Predictors of Loss of Lung Function in the Elderly

Abstract

Pulmonary function, as measured by spirometry (FEV1 or FVC), is an important independent predictor of morbidity and mortality in elderly persons. In this study we examined the predictors of longitudinal decline in lung function for participants of the Cardiovascular Health Study (CHS). The CHS was started in 1990 as a population-based observational study of cardiovascular disease in elderly persons. Spirometry testing was conducted at baseline, 4 and 7 yr later. The data were analyzed using a random effects model (REM) including an AR(1) error structure. There were 5,242 subjects (57.6% female, mean age 73 yr, 87.5% white and 12.5% African-American) with eligible FEV1 measures representing 89% of the baseline cohort. The REM results showed that African-Americans had significantly lower spirometry levels than whites but that their rate of decline with age was significantly less. Subjects reporting congestive heart failure (CHF), high systolic blood pressure (> 160 mm Hg), or taking beta-blockers had significantly lower spirometry levels; however, the effects of high blood pressure and taking beta-blockers diminished with increasing age. Chronic bronchitis, pneumonia, emphysema, and asthma were associated with reduced spirometry levels. The most notable finding of these analyses was that current smoking (especially for men) was associated with more rapid rates of decline in FVC and FEV1. African-Americans (especially women) had slower rates of decline in FEV1 than did whites. Although participants with current asthma had a mean 0.5 L lower FEV1 at their baseline examination, they did not subsequently experience more rapid declines in FEV1.

Expiratory flow limitation and obstruction in the elderly

“…This group included mainly males whose values were not significantly different from those of the healthy group except for FEV1/FVC, which was slightly lower. The present observations suggest that in some people, smoking does not have the predicted deleterious effect on respiratory function [24,26]. However, these males had a higher FEV1 and FVC than the healthy subjects of the same age and height, suggesting that they benefited from higher adult lung volumes than the others.…”

“…The same percentage of healthy people was obtained by ENRIGHT et al [18] in their population using the same criteria. Several studies have attempted to evaluate the decline in FVC and FEV1 with age in elderly cohorts [19][20][21][22][23][24][25][26]. Interestingly, ENRIGHT et al [18] compared their reference equation (Cardiovascular Health Study) with those of four previous studies [19][20][21][22].…”

“…As a high systolic blood pressure has been described as a strong predictor of reduced FEV1 and FVC [18,26,27], attention was focussed on the data of subjects reporting hypertension. The subjects without any symptoms, but reporting hypertension (AsHT), did not show any alteration in FEV1 and EFL in comparison with healthy subjects.…”

Review article: Age related alterations in respiratory function — anesthetic considerations

“…14 Chronic smoking dramatically intensifies these agerelated changes. 15 In healthy elderly subjects from 65 to 85 yr of age, the normal FEV 1 /FVC ratio may be as low as 65% to 55%, and the rule of thumb that 70% represents the lower limit of the normal range for the FEV 1 / FVC ratio is not applicable. 16 Lung function gradually deteriorates with aging even in individuals who attempt to maintain aerobic capacity over the sixth and seventh decades of life.…”

Correlação entre a capacidade vital lenta e o tempo máximo de fonação em idosos

“…The respiratory system undergoes progressive changes due to age [4][5][6] . With aging, the vital capacity (VC) is one of the respiratory variables that can be modified, with a reduction of 40% on average from 20 to 80 years old 4,5 .…”