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The Natural History of Chronic Airflow Obstruction Revisited

An Analysis of the Framingham Offspring Cohort

¹ Program of Epidemiology and Clinical Research, Fundación Caubet-CIMERA Illes Balears, International Centre for Advanced Respiratory Medicine, Bunyola, Illes Balears, Spain; ² Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD, Vienna, Austria; ³ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp), Subdirección de Salud Pública de Gipuzkoa, Donostia, Spain; ⁴ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), Spain; ⁵ Pneumology Department, Hospital Universitari Son Dureta, Palma de Mallorca, Illes Balears, Spain; ⁶ Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon; and ⁷ Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, Kentucky

Correspondence and requests for reprints should be addressed to Joan B. Soriano, M.D., Epidemiology and Clinical Research, Fundación Caubet-CIMERA Illes Balears, Carretera Soller km 12, Recinte Hospital Joan March, 07110-Bunyola, Illes Balears, Spain. E-mail: jbsoriano{at}caubet-cimera.es

Rationale: Understanding normal lung development and aging in health and disease, both in men and in women, is essential to interpreting any therapeutic intervention.

Objectives: We aimed to describe lung function changes in healthy never-smoking males and females, from adolescence to old age, and to determine the effects of smoking and those derived from quitting.

Methods: Prospective cohort study within all participants of the Framingham Offspring cohort who had two or more valid spirometry measurements during follow-up (n = 4,391; age range at baseline 13 to 71 yr), with a median follow-up time of 23 years.

Measurements and Main Results: To best fit the curves describing FEV₁ changes with age to raw data, we used a generalized additive model with smooth terms and incorporating the subject-specific (longitudinal) random effects. We found that: (1) healthy never-smoker females achieve full lung growth earlier than males, and their rate of decline with age was slightly, but not significantly, lower; (2) smoking increases the rate of lung function decline, both in males and in females; (3) there is a range of susceptibility to the effects of smoking. The presence of respiratory symptoms at baseline and/or a respiratory diagnosis during follow-up appears to identify a group of susceptible smokers; and (4) quitting smoking has a beneficial effect at any age, but it is more pronounced in earlier quitters.

Conclusions: Lung function changes from adolescence to old age differ in males and females, smoking has similar deleterious effects in both sexes, and quitting earlier is better.

Key Words: chronic obstructive pulmonary disease • FEV₁ • sex • lung function • natural history

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Determining lung function development, both in health and in disease, remains an important issue, especially to interpret new strategies and drugs targeted to modify the natural history of chronic obstructive pulmonary disease. What This Study Adds to the Field Lung function changes from adolescence to old age differ in males and females, smoking has similar deleterious effects in both sexes, and quitting earlier is better.

 

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