The natural history of chronic airflow obstruction revisited: An analysis of the Framingham Offspring Cohort

Robab Kohansal, Pablo Martinez-Camblor, Alvar Agustí, A. Sonia Buist, David M. Mannino, Joan B. Soriano

Research output: Contribution to journalArticlepeer-review

509 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)3-10
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Issue number1
StatePublished - Jul 1 2009


  • Chronic obstructive pulmonary disease
  • FEV
  • Lung function
  • Natural history
  • Sex

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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