Analysis of FEV1 decline in relatively healthy heavy smokers: Implications of expressing changes in FEV1 in relative terms

Laura H. Thomsen; Asger Dirksen; Saher B. Shaker; Lene Theil Skovgaard; Magnus Dahlbäck; Jesper H. Pedersen

doi:10.3109/15412555.2013.830096

Analysis of FEV₁ decline in relatively healthy heavy smokers: Implications of expressing changes in FEV₁ in relative terms

Laura H. Thomsen^*, Asger Dirksen, Saher B. Shaker, Lene Theil Skovgaard, Magnus Dahlbäck, Jesper H. Pedersen

^*Corresponding author for this work

13 Citations (Scopus)

Abstract

Progressive decline in lung function has been widely accepted as the hallmark of chronic obstructive pulmonary disease (COPD); however, recent evidence indicates that the rate of decline measured as decline in forced expiratory volume in one second (FEV₁) is higher in mild to moderate COPD than in severe COPD. Usually changes in FEV₁ are measured in ml that is "absolute"; however, changes can also be measured "relative" as a percentage of the actual FEV₁. We hypothesize that relative measurements could be more appropriate than absolute measurements for describing changes in lung function. We analyzed data from 3,218 relatively healthy heavy smokers who participated in the Danish Lung Cancer Screening Trial. The influences of age, sex, height, body mass index, smoking, and severity of airflow limitation on FEV₁ were analyzed in mixed effects models. In absolute terms those with the best lung function consistently showed the steepest decline, whereas in relative terms most fast decliners are found among those with low lung function. Measuring changes in relative terms implied statistically significant acceleration of decline with advancing age, smoking (pack-years) and severity of airflow limitation. Relative measurements may lead to a better understanding of changes in lung function. Smoking and severity of airflow limitation speed up the loss of lung function, and this emphasizes the importance of abstaining from smoking the sooner the better. Measuring changes in relative terms could have important implications for the interpretation of results from clinical trials where FEV₁ is the primary outcome. DLCST; www.ClinicalTrials.org, registration number: NCT00496977.

Original language	English
Journal	C O P D
Volume	11
Issue number	1
Pages (from-to)	96-104
Number of pages	9
ISSN	1541-2555
DOIs	https://doi.org/10.3109/15412555.2013.830096
Publication status	Published - Feb 2014

Keywords

Epidemiology (pulmonary)
Lung function tests
Relatively healthy heavy smokers
Smoking

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title = "Analysis of FEV1 decline in relatively healthy heavy smokers: Implications of expressing changes in FEV1 in relative terms",

abstract = "Progressive decline in lung function has been widely accepted as the hallmark of chronic obstructive pulmonary disease (COPD); however, recent evidence indicates that the rate of decline measured as decline in forced expiratory volume in one second (FEV1) is higher in mild to moderate COPD than in severe COPD. Usually changes in FEV1 are measured in ml that is {"}absolute{"}; however, changes can also be measured {"}relative{"} as a percentage of the actual FEV1. We hypothesize that relative measurements could be more appropriate than absolute measurements for describing changes in lung function. We analyzed data from 3,218 relatively healthy heavy smokers who participated in the Danish Lung Cancer Screening Trial. The influences of age, sex, height, body mass index, smoking, and severity of airflow limitation on FEV1 were analyzed in mixed effects models. In absolute terms those with the best lung function consistently showed the steepest decline, whereas in relative terms most fast decliners are found among those with low lung function. Measuring changes in relative terms implied statistically significant acceleration of decline with advancing age, smoking (pack-years) and severity of airflow limitation. Relative measurements may lead to a better understanding of changes in lung function. Smoking and severity of airflow limitation speed up the loss of lung function, and this emphasizes the importance of abstaining from smoking the sooner the better. Measuring changes in relative terms could have important implications for the interpretation of results from clinical trials where FEV1 is the primary outcome. DLCST; www.ClinicalTrials.org, registration number: NCT00496977.",

keywords = "Epidemiology (pulmonary), Lung function tests, Relatively healthy heavy smokers, Smoking",

author = "Thomsen, {Laura H.} and Asger Dirksen and Shaker, {Saher B.} and Skovgaard, {Lene Theil} and Magnus Dahlb{\"a}ck and Pedersen, {Jesper H.}",

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AU - Thomsen, Laura H.

AU - Dirksen, Asger

AU - Shaker, Saher B.

AU - Skovgaard, Lene Theil

AU - Dahlbäck, Magnus

AU - Pedersen, Jesper H.

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N2 - Progressive decline in lung function has been widely accepted as the hallmark of chronic obstructive pulmonary disease (COPD); however, recent evidence indicates that the rate of decline measured as decline in forced expiratory volume in one second (FEV1) is higher in mild to moderate COPD than in severe COPD. Usually changes in FEV1 are measured in ml that is "absolute"; however, changes can also be measured "relative" as a percentage of the actual FEV1. We hypothesize that relative measurements could be more appropriate than absolute measurements for describing changes in lung function. We analyzed data from 3,218 relatively healthy heavy smokers who participated in the Danish Lung Cancer Screening Trial. The influences of age, sex, height, body mass index, smoking, and severity of airflow limitation on FEV1 were analyzed in mixed effects models. In absolute terms those with the best lung function consistently showed the steepest decline, whereas in relative terms most fast decliners are found among those with low lung function. Measuring changes in relative terms implied statistically significant acceleration of decline with advancing age, smoking (pack-years) and severity of airflow limitation. Relative measurements may lead to a better understanding of changes in lung function. Smoking and severity of airflow limitation speed up the loss of lung function, and this emphasizes the importance of abstaining from smoking the sooner the better. Measuring changes in relative terms could have important implications for the interpretation of results from clinical trials where FEV1 is the primary outcome. DLCST; www.ClinicalTrials.org, registration number: NCT00496977.

AB - Progressive decline in lung function has been widely accepted as the hallmark of chronic obstructive pulmonary disease (COPD); however, recent evidence indicates that the rate of decline measured as decline in forced expiratory volume in one second (FEV1) is higher in mild to moderate COPD than in severe COPD. Usually changes in FEV1 are measured in ml that is "absolute"; however, changes can also be measured "relative" as a percentage of the actual FEV1. We hypothesize that relative measurements could be more appropriate than absolute measurements for describing changes in lung function. We analyzed data from 3,218 relatively healthy heavy smokers who participated in the Danish Lung Cancer Screening Trial. The influences of age, sex, height, body mass index, smoking, and severity of airflow limitation on FEV1 were analyzed in mixed effects models. In absolute terms those with the best lung function consistently showed the steepest decline, whereas in relative terms most fast decliners are found among those with low lung function. Measuring changes in relative terms implied statistically significant acceleration of decline with advancing age, smoking (pack-years) and severity of airflow limitation. Relative measurements may lead to a better understanding of changes in lung function. Smoking and severity of airflow limitation speed up the loss of lung function, and this emphasizes the importance of abstaining from smoking the sooner the better. Measuring changes in relative terms could have important implications for the interpretation of results from clinical trials where FEV1 is the primary outcome. DLCST; www.ClinicalTrials.org, registration number: NCT00496977.

KW - Epidemiology (pulmonary)

KW - Lung function tests

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KW - Smoking

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DO - 10.3109/15412555.2013.830096

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