ATS 2023 Abstracts Highlight Risk Factors for COPD Outside of Smoking

Pulmonary conditions such as chronic obstructive pulmonary disease (COPD) and lung cancer share a common risk factor in tobacco smoking, but a variety of known and potentially impactful factors may also come into play, as shown by research presented at the 2023 American Thoracic Society International Conference.

A range of posters presented at the conference, which took place in Washington, DC, highlighted a plethora of risk factors for pulmonary conditions outside of smoking history. A pair of posters explored asthma status and COPD exacerbations in adults.

There is limited research on pulmonary disease status in elderly adults who have a history of asthma in childhood, according to one poster presented at the session.¹

In a 60-year follow-up study of children with a history of severe childhood asthma, researchers assessed disease characteristics via questionnaires and measurements of blood samples, spirometry, fractional exhaled nitric oxide, bronchodilator reversibility, bronchial provocation with mannitol, and static lung volumes.

In a cohort of 1401 individuals in Denmark with severe childhood asthma, 169 had been examined at the time of the analysis. About half were never-smokers, and only 7.1% reported 1 exacerbation in the past 12 months. In the assessed cohort, 147 (86.9%) still had asthma, and 24 of these had concomitant COPD. Compared with patients who had asthma remission in adulthood, those with asthma had worse lung measurements.

Overall, the study found that 1 in 10 patients in the cohort had asthma remission, and 1 in every 3 had persistent airflow limitations. This suggests that severe childhood asthma is a risk factor for severe, possibly debilitating lung disease in elderly adults.

Another poster explored hospitalization outcomes in a cohort of patients with asthma-COPD overlap (ACO) syndrome compared with individuals with only asthma or COPD.²

“Recently, ACO, a phenotype with clinical features of both diseases, has been associated with increased exacerbation frequency and healthcare utilization in comparison to either disease alone,” the authors wrote. But hospital-based outcomes have not been described in research to the authors’ knowledge.

The researchers compared outcomes of index admissions and 30-day readmissions among 2,522,013 patients with asthma (n = 668,867), COPD (n = 1,732,946), or ACO (n = 120,200), as well as baseline patient characteristics and demographic data.

ACO was associated with higher rates of comorbidities at baseline, although patients with ACO were younger on average than those with COPD alone (63 years vs 69 years). Despite being younger, patients with ACO had higher rates of respiratory failure, increased hospital length of stay, and higher costs during index admissions, but not a significantly higher risk of readmissions.

Overall, ACO was associated with longer hospital stays and higher care costs vs asthma or COPD alone, but not increased mortality or readmission risk. The findings show a differential burden of ACO vs asthma or COPD alone.

References

1. Savran O, Bonnelykke K, Ulrik CS. Characteristics of adults with a history of severe childhood asthma - a cohort study with a 60-year follow-up. Abstract presented at: American Thoracic Society International Conference; May 20-24, 2023; Washington, DC. Accessed May 24, 2023.

https://cattendee.abstractsonline.com/meeting/10703/Presentation/7735

2. Sleiman J, Attaway A, Zein J, Rowlands W. Analysis of hospitalization outcomes in patients with asthma-COPD overlap syndrome. Abstract presented at: American Thoracic Society International Conference; May 20-24, 2023; Washington, DC. Accessed May 24, 2023. https://cattendee.abstractsonline.com/meeting/10703/Presentation/7737