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 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.
  
  
  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.
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO. Electronic address: Bowlerr@njhealth.org.
authors.forename: Russell P
authors.initials: RP
authors.lastname: Bowler
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA.
authors.forename: Victor
authors.initials: V
authors.lastname: Kim
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Regan
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO.
authors.forename: André A A
authors.initials: AAA
authors.lastname: Williams
authors.affiliation: Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Santorico
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Make
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO.
authors.forename: David A
authors.initials: DA
authors.lastname: Lynch
authors.affiliation: Department of Medicine and the Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: John E
authors.initials: JE
authors.lastname: Hokanson
authors.affiliation: Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: George R
authors.initials: GR
authors.lastname: Washko
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA.
authors.forename: Peter
authors.initials: P
authors.lastname: Bercz
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California at San Diego, La Jolla, CA.
authors.forename: Xavier
authors.initials: X
authors.lastname: Soler
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Marchetti
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Criner
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California at San Diego, La Jolla, CA.
authors.forename: Joe
authors.initials: J
authors.lastname: Ramsdell
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: MeiLan K
authors.initials: MK
authors.lastname: Han
authors.affiliation: Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Demeo
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, TX.
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.affiliation: University of Iowa, Iowa City, IA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Comellas
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO.
authors.forename: James D
authors.initials: JD
authors.lastname: Crapo
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Mark
authors.initials: M
authors.lastname: Dransfield
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Wells
authors.affiliation: Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Hersh
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Neil
authors.initials: N
authors.lastname: MacIntyre
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Fernando
authors.initials: F
authors.lastname: Martinez
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Hrudaya P
authors.initials: HP
authors.lastname: Nath
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Dennis
authors.initials: D
authors.lastname: Niewoehner
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Frank
authors.initials: F
authors.lastname: Sciurba
authors.affiliation: Baylor College of Medicine, Houston, TX.
authors.forename: Amir
authors.initials: A
authors.lastname: Sharafkhaneh
authors.affiliation: Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Silverman
authors.affiliation: Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, Scotland.
authors.forename: Edwin J R
authors.initials: EJR
authors.lastname: van Beek
authors.affiliation: Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO.
authors.forename: Carla
authors.initials: C
authors.lastname: Wilson
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Christine
authors.initials: C
authors.lastname: Wendt
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis*; D011788:Quality of Life; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014481:United States