Incidence trends of airflow obstruction among European adults without asthma: a 20-year cohort study

Accordini, Simone; Calciano, Lucia; Marcon, Alessandro; Pesce, Giancarlo; Antó i Boqué, Josep Maria; Beckmeyer-Borowko, Anna B.; Carsin, Anne-Elie; Corsico, Angelo G.; Imboden, Medea; Janson, Christer; Keidel, Dirk; Locatelli, Francesca; Svanes, Cecilie; Burney, Peter; Jarvis, Deborah; Probst-Hensch, Nicole; Minelli, Cosetta

doi:http://dx.doi.org/10.1038/s41598-020-60478-5

Incidence trends of airflow obstruction among European adults without asthma: a 20-year cohort study

Citation

Accordini S, Calciano L, Marcon A, Pesce G, Antó JM, Beckmeyer-Borowko AB, Carsin AE, Corsico AG, Imboden M, Janson C, Keidel D, Locatelli F, Svanes C, Burney PGJ, Jarvis D, Probst-Hensch NM, Minelli C. Incidence trends of airflow obstruction among European adults without asthma: a 20-year cohort study. Sci Rep. 2020; 10(1):3452. DOI: 10.1038/s41598-020-60478-5

Abstract

Investigating COPD trends may help healthcare providers to forecast future disease burden. We estimated sex- and smoking-specific incidence trends of pre-bronchodilator airflow obstruction (AO) among adults without asthma from 11 European countries within a 20-year follow-up (ECRHS and SAPALDIA cohorts). We also quantified the extent of misclassification in the definition based on pre-bronchodilator spirometry (using post-bronchodilator measurements from a subsample of subjects) and we used this information to estimate the incidence of post-bronchodilator AO (AOpost-BD), which is the primary characteristic of COPD. AO incidence was 4.4 (95% CI: 3.5-5.3) male and 3.8 (3.1-4.6) female cases/1,000/year. Among ever smokers (median pack-years: 20, males; 12, females), AO incidence significantly increased with ageing in men only [incidence rate ratio (IRR), 1-year increase: 1.05 (1.03-1.07)]. A strong exposure-response relationship with smoking was found both in males [IRR, 1-pack-year increase: 1.03 (1.02-1.04)] and females [1.03 (1.02-1.05)]. The positive predictive value of AO for AOpost-BD was 59.1% (52.0-66.2%) in men and 42.6% (35.1-50.1%) in women. AOpost-BD incidence was 2.6 (1.7-3.4) male and 1.6 (1.0-2.2) female cases/1,000/year. AO incidence was considerable in Europe and the sex-specific ageing-related increase among ever smokers was strongly related to cumulative tobacco exposure. AOpost-BD incidence is expected to be half of AO incidence.