053 Epidermal barrier dysfunction is associated with chronic bronchitis in adults: Results from the National Health and Nutrition Examination Survey, 1999-2006

Abstract

Epidermal barrier dysfunction (EBD) has been associated with increased circulating pro-inflammatory cytokines (e.g., IL-1β, IL-6, TNF-α), many of which are also elevated in chronic bronchitis and emphysema; few studies have examined the relationship between EBD and these inflammatory lung conditions, which we investigated using the United States National Health and Nutrition Examination Survey (NHANES). The study population included adult participants (age ≥20 years) from survey years 1999-2006. The exposure of interest was EBD, defined as self-reported “dermatitis, eczema, rash in past year” for survey years 1999-2004 and “itchy rash at any time in past 12 months” for survey years 2005-2006. Outcomes of interest included self-reported ever diagnosis of chronic bronchitis and emphysema, as well as frequent cough and phlegm production in the past three months. We used survey-weighted multiple logistic regression to calculate adjusted odds ratios (aOR) for each outcome. Models were adjusted for survey cycle, sex, age group, race/ ethnicity, education level, income to poverty ratio, body mass index category, smoking history (≥100 cigarettes in lifetime), and alcohol use history (≥12 drinks in past year). Among 15,158 adult participants included in the study, 1,627 (10.7%) had EBD. After adjusting for covariates, EBD was associated with 61% increased odds of having a history of chronic bronchitis (aOR 1.61, 95% CI 1.29-2.01, P<0.001), but no association was seen for emphysema (aOR 1.25, 95% CI 0.76-2.05, P=0.37). EBD was also associated with frequent cough (aOR 1.69, 95% CI 1.36-2.09, P<0.001) and phlegm production (aOR 1.60, 95% CI 1.28-1.99, P<0.001). Associations of EBD with chronic bronchitis and related respiratory symptoms provide further support for the link between skin barrier disruption and systemic inflammatory processes. Additional research is needed to further elucidate this link and explore the role of skin barrier restoration in the management of pulmonary disorders.