Nirupama Putcha1, Ashraf Fawzy2, Elizabeth C Matsui3, Mark C Liu2, Russ P Bowler4, Prescott G Woodruff5, Wanda K O'Neal6, Alejandro P Comellas7, MeiLan K Han8, Mark T Dransfield9, J Michael Wells9, Njira Lugogo8, Li Gao10, C Conover Talbot11, Eric A Hoffman7, Christopher B Cooper12, Laura M Paulin13, Richard E Kanner14, Gerard Criner15, Victor E Ortega16, R Graham Barr17, Jerry A Krishnan18, Fernando J Martinez19, M Bradley Drummond20, Robert A Wise2, Gregory B Diette2, Craig P Hersh21, Nadia N Hansel2. 1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: Nputcha1@jhmi.edu. 2. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Departments of Population Health and Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX. 4. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO. 5. Division of Pulmonary, Critical Care and Sleep, University of California San Francisco, San Francisco, CA. 6. University of North Carolina Marsico Lung Institute, Chapel Hill, NC. 7. Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA. 8. Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, Ann Arbor, MI. 9. Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, University of Alabama Birmingham Lung Health Center, and Birmingham Veterans' Affairs Medical Center. 10. Division of Allergy and Clinical Immunology, Johns Hopkins University, Baltimore, MD. 11. The Johns Hopkins School of Medicine Institute for Basic Biomedical Sciences, Baltimore, MD. 12. Division of Pulmonary and Critical Care, University of California Los Angeles, Los Angeles, CA. 13. Section of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, NH. 14. Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT. 15. Department of Pulmonary, Temple University Philadelphia, PA. 16. Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC. 17. Division of General Internal Medicine, Columbia University Medical Center, New York, NY. 18. Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL. 19. Cornell University School of Medicine, New York, NY. 20. Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. 21. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA.
Abstract
BACKGROUND: Little is known about the concordance of atopy with asthma COPD overlap. Among individuals with COPD, a better understanding of the phenotypes characterized by asthma overlap and atopy is needed to better target therapies. RESEARCH QUESTION: What is the overlap between atopy and asthma status among individuals with COPD, and how are categories defined by the presence of atopy and asthma status associated with clinical and radiologic phenotypes and outcomes in the Genetic Epidemiology of COPD Study (COPDGene) and Subpopulation and Intermediate Outcome Measures in COPD Study (SPIROMICS)? STUDY DESIGN AND METHODS: Four hundred three individuals with COPD from SPIROMICS and 696 individuals from COPDGene with data about specific IgEs to 10 common allergens and mixes (simultaneous assessment of combination of allergens in similar category) were included. Comparison groups were defined by atopic and asthma status (neither, atopy alone, atopic asthma, nonatopic asthma, with atopy defined as any positive specific IgE (≥0.35 KU/L) to any of the 10 allergens or mixes and asthma defined as self-report of doctor-diagnosed current asthma). Multivariable regression analyses (linear, logistic, and zero inflated negative binomial where appropriate) adjusted for age, sex, race, lung function, smoking status, pack-years smoked, and use of inhaled corticosteroids were used to determine characteristics of groups and relationship with outcomes (exacerbations, clinical outcomes, CT metrics) separately in COPDGene and SPIROMICS, and then adjusted results were combined using meta-analysis. RESULTS: The prevalence of atopy was 35% and 36% in COPD subjects from SPIROMICS and COPDGene, respectively, and less than 50% overlap was seen between atopic status with asthma in both cohorts. In meta-analysis, individuals with nonatopic asthma had the most impaired symptom scores (effect size for St. George's Respiratory Questionnaire total score, 4.2; 95% CI, 0.4-7.9; effect size for COPD Assessment Test score, 2.8; 95% CI, 0.089-5.4), highest risk for exacerbations (incidence rate ratio, 1.41; 95% CI, 1.05-1.88) compared with the group without atopy or asthma. Those with atopy and atopic asthma were not at increased risk for adverse outcomes. INTERPRETATION: Asthma and atopy had incomplete overlap among former and current smokers with COPD in COPDGene and SPIROMICS. Nonatopic asthma was associated with adverse outcomes and exacerbation risk in COPD, whereas groups having atopy alone and atopic asthma had less risk.
BACKGROUND: Little is known about the concordance of atopy with asthma COPD overlap. Among individuals with COPD, a better understanding of the phenotypes characterized by asthma overlap and atopy is needed to better target therapies. RESEARCH QUESTION: What is the overlap between atopy and asthma status among individuals with COPD, and how are categories defined by the presence of atopy and asthma status associated with clinical and radiologic phenotypes and outcomes in the Genetic Epidemiology of COPD Study (COPDGene) and Subpopulation and Intermediate Outcome Measures in COPD Study (SPIROMICS)? STUDY DESIGN AND METHODS: Four hundred three individuals with COPD from SPIROMICS and 696 individuals from COPDGene with data about specific IgEs to 10 common allergens and mixes (simultaneous assessment of combination of allergens in similar category) were included. Comparison groups were defined by atopic and asthma status (neither, atopy alone, atopic asthma, nonatopic asthma, with atopy defined as any positive specific IgE (≥0.35 KU/L) to any of the 10 allergens or mixes and asthma defined as self-report of doctor-diagnosed current asthma). Multivariable regression analyses (linear, logistic, and zero inflated negative binomial where appropriate) adjusted for age, sex, race, lung function, smoking status, pack-years smoked, and use of inhaled corticosteroids were used to determine characteristics of groups and relationship with outcomes (exacerbations, clinical outcomes, CT metrics) separately in COPDGene and SPIROMICS, and then adjusted results were combined using meta-analysis. RESULTS: The prevalence of atopy was 35% and 36% in COPD subjects from SPIROMICS and COPDGene, respectively, and less than 50% overlap was seen between atopic status with asthma in both cohorts. In meta-analysis, individuals with nonatopic asthma had the most impaired symptom scores (effect size for St. George's Respiratory Questionnaire total score, 4.2; 95% CI, 0.4-7.9; effect size for COPD Assessment Test score, 2.8; 95% CI, 0.089-5.4), highest risk for exacerbations (incidence rate ratio, 1.41; 95% CI, 1.05-1.88) compared with the group without atopy or asthma. Those with atopy and atopic asthma were not at increased risk for adverse outcomes. INTERPRETATION: Asthma and atopy had incomplete overlap among former and current smokers with COPD in COPDGene and SPIROMICS. Nonatopic asthma was associated with adverse outcomes and exacerbation risk in COPD, whereas groups having atopy alone and atopic asthma had less risk.
Authors: David Couper; Lisa M LaVange; MeiLan Han; R Graham Barr; Eugene Bleecker; Eric A Hoffman; Richard Kanner; Eric Kleerup; Fernando J Martinez; Prescott G Woodruff; Stephen Rennard Journal: Thorax Date: 2013-09-12 Impact factor: 9.139
Authors: Jerry A Krishnan; Anjan Nibber; Alison Chisholm; David Price; Eric D Bateman; Leif Bjermer; Job F M van Boven; Guy Brusselle; Richard W Costello; Ronald J Dandurand; Zuzana Diamant; Eric Van Ganse; Caroline Gouder; Sanne C van Kampen; Alan Kaplan; Janwillem Kocks; Marc Miravitlles; Akio Niimi; Emilio Pizzichini; Chin Kook Rhee; Joan B Soriano; Claus Vogelmeier; Miguel Román-Rodriguez; Victoria Carter; Anthony D D'Urzo; Nicolas Roche Journal: Ann Am Thorac Soc Date: 2019-09
Authors: Stephanie A Christenson; Katrina Steiling; Maarten van den Berge; Kahkeshan Hijazi; Pieter S Hiemstra; Dirkje S Postma; Marc E Lenburg; Avrum Spira; Prescott G Woodruff Journal: Am J Respir Crit Care Med Date: 2015-04-01 Impact factor: 21.405
Authors: Wendy C Moore; Deborah A Meyers; Sally E Wenzel; W Gerald Teague; Huashi Li; Xingnan Li; Ralph D'Agostino; Mario Castro; Douglas Curran-Everett; Anne M Fitzpatrick; Benjamin Gaston; Nizar N Jarjour; Ronald Sorkness; William J Calhoun; Kian Fan Chung; Suzy A A Comhair; Raed A Dweik; Elliot Israel; Stephen P Peters; William W Busse; Serpil C Erzurum; Eugene R Bleecker Journal: Am J Respir Crit Care Med Date: 2009-11-05 Impact factor: 21.405
Authors: Gerard J Criner; Bartolome R Celli; Christopher E Brightling; Alvar Agusti; Alberto Papi; Dave Singh; Don D Sin; Claus F Vogelmeier; Frank C Sciurba; Mona Bafadhel; Vibeke Backer; Motokazu Kato; Alejandra Ramírez-Venegas; Yu-Feng Wei; Leif Bjermer; Vivian H Shih; Maria Jison; Sean O'Quinn; Natalya Makulova; Paul Newbold; Mitchell Goldman; Ubaldo J Martin Journal: N Engl J Med Date: 2019-05-20 Impact factor: 176.079
Authors: Nirupama Putcha; Milo A Puhan; M Bradley Drummond; MeiLan K Han; Elizabeth A Regan; Nicola A Hanania; Carlos H Martinez; Marilyn Foreman; Surya P Bhatt; Barry Make; Joe Ramsdell; Dawn L DeMeo; R Graham Barr; Stephen I Rennard; Fernando Martinez; Edwin K Silverman; James Crapo; Robert A Wise; Nadia N Hansel Journal: PLoS One Date: 2014-12-16 Impact factor: 3.240
Authors: Deepak A Kaji; Andrew J Belli; Meredith C McCormack; Elizabeth C Matsui; D'Ann L Williams; Laura Paulin; Nirupama Putcha; Roger D Peng; Gregory B Diette; Patrick N Breysse; Nadia N Hansel Journal: BMC Pulm Med Date: 2014-09-10 Impact factor: 3.317
Authors: Nirupama Putcha; Han Woo; Meredith C McCormack; Ashraf Fawzy; Karina Romero; Meghan F Davis; Robert A Wise; Gregory B Diette; Kirsten Koehler; Elizabeth C Matsui; Nadia N Hansel Journal: Am J Respir Crit Care Med Date: 2022-02-15 Impact factor: 21.405
Authors: Daniel C Belz; Han Woo; Nirupama Putcha; Laura M Paulin; Kirsten Koehler; Ashraf Fawzy; Neil E Alexis; R Graham Barr; Alejandro P Comellas; Christopher B Cooper; David Couper; Mark Dransfield; Amanda J Gassett; MeiLan Han; Eric A Hoffman; Richard E Kanner; Jerry A Krishnan; Fernando J Martinez; Robert Paine; Roger D Peng; Stephen Peters; Cheryl S Pirozzi; Prescott G Woodruff; Joel D Kaufman; Nadia N Hansel Journal: Sci Total Environ Date: 2022-03-19 Impact factor: 10.753
Authors: Marek Lommatzsch; Timotheus Speer; Christian Herr; Rudolf A Jörres; Henrik Watz; Achim Müller; Tobias Welte; Claus F Vogelmeier; Robert Bals Journal: Respir Res Date: 2022-01-04
Authors: Eunyong Shin; Juhae Jin; Seo Young Park; Young Sang Yoo; Ji-Hyang Lee; Jin An; Woo-Jung Song; Hyouk-Soo Kwon; You Sook Cho; Hee-Bom Moon; Jung-Bok Lee; Tae-Bum Kim Journal: Asia Pac Allergy Date: 2022-04-28
Authors: Roberto W Dal Negro; Mauro Carone; Giuseppina Cuttitta; Luca Gallelli; Massimo Pistolesi; Salvatore Privitera; Piero Ceriana; Pietro Pirina; Bruno Balbi; Carlo Vancheri; Franca M Gallo; Alfredo Chetta; Paola Turco Journal: Multidiscip Respir Med Date: 2021-10-01