Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program.

Chronic obstructive pulmonary disease (COPD) is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients > or = 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry-office spirometry--for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Office spirometry for lung health assessment in adults: A consensus statement from the National Lung Health Education Program.

COPD is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients >/= 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry-office spirometry-for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Familial resemblance for hostility: the National Heart, Lung, and Blood Institute Family Heart Study.

OBJECTIVE: The purpose of this study was to examine whether several aspects of hostility as measured by the Cook-Medley Hostility Scale (ie, aggressive responding, hostile affect, cynicism, and overall hostility score) were determined in part by family factors (ie, genes and/or familial environments). METHODS: Analyses were based on 680 European-American families (2525 individuals) from the NHLBI Family Heart Study (FHS), a population-based study of genetic and nongenetic determinants of CHD, atherosclerosis, and cardiovascular risk factors. The influence of family relationships, age, and education on the variation in each of the four hostility scores were estimated. RESULTS: Significant familial resemblance in all hostility scores was found, accounting for 42% of the variance in total hostility, 30% in cynicism, 38% in aggressive responding, and 18% in hostile affect. Very little of this resemblance could be explained by similarities in education. Familial resemblance for cynicism was solely due to significant parent-offspring and sibling correlations (ie, no spouse resemblance), suggesting the possibility of genetic influences. Gender and generation differences were also evident in the familial correlations. CONCLUSIONS: Hostility aggregates in families. Both family environmental and genetic sources of resemblance are suggested for hostility.

Obesity and coronary heart disease.

Obesity carries a penalty of an associated adverse cardiovascular risk profile. Largely as a consequence of this, it is associated with an excess occurrence of cardiovascular disease morbidity and mortality. It is concluded on the basis of data from the Framingham study and other large prospective studies that the rate of development of cardiovascular disease rises rapidly in relation to even modest amounts of adiposity. The abdominal pattern of adiposity, and specifically visceral adiposity, appears to be the most hazardous. First identified as a cause of glucose intolerance, abdominal adiposity has been identified as promoting insulin resistance, hypertension and dyslipidemia, as well as CHD. While the impact of epidemic obesity on the health of white Americans is becoming more fully understood, there are important gaps in the knowledge about the nature of influence of adiposity on CHD in large subgroups of the population. The dearth of detailed and long term prospective studies of African-Americans is the most conspicuous shortcoming of the research base. Finally, because there is a great potential benefit of remaining lean or achieving a sustained weight loss when indicated, and given the high prevalence of obesity, research on adiposity prevention and more effective weight reduction methodology are urgently needed.

Does dietary vitamin A protect against airway obstruction? The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

A recent report based on data from the first National Health and Nutrition Examination Survey suggested that low intake of vitamin A may be associated with a greater risk of airway obstruction. We attempted to replicate these findings in a population-based sample of middle-aged adults (n = 15,743) who participated in the baseline examination of the Atherosclerosis Risk in Communities (ARIC) Study. Vitamin A intake was estimated from a 66-item food frequency questionnaire, and the presence of airway obstruction was determined by spirometry. Although airway obstruction was associated in ARIC with well-established risk factors such as age, sex, and smoking, there was little evidence for a role of vitamin A. With only one exception, vitamin A intake was unrelated to airway obstruction in all smoking categories using either categorical or continuous measures of lung function (FEV1, FVC, FEV1/FVC). Only among current smokers in the upper tertile of lifetime cigarette smoking (> 41 pack-years) was the odds ratio of having airway obstruction for the lowest quartile of vitamin A intake compared with the highest quartile elevated (1.7 [95% confidence interval 1.1 to 2.7]). Despite some biological plausibility that vitamin A intake may prevent obstructive lung disease, the inability to demonstrate association in a larger population study, with better estimation of usual dietary intake, casts doubt on the existence of causal relationship.

Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study.

Spirometry was performed by 5,201 elderly participants of the Cardiovascular Health Study during their baseline examination and a subset of the ATS/DLD-78 respiratory questionnaire was administered by trained interviewers. In never smokers (46 percent of the cohort), the overall prevalence of chronic cough was 9 percent, chronic phlegm was 13 percent, attacks of wheezing with dyspnea were 8 percent, and grade 3 dyspnea on exertion was 10 percent. The prevalence of lung disease in current smokers (12 percent of the cohort) was 8/7 percent (men/women) with chronic bronchitis and 14/5 percent with emphysema. Overall, 6 percent reported asthma (a physician-confirmed history) and 12 percent reported hay fever. Using a logistic regression model, attacks of wheezing with dyspnea were strongly associated with a lower FEV1, coronary heart disease, heart failure, and a large waist size (in participants without a diagnosis of asthma, chronic bronchitis, or emphysema). Undiagnosed airways obstruction was twice as likely in women and those with lower income, and was associated with current and former smoking, pack-years of smoking, and chronic cough. Dyspnea on exertion (DOE) was three times or more likely if a participant reported heart failure, coronary heart disease, or emphysema; and much more likely if their FEV1 or FVC was substantially reduced. Dyspnea on exertion was also positively associated with older age, chronic bronchitis or asthma, a larger waist or hip size, pack-years of smoking, and less education. We conclude that DOE and attacks of wheezing with dyspnea are commonly associated with cardiovascular disease and a low FEV1 in those over 65 years and that airways obstruction frequently remains undiagnosed in the elderly.

Dietary n-3 polyunsaturated fatty acids and smoking-related chronic obstructive pulmonary disease. Atherosclerosis Risk in Communities Study Investigators.

BACKGROUND: Fish contain n-3 polyunsaturated fatty acids, principally eicosapentaenoic acid and docosahexaenoic acid, which are known to interfere with the body's inflammatory response and may be of benefit in chronic inflammatory conditions. METHODS: We studied the relation between the dietary intake of n-3 fatty acids and chronic obstructive pulmonary disease (COPD) in 8960 current or former smokers participating in a population-based study of atherosclerosis. Intake of fatty acids was estimated with a dietary questionnaire. The presence of COPD was assessed by a questionnaire on respiratory symptoms and by spirometry. Three case definitions of COPD were used: symptoms of chronic bronchitis (667 subjects), physician-diagnosed emphysema reported by the subject (185 subjects), and spirometrically detected COPD (197 subjects). RESULTS: After control for pack-years of smoking, age, sex, race, height, weight, energy intake, and educational level, the combined intake of eicosapentaenoic acid and docosahexaenoic acid was inversely related to the risk of COPD in a quantity-dependent fashion. The adjusted odds ratio for the highest quartile of intake as compared with the lowest quartile was 0.66 for chronic bronchitis (95 percent confidence interval, 0.52 to 0.85; P < 0.001 for linear trend across the range of intake values), 0.31 for physician-diagnosed emphysema (95 percent confidence interval, 0.18 to 0.52; P for linear trend, 0.003), and 0.50 for spirometrically detected COPD (95 percent confidence interval, 0.32 to 0.79; P for linear trend, 0.007). CONCLUSIONS: A high dietary intake of n-3 fatty acids may protect cigarette smokers against COPD.

Smoking and lung function in elderly men and women. The Cardiovascular Health Study.

OBJECTIVE: To investigate relationships between cigarette smoking and pulmonary function in elderly men and women. DESIGN: Cross-sectional analysis of baseline data from a prospective, population-based study of risk factors, preclinical, and overt cardiovascular and pulmonary disease. SETTING: Defined communities in Forsyth County, North Carolina; Pittsburgh, Pa; Sacramento County, California; and Washington County, Maryland. POPULATION: A total of 5201 noninstitutionalized men and women 65 years of age and older. MAIN OUTCOME MEASURES: Pulmonary function; means of forced expiratory volume in 1 second (FEV1) and forced vital capacity and prevalence of low FEV1 levels. RESULTS: Prevalence of cigarette smoking was 10% to 20% and higher in women than men and in blacks than whites. Forced vital capacity and FEV1 levels were related positively to height and white race and negatively to age and waist girth. Age- and height-adjusted FEV1 means were 23% and 18% lower in male and female current smokers, respectively, than in never smokers but not reduced in never smokers currently living with a smoker. Smokers who quit before age 40 years had FEV1 levels similar to never smokers, but FEV1 levels were lower by 7% and 14% in smokers who quit at ages 40 to 60 years and older than 60 years, respectively. Lung function was related inversely to pack-years of cigarette use. Prevalence rates of impaired lung function were highest in current smokers and lowest in never smokers. Regression coefficients for the smoking variables were smaller in persons without cardiovascular or respiratory conditions than in the total cohort. CONCLUSIONS: Cigarette smoking is associated with reduced pulmonary function in elderly men and women. However, smokers who quit, even after age 60 years, have better pulmonary function than continuing smokers.

NHLBI workshop summary. Research needs and opportunities related to respiratory health of women.

To summarize, the overwhelming conclusion of the participants was that relatively little is known about respiratory health and disease in women. Much work will be required to obtain even the most basic information upon which hypotheses for future research can be developed and to determine whether pulmonary biology differs between men and women and between women of various ages. The many recommendations and suggestions generated at the workshop should serve to underscore the unique opportunities for research in the field of respiratory health of women.

Comparison of respiratory symptoms and pulmonary function between two communities; Tecumseh (US) and Bordeaux (France).

Respiratory symptoms, pulmonary function and smoking habits in two adult populations, aged 20-59 years, are compared in Tecumseh (Michigan) and Bordeaux (France). Personal, demographic, and medical characteristics were ascertained by self-administered questionnaires; Forced vital capacity and Forced expiratory volume in one second (FEV1) were measured. In Tecumseh, the proportion of smokers was higher, people started to smoke earlier and the number of cigarettes per day was higher, the differences were significant. The prevalences of respiratory symptoms tended to be higher in Tecumseh than in Bordeaux although the differences did not reach statistical significance. The age-adjusted odds ratios according to smoking and socio-economic status for respiratory conditions, or relating FEV1 less than 80% predicted did not differ significantly but tended to be greater in Tecumseh. These trends might suggest a greater morbidity and/or a greater impact of risk factors in Tecumseh.

Health and other characteristics of employed women and homemakers in Tecumseh, 1959-1978. II. Prevalence of respiratory and cardiovascular symptoms and illnesses, mortality rates and physical and physiological measurements.

Using data collected in 1959-60 and 1978-79 in the Tecumseh Community Health Study, characteristics of 866 women aged 20-44 years at baseline were analyzed according to employment status, at baseline and follow-up (employed/employed, homemaker/employed, employed/homemaker, and homemaker/homemaker). To avoid the bias of including unhealthy women with homemakers, disabled and retired women were excluded. There were few significant differences in health among the groups. Prevalence rates of respiratory conditions were slightly higher at follow-up for women employed at both exams, while prevalence rates of cardiovascular conditions were slightly higher for homemakers at follow-up. The rate of reporting heart attacks was significantly higher for homemakers at both exams, although rates of diagnosed coronary heart disease were similar among employment groups.

Health and other characteristics of employed women and homemakers in Tecumseh, 1959-1978. I. Demographic characteristics, smoking habits, alcohol consumption, and pregnancy outcomes and conditions.

Using data collected in 1959-60 and 1978-79 in the Tecumseh Community Health Study, characteristics of 866 women aged 20-44 years at baseline were analyzed according to employment status at baseline and follow-up (employed/employed, homemaker/employed, employed/homemaker and homemaker/homemaker). To avoid the bias of including unhealthy women with homemakers, disabled and retired women were excluded. Women employed at both exams more frequently reported current alcohol consumption than other women, and the association persisted after controlling for covariables. Smoking habits, rates of reported pregnancy outcomes and conditions, and rates of gynecological problems did not differ significantly among employment groups.

Mortality from chronic obstructive pulmonary diseases and asthma in France, 1969-1983. Comparisons with the United States and Canada.

This article focuses on international similarities and differences in levels and trends of mortality for chronic obstructive pulmonary disease (COPD) and asthma in the US, Canada and France from 1969 to 1983. Comparisons have been made of national vital statistics data for age groups 55-64 years, 65-74 years and 75-84 years. From 1969 to 1978, under the 8th revision of the International Classification of Diseases (ICD), the COPD and asthma category included the codes 490-493 and, for the US and Canada, a special code 519.3. From 1979, under the 9th revision, COPD and asthma codes 490-493, 496 were in use in all three countries. The analyses of US, Canadian and French data show lower death rates for COPD and asthma in France. The ratio of male to female deaths from COPD increased with age in the US and Canada, but not in France. The proportion of COPD and asthma deaths attributed to bronchitis was higher in France. An increased use of code 496 (under 9th revision) was observed in the US and above all in Canada. In the three countries, death rates increased faster between 1979 and 1983 in women than in men and increases in women were steeper in the US and Canada than in France. Intercountry comparability is better for COPD mortality in the 9th revision than the 8th revision. Some differences observed between the three countries can be partly explained by coding practices and ICD revisions, but, allowing for differences in coding and classifying respiratory causes of death as well as ICD revisions, death rates are obviously higher in the US and Canada than in France. This suggests that the difference is real.

Trends in COPD morbidity and mortality in Tecumseh, Michigan.

Trends in COPD morbidity and mortality were investigated among the population of Tecumseh, Michigan, for the period 1959 to 1987. COPD was mentioned on the death certificates of 11% (102) of deceased men and 13% (24) of deceased women. Forty-one percent of these deaths was attributed to COPD as the underlying cause and the remainder to COPD as a contributory cause. Usage of diagnostic terms changed during the course of the study; emphysema was mentioned on 81% of certificates completed prior to 1968, whereas COPD was entered on 77% of the certificates written after 1978. Proportional mortality rates of COPD increased from 8% during 1959 to 1967 to 13.3% during 1979 to 1987 among men, and from 2.7% during the earlier years to 4.3% during the later years among women. Death rates for COPD and for all causes combined increased among men from the early 1960s to the late 1970s, then declined. Death rates for all causes combined were stable among women, but COPD death rates may have increased. Prevalence rates for chronic bronchitis were lower at the third examination than at the second in both sexes. Prevalence of obstructive airway disease was highest at the first and lower at the second and third examinations in men but not in women. Agreement between study diagnoses of COPD and entry of COPD on death certificates was poor. COPD was recorded on the death certificate for only 21% of men and only 6% of women who had COPD diagnosed at a study examination.(ABSTRACT TRUNCATED AT 250 WORDS)