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The clinical impact of non-obstructive chronic bronchitis in current and former smokers

Author(s): C. H. Martinez, V. Kim, Y. Chen, E. A. Kazerooni, S. Murray, G. J. Criner, J. L. Curtis, E. A. Regan, E. Wan, C. P. Hersh, E. K. Silverman, J. D. Crapo, F. J. Martinez, M. K. Han

BACKGROUND: As the clinical significance of chronic bronchitis among smokers without airflow obstruction is unclear, we sought to determine morbidity associated with this disorder. METHODS: We examined subjects from the COPDGene study and compared those with FEV1/FVC >/=0.70, no diagnosis of asthma and chronic bronchitis as defined as a history of cough and phlegm production for >/=3 months/year for >/=2 years (NCB) to non-obstructed subjects without chronic bronchitis (CB-). Multivariate analysis was used to determine factors associated with and impact of NCB. RESULTS: We identified 597 NCB and 4283 CB- subjects. NCB participants were younger (55.4 vs. 57.2 years, p < 0.001) with greater tobacco exposure (42.9 vs. 37.8 pack-years, p < 0.001) and more often current smokers; more frequently reported occupational exposure to fumes (52.8% vs. 42.2%, p < 0.001), dust for >/=1 year (55.3% vs. 42.0%, p < 0.001) and were less likely to be currently working. NCB subjects demonstrated worse quality-of-life (SGRQ 35.6 vs. 15.1, p < 0.001) and exercise capacity (walk distance 415 vs. 449 m, p < 0.001) and more frequently reported respiratory "flare-ups" requiring treatment with antibiotics or steroids (0.30 vs. 0.10 annual events/subject, p < 0.001) prior to enrollment and during follow-up (0.34 vs. 0.16 annual events/subject, p < 0.001). In multivariate analysis, current smoking, GERD, sleep apnea and occupational exposures were significantly associated with NCB. CONCLUSIONS: While longitudinal data will be needed to determine whether NCB progresses to COPD, NCB patients have poorer quality-of-life, exercise capacity and frequent respiratory events. Beyond smoking cessation interventions, further research is warranted to determine the benefit of other therapeutics in this population. Clinical Trials Registration # NCT00608764 ( Link to study protocol:

Full version: Available here

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ISBN: 1532-3064 (Electronic)0954-6111 (Linking)
Publication Year: 2013
Periodical: Respir Med
Periodical Number:
Author Address: Pulmonary & Critical Care Division, University of Michigan Health System, Ann Arbor, MI, USA. Electronic address: