Longitudinal Lung Function Decline in Subjects with Respiratory Symptoms

Abstract

The relation of respiratory symptoms and lung function has not been extensively investigated. To determine better the rate of FEV1 decline in subjects reporting persistent wheeze, chronic cough, chronic phlegm, and/or dyspnea, longitudinal data from an adult population sample of 3,948 subjects (1,757 men; 2,191 women) followed for 12 yr were analyzed. At the initial and subsequent follow-up visits, subjects completed a standardized respiratory questionnaire and performed spirometry using the same methods and spirometers. Subjects were categorized based on the presence or absence of self-reported respiratory symptoms (persistent wheeze, chronic cough, chronic phlegm, or shortness of breath) at the initial visit. Six-specific linear regression models were fitted to determine the effect of these respiratory symptoms on lung function. In both men and women, reporting of any respiratory symptoms was associated with both a reduction in initial lung function and more rapid decline in height-adjusted FEV1. Furthermore, after adjustment for height, age, and cigarette smoking, men with cough or phlegm and women with cough alone showed accelerated loss in FEV1. Clinicians should be aware of the predictive value of these respiratory symptoms, because therapeutic intervention may modify the associated decline in lung function.

Self-reported prevalence of pulmonary symptoms in subjects with spinal cord injury

“…Thirty-®ve percent were current smokers, 35% former smokers and 30% non-smokers, similar to those of our study group (33%, 38% and 29%, respectively). By comparison of current ®ndings with those obtained by Sherman et al 20 it is apparent that complaints of breathlessness, or any symptom, in subjects with tetraplegia or paraplegia in all smoking categories far exceeded those observed in the general population (Table 4). In addition, among subjects with tetraplegia, wheeze was more prevalent among current and former smokers and all symptoms were more prevalent among non-smokers.…”

“…Among ablebodied men, the reporting of any respiratory symptom was associated with a reduction in initial lung function and more rapid decline in height-adjusted forced expiratory volume in one second (FEV1). 20 In addition, after adjustment for height, age and cigarette smoking, healthy men with cough or phlegm demonstrated accelerated loss in FEV1. In a study of the natural history of chronic air¯ow obstruction, symptoms of cough and phlegm, wheeze, and breath- Figure 4 (A) Prevalence of cough combined with phlegm among positive responders for increasing episodes or occurring greater than three weeks per year.…”

“…However, by use of the standard questionnaire, Sherman et al quantitated respiratory symptoms in 1757 healthy able-bodied men with a mean age of 47.5 years, comparable to that of our SCI population. 20 The normal male subjects were selected from census lists from six cities in the eastern United States. Thirty-®ve percent were current smokers, 35% former smokers and 30% non-smokers, similar to those of our study group (33%, 38% and 29%, respectively).…”

“…Among subjects with paraplegia, phlegm and wheeze were more prevalent among current smokers and wheeze was more prevalent among former smokers. 20 It is unknown whether respiratory symptoms among subjects with SCI correlate with long-term pulmonary function decline or increased mortality. Among ablebodied men, the reporting of any respiratory symptom was associated with a reduction in initial lung function and more rapid decline in height-adjusted forced expiratory volume in one second (FEV1).…”

Longitudinal Change in FEV1 and FVC in Chronic Spinal Cord Injury

“…The onset of cough and phlegm was associated with a significant decline in FEV 1 /FVC. An early study by Fletcher and coworkers in able-bodied individuals found that chronic cough and phlegm were not associated with lung function decline (43), whereas more recent studies have reported significant associations (44,45). Persons in the lowest MIP quartile had a greater decline in FVC and FEV 1 and also had the greatest decline in MIP across each test interval.…”