title: Persistent and Newly Developed Chronic Bronchitis Are Associated with Worse Outcomes in Chronic Obstructive Pulmonary Disease.
abstract: Chronic bronchitis is, by definition, a chronic condition, but the development and remission of this condition in cigarette smokers with or without chronic obstructive pulmonary disease (COPD) are poorly understood. Also, it is unclear how the persistence or new development of chronic bronchitis affects symptoms and outcomes.
  
  
  
  To ascertain the relationship between smoking status and the presence or absence of chronic bronchitis and the subsequent effects on symptoms and outcomes.
  
  
  
  We analyzed 1,775 current or ex-smokers with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage 0-IV COPD in phase 2 of the Genetic Epidemiology of COPD (COPDGene) Study, which included subjects after 5 years of follow-up from phase 1. We asked subjects at enrollment and at 5 years of follow-up about symptoms consistent with chronic bronchitis. We divided subjects into four groups: persistent chronic bronchitis- (negative at phase 1/negative at phase 2), resolved chronic bronchitis (positive/negative), new chronic bronchitis (negative/positive), and persistent chronic bronchitis+ (positive/positive). We analyzed respiratory symptoms, health-related quality of life, lung function, exacerbation frequency, and 6-minute walk distance.
  
  
  
  Compared with the persistent chronic bronchitis- group, members of the persistent chronic bronchitis+ group were more likely to have continued smoking (53.4%). Subjects with new chronic bronchitis were more likely to have resumed (6.6%) or continued smoking (45.6%), whereas subjects with resolved chronic bronchitis were more likely to have quit smoking (23.5%). Compared with the persistent chronic bronchitis- group, the other groups had a shorter 6-minute walk distance, worse lung function, greater exacerbation frequency, and worse respiratory symptoms. Modified Medical Research Council dyspnea and St. George's Respiratory Questionnaire scores worsened between phase 1 and phase 2 in subjects with new chronic bronchitis but improved in the resolved chronic bronchitis group. On multinomial logistic regression, quitting smoking conferred an odds ratio (OR) of 4.289 (95% confidence interval [CI], 2.689-6.842) for resolved chronic bronchitis, whereas resuming smoking had an OR of 4.585 (95% CI, 2.008-10.471) for new chronic bronchitis. Persistent smoking had an OR of 2.621 (95% CI, 1.677-4.096) and 5.767 (95% CI, 3.702-8.983) for subjects with new chronic bronchitis and subjects with persistent chronic bronchitis, respectively.
  
  
  
  Persistent and newly developed chronic bronchitis are associated with continued or resumed smoking, greater respiratory symptoms, worse health-related quality of life, worse lung function, and greater exacerbation frequency. These findings stress the importance of repeatedly assessing chronic cough and sputum production in smokers to identify those at risk for poor outcomes.
authors.affiliation: 1 Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Victor
authors.initials: V
authors.lastname: Kim
authors.affiliation: 1 Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Huaqing
authors.initials: H
authors.lastname: Zhao
authors.affiliation: 2 Baylor College of Medicine, Houston, Texas.
authors.forename: Aladin M
authors.initials: AM
authors.lastname: Boriek
authors.affiliation: 3 University of Texas Health Science Center at San Antonio, Medicine, San Antonio, Texas.
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.affiliation: 4 University of California San Diego School of Medicine, San Diego, California.
authors.forename: Xavier
authors.initials: X
authors.lastname: Soler
authors.affiliation: 5 University of Alabama at Birmingham and UAB Lung Health Center, Birmingham, Alabama.
authors.forename: Surya P
authors.initials: SP
authors.lastname: Bhatt
authors.affiliation: 6 University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Rennard
authors.affiliation: 7 Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Robert
authors.initials: R
authors.lastname: Wise
authors.affiliation: 8 University of Iowa, Iowa City, Iowa.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Comellas
authors.affiliation: 4 University of California San Diego School of Medicine, San Diego, California.
authors.forename: Joe W
authors.initials: JW
authors.lastname: Ramsdell
authors.affiliation: 9 University of Colorado School of Public Health-Epidemiology, Denver, Colorado.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Kinney
authors.affiliation: 10 University of Michigan Health Care System, Ann Arbor, Michigan.
authors.forename: MeiLan K
authors.initials: MK
authors.lastname: Han
authors.affiliation: 10 University of Michigan Health Care System, Ann Arbor, Michigan.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Martinez
authors.affiliation: 11 Department of Radiology, University of California San Diego, San Diego, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Yen
authors.affiliation: 12 University of Colorado School of Public Health, Aurora, Colorado.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Black-Shinn
authors.affiliation: 13 David Geffen School of Medicine University of California Los Angeles, Los Angeles, California.
authors.forename: Janos
authors.initials: J
authors.lastname: Porszasz
authors.affiliation: 1 Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Criner
authors.affiliation: 2 Baylor College of Medicine, Houston, Texas.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Hanania
authors.affiliation: 2 Baylor College of Medicine, Houston, Texas.
authors.forename: Amir
authors.initials: A
authors.lastname: Sharafkhaneh
authors.affiliation: 14 National Jewish Health, Denver, Colorado.
authors.forename: James D
authors.initials: JD
authors.lastname: Crapo
authors.affiliation: 14 National Jewish Health, Denver, Colorado.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Make
authors.affiliation: 15 Brigham and Women's Hospital, Boston, Massachusetts; and.
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Silverman
authors.affiliation: 10 University of Michigan Health Care System, Ann Arbor, Michigan.|16 Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Curtis
mesh_terms: D000368:Aged; D029481:Bronchitis, Chronic / Q000453:epidemiology / Q000503:physiopathology*; D003371:Cough / Q000209:etiology; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology*; D011788:Quality of Life; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology
keywords: chronic bronchitis; chronic obstructive pulmonary disease; smoking