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Lung function trajectories and associated mortality among adults with and without airway obstruction
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-0553-8067
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-2452-7347
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0003-1524-0851
Department of Health and Technology, Luleå University of Technology, Luleå, Sweden.
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2023 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 208, no 10, p. 1063-1074Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
American Thoracic Society , 2023. Vol. 208, no 10, p. 1063-1074
Keywords [en]
prognosis, chronic obstructive pulmonary disease, FEV1, natural history
National Category
Respiratory Medicine and Allergy
Research subject
Lung Medicine; Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-212976DOI: 10.1164/rccm.202211-2166ocISI: 001099650500015PubMedID: 37460250Scopus ID: 2-s2.0-85183557430OAI: oai:DiVA.org:umu-212976DiVA, id: diva2:1789087
Part of project
Obstructive Lung Disease in Northern Sweden - epidemiological studies about asthma, allergy and COPD ongoing since 1985., Swedish Research Council
Funder
Swedish Heart Lung FoundationUmeå UniversityVisare NorrNorrbotten County CouncilSvensk Lungmedicinsk FöreningRegion VästerbottenAvailable from: 2023-08-17 Created: 2023-08-17 Last updated: 2024-04-08Bibliographically approved

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Backman, HelenaBlomberg, AndersLundquist, AndersSawalha, SamiNilsson, UlfEriksson Ström, JonasHedman, LinneaStridsman, CarolineRönmark, EvaLindberg, Anne

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Backman, HelenaBlomberg, AndersLundquist, AndersSawalha, SamiNilsson, UlfEriksson Ström, JonasHedman, LinneaStridsman, CarolineRönmark, EvaLindberg, Anne
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Section of Sustainable HealthDepartment of Public Health and Clinical MedicineStatistics
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American Journal of Respiratory and Critical Care Medicine
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