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Atopy is a risk factor for respiratory symptoms in COPD patients: results from the EUROSCOP study

Fatemeh Fattahi123, Nick H T ten Hacken13*, Claes-Göran Löfdahl4, Machteld N Hylkema23, Wim Timens23, Dirkje S Postma13 and Judith M Vonk35

Author Affiliations

1 Department of Pulmonology, University of Groningen, University Medical Center Groningen, PO Box 196 9700 AD, Groningen, The Netherlands

2 Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

3 Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

4 Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden

5 Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

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Respiratory Research 2013, 14:10  doi:10.1186/1465-9921-14-10

Published: 28 January 2013

Abstract

Background

The pathogenesis of COPD is complex and remains poorly understood. The European Respiratory Society Study on Chronic Obstructive Pulmonary Disease (EUROSCOP) investigated long-term effects of budesonide; 18% of the COPD participants were atopic. So far effects of atopy on the long-term course of COPD have not been elucidated.

Methods

Factors related to the presence of atopy (positive phadiatop) in 1277 mild-to-moderate COPD patients participating in EUROSCOP were analysed using regression analysis. Incidence and remission of respiratory symptoms during 3-year follow-up were analysed using generalised estimating equations models, and association of atopy with lung function decline using linear mixed effects models.

Results

Independent predisposing factors associated with the presence of atopy were: male gender (OR: 2.21; 95% CI: 1.47–3.34), overweight/obese (OR: 1.41; 95% CI: 1.04–1.92) and lower age (OR: 0.98; 95% CI: 0.96–0.99). Atopy was associated with a higher prevalence of cough (OR: 1.71; 95% CI: 1.26–2.34) and phlegm (OR: 1.50; 95% CI: 1.10–2.03), but not with lung function levels or FEV1 decline. Atopic COPD patients not treated with budesonide had an increased incidence of cough over time (OR: 1.79, 95% CI: 1.03–3.08, p = 0.038), while those treated with budesonide had increased remission of cough (OR: 1.93, 95% CI: 1.11–3.37, p = 0.02) compared to non-atopic COPD patients.

Conclusions

Atopic COPD patients are more likely male, have overweight/obesity and are younger as compared with non-atopic COPD patients. Atopy in COPD is associated with an increased incidence and prevalence of respiratory symptoms. If atopic COPD patients are treated with budesonide, they more often show remission of symptoms compared to non-atopic COPD patients who are treated with budesonide. We recommend including atopy in the diagnostic work-up and management of COPD.

Keywords:
Allergy; Chronic obstructive pulmonary disease; Corticosteroid; Gender; Lung function; Respiratory symptoms