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Background: COPD and coronary heart disease (CHD) frequently co-occur, yet which COPD phenotypes are most prone to CHD is poorly understood. The aim of this study was to see whether COPD patients did have a true higher risk for CHD than subjects without COPD, and to examine a range of potential factors associated with CHD in COPD patients and controls., Methods: 347 COPD patients and 428 non-COPD controls, were invited for coronary computed tomography angiography (CCTA) and pulmonary CT. Arterial blood gas, bioelectrical impedance and lung function was measured, and a detailed medical history taken. The CCTA was evaluated for significant coronary stenosis and calcium score (CaSc), and emphysema defined as >10% of total area <-950 Hounsfield units., Results: 12.6% of the COPD patients and 5.7% of the controls had coronary stenosis (p<0.01), whereas 55.9% of the COPD patients had a CaSc>100 compared to 31.6% of the controls (p<0.01). In a multivariable model adjusting for sex, age, body composition, pack-years, CRP, cholesterol/blood pressure lowering medication use and diabetes mellitus, the OR (95% CI) for having significant stenosis was 1.80 (0.86-3.78) in COPD patients compared with controls. In a similar model, the OR (95% CI) for having CaSc>100 was 1.68 (1.12-2.53) in COPD patients compared with controls. Examining the risk of significant stenosis and CaSc>100 among COPD patients, no variable was associated with significant stenosis, whereas male sex [OR 2.85 (1.56-5.21)], age [OR 3.74 (2.42-5.77)], statin use [OR 2.23 (1.23-4.50)] were associated with CaSc>100, after adjusting for body composition, pack-years, C-reactive protein, use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), diabetes, emphysema score, GOLD category, exacerbation frequency, eosinophilia, and hypoxemia., Conclusion: COPD patients were more likely to have CHD, but neither emphysema score, lung function, exacerbation frequency, nor hypoxemia predicted presence of either coronary stenosis or CaSc>100., Competing Interests: The authors have declared that no competing interests exist.

Background: Data on discomfort and complications from research bronchoscopy in chronic obstructive pulmonary disease (COPD) and asthma is limited. We present complications and discomfort occurring within a week after bronchoscopy, and investigate personal and procedural risk factors., Methods: 239 subjects with COPD, asthma or without lung disease underwent research bronchoscopies as part of a microbiome study of the lower airways (the MicroCOPD study). Bronchoscopy was done in the supine position with oral scope insertion with the option of light conscious alfentanil sedation. Sampling consisted of protected specimen brushes, bronchoalveolar lavage, small volume lavage and for some, endobronchial biopsies. Bleeding, desaturation, cough, haemodynamic changes, dyspnoea and other events that required an unplanned intervention or early termination of bronchoscopy were prospectively recorded. Follow-up consisted of a telephone interview where subjects rated discomfort and answered questions about fever sensation and respiratory symptoms in the week following bronchoscopy., Results: An unplanned intervention or early termination of bronchoscopy was required in 25.9% of bronchoscopies. Three subjects (1.3%) experienced potentially severe complications, of which all recovered without sequelae. COPD subjects experienced more dyspnoea than controls. Sedation and lower age was associated with less unplanned intervention or premature termination. About half of the subjects (47.7%) reported fever. Discomfort was associated with postprocedural fever, dread of bronchoscopy, higher score on the COPD Assessment Test and never-smoking. In subjects undergoing more than one bronchoscopy, the first bronchoscopy was often predictive for complications and postprocedural fever in the repeated bronchoscopy., Conclusion: Research bronchoscopies were not associated with more complications or discomfort in COPD subjects. 47.7% experienced postbronchoscopy fever sensation, which was associated with discomfort., Competing Interests: Competing interests: EOL, EMHM, EN, KSK, ØS and PSB declare no competing interests. TMLE has for the last three years received lecture fees from Boehringer Ingelheim, Roche and Astra Zeneca. GRH has for the last three years received lecture fees from Novartis and Boehringer Ingelheim. RN reports grants from GlaxoSmithKline, during the conduct of the study; grants from Boehringer Ingelheim, grants and personal fees from AstraZeneca, grants from Novartis, personal fees from GlaxoSmithKline, outside the submitted work. SL has for the last three years received lecture fees from Philips, Novartis and Astra Zeneca, and advisory board fees (paid to employer) from Novartis and Astra Zeneca, all outside the submitted work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To assess how frequently drugs used to treat asthma and ADHD are prescribed to the same patients., Method: The authors used data from the Norwegian Prescription Database for 2006, including the total Norwegian population (n = 4,640,219)., Results: Anti-asthma drugs were prescribed to 350,894 persons (7.56 % of the population), anti-ADHD drugs to 18,481 persons (0.40 %), and both to 1,730 persons. There was a 65% increased overall risk (OR = 1.65) of being prescribed one of the drugs given a prescription of the other. Women had a markedly higher risk than men. When data for each age group (10 years interval) and each gender were analyzed separately, the strongest associations were found for women between 20 and 49 years of age and men between 30 and 49 years of age., Conclusion: These prescription patterns suggested a marked comorbidity between asthma and ADHD.

Background: Attention deficit hyperactivity disorder (ADHD) is increasingly recognized as a common disorder not only in children, but also in the adult population. Similarly, asthma also has a substantial prevalence among adults. Previous studies concerning a potential relationship between ADHD and asthma have not presented consistent results., Methods: A cross-sectional study of 594 adult patients diagnosed with ADHD, compared with 719 persons from the general population. Information was collected between 1997 and 2005 using auto-questionnaires rating past and present symptoms of ADHD, co-morbid conditions, including asthma, and work status., Results: The prevalence of asthma was significantly higher in the ADHD patient group compared to the controls, 24.4% vs. 11.3% respectively (OR = 2.54, 95% CI 1.89-3.44), and controls with asthma scored higher on ratings of both past and present symptoms of ADHD. Female ADHD patients had a significantly higher prevalence of asthma compared to male ADHD patients (30.9% vs. 18.2%, OR = 2.01, CI 1.36-2.95), but in controls a slight female preponderance was not statistically significant. In both ADHD patients and controls, having asthma was associated with an increased prevalence of symptoms of mood- and anxiety disorders., Conclusions: The present findings point to a co-morbidity of ADHD and asthma, and these patients may represent a clinical and biological subgroup of adult patients with ADHD.

Background: Respiratory symptoms are common in the general population, and their presence is related to Health-related quality of life (HRQoL). The objective was to describe the association of respiratory symptoms with HRQoL in subjects with and without asthma or COPD and to investigate the role of atopy, bronchial hyperresponsiveness (BHR), and lung function in HRQoL., Methods: The European Community Respiratory Health Survey (ECRHS) I and II provided data on HRQoL, lung function, respiratory symptoms, asthma, atopy, and BHR from 6009 subjects. Generic HRQoL was assessed through the physical component summary (PCS) score and the mental component summary (MCS) score of the SF-36.Factor analyses and linear regressions adjusted for age, gender, smoking, occupation, BMI, comorbidity, and study centre were conducted., Results: Having breathlessness at rest in ECRHS II was associated with mean score (95% CI) impairment in PCS of -8.05 (-11.18, -4.93). Impairment in MCS score in subjects waking up with chest tightness was -4.02 (-5.51, -2.52). The magnitude of HRQoL impairment associated with respiratory symptoms was similar for subjects with and without asthma/COPD. Adjustments for atopy, BHR, and lung function did not explain the association of respiratory symptoms and HRQoL in subjects without asthma and/or COPD., Conclusion: Subjects with respiratory symptoms had poorer HRQoL; including subjects without a diagnosis of asthma or COPD. These findings suggest that respiratory symptoms in the absence of a medical diagnosis of asthma or COPD are by no means trivial, and that clarifying the nature and natural history of respiratory symptoms is a relevant challenge. Several community studies have estimated the prevalence of common respiratory symptoms like cough, dyspnoea, and wheeze in adults. Although the prevalence varies to a large degree between studies and geographical areas, respiratory symptoms are quite common. The prevalences of respiratory symptoms in the European Community Respiratory Health Study (ECRHS) varied from one percent to 35%. In fact, two studies have reported that more than half of the adult population suffers from one or more respiratory symptoms. Respiratory symptoms are important markers of the risk of having or developing disease. Respiratory symptoms have been shown to be predictors for lung function decline, asthma, and even all-cause mortality in a general population study . In patients with a known diagnosis of asthma or chronic obstructive pulmonary disease (COPD), respiratory symptoms are important determinants of reduced health related quality of life (HRQoL). The prevalence of respiratory symptoms exceeds the combined prevalences of asthma and COPD, and both asthma and COPD are frequently undiagnosed diseases. Thus, the high prevalence of respiratory symptoms may mirror undiagnosed and untreated disease.The common occurrence of respiratory symptoms calls for attention to how these symptoms affect health also in subjects with no diagnosis of obstructive airways disease. Impaired HRQoL in the presence of respiratory symptoms have been found in two population-based studies 619, but no study of respiratory symptoms and HRQoL have separate analyses for subjects with and without asthma and COPD, and no study provide information about extensive objective measurements of respiratory health. The ECRHS is a randomly sampled, multi-cultural, population based cohort study. The ECRHS included measurements of atopy, bronchial hyperresponsiveness (BHR), and lung function, and offers a unique opportunity to investigate how respiratory symptoms affect HRQoL among subjects both with and without obstructive lung disease.In the present paper we aimed to: 1) Describe the relationship between respiratory symptoms and HRQoL in an international adult general population and: 2) To assess whether this relationship varied with presence of asthma and/or COPD, or presence of objective functional markers like atopy and BHR.

Objective: To study the effect of occupational exposure on the incidence of adult asthma and six respiratory symptoms using a job exposure matrix (JEM)., Methods: From 1985, we conducted an 11-year community cohort study on the incidence of asthma and respiratory symptoms in Western Norway (N=2401, aged 15-70 years at baseline). The analyses in the current study were based on subjects < or =65 years at baseline, since those >65 years were unlikely to experience significant occupational exposures within the follow-up period., Results: More women than men were exposed to biological dust (38% versus 29%), while more men were exposed to mineral dust (48% versus 19%), and gas or fumes (58% versus 53%). After adjusting for age, educational level, smoking, and previous occupational exposures, we found that high exposure to biological dust exposure was significantly related to a higher incidence of chronic and morning cough in men; for women, low exposure was related to attacks of dyspnea. Low exposure to workplace gas or fumes was significantly related to incident phlegm cough and attacks of dyspnea for women, while for men, high exposure was related to dyspnea grade 2. For the incidence of asthma and phlegm cough, after adjusting for all confounders, we found a significant interaction between workplace exposures and gender, where women had a higher risk of disease., Conclusions: Assessed by a JEM, occupational airborne exposure was weakly related to the incidence of asthma and respiratory symptoms, significantly more so for women than for men.

Background: Health-related quality of life (HRQoL) is an increasingly important outcome measure in medical research. We wanted to evaluate how adjustment for potential confounders affected the relationship between HRQoL and asthma. Furthermore, we wanted to evaluate the relationship of environmental tobacco smoke (ETS) with HRQoL., Methods: We carried out a cross-sectional Norwegian community study in 1996/1997 including 2306 randomly selected subjects aged 26 years-81 years. Data on HRQoL were measured by SF-12. The data were analyzed by robust linear regression analyses with the physical component score (PCS) and the mental component score (MCS) as dependent variables. The effect of adjusting for the potential confounders was analyzed by bootstrap confidence intervals for differences between the adjusted and unadjusted models., Results: The difference in the asthma coefficients between the unadjusted and adjusted models for both PCS and MCS varied from 0.1 to 1.1. The confidence intervals for these differences for PCS were (-0.3, 1.6) and (0.4, 1.8), using the definition 'asthma last 12 months' and 'physician's diagnosis of asthma', respectively. The confidence intervals for the corresponding differences for MCS were (-0.01, 1.3) and (-0.6, 0.4), respectively. Univariately, PCS was lower among subjects reporting ETS at home compared to people not reporting ETS at home, but this difference did not persist in the multivariate analyses. ETS at home was associated with slightly improved MCS., Conclusion: Adjusting for potential confounders does not change the relationship between asthma and HRQoL overtly.

The effects of pre- or postnatal passive smoking on the adult incidence of asthma have not been reported previously. Between 1985 and 1996/1997, we conducted an 11-year community cohort study on the incidence of asthma and respiratory symptoms in Western Norway. The cohort included 3,786 subjects aged 15 to 70 years, of which 2,819 were responders at both baseline and follow-up. The incidence of asthma and five respiratory symptoms by self-reported exposure to maternal smoking in utero and in childhood, as well as smoking by other household members in childhood, was examined. After adjustment for sex, age, education, hay fever, personal smoking, and occupational exposure, maternal smoking was associated with asthma, phlegm cough, chronic cough, dyspnea grade 2, attacks of dyspnea, and wheezing, with odds ratios (95% confidence intervals [CI]) of 3.0 (1.6, 5.6), 1.7 (1.1, 2.6), 1.9 (1.2, 3.0), 1.9 (1.2, 3.0), 2.0 (1.3, 3.0), and 1.4 (0.9, 2.2), respectively. The adjusted attributable fractions (95% CI) of the adult incidence of asthma were 17.3% (5.2, 27.9) caused by maternal smoking and 9.3% (95% CI, -23.2, 33.2) caused by smoking by other household members. Exposure to pre- and postnatal smoking carries a substantial risk for developing adult asthma and respiratory symptoms.

Few studies have examined the impact of socioeconomic status on the incidence of asthma and respiratory symptoms. Between 1985 and 1996/97, we conducted an 11-years community cohort study with 2819 subjects, aged 15-70 years at baseline, in Western Norway. We examined the cumulative incidence of asthma and respiratory symptoms by educational level (primary, secondary, and university), as well as estimating the odds ratios (ORs) of educational level on the incidences, after adjustment for sex, age, hay fever, smoking habits, pack years, and occupational exposure. For all respiratory symptoms, the incidences decreased with increasing educational level. The cumulative incidence of asthma was 5.3%, 4.1%, and 1.8%, respectively, for those with a primary educational level, secondary educational level, and university level. Subjects with a primary educational level had adjusted ORs (95% CI) from 1.4 (0.9, 2.3) for the incidence of chronic cough to 2.5 (1.6, 4.0) for the incidence of dyspnea grade 2, compared to those with a university level education. The adjusted OR (95% CI) for the incidence of asthma was 2.1 (1.01, 4.4) in subjects with a primary educational level, and 2.0 (1.04, 3.6) in subjects with a secondary educational level, compared to subjects with a university educational level. In conclusion, subjects with a lower educational level had a higher risk of developing asthma and respiratory symptoms, after adjustment for sex, age, hay fever, smoking, and occupational exposure.

Several prevalence studies have suggested an association between occupational exposure and respiratory symptoms and asthma, but there has been a lack of incidence studies to verify this. This study examined the incidence of respiratory symptoms and asthma in an 11-year Norwegian community cohort study with 2,819 subjects. Predictors examined were sex, age, educational level, lifetime exposure to quartz, asbestos, and dust or fumes, as well as smoking habits and pack-years. The prevalence of exposure to quartz, asbestos, and dust or fumes was, respectively, 3.7%, 5.0%, and 28.3% at baseline. In those exposed to dust or fumes, the odds ratios (95% confidence intervals) varied between 1.4 (1.1, 1.7) and 2.1 (1.3, 3.2) for developing respiratory symptoms or asthma after adjusting for sex, age, educational level, and smoking. Between 5.7% and 19.3% of the incidence of respiratory symptoms and 14.4% of the incidence of asthma were attributable to dust or fumes exposure after adjustment for sex, age, educational level, and smoking. In conclusion, airborne occupational exposure increases the incidence of respiratory symptoms and asthma, independent of sex, age, educational level, smoking habits, and pack-years.

We have assessed predictors for response in a Norwegian community cohort study, with an 11-year follow-up. We also examined to what extent the association of gender, age, and smoking to the incidence of respiratory symptoms and asthma differed if the analyses were based on the 65% (n = 2,079) initial responders, or were based on the 89% (n = 2,819) who responded after three reminders. The associations between the six symptoms/asthma and the gender, age, and smoking groups amounted to 42 odds ratios. The adjusted odds ratio for responding at follow-up was 1.39 (95% CI: 1.01, 1.90) for those being middle aged at baseline compared to younger subjects. The adjusted odds ratios for responding at follow-up for those being students, unemployed, or retired at baseline were 0.50 (95% CI: 0.35, 0.73), 0.29 (95% CI: 0.16, 0.55), 0.21 (95% CI: 0.13, 0.36), respectively, compared to being employed. Of the 42 odds ratios mentioned above, 25 differed less than 10% when comparing the initial and all respondents. Twelve differed 10-20% and five differed 20-45%. The study indicates that to ensure a high participation rate in a follow-up study one should pay special attention to those being late responders, unemployed, retired, or students at baseline. No overt differences were observed in the gender, age, and, smoking associations to the respiratory disorders when the analyses were based on the initial compared to all respondents.

Abstract: Objectives: To examine the prevalence of self‐reported symptoms of obstructive sleep apnoea (OSA) in relation to asthma, respiratory symptoms and pulmonary function. A secondary objective was to determine how sex impacted these relationships. Methods: A random sample of all adults aged 47–48 and 71–73 years living in Bergen, Norway, were invited. Participants (3506, 69%) underwent spirometry testing and completed a questionnaire on sleep, respiratory symptoms and past medical history. OSA was defined by positive answers to questions on snoring, breathing cessations and daytime sleepiness. Current asthma was defined by ever having received a physician's diagnosis of asthma and current use of anti‐asthma medication. Logistic regression analyses, including interaction analyses between sex and the different explanatory variables, were used to examine associations between OSA and current asthma, pre‐ and post‐bronchodilator pulmonary function tests, smoking habits and respiratory symptoms. All models were adjusted for age, sex, waist‐hip ratio and smoking. Results: OSA was more prevalent in the middle‐aged compared to the elderly (6.2% vs 3.6%), and in subjects reporting respiratory symptoms. 4.8% had OSA and 6.1% had current asthma. Current asthma and the lowest quartile of post‐bronchodilator FVC were significantly associated with OSA with ORs of 2.5 (1.5, 4.2) and 1.7 (1.1, 2.7), respectively. In interaction analyses, women with post‐bronchodilator FEV1/FVC < 0.7 had an increased risk of OSA [OR of 4.1 (1.7, 9.7)] compared to women with a FEV1/FVC ≥ 0.7. Conclusions: Current asthma was associated with increased risk of OSA. Women with chronic airflow limitation, but not men, had increased risk of OSA. [ABSTRACT FROM AUTHOR]