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The Influence of Constipation on Asthma: A Real-world, Population-based Cohort Study
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  • Yen Chu Huang,
  • Meng Che Wu,
  • Yu-Hsun Wang,
  • James Cheng-Chung Wei
Yen Chu Huang
Taichung Veterans General Hospital
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Meng Che Wu
Taichung Veterans General Hospital
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Yu-Hsun Wang
Chung Shan Medical University, Taichung,
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James Cheng-Chung Wei
Chung Shan Medical University
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Abstract

Background Among respiratory diseases, asthma is one of the most burdensome disorder worldwide. Growing evidence disclose gut dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microflora. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess the risk of asthma in constipated patients by a nationwide population-based cohort study. Methods We analyzed 82421 constipated patients and 82421 individuals without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Analysis of propensity score was utilized to match age, gender, comorbidities, and medications at a ratio of 1:1. Besides, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and a stratified analysis were conducted. Results The incidence of asthma was 10.8 per 1,000 person-years in the constipation group, which was higher than the rate of 5.6 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, and medications, constipated patients had a 1.91-fold greater risk of asthma compared to those without constipation (adjusted hazard ratio [aHR]: 1.91 (95% C.I. 1.84-1.99). In subgroup analyses, patients aged 20-39 years had a 2.04-fold highest risk of asthma in the constipation cohort (aHR:2.04, 95% CI, 1.84-2.26). Besides, the severity of constipation is associated with an increased risk of asthma; the aHR was 1.76 (1.69-1.85), 2.15(2.03-2.27), and 2.29(2.10-2.49) for < 3 times, 3-12 times, and ≥12 times of laxatives prescription within one year, respectively. (p<0.001) Moreover, constipated patients had a higher likelihood of asthma, regardless of gender, comorbidities, and medications. Conclusion Constipation relates to a significantly increased risk of asthma. Physicians should be aware of the possibility of asthma in constipated people. Further research is warranted to investigate the possible pathological mechanisms of this association.

Peer review status:ACCEPTED

23 Dec 2020Submitted to International Journal of Clinical Practice
23 Dec 2020Submission Checks Completed
23 Dec 2020Assigned to Editor
17 Jan 2021Reviewer(s) Assigned
18 Jan 2021Review(s) Completed, Editorial Evaluation Pending
03 Mar 20211st Revision Received
04 Mar 2021Assigned to Editor
04 Mar 2021Submission Checks Completed
26 Apr 2021Reviewer(s) Assigned
30 Apr 2021Review(s) Completed, Editorial Evaluation Pending
24 May 20212nd Revision Received
24 May 2021Submission Checks Completed
24 May 2021Assigned to Editor
24 May 2021Review(s) Completed, Editorial Evaluation Pending
25 May 2021Reviewer(s) Assigned
14 Jun 2021Editorial Decision: Accept