Developing COPD: a 25 year follow up study of the general population

A Løkke, P Lange, H Scharling, P Fabricius, J Vestbo, A Løkke, P Lange, H Scharling, P Fabricius, J Vestbo

Abstract

Background: Smokers are more prone to develop chronic obstructive pulmonary disease (COPD) than non-smokers, but this finding comes from studies spanning 10 years or less. The aim of this study was to determine the 25 year absolute risk of developing COPD in men and women from the general population.

Methods: As part of the Copenhagen City Heart Study, 8045 men and women aged 30-60 years with normal lung function at baseline were followed for 25 years. Lung function measurements were collected and mortality from COPD during the 25 year observation period was analysed.

Results: The percentage of men with normal lung function ranged from 96% of never smokers to 59% of continuous smokers; for women the proportions were 91% and 69%, respectively. The 25 year incidence of moderate and severe COPD was 20.7% and 3.6%, respectively, with no apparent difference between men and women. Smoking cessation, especially early in the follow up period, decreased the risk of developing COPD substantially compared with continuous smoking. During the follow up period there were 2912 deaths, 109 of which were from COPD. 92% of the COPD deaths occurred in subjects who were current smokers at the beginning of the follow up period.

Conclusion: The absolute risk of developing COPD among continuous smokers is at least 25%, which is larger than was previously estimated.

Conflict of interest statement

Competing interests: none declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2121175/bin/tx62802.f1.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/2121175/bin/tx62802.f2.jpg

References

    1. Pauwels R A, Rabe K F. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet 2004364613–620.
    1. Celli B R, MacNee W, Agusti al Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23: 932–46, Also available at and
    1. Murray C J, Lopez A D. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 19973491498–1504.
    1. Fletcher C M, Tinker, Peto alThe natural history of chronic bronchitis and emphysema. Oxford: Oxford University Press, 1976
    1. Burrows B, Knudson R J, Camilli A al The “horse‐racing effect” and predicting decline in forced expiratory volume in one second from screening spirometry. Am Rev Respir Dis 1987135788–793.
    1. Tager I B, Segal M R, Speizer F al The natural history of forced expiratory volumes. Effect of cigarette smoking and respiratory symptoms. Am Rev Respir Dis 1988138837–849.
    1. Xu X, Dockery D W, Ware J al Effects of cigarette smoking on rate of loss of pulmonary function in adults: a longitudinal assessment. Am Rev Respir Dis 19921461345–1348.
    1. Lange P, Groth S, Nyboe al Effects of smoking and changes in smoking habits on the decline of FEV1. Eur Respir J 19892811–816.
    1. Camilli A E, Burrows B, Knudson R al Longitudinal changes in forced expiratory volume in one second in adults. Am Rev Respir Dis 1987135794–799.
    1. Anthonisen N R, Connett J E, Kiley J al Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 19942721497–1505.
    1. Appleyard M. The Copenhagen City Heart Study. Scand J Soc Med 1989Suppl 41
    1. Schnohr P, Jensen G, Lange al The Copenhagen City Heart Study. Tables with data from the third examination 1991–94. Eur Heart J 20013 (Suppl H)
    1. Torén K, Brisman J, Järvholm B. Asthma and asthma‐like symptoms in adults assessed by questionnaires. Chest 1993104600–608.
    1. Lange P, Nyboe J, Jensen al Ventilatory function impairment and risk of cardiovascular death and of fatal or non‐fatal myocardial infarction. Eur Respir J 199141080–1087.
    1. Danish Respiratory Society Spirometry – a recommendation (in Danish). Copenhagen: Danish Respiratory Society, 1986
    1. Huhti E, Ikkala J. A follow‐up study on respiratory symptoms and ventilatory function in a middle‐aged rural population. Eur J Respir Dis 19806133–45.
    1. Krzyzanowski M, Jedrychowski W, Wysocki M. Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13‐year follow up of the Cracow study. Am Rev Respir Dis 19861341011–1019.
    1. Vestbo J, Lange P. Can GOLD stage 0 provide information of prognostic value in chronic obstructive pulmonary disease? Am J Respir Crit Care Med 2002166329–332.
    1. Lindberg A, Jonsson A ‐ C, Rönmark al Ten‐year cumulative incidence of COPD and risk factors for incident disease in a symptomatic cohort. Chest 20051271544–1552.
    1. Rennard S I, Vestbo J. The dangerous underestimate of 15%. Lancet 20063671216–1219.
    1. Anthonisen N R, Connett J E, Murray R P, for the Lung Health Study Research Group Smoking and lung function of Lung Health Study participants after 11 years. Am J Respir Crit Care Med 2002166675–679.
    1. Anthonisen N R, Skeans M A, Wise R A, for the Lung Health Study Research Group et al The effects of a smoking cessation intervention on 14.5 year mortality. Ann Intern Med 2005142233–239.
    1. Bergdahl I A, Torén K, Eriksson al Increased mortality in COPD among construction workers exposed to inorganic dust. Eur Respir J 200423402–406.
    1. Ezzati M, Lopez A D. Estimates of global mortality attributable to smoking in 2000. Lancet 2003362847–852.
    1. Lange P. Development and prognosis of chronic obstructive pulmonary disease with special reference to the role of tobacco smoking. Danish Med Bull 19923930–48.
    1. Mannino D M, Buist A S, Petty T al Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax 200358388–393.
    1. Mannino D M, Homa D M, Akinbami L al Chronic obstructive pulmonary disease surveillance – United States, 1971–2000. MMWR 2002511–16.

Source: PubMed

3
Subskrybuj