc
复制
发表时间：
2015-07-15
影响因子：
24.7
通讯作者：
Lange, Peter
中科院分区：
文献类型：
--
作者：
Colak, Yunus;Afzal, Shoaib;Lange, Peter
理论基础：哮喘与并发症、心血管并发症和某些个体更高的死亡率有关。目的：检验一个假设，即在哮喘患者中，从不吸烟的人有不同的特征和比吸烟者更好的预后。方法：我们从哥本哈根普通人群研究中招募了94079名年龄在20-100岁之间的人，这是一项前瞻性的队列研究。在这些人中，5691人(6%)有自我报告的哮喘(2304人从不吸烟者，2467人以前吸烟者，920人现在吸烟者)。我们检查了呼吸道症状、肺功能以及体循环中炎症和过敏性生物标志物的水平。此外，我们前瞻性地评估了4.5年随访期间哮喘或慢性阻塞性肺疾病(COPD)恶化、肺炎、肺癌、缺血性心脏病、缺血性中风和全因死亡率的风险。测量和主要结果：与从不吸烟的非哮喘患者相比，哮喘患者有更多的呼吸道症状和气流受限，炎症和过敏生物标志物水平更高，这些在吸烟者中最为明显。在哮喘患者中，与从不吸烟的非哮喘患者相比，非吸烟者哮喘加重的多变量调整风险比为11(95%可信区间：5.8-22)，既往吸烟者为13(6.2-29)，现在吸烟者为18(8.2-39)。其他终点的相应数值分别为8.9(2.1-38)、23(8.8-58)和36(12-105)；肺炎为1.5(0.9-2.2)、1.6(1.0-2.4)和2.4(1.6-3.7)；肺癌为0.6(0.1-5.1)、4.0(1.3-12)和13(4.3-41)；缺血性心脏病1.2(0.9-1.6)、1.5(1.2-2.0)、2.0(1.4-2.9)；缺血性中风1.4(0.9-2.1)、1.2(0.8-1.9)、3.0(1.7-5.3)；全因死亡率分别为0.9(0.6~1.3)、1.5(1.1~2.0)和2.7(1.9~3.7)。重要的是，肺癌、心血管并发症和死亡的风险仅限于患有哮喘的吸烟者。因此，吸烟是哮喘患者预后不良的主要原因。
Rationale: Asthma is associated with complications, cardiovascular comorbidities, and higher mortality in some individuals.Objectives: To test the hypothesis that, among individuals with asthma, never-smokers have different characteristics and a better prognosis than smokers.Methods: We recruited 94,079 individuals aged 20-100 years from the Copenhagen General Population Study, a prospective cohort study. Among these individuals, 5,691 (6%) had self-reported asthma (2,304 never-smokers, 2,467 former smokers, and 920 current smokers). We examined respiratory symptoms, lung function, and levels of inflammatory and allergic biomarkers in systemic circulation. Furthermore, we assessed prospectively the risk of asthma or chronic obstructive pulmonary disease (COPD) exacerbations, pneumonias, lung cancer, ischemic heart disease, ischemic stroke, and all-cause mortality during 4.5 years of follow-up.Measurements and Main Results: Compared with never-smokers without asthma, individuals with asthma had more respiratory symptoms and airflow limitation and higher levels of inflammatory and allergic biomarkers, which were most pronounced in smokers. Among individuals with asthma compared with never-smokers without asthma, multivariable adjusted hazard ratios for asthma exacerbations were 11 (95% confidence interval: 5.8-22) in never-smokers, 13 (6.2-29) in former smokers, and 18 (8.2-39) in current smokers. The corresponding values for other endpoints were, respectively, 8.9 (2.1-38), 23 (8.8-58), and 36 (12-105) for COPD exacerbations; 1.5 (0.9-2.2), 1.6 (1.0-2.4), and 2.4 (1.6-3.7) for pneumonias; 0.6 (0.1-5.1), 4.0 (1.3-12), and 13 (4.3-41) for lung cancer; 1.2 (0.9-1.6), 1.5 (1.2-2.0), and 2.0 (1.4-2.9) for ischemic heart disease; 1.4 (0.9-2.1), 1.2 (0.8-1.9), and 3.0 (1.7-5.3) for ischemic stroke; and 0.9 (0.6-1.3), 1.5 (1.1-2.0), and 2.7 (1.9-3.7) for all-cause mortality.Conclusions: Never-smokers with asthma had an increased risk of asthma and COPD exacerbations, and possibly pneumonias. Importantly, the risks for lung cancer, cardiovascular comorbidities, and death were restricted to smokers with asthma. Thus, tobacco smoking was the main explanation for poor prognosis in asthma.