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Published ahead of print on January 26, 2006, doi:10.1164/rccm.200508-1344OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 9, May 2006, 985-990

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Submitted on August 30, 2005
Accepted on January 26, 2006

Lung Function Decline and Outcomes in an Adult Population

David M Mannino1*, Matthew M Reichert1, and Kourtney J Davis2

1 Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, Lexington, KY, USA, 2 Research and Development, GlaxoSmithKline, Research Triangle Park, NC, USA

* To whom correspondence should be addressed. E-mail: dmannino{at}uky.edu.

Rationale: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality. Objectives: To determine risk factors for and outcomes of rapid lung function decline in a cohort of U.S. adults. Methods: We analyzed data from 15,536 adults aged 44-66 years in the Atherosclerosis Risk in Communities (ARIC) study. We used Cox proportional hazard models to determine the risk of rapid lung function decline at three years on mortality and COPD hospitalizations over the subsequent eight years. Measurements and Main Results: Of those in the baseline cohort, 13,756 (88.5%) had spirometry at the year 3 visit. The strongest risk factors for not having a follow-up spirometry were being GOLD stage 3 or 4 at baseline (adjusted odds ratio [OR] 2.8, 95% confidence interval [CI] 2.1, 3.8), being of black race (adjusted OR 2.4, 95% CI 2.1, 2.7), and being a current smoker (adjusted OR 1.8, 95% CI 1.5, 2.0). Participants with GOLD stage 3 or 4 were also more likely to be in the most rapidly declining lung function quartile (adjusted OR 3.7, 95% CI 2.7, 5.0). Overall, participants with the most rapidly declining lung function had a modestly increased risk of death (adjusted hazard ratio [HR] 1.4, 95% CI 1.2, 1.7) and time to a COPD-related hospitalization (adjusted HR 1.4, 95% CI 1.2, 1.8). Conclusion: Rapid lung function decline was independently associated with a modest increased risk of COPD hospitalizations and deaths.
Key words: COPD, lung function, mortality




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