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

George R. Washko*, Laura A. Colangelo, Raul San José Estépar, Samuel Y. Ash, Surya P. Bhatt, Yuka Okajima, Kiang Liu, David R. Jacobs, Carlos Iribarren, Bharat Thyagarajan, Cora E. Lewis, Rajesh Kumar, Mei Lan K. Han, Mark T. Dransfield, Mercedes R. Carnethon, Ravi Kalhan

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory 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. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. 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 years. 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 years), 2.5% (n = 67; mean age of 45 years), and 7.1% (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 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 (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44). Conclusions: Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.

Original languageEnglish (US)
Pages (from-to)222-230.e11
JournalAmerican Journal of Medicine
Volume133
Issue number2
DOIs
StatePublished - Feb 2020

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Emphysema
Lung
Odds Ratio
Confidence Intervals
Forced Expiratory Volume
Smoke
Tobacco
Smoking
Health
Population

Keywords

  • Emphysema risk
  • Lung function trajectory

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Washko, George R. ; Colangelo, Laura A. ; Estépar, Raul San José ; Ash, Samuel Y. ; Bhatt, Surya P. ; Okajima, Yuka ; Liu, Kiang ; Jacobs, David R. ; Iribarren, Carlos ; Thyagarajan, Bharat ; Lewis, Cora E. ; Kumar, Rajesh ; Han, Mei Lan K. ; Dransfield, Mark T. ; Carnethon, Mercedes R. ; Kalhan, Ravi. / Adult Life-Course Trajectories of Lung Function and the Development of Emphysema : The CARDIA Lung Study. In: American Journal of Medicine. 2020 ; Vol. 133, No. 2. pp. 222-230.e11.
@article{ba82fee401394491a8959a7decc76557,
title = "Adult Life-Course Trajectories of Lung Function and the Development of Emphysema: The CARDIA Lung Study",
abstract = "Background: Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory 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. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. 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 years. 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 years), 2.5{\%} (n = 67; mean age of 45 years), and 7.1{\%} (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 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 (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44). Conclusions: Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.",
keywords = "Emphysema risk, Lung function trajectory",
author = "Washko, {George R.} and Colangelo, {Laura A.} and Est{\'e}par, {Raul San Jos{\'e}} and Ash, {Samuel Y.} and Bhatt, {Surya P.} and Yuka Okajima and Kiang Liu and Jacobs, {David R.} and Carlos Iribarren and Bharat Thyagarajan and Lewis, {Cora E.} and Rajesh Kumar and Han, {Mei Lan K.} and Dransfield, {Mark T.} and Carnethon, {Mercedes R.} and Ravi Kalhan",
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Washko, GR, Colangelo, LA, Estépar, RSJ, Ash, SY, Bhatt, SP, Okajima, Y, Liu, K, Jacobs, DR, Iribarren, C, Thyagarajan, B, Lewis, CE, Kumar, R, Han, MLK, Dransfield, MT, Carnethon, MR & Kalhan, R 2020, 'Adult Life-Course Trajectories of Lung Function and the Development of Emphysema: The CARDIA Lung Study', American Journal of Medicine, vol. 133, no. 2, pp. 222-230.e11. https://doi.org/10.1016/j.amjmed.2019.06.049

Adult Life-Course Trajectories of Lung Function and the Development of Emphysema : The CARDIA Lung Study. / Washko, George R.; Colangelo, Laura A.; Estépar, Raul San José; Ash, Samuel Y.; Bhatt, Surya P.; Okajima, Yuka; Liu, Kiang; Jacobs, David R.; Iribarren, Carlos; Thyagarajan, Bharat; Lewis, Cora E.; Kumar, Rajesh; Han, Mei Lan K.; Dransfield, Mark T.; Carnethon, Mercedes R.; Kalhan, Ravi.

In: American Journal of Medicine, Vol. 133, No. 2, 02.2020, p. 222-230.e11.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adult Life-Course Trajectories of Lung Function and the Development of Emphysema

T2 - The CARDIA Lung Study

AU - Washko, George R.

AU - Colangelo, Laura A.

AU - Estépar, Raul San José

AU - Ash, Samuel Y.

AU - Bhatt, Surya P.

AU - Okajima, Yuka

AU - Liu, Kiang

AU - Jacobs, David R.

AU - Iribarren, Carlos

AU - Thyagarajan, Bharat

AU - Lewis, Cora E.

AU - Kumar, Rajesh

AU - Han, Mei Lan K.

AU - Dransfield, Mark T.

AU - Carnethon, Mercedes R.

AU - Kalhan, Ravi

PY - 2020/2

Y1 - 2020/2

N2 - Background: Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory 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. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. 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 years. 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 years), 2.5% (n = 67; mean age of 45 years), and 7.1% (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 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 (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44). Conclusions: Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.

AB - Background: Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory 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. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. 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 years. 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 years), 2.5% (n = 67; mean age of 45 years), and 7.1% (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 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 (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44). Conclusions: Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.

KW - Emphysema risk

KW - Lung function trajectory

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