A reexamination of risk factors for ventilatory impairment

Previous cross-sectional analyses of data from the Tucson Epidemiological Study of Airways Obstructive Diseases have shown significant relationships of ventilatory impairment to a variety of risk factors, including smoking, chronic productive cough, a history of childhood respiratory illnesses, atopy, blood eosinophilia, and serum immunoglobulin E (IgE). In the present report, we reexamine these relationships in subjects 40 to 74 yr of age to determine the effect of excluding known asthmatics who, as a group, have markedly impaired lung function. After exclusion of asthmatics, atopy, eosinophilia, and IgE no longer appear to be significant risk factors for ventilatory impairment, and nonasthmatic nonsmokers show almost no remaining ventilatory impairment. In current smokers, quantitative relationships of FEV1 to pack-years of cigarette consumption and to chronic productive cough are changed little by excluding asthmatics. In nonasthmatic ex-smokers, however, age at quitting smoking adds significantly to prediction of FEV1 after accounting for pack-years. Young ex-smokers closely resemble nonsmokers, but they become increasingly similar to current smokers as their age at quitting increases. A history of respiratory trouble before 16 yr of age continues to appear to increase susceptibility to smoking effects, even after exclusion of asthmatics. But, as in previous studies, the possible bias of preferential recall of childhood illnesses by impaired subjects limits interpretations of this observation. On the other hand, present findings suggest that such factors as atopy, eosinophilia, and elevated serum IgE may well be risk factors for persistent asthma, but they have no relationship to nonasthmatic forms of chronic obstructive pulmonary disease (COPD).(ABSTRACT TRUNCATED AT 250 WORDS)