Respiratory symptoms in young adults and future lung disease the cardia lung study

Ravi Kalhan, Mark T. Dransfield, Laura A. Colangelo, Michael J. Cuttica, David R. Jacobs, Bharat Thyagarajan, Raul San Jose Estepar, Rola Harmouche, Jorge Onieva Onieva, Samuel Y. Ash, Yuka Okajima, Carlos Iribarren, Stephen Sidney, Cora E. Lewis, David M. Mannino, Kiang Liu, Lewis J. Smith, George R. Washko

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49 Scopus citations


Rationale: There are limited data on factors in young adulthood that predict future lung disease. Objectives: To determine the relationship between respiratory symptoms, loss of lung health, and incident respiratory disease in a population-based study of young adults. Methods:Weexamined prospective data from2,749 participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who completed respiratory symptom questionnaires at baseline and 2 years later and repeated spirometry measurements over 30 years. Measurements and Main Results: Cough or phlegm, episodes of bronchitis, wheeze, shortness of breath, and chest illnesses at both baseline and Year 2 were the main predictor variables in models assessing decline in FEV1 and FVC from Year 5 to Year 30, incident obstructive and restrictive lung physiology, and visual emphysema on thoracic computed tomography scan. After adjustment for covariates, including body mass index, asthma, and smoking, report of any symptom was associated with22.71 ml/yr excess decline in FEV1 (P, 0.001) and22.18 in FVC (P,0.001) aswell as greater odds of incident (prebronchodilator) obstructive (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.24-2.14) and restrictive (OR, 1.40; 95% CI, 1.09-1.80) physiology. Cough-related symptoms (OR, 1.56; 95% CI, 1.13-2.16) were associated with greater odds of future emphysema. Conclusions: Persistent respiratory symptoms in young adults are associated with accelerated decline in lung function, incident obstructive and restrictive physiology, and greater odds of future radiographic emphysema.

Original languageEnglish (US)
Pages (from-to)1616-1624
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Issue number12
StatePublished - Jun 15 2018

Bibliographical note

Funding Information:
University of Alabama at Birmingham, grants HHSN268201300025C and HHSN268201300026C

Funding Information:
The CARDIA (Coronary Artery Risk Development in Young Adults) study is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham, grants HHSN268201300025C and HHSN268201300026C, Northwestern University grant HHSN268201300027C, University of Minnesota grant HHSN268201300028C, Kaiser Foundation Research Institute grant HHSN268201300029C, and Johns Hopkins University School of Medicine grant HHSN268200900041C. CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging and an intra-agency agreement between the National Institute on Aging and NHLBI, grant AG0005. Additional funding was provided by NHLBI grant R01 HL122477 (CARDIA Lung Study). This manuscript has been reviewed by CARDIA for scientific content.

Publisher Copyright:
Copyright © 2018 by the American Thoracic Society.


  • Chronic obstructive pulmonary disease
  • Respiratory epidemiology
  • Respiratory function tests
  • Respiratory symptoms


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