• Russell P Bowler, Victor Kim, Elizabeth Regan, WilliamsAndré A AAAADepartment of Medicine, National Jewish Health, Denver, CO., 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, J Michael Wells, Craig P Hersh, Neil MacIntyre, Fernando Martinez, Hrudaya P Nath, Dennis Niewoehner, Frank Sciurba, Amir Sharafkhaneh, Edwin K Silverman, van BeekEdwin J REJRClinical Research Imaging Centre, University of Edinburgh, Edinburgh, Scotland., Carla Wilson, Christine Wendt, and Robert A Wise.
• Department of Medicine, National Jewish Health, Denver, CO. Electronic address: Bowlerr@njhealth.org.
• Chest. 2014 Oct 1; 146 (4): 941950941-950.

BackgroundThe risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown.MethodsEight 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.ResultsAt 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 FEV1), 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.ConclusionsAlthough 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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