Chest
Volume 126, Issue 6, December 2004, Pages 1875-1882
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Clinical Investigations
PULMONARY FUNCTION TRAITS
A Single Measure of FEV1 Is Associated With Risk of Asthma Attacks in Long-term Follow-up

https://doi.org/10.1378/chest.126.6.1875Get rights and content

Background:

Clinical practice guidelines for asthma care emphasize the use of objective measures of asthma severity, and yet little data exist on the relationship between FEV1 and asthma outcomes over long-term follow-up.

Methods:

We explored the association between measures of FEV1 percentage of predicted (FEV1% predicted) and subsequent asthma attacks over 3-year intervals. Subjects were identified from two longitudinal cohort studies conducted in the United States and the Netherlands. Persons were included in the analysis if they reported ever having an attack of wheezing with associated shortness of breath prior to or during the follow-up period

Results:

Over the course of longitudinal follow-up at 3-year intervals, 195 subjects in the Netherlands cohort contributed 510 observations, and 698 subjects in the US cohort contributed 1,268 observations (for each observation, the report of an attack since their last visit was paired with the subject’s FEV1 recorded 3 years prior). Overall, subjects in the Netherlands cohort experienced 114 attacks (22% of the observations) and subjects in the US cohort had 517 attacks (40.6% of the observations). FEV1% predicted was significantly associated with risk of an asthma attack over the 3 years following its measurement. After adjusting for current smoking and gender, FEV1% predicted remained an independent predictor of subsequent asthma attacks.

Conclusions:

These findings support the use of spirometry as an objective measure of asthma severity and risk of adverse outcomes.

Section snippets

Populations

We analyzed data from two large population-based cohorts, details of which have been published elsewhere.11121314 The Netherlands cohort, a longitudinal study of host factors and environmental determinants of chronic obstructive lung disease, was initiated in 1965 with a random sample of residents in Vlagtwedde and Vlaardingen, the Netherlands. From this sample, those aged (at the time of the 1965 study) 40 to 44 years from Vlagtwedde and 40 to 54 years from Vlaardingen were combined with a

Results

The original Netherlands and US cohorts included 4,692 subjects and 8,842 subjects, respectively. The current analysis was limited to the 195 subjects in the Netherlands cohort and the 698 subjects in the US cohort who reported an “asthma attack” (one or more attacks of wheezing and shortness of breath), at some time during the follow-up and who had a cumulative smoking history of ≤ 10 pack-years.

Table 1shows baseline characteristics of the individual subjects included in the current analysis.

Discussion

The NAEPP has endorsed the use of objective measures of lung function to assign a severity rating to patients with asthma.2 The purpose of such a severity rating is to guide asthma therapy, and the major assumption underlying it is that different categories of FEV1% predicted suggest different risks of adverse disease outcomes. Despite its intuitive appeal, little data exist in the literature to support this assumption. Our study suggests that in two separate cohorts, a single measure of FEV1

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    Funding was provided by AstraZeneca Pharmaceuticals, 1-K08 HL03919–01; and National Heart, Lung and Blood Institute, National Institutes of Health grant HL027427.

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