Changes in lung function in European adults born between 1884 and 1996 and implications for the diagnosis of lung disease: a cross-sectional analysis of ten population-based studies
Year: 2021
Type: article
Study design: Observational Study
Abstract: Background During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements. Methods In our analyses of cross-sectional data from ten European population-based studies, we included individuals aged 20–94 years who were born between 1884 and 1996, regardless of previous respiratory diagnoses or symptoms. FEV 1 , forced vital capacity (FVC), height, weight, and smoking behaviour were measured between 1965 and 2016. We used meta-regression to investigate how FEV 1 and FVC (adjusting for age, study, height, sex, smoking status, smoking pack-years, and weight) and the FEV 1 /FVC ratio (adjusting for age, study, sex, and smoking status) changed with birth year. Using estimates from these models, we graphically explored how mean lung function values would be expected to progressively deviate from predicted values. To substantiate our findings, we used linear regression to investigate how the FEV 1 and FVC values predicted by 32 reference equations published between 1961 and 2015 changed with estimated birth year. Findings Across the ten included studies, we included 243 465 European participants (mean age 51·4 years, 95% CI 51·4–51·5) in our analysis, of whom 136 275 (56·0%) were female and 107 190 (44·0%) were male. After full adjustment, FEV 1 increased by 4·8 mL/birth year (95% CI 2·6–7·0; p<0·0001) and FVC increased by 8·8 mL/birth year (5·7–12·0; p<0·0001). Birth year-related increases in the FEV 1 and FVC values predicted by published reference equations corroborated these findings. This height-independent increase in FEV 1 and FVC across the last century will have caused mean population values to progressively exceed previously predicted values. However, the population mean adjusted FEV 1 /FVC ratio decreased by 0·11 per 100 birth years (95% CI 0·09–0·14; p<0·0001). Interpretation If current diagnostic criteria remain unchanged, the identified shifts in European values will allow the easier fulfilment of diagnostic criteria for lung diseases such as chronic obstructive pulmonary disease, but the systematic underestimation of lung disease severity. Funding The European Respiratory Society, AstraZeneca, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, and Sanofi-Genzyme.
Source: The Lancet Respiratory Medicine
Authors: James P Allinson, Shoaib Afzal, Yunus Çolak, Debbie Jarvis, Helena Backman, Maarten van den Berge, H Marike Boezen, Marie-Kathrin Breyer, Robab Breyer-Kohansal, Guy Brusselle, Otto C Burghuber, Rosa Faner, Sylvia Hartl, Lies Lahousse, Arnulf Langhammer, Bo Lundbäck, Bright I Nwaru, Eva Rönmark, Sigrid A Aalberg Vikjord, Judith M Vonk, Sara R A Wijnant, Peter Lange, Børge G Nordestgaard, Nuria Olvera, Alvar Agusti, Gavin C Donaldson, Jadwiga A Wedzicha, Jørgen Vestbo, Lowie E G W Vanfleteren
Institutions: Royal Brompton Hospital, Imperial College London, University of Copenhagen, Herlev Hospital, Copenhagen University Hospital, Gentofte Hospital, Umeå University, University Medical Center Groningen, University of Groningen, Ludwig Boltzmann Institute for Lung Health, Ghent University Hospital, Erasmus MC, Sigmund Freud Privatuniversität Wien, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Ghent University, Norwegian University of Science and Technology, Levanger Hospital, Helse Nord-Trøndelag HF, University of Gothenburg, Wallenberg Centre for Molecular and Translational Medicine, Hospital Clínic de Barcelona, Universitat de Barcelona, Manchester Academic Health Science Centre, University of Manchester, Sahlgrenska University Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,000
OpenAlex ID: W3201694934