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Am J Med. 2019 Jul 29. pii: S0002-9343(19)30600-X. doi: 10.1016/j.amjmed.2019.06.049. [Epub ahead of print]

Adult Life-Course Trajectories of Lung Function and the Development of Emphysema: The CARDIA Lung Study.

Author information

1
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: Gwashko@BWH.Harvard.edu.
2
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
3
Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Boston, MA.
4
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA.
5
Lung Health Center, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
6
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA.
7
Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA.
8
Department of Pathology and Laboratory Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
9
Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL, USA.
10
Division of Allergy and Clinical Immunology, Department of Pediatrics, Northwestern University and The Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
11
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
12
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Abstract

BACKGROUND:

Peak lung function and rate of decline predict future airflow obstruction and non-respiratory comorbid conditions. Associations between lung function trajectories and emphysema have not been explored.

METHODS:

Using data from the population-based CARDIA Study, we sought to describe the prevalence of visually ascertained emphysema at multiple time points and contextualize its development based upon participant's adult life course measures of lung function. 3171 men and women were enrolled at a mean age of 25years and underwent serial spirometric examinations through a mean age of 55. Trajectories for the change in percent-predicted forced expiratory volume in one second (FEV1) were determined by fitting a mixture model via maximum likelihood. Emphysema was visually identified on computed tomographic scans and its prevalence reported at mean ages of 40, 45 and 50.

RESULTS:

We identified 5 trajectories describing peak and change in FEV1: "Preserved Ideal", "Preserved Good", "Preserved Impaired", "Worsening", and "Persistently Poor". Ever smokers comprised part of all 5 trajectories. The prevalence of emphysema was 1.7% (n=46; mean age of 40), 2.5% (n=67; mean age of 45) and 7.1% (n=189; mean age of 50). Of those with emphysema at a mean age of 50, 18.0% were never smokers. Worsening and Poor lung health trajectories were associated with increased odds of future emphysema independent of chronic tobacco smoke exposure (OR 5.06, CI 1.84-13.96; OR 4.85, CI 1.43-16.44).

CONCLUSIONS:

Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.

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