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Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease.
Peter Lange1, Bartolome Celli, Alvar Agustí
1From the Institute of Public Health, Section of Social Medicine (P.L.), Respiratory Section, Hvidovre Hospital (P.L.), Copenhagen City Heart Study, Frederiksberg Hospital (P.L., G.B.J., J.L.M., P.S.), and the Department of Respiratory Medicine, Gentofte Hospital (J.V.), Copenhagen University, Copenhagen, and University of Southern Denmark, Odense (G.B.J.) - all in Denmark; Brigham and Women's Hospital, Harvard Medical School, Boston (B.C., M.D., C.A.O., V.P.-P.); Servei de Pneumologia, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona (A.A.), and Fundació Clínic per a la Recerca Biomèdica (R.F.) - both in Barcelona; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (A.A., R.F.) and Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid (UAM), Cátedra UAM-Linde (J.B.S.) - both in Madrid; Arizona Respiratory Center, University of Arizona, Tucson (S.G., F.D.M.); Universidad Autónoma de Chile, Santiago, Chile (P.M.-C.); University of Colorado, Denver, Denver (P.M.); Lovelace Respiratory Research Institute (H.P., Y.T.) and University of New Mexico (A.S.) - both in Albuquerque; and the Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom (J.V.).
The New England Journal of Medicine
|July 9, 2015
Summary
Low forced expiratory volume in 1 second (FEV1) in early adulthood, not just accelerated decline, contributes to chronic obstructive pulmonary disease (COPD). This finding challenges the traditional view of COPD development.
Area of Science:
- Pulmonary Medicine
- Respiratory Health
- Epidemiology
Background:
- Chronic obstructive pulmonary disease (COPD) is traditionally linked to an accelerated decline in lung function.
- However, the role of a lower-than-normal maximal attained forced expiratory volume in 1 second (FEV1) in early life as a precursor to COPD remains less understood.
Purpose of the Study:
- To investigate the association between baseline lung function in early adulthood and the subsequent development of COPD.
- To determine whether a normal rate of FEV1 decline can lead to COPD in individuals with initially suboptimal lung function.
Main Methods:
- Analysis of three independent cohorts, stratifying participants by baseline FEV1 (≥80% or <80% of predicted value) around age 40.
- Tracking FEV1 decline over approximately 22 years to assess COPD incidence based on initial lung function and decline rate.
Main Results:
- Individuals with a baseline FEV1 <80% predicted before age 40 had a significantly higher incidence of COPD (26%) after 22 years compared to those with FEV1 ≥80% (7%).
- About half of COPD cases developed in individuals with initially normal FEV1 but rapid subsequent decline, while the other half had low FEV1 early in life with a slower decline rate.
- Smoking exposure was similar between groups, suggesting FEV1 trajectory and baseline are critical factors.
Conclusions:
- Low FEV1 in early adulthood is a significant factor in the development of COPD.
- Accelerated FEV1 decline is not a prerequisite for developing COPD; suboptimal lung function from a younger age plays a crucial role.