Effects of allergic phenotype on respiratory symptoms and exacerbations in patients with chronic obstructive pulmonary disease

Daniel B. Jamieson, Elizabeth C. Matsui, Andrew Belli, Meredith C. McCormack, Eric Peng, Simon Pierre-Louis, Jean Curtin-Brosnan, Patrick N. Breysse, Gregory B. Diette, Nadia N. Hansel

Research output: Contribution to journalArticle

Abstract

Rationale: Chronic obstructive pulmonary disease (COPD) guidelines make no recommendations for allergy diagnosis or treatment. Objectives: To determine whether an allergic phenotype contributes to respiratory symptoms and exacerbations in patients with COPD. Methods: Two separate cohorts were analyzed: National Health and Nutrition Survey III (NHANES III) and the COPD and domestic endotoxin (CODE) cohort. Subjects from NHANES III with COPD (n = 1,381) defined as age > 40 years, history of smoking, FEV1/FVC < 0.70, and no diagnosis of asthma were identified. The presence of an allergic phenotype (n = 296) was defined as self-reported doctor diagnosed hay fever or allergic upper respiratory symptoms. In CODE, former smokers with COPD (n = 77) were evaluated for allergic sensitization defined as a detectable specific IgE to perennial allergens. Bivariate and multivariate models were used to determine whether an allergic phenotype was associated with respiratory symptoms and exacerbations. Measurements and Main Results: In NHANES III, multivariate analysis revealed that individuals with allergic phenotype were more likely to wheeze (odds ratio [OR], 2.1; P < 0.01), to have chronic cough (OR, 1.9; P = 0.01) and chronic phlegm (OR, 1.5; P <0.05), and to have increased risk of COPD exacerbation requiring an acute doctor visit (OR, 1.7; P = 0.04). In the CODE cohort, multivariate analysis revealed that sensitized subjects reported more wheeze (OR, 5.91; P < 0.01), more nighttime awakening due to cough (OR, 4.20; P = 0.03), increased risk of COPD exacerbations requiring treatment with antibiotics (OR, 3.79; P = 0.02), and acute health visits (OR, 11.05; P < 0.01). An increasing number of sensitizations was associated with a higher risk for adverse health outcomes. Conclusions: Among individuals with COPD, evidence of an allergic phenotype is associated with increased respiratory symptoms and risk of COPD exacerbations.

Original languageEnglish (US)
Pages (from-to)187-192
Number of pages6
JournalAmerican journal of respiratory and critical care medicine
Volume188
Issue number2
DOIs
StatePublished - Jul 15 2013

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Keywords

  • Allergic sensitization
  • Allergy
  • Atopy
  • Chronic obstructive pulmonary disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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