RT Journal Article
SR Electronic
T1 Lung function decline and outcomes in an elderly population
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 472
OP 477
DO 10.1136/thx.2005.052449
VO 61
IS 6
A1 D M Mannino
A1 K J Davis
YR 2006
UL http://thorax.bmj.com/content/61/6/472.abstract
AB Objective: To determine the risk factors for and outcomes associated with the rapid decline in lung function in a cohort of elderly US adults.Methods: Data from 4923 adult participants aged 65 years and older at baseline in the Cardiovascular Health Study were analysed. Subjects were classified using a modification of the GOLD criteria for chronic obstructive pulmonary disease (COPD) and a “restricted” category (FEV1/FVC ⩾70% and FVC <80% predicted) was added. Cox proportional hazard models were used to determine the risk of lung function decline over 4 years on subsequent mortality and COPD hospital admissions after adjusting for age, race, sex, smoking status, and other factors.Results: Of the participants in the initial cohort, 3388 (68.8%) had spirometric tests at the year 4 visit. Participants with GOLD stages 3 or 4 COPD at baseline were less likely than normal subjects to have follow up spirometric tests (52.7% v 77.9%, p<0.01) and were more likely to be in the most rapidly declining quartile of FEV1 (28.2% v 21.3%, p<0.01) with an annual loss of FEV1 of at least 3.5%. Overall, being in the most rapidly declining quartile of FEV1 from baseline to year 4 was associated with an increased risk of admission to hospital for COPD (adjusted hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.3 to 2.0) and all-cause death (adjusted HR 1.5, 95% CI 1.2 to 1.7) over an additional 7 years of follow up.Conclusion: More rapid decline in lung function is independently associated with a modest increased risk of hospital admissions and deaths from COPD in an elderly cohort of US participants.