Prediction of acute respiratory disease in current and former smokers with and without COPD

Russell P. Bowler, Victor Kim, Elizabeth Regan, André A A Williams, Stephanie A. Santorico, Barry J. Make, David A. Lynch, John E. Hokanson, George R. Washko, Peter Bercz, Xavier Soler, Nathaniel Marchetti, Gerard J. Criner, Joe Ramsdell, MeiLan K. Han, Dawn Demeo, Antonio Anzueto, Alejandro Comellas, James D. Crapo, Mark Dransfield & 90 others J. Michael Wells, Craig P. Hersh, Neil MacIntyre, Fernando Martinez, Hrudaya P. Nath, Dennis Niewoehner, Frank Sciurba, Amir Sharafkhaneh, Edwin K. Silverman, Edwin J R Van Beek, Carla Wilson, Christine Wendt, Robert A Wise, Jeffrey Curtis, Ella Kazerooni, Nicola Hanania, Philip Alapat, Venkata Bandi, Kalpalatha Guntupalli, Elizabeth Guy, William Lunn, Antara Mallampalli, Charles Trinh, Mustafa Atik, Francine Jacobson, R. Graham Barr, Byron Thomashow, John Austin, Lacey Washington, H. Page McAdams, Richard Rosiello, Timothy Bresnahan, Charlene McEvoy, Joseph Tashjian, Nadia Hansel, Robert Howard Brown, Richard Casaburi, Janos Porszasz, Hans Fischer, Matt Budoff, Tadashi Allen, Kathryn Rice, Marilyn Foreman, Gloria Westney, Eugene Berkowitz, Adam Friedlander, Eleonora Meoni, Aditi Satti, A. James Mamary, Robert Steiner, Chandra Dass, William Bailey, Lynn Gerald, Paul Ferguson, Paul Friedman, Geoffrey McLennan, Edwin J R Van Beek, Deborah Thompson, Joel Weissfeld, Carl Fuhrman, Jessica Bon, Sandra Adams, Carlos Orozco, C. Santiago Restrepo, Amy Mumbower, Jonathan Samet, Amy Willis, Douglas Stinson, Terri L Beaty, Barbara Klanderman, Nan Laird, Christoph Lange, Iuliana Ionita, Joyce Schroeder, John Newell, John Reilly, Harvey Coxson, Philip Judy, Eric Hoff Man, Raul San Jose Estepar, Rebecca Leek, Jordan Zach, Alex Kluiber, Anastasia Rodionova, Tanya Mann, Robert Crapo, Robert Jensen, Homayoon Farzadegan, James Murphy, Douglas Everett

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown.

METHODS: Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score.

RESULTS: At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV 1 ), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD.

CONCLUSIONS: Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.

Original languageEnglish (US)
Pages (from-to)941-950
Number of pages10
JournalChest
Volume146
Issue number4
DOIs
StatePublished - Oct 1 2014

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Acute Disease
Chronic Obstructive Pulmonary Disease
Hospitalization
Molecular Epidemiology
Respiratory Rate
Proportional Hazards Models
Adrenal Cortex Hormones
Quality of Life
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Bowler, R. P., Kim, V., Regan, E., Williams, A. A. A., Santorico, S. A., Make, B. J., ... Everett, D. (2014). Prediction of acute respiratory disease in current and former smokers with and without COPD. Chest, 146(4), 941-950. https://doi.org/10.1378/chest.13-2946

Prediction of acute respiratory disease in current and former smokers with and without COPD. / Bowler, Russell P.; Kim, Victor; Regan, Elizabeth; Williams, André A A; Santorico, Stephanie A.; Make, Barry J.; Lynch, David A.; Hokanson, John E.; Washko, George R.; Bercz, Peter; Soler, Xavier; Marchetti, Nathaniel; Criner, Gerard J.; Ramsdell, Joe; Han, MeiLan K.; Demeo, Dawn; Anzueto, Antonio; Comellas, Alejandro; Crapo, James D.; Dransfield, Mark; Wells, J. Michael; Hersh, Craig P.; MacIntyre, Neil; Martinez, Fernando; Nath, Hrudaya P.; Niewoehner, Dennis; Sciurba, Frank; Sharafkhaneh, Amir; Silverman, Edwin K.; Van Beek, Edwin J R; Wilson, Carla; Wendt, Christine; Wise, Robert A; Curtis, Jeffrey; Kazerooni, Ella; Hanania, Nicola; Alapat, Philip; Bandi, Venkata; Guntupalli, Kalpalatha; Guy, Elizabeth; Lunn, William; Mallampalli, Antara; Trinh, Charles; Atik, Mustafa; Jacobson, Francine; Barr, R. Graham; Thomashow, Byron; Austin, John; Washington, Lacey; McAdams, H. Page; Rosiello, Richard; Bresnahan, Timothy; McEvoy, Charlene; Tashjian, Joseph; Hansel, Nadia; Brown, Robert Howard; Casaburi, Richard; Porszasz, Janos; Fischer, Hans; Budoff, Matt; Allen, Tadashi; Rice, Kathryn; Foreman, Marilyn; Westney, Gloria; Berkowitz, Eugene; Friedlander, Adam; Meoni, Eleonora; Satti, Aditi; Mamary, A. James; Steiner, Robert; Dass, Chandra; Bailey, William; Gerald, Lynn; Ferguson, Paul; Friedman, Paul; McLennan, Geoffrey; Van Beek, Edwin J R; Thompson, Deborah; Weissfeld, Joel; Fuhrman, Carl; Bon, Jessica; Adams, Sandra; Orozco, Carlos; Restrepo, C. Santiago; Mumbower, Amy; Samet, Jonathan; Willis, Amy; Stinson, Douglas; Beaty, Terri L; Klanderman, Barbara; Laird, Nan; Lange, Christoph; Ionita, Iuliana; Schroeder, Joyce; Newell, John; Reilly, John; Coxson, Harvey; Judy, Philip; Man, Eric Hoff; Estepar, Raul San Jose; Leek, Rebecca; Zach, Jordan; Kluiber, Alex; Rodionova, Anastasia; Mann, Tanya; Crapo, Robert; Jensen, Robert; Farzadegan, Homayoon; Murphy, James; Everett, Douglas.

In: Chest, Vol. 146, No. 4, 01.10.2014, p. 941-950.

Research output: Contribution to journalArticle

Bowler, RP, Kim, V, Regan, E, Williams, AAA, Santorico, SA, Make, BJ, Lynch, DA, Hokanson, JE, Washko, GR, Bercz, P, Soler, X, Marchetti, N, Criner, GJ, Ramsdell, J, Han, MK, Demeo, D, Anzueto, A, Comellas, A, Crapo, JD, Dransfield, M, Wells, JM, Hersh, CP, MacIntyre, N, Martinez, F, Nath, HP, Niewoehner, D, Sciurba, F, Sharafkhaneh, A, Silverman, EK, Van Beek, EJR, Wilson, C, Wendt, C, Wise, RA, Curtis, J, Kazerooni, E, Hanania, N, Alapat, P, Bandi, V, Guntupalli, K, Guy, E, Lunn, W, Mallampalli, A, Trinh, C, Atik, M, Jacobson, F, Barr, RG, Thomashow, B, Austin, J, Washington, L, McAdams, HP, Rosiello, R, Bresnahan, T, McEvoy, C, Tashjian, J, Hansel, N, Brown, RH, Casaburi, R, Porszasz, J, Fischer, H, Budoff, M, Allen, T, Rice, K, Foreman, M, Westney, G, Berkowitz, E, Friedlander, A, Meoni, E, Satti, A, Mamary, AJ, Steiner, R, Dass, C, Bailey, W, Gerald, L, Ferguson, P, Friedman, P, McLennan, G, Van Beek, EJR, Thompson, D, Weissfeld, J, Fuhrman, C, Bon, J, Adams, S, Orozco, C, Restrepo, CS, Mumbower, A, Samet, J, Willis, A, Stinson, D, Beaty, TL, Klanderman, B, Laird, N, Lange, C, Ionita, I, Schroeder, J, Newell, J, Reilly, J, Coxson, H, Judy, P, Man, EH, Estepar, RSJ, Leek, R, Zach, J, Kluiber, A, Rodionova, A, Mann, T, Crapo, R, Jensen, R, Farzadegan, H, Murphy, J & Everett, D 2014, 'Prediction of acute respiratory disease in current and former smokers with and without COPD', Chest, vol. 146, no. 4, pp. 941-950. https://doi.org/10.1378/chest.13-2946
Bowler RP, Kim V, Regan E, Williams AAA, Santorico SA, Make BJ et al. Prediction of acute respiratory disease in current and former smokers with and without COPD. Chest. 2014 Oct 1;146(4):941-950. https://doi.org/10.1378/chest.13-2946
Bowler, Russell P. ; Kim, Victor ; Regan, Elizabeth ; Williams, André A A ; Santorico, Stephanie A. ; Make, Barry J. ; Lynch, David A. ; Hokanson, John E. ; Washko, George R. ; Bercz, Peter ; Soler, Xavier ; Marchetti, Nathaniel ; Criner, Gerard J. ; Ramsdell, Joe ; Han, MeiLan K. ; Demeo, Dawn ; Anzueto, Antonio ; Comellas, Alejandro ; Crapo, James D. ; Dransfield, Mark ; Wells, J. Michael ; Hersh, Craig P. ; MacIntyre, Neil ; Martinez, Fernando ; Nath, Hrudaya P. ; Niewoehner, Dennis ; Sciurba, Frank ; Sharafkhaneh, Amir ; Silverman, Edwin K. ; Van Beek, Edwin J R ; Wilson, Carla ; Wendt, Christine ; Wise, Robert A ; Curtis, Jeffrey ; Kazerooni, Ella ; Hanania, Nicola ; Alapat, Philip ; Bandi, Venkata ; Guntupalli, Kalpalatha ; Guy, Elizabeth ; Lunn, William ; Mallampalli, Antara ; Trinh, Charles ; Atik, Mustafa ; Jacobson, Francine ; Barr, R. Graham ; Thomashow, Byron ; Austin, John ; Washington, Lacey ; McAdams, H. Page ; Rosiello, Richard ; Bresnahan, Timothy ; McEvoy, Charlene ; Tashjian, Joseph ; Hansel, Nadia ; Brown, Robert Howard ; Casaburi, Richard ; Porszasz, Janos ; Fischer, Hans ; Budoff, Matt ; Allen, Tadashi ; Rice, Kathryn ; Foreman, Marilyn ; Westney, Gloria ; Berkowitz, Eugene ; Friedlander, Adam ; Meoni, Eleonora ; Satti, Aditi ; Mamary, A. James ; Steiner, Robert ; Dass, Chandra ; Bailey, William ; Gerald, Lynn ; Ferguson, Paul ; Friedman, Paul ; McLennan, Geoffrey ; Van Beek, Edwin J R ; Thompson, Deborah ; Weissfeld, Joel ; Fuhrman, Carl ; Bon, Jessica ; Adams, Sandra ; Orozco, Carlos ; Restrepo, C. Santiago ; Mumbower, Amy ; Samet, Jonathan ; Willis, Amy ; Stinson, Douglas ; Beaty, Terri L ; Klanderman, Barbara ; Laird, Nan ; Lange, Christoph ; Ionita, Iuliana ; Schroeder, Joyce ; Newell, John ; Reilly, John ; Coxson, Harvey ; Judy, Philip ; Man, Eric Hoff ; Estepar, Raul San Jose ; Leek, Rebecca ; Zach, Jordan ; Kluiber, Alex ; Rodionova, Anastasia ; Mann, Tanya ; Crapo, Robert ; Jensen, Robert ; Farzadegan, Homayoon ; Murphy, James ; Everett, Douglas. / Prediction of acute respiratory disease in current and former smokers with and without COPD. In: Chest. 2014 ; Vol. 146, No. 4. pp. 941-950.
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title = "Prediction of acute respiratory disease in current and former smokers with and without COPD",
abstract = "BACKGROUND: The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown.METHODS: Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score.RESULTS: At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95{\%} CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95{\%} CI, 0.91-0.96 per 10{\%} change in {\%} predicted FEV 1 ), and poor health-related quality of life (HR, 1.07; 95{\%} CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD.CONCLUSIONS: Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.",
author = "Bowler, {Russell P.} and Victor Kim and Elizabeth Regan and Williams, {Andr{\'e} A A} and Santorico, {Stephanie A.} and Make, {Barry J.} and Lynch, {David A.} and Hokanson, {John E.} and Washko, {George R.} and Peter Bercz and Xavier Soler and Nathaniel Marchetti and Criner, {Gerard J.} and Joe Ramsdell and Han, {MeiLan K.} and Dawn Demeo and Antonio Anzueto and Alejandro Comellas and Crapo, {James D.} and Mark Dransfield and Wells, {J. Michael} and Hersh, {Craig P.} and Neil MacIntyre and Fernando Martinez and Nath, {Hrudaya P.} and Dennis Niewoehner and Frank Sciurba and Amir Sharafkhaneh and Silverman, {Edwin K.} and {Van Beek}, {Edwin J R} and Carla Wilson and Christine Wendt and Wise, {Robert A} and Jeffrey Curtis and Ella Kazerooni and Nicola Hanania and Philip Alapat and Venkata Bandi and Kalpalatha Guntupalli and Elizabeth Guy and William Lunn and Antara Mallampalli and Charles Trinh and Mustafa Atik and Francine Jacobson and Barr, {R. Graham} and Byron Thomashow and John Austin and Lacey Washington and McAdams, {H. Page} and Richard Rosiello and Timothy Bresnahan and Charlene McEvoy and Joseph Tashjian and Nadia Hansel and Brown, {Robert Howard} and Richard Casaburi and Janos Porszasz and Hans Fischer and Matt Budoff and Tadashi Allen and Kathryn Rice and Marilyn Foreman and Gloria Westney and Eugene Berkowitz and Adam Friedlander and Eleonora Meoni and Aditi Satti and Mamary, {A. James} and Robert Steiner and Chandra Dass and William Bailey and Lynn Gerald and Paul Ferguson and Paul Friedman and Geoffrey McLennan and {Van Beek}, {Edwin J R} and Deborah Thompson and Joel Weissfeld and Carl Fuhrman and Jessica Bon and Sandra Adams and Carlos Orozco and Restrepo, {C. Santiago} and Amy Mumbower and Jonathan Samet and Amy Willis and Douglas Stinson and Beaty, {Terri L} and Barbara Klanderman and Nan Laird and Christoph Lange and Iuliana Ionita and Joyce Schroeder and John Newell and John Reilly and Harvey Coxson and Philip Judy and Man, {Eric Hoff} and Estepar, {Raul San Jose} and Rebecca Leek and Jordan Zach and Alex Kluiber and Anastasia Rodionova and Tanya Mann and Robert Crapo and Robert Jensen and Homayoon Farzadegan and James Murphy and Douglas Everett",
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month = "10",
day = "1",
doi = "10.1378/chest.13-2946",
language = "English (US)",
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pages = "941--950",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
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TY - JOUR

T1 - Prediction of acute respiratory disease in current and former smokers with and without COPD

AU - Bowler, Russell P.

AU - Kim, Victor

AU - Regan, Elizabeth

AU - Williams, André A A

AU - Santorico, Stephanie A.

AU - Make, Barry J.

AU - Lynch, David A.

AU - Hokanson, John E.

AU - Washko, George R.

AU - Bercz, Peter

AU - Soler, Xavier

AU - Marchetti, Nathaniel

AU - Criner, Gerard J.

AU - Ramsdell, Joe

AU - Han, MeiLan K.

AU - Demeo, Dawn

AU - Anzueto, Antonio

AU - Comellas, Alejandro

AU - Crapo, James D.

AU - Dransfield, Mark

AU - Wells, J. Michael

AU - Hersh, Craig P.

AU - MacIntyre, Neil

AU - Martinez, Fernando

AU - Nath, Hrudaya P.

AU - Niewoehner, Dennis

AU - Sciurba, Frank

AU - Sharafkhaneh, Amir

AU - Silverman, Edwin K.

AU - Van Beek, Edwin J R

AU - Wilson, Carla

AU - Wendt, Christine

AU - Wise, Robert A

AU - Curtis, Jeffrey

AU - Kazerooni, Ella

AU - Hanania, Nicola

AU - Alapat, Philip

AU - Bandi, Venkata

AU - Guntupalli, Kalpalatha

AU - Guy, Elizabeth

AU - Lunn, William

AU - Mallampalli, Antara

AU - Trinh, Charles

AU - Atik, Mustafa

AU - Jacobson, Francine

AU - Barr, R. Graham

AU - Thomashow, Byron

AU - Austin, John

AU - Washington, Lacey

AU - McAdams, H. Page

AU - Rosiello, Richard

AU - Bresnahan, Timothy

AU - McEvoy, Charlene

AU - Tashjian, Joseph

AU - Hansel, Nadia

AU - Brown, Robert Howard

AU - Casaburi, Richard

AU - Porszasz, Janos

AU - Fischer, Hans

AU - Budoff, Matt

AU - Allen, Tadashi

AU - Rice, Kathryn

AU - Foreman, Marilyn

AU - Westney, Gloria

AU - Berkowitz, Eugene

AU - Friedlander, Adam

AU - Meoni, Eleonora

AU - Satti, Aditi

AU - Mamary, A. James

AU - Steiner, Robert

AU - Dass, Chandra

AU - Bailey, William

AU - Gerald, Lynn

AU - Ferguson, Paul

AU - Friedman, Paul

AU - McLennan, Geoffrey

AU - Van Beek, Edwin J R

AU - Thompson, Deborah

AU - Weissfeld, Joel

AU - Fuhrman, Carl

AU - Bon, Jessica

AU - Adams, Sandra

AU - Orozco, Carlos

AU - Restrepo, C. Santiago

AU - Mumbower, Amy

AU - Samet, Jonathan

AU - Willis, Amy

AU - Stinson, Douglas

AU - Beaty, Terri L

AU - Klanderman, Barbara

AU - Laird, Nan

AU - Lange, Christoph

AU - Ionita, Iuliana

AU - Schroeder, Joyce

AU - Newell, John

AU - Reilly, John

AU - Coxson, Harvey

AU - Judy, Philip

AU - Man, Eric Hoff

AU - Estepar, Raul San Jose

AU - Leek, Rebecca

AU - Zach, Jordan

AU - Kluiber, Alex

AU - Rodionova, Anastasia

AU - Mann, Tanya

AU - Crapo, Robert

AU - Jensen, Robert

AU - Farzadegan, Homayoon

AU - Murphy, James

AU - Everett, Douglas

PY - 2014/10/1

Y1 - 2014/10/1

N2 - BACKGROUND: The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown.METHODS: Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score.RESULTS: At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV 1 ), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD.CONCLUSIONS: Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.

AB - BACKGROUND: The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown.METHODS: Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score.RESULTS: At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV 1 ), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD.CONCLUSIONS: Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.

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U2 - 10.1378/chest.13-2946

DO - 10.1378/chest.13-2946

M3 - Article

VL - 146

SP - 941

EP - 950

JO - Chest

JF - Chest

SN - 0012-3692

IS - 4

ER -