Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study

Elizabeth C. Oelsner, Pallavi P. Balte, Surya P. Bhatt, Patricia A. Cassano, David Couper, Aaron R. Folsom, Neal D. Freedman, David R. Jacobs, Ravi Kalhan, Amanda R. Mathew, Richard A. Kronmal, Laura R. Loehr, Stephanie J. London, Anne B. Newman, George T. O'Connor, Joseph E. Schwartz, Lewis J. Smith, Wendy B. White, Sachin Yende

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease. Methods: We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption. Findings: 25 352 participants (ages 17–93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3–20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66–31·37) in sustained never-smokers, 34·97 mL per year (34·36–35·57) in former smokers, and 39·92 mL per year (38·92–40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95% CI 1·24–2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35–10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV1 decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21–9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86–12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00–2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results. Interpretation: Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage. Funding: National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.

Original languageEnglish (US)
Pages (from-to)34-44
Number of pages11
JournalThe Lancet Respiratory Medicine
Volume8
Issue number1
DOIs
StatePublished - Jan 2020

Fingerprint

National Heart, Lung, and Blood Institute (U.S.)
Tobacco Products
Cohort Studies
Lung
Smoking Cessation
Spirometry
Lung Diseases
Smoking
Social Adjustment
United States Environmental Protection Agency
National Institutes of Health (U.S.)
Developed Countries
Young Adult
Population

Cite this

Lung function decline in former smokers and low-intensity current smokers : a secondary data analysis of the NHLBI Pooled Cohorts Study. / Oelsner, Elizabeth C.; Balte, Pallavi P.; Bhatt, Surya P.; Cassano, Patricia A.; Couper, David; Folsom, Aaron R.; Freedman, Neal D.; Jacobs, David R.; Kalhan, Ravi; Mathew, Amanda R.; Kronmal, Richard A.; Loehr, Laura R.; London, Stephanie J.; Newman, Anne B.; O'Connor, George T.; Schwartz, Joseph E.; Smith, Lewis J.; White, Wendy B.; Yende, Sachin.

In: The Lancet Respiratory Medicine, Vol. 8, No. 1, 01.2020, p. 34-44.

Research output: Contribution to journalArticle

Oelsner, EC, Balte, PP, Bhatt, SP, Cassano, PA, Couper, D, Folsom, AR, Freedman, ND, Jacobs, DR, Kalhan, R, Mathew, AR, Kronmal, RA, Loehr, LR, London, SJ, Newman, AB, O'Connor, GT, Schwartz, JE, Smith, LJ, White, WB & Yende, S 2020, 'Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study', The Lancet Respiratory Medicine, vol. 8, no. 1, pp. 34-44. https://doi.org/10.1016/S2213-2600(19)30276-0
Oelsner, Elizabeth C. ; Balte, Pallavi P. ; Bhatt, Surya P. ; Cassano, Patricia A. ; Couper, David ; Folsom, Aaron R. ; Freedman, Neal D. ; Jacobs, David R. ; Kalhan, Ravi ; Mathew, Amanda R. ; Kronmal, Richard A. ; Loehr, Laura R. ; London, Stephanie J. ; Newman, Anne B. ; O'Connor, George T. ; Schwartz, Joseph E. ; Smith, Lewis J. ; White, Wendy B. ; Yende, Sachin. / Lung function decline in former smokers and low-intensity current smokers : a secondary data analysis of the NHLBI Pooled Cohorts Study. In: The Lancet Respiratory Medicine. 2020 ; Vol. 8, No. 1. pp. 34-44.
@article{78f931d2a291416399e90e318aa9e492,
title = "Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study",
abstract = "Background: Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease. Methods: We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption. Findings: 25 352 participants (ages 17–93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3–20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95{\%} CI 30·66–31·37) in sustained never-smokers, 34·97 mL per year (34·36–35·57) in former smokers, and 39·92 mL per year (38·92–40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95{\%} CI 1·24–2·40) compared to never-smokers, which was approximately 20{\%} of the effect estimate for current smokers (9·21 mL per year; 95{\%} CI 8·35–10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV1 decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95{\%} CI 6·21–9·09) was 68{\%} of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86–12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00–2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results. Interpretation: Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage. Funding: National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.",
author = "Oelsner, {Elizabeth C.} and Balte, {Pallavi P.} and Bhatt, {Surya P.} and Cassano, {Patricia A.} and David Couper and Folsom, {Aaron R.} and Freedman, {Neal D.} and Jacobs, {David R.} and Ravi Kalhan and Mathew, {Amanda R.} and Kronmal, {Richard A.} and Loehr, {Laura R.} and London, {Stephanie J.} and Newman, {Anne B.} and O'Connor, {George T.} and Schwartz, {Joseph E.} and Smith, {Lewis J.} and White, {Wendy B.} and Sachin Yende",
year = "2020",
month = "1",
doi = "10.1016/S2213-2600(19)30276-0",
language = "English (US)",
volume = "8",
pages = "34--44",
journal = "The Lancet Respiratory Medicine",
issn = "2213-2600",
publisher = "Elsevier Limited",
number = "1",

}

TY - JOUR

T1 - Lung function decline in former smokers and low-intensity current smokers

T2 - a secondary data analysis of the NHLBI Pooled Cohorts Study

AU - Oelsner, Elizabeth C.

AU - Balte, Pallavi P.

AU - Bhatt, Surya P.

AU - Cassano, Patricia A.

AU - Couper, David

AU - Folsom, Aaron R.

AU - Freedman, Neal D.

AU - Jacobs, David R.

AU - Kalhan, Ravi

AU - Mathew, Amanda R.

AU - Kronmal, Richard A.

AU - Loehr, Laura R.

AU - London, Stephanie J.

AU - Newman, Anne B.

AU - O'Connor, George T.

AU - Schwartz, Joseph E.

AU - Smith, Lewis J.

AU - White, Wendy B.

AU - Yende, Sachin

PY - 2020/1

Y1 - 2020/1

N2 - Background: Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease. Methods: We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption. Findings: 25 352 participants (ages 17–93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3–20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66–31·37) in sustained never-smokers, 34·97 mL per year (34·36–35·57) in former smokers, and 39·92 mL per year (38·92–40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95% CI 1·24–2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35–10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV1 decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21–9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86–12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00–2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results. Interpretation: Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage. Funding: National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.

AB - Background: Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease. Methods: We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption. Findings: 25 352 participants (ages 17–93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3–20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66–31·37) in sustained never-smokers, 34·97 mL per year (34·36–35·57) in former smokers, and 39·92 mL per year (38·92–40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95% CI 1·24–2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35–10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV1 decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21–9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86–12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00–2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results. Interpretation: Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage. Funding: National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.

UR - http://www.scopus.com/inward/record.url?scp=85076534988&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076534988&partnerID=8YFLogxK

U2 - 10.1016/S2213-2600(19)30276-0

DO - 10.1016/S2213-2600(19)30276-0

M3 - Article

C2 - 31606435

AN - SCOPUS:85076534988

VL - 8

SP - 34

EP - 44

JO - The Lancet Respiratory Medicine

JF - The Lancet Respiratory Medicine

SN - 2213-2600

IS - 1

ER -