Self-Reported Physician Diagnosed Asthma with COPD is Associated with Higher Mortality than Self-Reported Asthma or COPD Alone – A Prospective 24-Year Study in the Population of Helsinki, Finland

Abstract Asthma and COPD are common chronic obstructive respiratory diseases. COPD is associated with increased mortality, but for asthma the results are varying. Their combination has been less investigated, and the results are contradictory. The aim of this prospective study was to observe the overall mortality in obstructive pulmonary diseases and how mortality was related to specific causes using postal questionnaire data. This study included data from 6,062 participants in the FinEsS Helsinki Study (1996) linked to mortality data during a 24-year follow-up. According to self-reported physician diagnosed asthma, COPD, or smoking status, the population was divided into five categories: combined asthma and COPD, COPD alone and asthma alone, ever-smokers without asthma or COPD and never-smokers without asthma or COPD (reference group). For the specific causes of death both the underlying and contributing causes of death were used. Participants with asthma and COPD had the highest hazard of mortality 2.4 (95% CI 1.7–3.5). Ever-smokers without asthma or COPD had a 9.5 (3.7–24.2) subhazard ratio (sHR) related to lower respiratory tract disease specific causes. For asthma, COPD and combined, the corresponding figures were 10.8 (3.4–34.1), 25.0 (8.1–77.4), and 56.1 (19.6–160), respectively. Ever-smokers without asthma or COPD sHR 1.7 (95% CI 1.3–2.5), and participants with combined asthma and COPD 3.5 (1.9–6.3) also featured mortality in association with coronary artery disease. Subjects with combined diseases had the highest hazard of overall mortality and combined diseases also showed the highest hazard of mortality associated with lower respiratory tract causes or coronary artery causes. Abbreviations: Cig Cigarette COPD Chronic obstructive pulmonary disease CVD Cardiovascular disease FEV1 Forced Expiratory Volume in one second FVC Forced Vital Capacity FinEsS Finland, Estonia, and Sweden study on chronic obstructive pulmonary diseases HR Hazard Ratio sHR Subhazard Ratio ICD-10 International Statistical Classifications of Diseases and Related Health Problems (Version 10)