COPD, Asthma May Up Risk for Inflammatory Bowel Disease

Laurie Barclay, MD

November 20, 2014

Rates of inflammatory bowel disease (IBD) incidence are significantly increased in people with asthma or chronic obstructive pulmonary disease (COPD), according to findings of a population-based study published online November 19 in the European Respiratory Journal.

"These findings have important implications for the early detection of [IBD] in airway disease patients," lead author Paul Brassard, MD, from the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada, said in a news release. "Although a link has previously been suggested, this is the first study to find significantly increased rates of [IBD] incidence in people with asthma and COPD. If we can confirm a link between the two conditions it will help diagnose and treat people sooner, reducing their symptoms and improving their quality of life."

The researchers compared the incidences of Crohn's disease (CD) and ulcerative colitis (UC) in patients with asthma and patients with COPD with incidences in the general population, using administrative health databases of Quebec from 2001 to 2006. They used prescription records to identify mutually exclusive asthma and COPD populations, and data from physician and hospital visits to identify CD and UC.

Among 136,178 patients with asthma, the average CD and UC incidences were 23.1 and 8.8/100,000 person-years, respectively. Among 143,904 patients with COPD, average incidences were 26.2 CD and 17 UC cases/100,000 person-years, respectively.

Compared with the general population of Quebec, CD incidence in patients with asthma and patients with COPD was 27% and 55% higher, respectively, and UC incidence was 30% higher among patients with COPD.

The highest incidence rate ratio was observed in children up to 10 years old for the asthma cohort and in adults aged 50 to 59 years for the COPD cohort. In these two subgroups, the incidence of CD was more than twice that in the general population.

"[IBD] and airway diseases may be associated through common inflammatory pathways, genetic and environmental factors," the authors write. "The intestinal and respiratory epithelia share the same embryologic origin, have a similar anatomic structure and serve as organ barriers between the body and the environment. Immunological dysfunctions triggered by environmental factors are a common element in the pathogenesis of both IBD and airway diseases such as asthma and [COPD]."

Limitations of this study include use of prescription information to identify patients with airway disease, possibly limited generalizability to other populations, and lack of data regarding smoking.

"Women with asthma were more likely to develop CD than men, and men with COPD were more likely to develop UC than women," the study authors conclude. "Confirmation of such results in future studies may have implications in earlier detection of IBD and in the therapeutic management of patients. Medical professionals involved in the care of airway disease patients who develop digestive symptoms need to be aware of the possible occurrence of new cases of IBD even in older age groups and regardless of smoking status."

The authors have disclosed no relevant financial relationships.

Eur Respir J. Published online November 19, 2014. Abstract


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