Asthma Attacks with Eosinophilia Predict Mortality from Chronic Obstructive Pulmonary Disease in a General Population Sample

We studied the association between allergy defined as eosinophilia (>/= 275 cells/mm(3)) and/or positive skin tests (sum score >/= 3) and mortality from chronic obstructive pulmonary disease (COPD) after adjustment for major risk factors. In addition, we investigated this association in subgroups of respiratory symptoms and lung function. We used data from 7,556 participants of the respiratory surveys in 1964 -1972 in the general populations of Vlagtwedde, Vlaardingen, and Meppel (The Netherlands; mean age +/- SD: 39.3 yr +/- 14 in the 1960s). In 1995, the vital status was available (5,135 alive, 106 lost to follow-up, 121 primary deaths from COPD, and 2,194 other primary causes of which 137 had a secondary death cause from COPD. Positive skin tests were not associated with increased COPD mortality. The association between eosinophilia and COPD mortality was restricted to those who had reported asthma attacks and was present for both COPD as a primary cause (relative risk RR = 4.80; 95% confidence interval CI 1.9 to 11.9) and combined primary and secondary causes of death (RR = 3. 90; 95% CI 2.05 to 7.40). We conclude that eosinophilia with asthma attacks is a risk factor for COPD mortality in addition to known risk factors also found in our study such as male gender, older age, current smoking, low lung function, underweight, and dyspnea.