The natural history of chronic airflow obstruction revisited: an analysis of the Framingham offspring cohort

  • Kohansal R
  • Martinez-Camblor P
  • Agusti A
 et al. 
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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 FEV(1) 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 males and females, smoking has similar deleterious effects in both sexes, and quitting earlier is better.

Author-supplied keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aging/*physiology
  • Female
  • Forced Expiratory Volume
  • Health Surveys
  • Humans
  • Lung/growth & development/*physiology/physiopathol
  • Male
  • Middle Aged
  • Prospective Studies
  • Smoking Cessation
  • Smoking/adverse effects/*physiopathology
  • Spirometry
  • Young Adult

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  • R Kohansal

  • P Martinez-Camblor

  • A Agusti

  • A S Buist

  • D M Mannino

  • J B Soriano

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