Adult Life-Course Trajectories of Lung Function and the Development of Emphysema: The CARDIA Lung Study

George R. Washko, Laura A. Colangelo, Raul San José Estépar, Samuel Y. Ash, Surya P. Bhatt, Yuka Okajima, Kiang Liu, David R. Jacobs, Carlos Iribarren, Bharat Thyagarajan, Cora E. Lewis, Rajesh Kumar, Mei Lan K. Han, Mark T. Dransfield, Mercedes R. Carnethon, Ravi Kalhan

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory comorbid conditions. Associations between lung function trajectories and emphysema have not been explored. Methods: Using data from the population-based CARDIA Study, we sought to describe the prevalence of visually ascertained emphysema at multiple time points and contextualize its development based upon participant's adult life course measures of lung function. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. Trajectories for the change in percent-predicted forced expiratory volume in one second (FEV1) were determined by fitting a mixture model via maximum likelihood. Emphysema was visually identified on computed tomographic scans and its prevalence reported at mean ages of 40, 45, and 50 years. Results: We identified 5 trajectories describing peak and change in FEV1: “Preserved Ideal,” “Preserved Good,” “Preserved Impaired,” “Worsening,” and “Persistently Poor.” Ever smokers comprised part of all 5 trajectories. The prevalence of emphysema was 1.7% (n = 46; mean age of 40 years), 2.5% (n = 67; mean age of 45 years), and 7.1% (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 18.0% were never smokers. Worsening and poor lung health trajectories were associated with increased odds of future emphysema independent of chronic tobacco smoke exposure (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44). Conclusions: Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.

Original languageEnglish (US)
Pages (from-to)222-230.e11
JournalAmerican Journal of Medicine
Issue number2
StatePublished - Feb 2020

Bibliographical note

Funding Information:
Funding: The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201300025C & HHSN268201300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute(HHSN268201300029C), and Johns Hopkins University School of Medicine (HHSN268200900041C). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005). Additional funding was provided by NHLBI R01 HL122477 (CARDIA Lung Study). This manuscript has been reviewed by CARDIA for scientific content. Conflict of Interest: GRW receives grant funding through the National Institutes of Health, Boehringer Ingelheim, BTG Interventional Medicine, and Janssen Pharmaceuticals; he has consultancies with Boehringer Ingelheim, GlaxoSmithKline, Janssen Pharmaceuticals, and PulmonX; he is a founder and co-owner of a data analytics company called Quantitative Imaging Solutions. RSJE reports grants from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study; grants from NHLBI, personal fees from Toshiba, personal fees from Boehringer Ingelheim, personal fees from Eolo Medical, outside the submitted work; and he is also a founder and co-owner of Quantitative Imaging Solutions, a company that provides image-based consulting and develops software to enable data sharing. CEL is a recipient of funding paid to her institution from the NIH for the CARDIA parent study and the CARDIA lung study. MKH has consulted for Glaxo Smith Kline, AstraZeneca, Mylan, and Boehringer Ingelheim on the topic of chronic obstructive pulmonary disease (COPD), and has received research support from Novartis and Sunovion, also related to COPD. MTD reports grant support from the American Lung Association, Department of Defense, Department of Veterans Affairs, and the National Institutes of Health; he has received consulting payments from AstraZeneca, GlaxoSmithKline, Mereo, PneumoRx/BTG, and Quark; and contracted clinical trial support from AstraZeneca, Gala, GlaxoSmithKline, Mereo, PneumoRx/BTG, Pulmonx, and Yungjin. RK has received grants and personal fees from Boehringer Ingelheim, grants from PneumRx (BTG), grants from Spiration, grants and personal fees from AstraZeneca, personal fees from CVS Caremark, personal fees from Aptus Health, grants and personal fees from GlaxoSmithKline, personal fees from Boston Scientific, and personal fees from Boston Consulting Group; all of these potential conflicts of interest fall outside the scope of the submitted work. All other authors report no conflicts of interest relevant to this manuscript.

Publisher Copyright:
© 2019


  • Emphysema risk
  • Lung function trajectory


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