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Lung function trajectories and associated mortality among adults with and without airway obstruction
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- Backman, Helena (author)
- Umeå universitet,Avdelningen för hållbar hälsa,Section for Sustainable Health, Umeå University, Umeå, Sweden
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- Blomberg, Anders, 1961- (author)
- Umeå universitet,Institutionen för folkhälsa och klinisk medicin,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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- Lundquist, Anders, 1978- (author)
- Umeå universitet,Statistik,Department of Statistics, Umeå School of Business, Economics and Statistics (USBE), Umeå University, Umeå, Sweden
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- American Thoracic Society, 2023
- 2023
- English.
- In: American Journal of Respiratory and Critical Care Medicine. - : American Thoracic Society. - 1073-449X .- 1535-4970. ; 208:10, s. 1063-1074
- Journal article (peer-reviewed)
Abstract
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- Rationale: Spirometry is essential for diagnosis and assessment of prognosis in COPD.Objectives: To identify FEV1 trajectories and their determinants, based on annual spirometry measurements among individuals with and without airway obstruction. Furthermore, to assess mortality in relation to trajectories.Methods: In 2002-04, individuals with airway obstruction (AO) (FEV1/VC<0.70, n=993) and age- and sex-matched non-obstructive (NO) referents were recruited from population-based cohorts. Annual spirometries until 2014 were utilized in joint-survival Latent Class Mixed Models to identify lung function trajectories. Mortality data were collected during 15 years of follow-up.Results: Three trajectories were identified among the AO-cases and two among the NO referents. Trajectory membership was driven by baseline FEV1%predicted (%pred) in both groups and additionaly, pack-years in AO and current smoking in NO. Longitudinal FEV1%pred level depended on baseline FEV1%pred, pack-years and obesity. The trajectories were distributed: 79.6% T1AO FEV1-high with normal decline, 12.8% T2AO FEV1-high with rapid decline, and 7.7% T3AO FEV1-low with normal decline (mean 27, 72 and 26 mL/year) among AO-individuals, and 96.7% T1NO FEV1-high with normal decline and 3.3% T2NO FEV1-high with rapid decline (mean 34 and 173 mL/year) among referents. Hazard for death was increased for T2AO (HR1.56) and T3AO (HR3.45) vs. T1AO, and for T2NO (HR2.99) vs. T1NO.Conclusions: Three different FEV1 trajectories were identified among those with airway obstruction and two among the referents, with different outcomes in terms of FEV1-decline and mortality. The FEV1 trajectories among airway obstructive and the relationship between low FVC and trajectory outcome are of particular clinical interest.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
Keyword
- prognosis
- chronic obstructive pulmonary disease
- FEV1
- natural history
- lungmedicin
- Lung Medicine
- epidemiologi
- Epidemiology
- Physiotherapy
Publication and Content Type
- ref (subject category)
- art (subject category)
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