Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease

Peter Lange; Bartolome Celli; Alvar Agustí; Gorm Boje Jensen; Miguel Divo; Rosa Faner; Stefano Guerra; Jacob Louis Marott; Fernando D Martinez; Pablo Martinez-Camblor; Paula Meek; Caroline A Owen; Hans Petersen; Victor Pinto-Plata; Peter Schnohr; Akshay Sood; Joan B Soriano; Yohannes Tesfaigzi; Jørgen Vestbo

doi:10.1056/nejmoa1411532

Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease

Peter Lange, Bartolome Celli, Alvar Agustí, Gorm Boje Jensen, Miguel Divo, Rosa Faner, Stefano Guerra, Jacob Louis Marott, Fernando D Martinez, Pablo Martinez-Camblor, Paula Meek, Caroline A Owen, Hans Petersen, Victor Pinto-Plata, Peter Schnohr, Akshay Sood, Joan B Soriano, Yohannes Tesfaigzi, Jørgen Vestbo

228 Citations (Scopus)

Abstract

BACKGROUND Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. METHODS We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. RESULTS Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a baseline FEV1 of at least 80% of the predicted value before 40 years of age, 158 (7%) had COPD after 22 years of observation (P<0.001). Approximately half the 332 persons with COPD at the end of the observation period had had a normal FEV1 before 40 years of age and had a rapid decline in FEV1 thereafter, with a mean (±SD) decline of 53±21 ml per year. The remaining half had had a low FEV1 in early adulthood and a subsequent mean decline in FEV1 of 27±18 ml per year (P<0.001), despite similar smoking exposure. CONCLUSIONS Our study suggests that low FEV1 in early adulthood is important in the genesis of COPD and that accelerated decline in FEV1 is not an obligate feature of COPD.

Original language	English
Journal	New England Journal of Medicine
Volume	373
Issue number	2
Pages (from-to)	111-122
Number of pages	12
ISSN	0028-4793
DOIs	https://doi.org/10.1056/nejmoa1411532
Publication status	Published - 9 Jul 2015

Keywords

Adult
Aged
Cohort Studies
Disease Progression
Female
Forced Expiratory Volume
Humans
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive
Smoking
Young Adult

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https://www.nejm.org/doi/pdf/10.1056/NEJMoa1411532?articleTools=true

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Lange, P., Celli, B., Agustí, A., Jensen, G. B., Divo, M., Faner, R., Guerra, S., Marott, J. L., Martinez, F. D., Martinez-Camblor, P., Meek, P., Owen, C. A., Petersen, H., Pinto-Plata, V., Schnohr, P., Sood, A., Soriano, J. B., Tesfaigzi, Y., & Vestbo, J. (2015). Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease. New England Journal of Medicine, 373(2), 111-122. https://doi.org/10.1056/nejmoa1411532

Lange, P, Celli, B, Agustí, A, Jensen, GB, Divo, M, Faner, R, Guerra, S, Marott, JL, Martinez, FD, Martinez-Camblor, P, Meek, P, Owen, CA, Petersen, H, Pinto-Plata, V, Schnohr, P, Sood, A, Soriano, JB, Tesfaigzi, Y & Vestbo, J 2015, 'Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease', New England Journal of Medicine, vol. 373, no. 2, pp. 111-122. https://doi.org/10.1056/nejmoa1411532

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title = "Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease",

abstract = "BACKGROUND Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. METHODS We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. RESULTS Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a baseline FEV1 of at least 80% of the predicted value before 40 years of age, 158 (7%) had COPD after 22 years of observation (P<0.001). Approximately half the 332 persons with COPD at the end of the observation period had had a normal FEV1 before 40 years of age and had a rapid decline in FEV1 thereafter, with a mean (±SD) decline of 53±21 ml per year. The remaining half had had a low FEV1 in early adulthood and a subsequent mean decline in FEV1 of 27±18 ml per year (P<0.001), despite similar smoking exposure. CONCLUSIONS Our study suggests that low FEV1 in early adulthood is important in the genesis of COPD and that accelerated decline in FEV1 is not an obligate feature of COPD.",

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author = "Peter Lange and Bartolome Celli and Alvar Agust{\'i} and Jensen, {Gorm Boje} and Miguel Divo and Rosa Faner and Stefano Guerra and Marott, {Jacob Louis} and Martinez, {Fernando D} and Pablo Martinez-Camblor and Paula Meek and Owen, {Caroline A} and Hans Petersen and Victor Pinto-Plata and Peter Schnohr and Akshay Sood and Soriano, {Joan B} and Yohannes Tesfaigzi and J{\o}rgen Vestbo",

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T1 - Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease

AU - Lange, Peter

AU - Celli, Bartolome

AU - Agustí, Alvar

AU - Jensen, Gorm Boje

AU - Divo, Miguel

AU - Faner, Rosa

AU - Guerra, Stefano

AU - Marott, Jacob Louis

AU - Martinez, Fernando D

AU - Martinez-Camblor, Pablo

AU - Meek, Paula

AU - Owen, Caroline A

AU - Petersen, Hans

AU - Pinto-Plata, Victor

AU - Schnohr, Peter

AU - Sood, Akshay

AU - Soriano, Joan B

AU - Tesfaigzi, Yohannes

AU - Vestbo, Jørgen

PY - 2015/7/9

Y1 - 2015/7/9

N2 - BACKGROUND Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. METHODS We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. RESULTS Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a baseline FEV1 of at least 80% of the predicted value before 40 years of age, 158 (7%) had COPD after 22 years of observation (P<0.001). Approximately half the 332 persons with COPD at the end of the observation period had had a normal FEV1 before 40 years of age and had a rapid decline in FEV1 thereafter, with a mean (±SD) decline of 53±21 ml per year. The remaining half had had a low FEV1 in early adulthood and a subsequent mean decline in FEV1 of 27±18 ml per year (P<0.001), despite similar smoking exposure. CONCLUSIONS Our study suggests that low FEV1 in early adulthood is important in the genesis of COPD and that accelerated decline in FEV1 is not an obligate feature of COPD.

AB - BACKGROUND Chronic obstructive pulmonary disease (COPD) is thought to result from an accelerated decline in forced expiratory volume in 1 second (FEV1) over time. Yet it is possible that a normal decline in FEV1 could also lead to COPD in persons whose maximally attained FEV1 is less than population norms. METHODS We stratified participants in three independent cohorts (the Framingham Offspring Cohort, the Copenhagen City Heart Study, and the Lovelace Smokers Cohort) according to lung function (FEV1 ≥80% or <80% of the predicted value) at cohort inception (mean age of patients, approximately 40 years) and the presence or absence of COPD at the last study visit. We then determined the rate of decline in FEV1 over time among the participants according to their FEV1 at cohort inception and COPD status at study end. RESULTS Among 657 persons who had an FEV1 of less than 80% of the predicted value before 40 years of age, 174 (26%) had COPD after 22 years of observation, whereas among 2207 persons who had a baseline FEV1 of at least 80% of the predicted value before 40 years of age, 158 (7%) had COPD after 22 years of observation (P<0.001). Approximately half the 332 persons with COPD at the end of the observation period had had a normal FEV1 before 40 years of age and had a rapid decline in FEV1 thereafter, with a mean (±SD) decline of 53±21 ml per year. The remaining half had had a low FEV1 in early adulthood and a subsequent mean decline in FEV1 of 27±18 ml per year (P<0.001), despite similar smoking exposure. CONCLUSIONS Our study suggests that low FEV1 in early adulthood is important in the genesis of COPD and that accelerated decline in FEV1 is not an obligate feature of COPD.

KW - Adult

KW - Aged

KW - Cohort Studies

KW - Disease Progression

KW - Female

KW - Forced Expiratory Volume

KW - Humans

KW - Male

KW - Middle Aged

KW - Pulmonary Disease, Chronic Obstructive

KW - Smoking

KW - Young Adult

U2 - 10.1056/nejmoa1411532

DO - 10.1056/nejmoa1411532

M3 - Journal article

C2 - 26154786

SN - 0028-4793

VL - 373

SP - 111

EP - 122

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 2

ER -

Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease

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Keywords

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