TY - JOUR
T1 - The natural history of chronic airflow obstruction revisited
T2 - An analysis of the Framingham Offspring Cohort
AU - Kohansal, Robab
AU - Martinez-Camblor, Pablo
AU - Agustí, Alvar
AU - Sonia Buist, A.
AU - Mannino, David M.
AU - Soriano, Joan B.
PY - 2009/7/1
Y1 - 2009/7/1
N2 - 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 malesandfemales, smoking has similar deleterious effects in both sexes, and quitting earlier is better.
AB - 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 malesandfemales, smoking has similar deleterious effects in both sexes, and quitting earlier is better.
KW - Chronic obstructive pulmonary disease
KW - FEV
KW - Lung function
KW - Natural history
KW - Sex
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U2 - 10.1164/rccm.200901-0047OC
DO - 10.1164/rccm.200901-0047OC
M3 - Article
C2 - 19342411
AN - SCOPUS:67649777117
SN - 1073-449X
VL - 180
SP - 3
EP - 10
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 1
ER -