A nationwide cohort study of the risk of chronic obstructive pulmonary disease in coeliac disease

Ludvigsson JF, Inghammar M, Ekberg M, Egesten A (Orebro University Hospital, Orebro; Karolinska Institutet, Stockholm; and Lund University, Ska degrees ne University Hospital, Lund, Sweden). A nationwide cohort study of the risk of chronic obstructive pulmonary disease in coeliac disease. J Intern Med 2012; 271: 481489. Objective. Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality and healthcare costs in the western world. Although smoking is an important trigger of COPD, other factors such as chronic inflammation and malnutrition are known to influence its development. Because coeliac disease (CD) is characterized both by dysregulated inflammation and malnutrition, the possibility of an association between CD and COPD was investigated. Methods. Through biopsy data from all Swedish pathology departments, we identified 10 990 individuals with CD who were biopsied between 1987 and 2008 (Marsh 3: villous atrophy). As controls, 54 129 reference individuals matched for age, sex, county and calendar year of first biopsy were selected. Cox regression analysis was then performed to estimate hazard ratios (HRs) for having a diagnosis of COPD according to the Swedish Patient Register. Results. During follow-up, 380 individuals with CD (3.5%) and 1391 (2.6%) controls had an incident diagnosis of COPD, which corresponds to an HR of 1.24 (95% CI: 1.101.38) and an excess risk of COPD of 79/100 000 person-years in CD. The risk increase remained 5 years after biopsy (HR = 1.17; 95% CI: 1.001.37). Risk estimates did not change with adjustment for type 1 diabetes, thyroid disease, rheumatoid arthritis, country of birth or level of education. Men with CD were at a higher risk of COPD (HR = 1.39; 95% CI: 1.181.62) than women with CD (HR = 1.11; 95% CI: 0.941.30). Of note, CD was also associated with COPD before CD diagnosis (odds ratio = 1.22; 95% CI: 1.021.46). Conclusion. Patients with CD seem to be at a moderately increased risk of COPD both before and after CD diagnosis.