Severity of obstruction in patients with COPD in a lifecourse approach

Background: COPD is a serious public health problem mainly in developing countries. Still, its development, progression and severity are not clearly understood in each stage of life. Purpose: To evaluate the factors associated with the severity of obstruction in patients with COPD based on a life course epidemiology approach. Methods: Cross-sectional study involving 140 patients with COPD (≥ 18 years). Epidemiological characteristics and factors associated with COPD were collected and presented within a participant’s life course model. Hierarchical logistic regression models were applied. Results: 42% patients presented obstruction level classified as severe. 31% reported childhood asthma and 90% still had shortness of breath; 69% had asthma and 34% another lung disease, with the presence of asthma associated in some cases. In addition, 29% of them were smokers and 39% former smokers. Patients with diabetes (OR 2.87; CI 1.16-7.06) and who were smokers (3.33; CI 1.19-9.26) or former ones (OR 2.95; CI 1.13 -7.71) had a greater chance of severe obstruction. Among the people with COPD who never smoked (figure 1), childhood asthma was shown as a possible associated factor against the severity of the disease (OR 0.39; 0.15-0.99), possibly because childhood asthmatics opted for habits and/or workplaces that would not worsen the natural history of the disease during their existence. Conclusion: Timeline composition (figure 2) provides a broad and comprehensive understanding of the development and/or severity of COPD, which makes possible to identify the most susceptible groups earlier and these findings allow us to focus on primary prevention of such individuals.