Analysis of FEV₁ Decline in Relatively Healthy Heavy Smokers: Implications of Expressing Changes in FEV₁ in Relative Terms

Abstract

Progressive decline in lung function has been widely accepted as the hallmark of chronic obstructive pulmonary disease (COPD); however, recent evidence indicates that the rate of decline measured as decline in forced expiratory volume in one second (FEV₁) is higher in mild to moderate COPD than in severe COPD. Usually changes in FEV₁ are measured in ml that is “absolute”; however, changes can also be measured “relative” as a percentage of the actual FEV₁. We hypothesize that relative measurements could be more appropriate than absolute measurements for describing changes in lung function. We analyzed data from 3,218 relatively healthy heavy smokers who participated in the Danish Lung Cancer Screening Trial. The influences of age, sex, height, body mass index, smoking, and severity of airflow limitation on FEV₁ were analyzed in mixed effects models. In absolute terms those with the best lung function consistently showed the steepest decline, whereas in relative terms most fast decliners are found among those with low lung function. Measuring changes in relative terms implied statistically significant acceleration of decline with advancing age, smoking (pack-years) and severity of airflow limitation. Relative measurements may lead to a better understanding of changes in lung function. Smoking and severity of airflow limitation speed up the loss of lung function, and this emphasizes the importance of abstaining from smoking the sooner the better. Measuring changes in relative terms could have important implications for the interpretation of results from clinical trials where FEV₁ is the primary outcome. DLCST; www.ClinicalTrials.org, registration number: NCT00496977.

Keywords :

• Lung function tests
• smoking
• epidemiology (pulmonary)
• relatively healthy heavy smokers

Acknowledgments

The authors thank the investigators, staff, and participants of the Danish Lung Cancer Screening Trial for their ­valuable contributions.