IBD & risk of respiratory Sx

April 18, 2023

Issue 08

Clinical Question

Do IBD patients have a higher risk of respiratory symptoms?

Editor’s Bottom Line

Respiratory disorders are common among IBD patients, although it remains unclear from this paper whether their prevalence exceeds that of the general population, Regardless, health care providers should consider screening IBD patients routinely for respiratory symptoms.

Reference

Valentin S, Renel B, Manneville F, et al. Prevalence of and Factors Associated with Respiratory Symptoms Among Patients with Inflammatory Bowel Disease: A Prospective Study. Inflamm Bowel Dis. 2023;29(2):207-216; https://academic.oup.com/ibdjournal/article

Synopsis

This prospective observational study in France included 325 patients with IBD treated in a single hospital between 2019 and 2021 and who received a questionnaire regarding respiratory symptoms.

Participants were a mean 43 years of age, 114 had Crohn’s disease (CD), 40% were male, the mean body mass index was 24 kg/m² and 42% were smokers or former smokers. The most common comorbidities were hypertension (9.5%), venous thromboembolic disease (7.4%), heart disease (5.3%), diabetes mellitus (3.1%), stroke (3.1%) and chronic renal failure (2.5%).

Roughly 21% of patients had articular extraintestinal manifestations of IBD, most commonly peripheral spondyloarthritis and ankylosing spondylitis. Less common extraintestinal manifestations of IBD included primary sclerosing cholangitis (4.9%), psoriasis (6.1%), uveitis (2.8%) and multiple sclerosis (1.8%).

Among CD patients, the mean duration of disease was 14.9 years and the mean age at diagnosis was 27.3 years. The mean disease duration of ulcerative colitis was 11.6 years and the mean age at diagnosis was 35 years.

Questionnaire results revealed that 50.8% of patients reported respiratory symptoms. The most common symptoms were dyspnea (31.4%), followed by wheezing (16%), diurnal shortness of breath (13.8%), cough (11.1%), daily cough (10.2%), daily expectoration (8.6%) and nocturnal shortness of breath (7.1%).

Fifty-seven percent of those reporting a respiratory symptom subsequently met with a pulmonologist and 42.2% of these individuals received a respiratory disease diagnosis. Asthma or chronic obstructive pulmonary disease accounted for 56% of these diagnoses, while less common diagnoses included bronchiectasis, hyperventilation syndrome, lung cancer, infectious pneumonia, bronchiolitis and interstitial lung disease. Additionally, 13.6% of patients were found to have obstructive sleep apnea.

Multivariate statistical analysis found several independent risk factors for respiratory symptoms, including increased body mass index (Odds Ratio [OR] for each 1 kg/m² increase: 1.08; 95% Confidence Interval [CI], 1.02–1.15; p=0.007), being a current or former smoker (OR: 1.86; 95% CI, 1.11–3.09; p=0.02) and having articular extraintestinal manifestations of IBD (OR: 4.73; 95% CI, 2.37–9.45; p<0.0001). Males were 50% less likely than females to report respiratory symptoms (OR: 0.5; 95% CI, 0.3–0.85; p=0.01). 

Details

Study Design: Prospective observational

Funding: None

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 1b