Decline of FEV1 by age and smoking status: facts, figures, and fallacies.
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Adult↗
Biomedical subjects
B Rijcken
Publications and source records attributed to B Rijcken.
Lack of correlation between bronchoconstrictor response and bronchodilator response in a population-based study.
Bronchodilator and bronchoconstrictor responsiveness have been considered physiological opposites in patients with obstructive airways disease. Provocation challenges have been replaced by bronchodilator tests in the assessment of cases of severe airways obstruction. The aim of this study was to examine the relationship between bronchoconstrictor and bronchodilator responsiveness, and their supposed interchangeability, in a general population. From the Vlagtwedde-Vlaardingen follow-up study, 101 adults were recruited (mean (SD) age 55 (11) yrs, 67 males and 34 females, and 31 were smokers). All completed a questionnaire on airways symptoms. Bronchoconstrictor and bronchodilator responsiveness were assessed with cumulative dose-response curves, using histamine and terbutaline, respectively. Thus, it was possible to relate histamine sensitivity of the airways (the concentration of histamine, at which forced expiratory volume in one second (FEV1) falls by 10% (PC10)) to the maximal bronchodilator response (delta FEV1) and the sensitivity to the bronchodilator (cumulative dose of inhaled terbutaline at which FEV1 increases by 10% (RD10)). Subjects with a bronchoconstrictor response (PC10 < or = 16 mg x mL(-1); n=38) had more respiratory symptoms than those without (n=63) (40 versus 21%) and also lower baseline FEV1 values (90 versus 96% predicted), but had comparable bronchodilator responsiveness. Subjects with a bronchodilator response (delta FEV1 > or = 9% of the predicted value; n=13) did not differ from those without (n=88) for all parameters, including symptoms, allergy and pulmonary function. In those with a bronchoconstrictor response, there was a weak but significant correlation between the PC10 and RD10 (rho=-0.32), but not between PC10 and delta FEV1. This study suggests that bronchoconstrictor and bronchodilator responsiveness are not highly correlated, even in subjects with airways obstruction. Symptoms were associated with the presence of a bronchoconstrictor, but not a bronchodilator, response. We conclude that bronchoconstrictor and bronchodilator responsiveness are two different phenotypic markers that are not interchangeable in epidemiological studies.
Administration, Inhalation↗
ERS/ATS workshop on longitudinal analysis of pulmonary function data, Barcelona, September 1995.
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Air Pollution↗
Association of skin test reactivity, specific IgE, total IgE, and eosinophils with nasal symptoms in a community-based population study. The Dutch ECRHS Group.
BACKGROUND: Skin prick tests and measurement of specific IgE are important markers of the possible causes of disorders of the upper respiratory tract. OBJECTIVE: In this study we investigated the association of skin test reactivity and specific IgE positivity to five common aeroallergens separately and of total serum IgE and eosinophil count with nasal allergy symptoms in a random sample of the adult population in the Netherlands. METHODS: A cross-sectional study was carried out in a sample of 2167 subjects, aged 20 to 70 years, stratified by age and gender. Nasal allergy symptoms were differentiated into three categories: symptoms after exposure to indoor allergens only, symptoms after exposure to outdoor allergens only, and symptoms after exposure to both indoor and outdoor allergens. Associations were investigated by multiple logistic regression analyses with adjustment for area of residence, gender, age, and smoking status. RESULTS: Skin test and specific IgE reactivity to indoor and outdoor allergens were significantly related to their corresponding nasal symptom groups. Odd ratios increased with increasing number of positive skin test results or increasing levels of specific IgE to allergens in all three nasal symptom groups. For each allergen, a positive skin test result together with a positive specific IgE measurement were the strongest predictors of nasal symptoms. Sensitization to house dust mite was the most prevalent in our study population, whereas the association of skin test reactivity and specific IgE positivity with nasal symptoms was strongest for cat allergen. Skin test and specific IgE reactivity to Cladosporium species were not significantly related to the prevalence of nasal symptoms. Total serum IgE was related to nasal symptoms only in subjects who reported symptoms in response to both indoor and outdoor allergens and only at high levels of IgE. Eosinophil count was associated with nasal symptoms in all nasal symptom groups. CONCLUSION: Our findings confirm the close relationship of skin test positivity with reported symptoms of nasal allergy in a general population. Specific IgE positivity also shows a close relationship with nasal symptoms in response to allergen exposure in a general population. Skin testing and specific IgE measurement may be considered complementary to one another in diagnosing allergic rhinitis. Total IgE may be considered an indicator of greater dysregulation of the immune system in atopic allergy. Eosinophil count is associated with nasal symptoms, regardless of type and extent of nasal symptoms.
Adult↗
Distribution of total serum IgE and specific IgE to common aeroallergens by sex and age, and their relationship to each other in a random sample of the Dutch general population aged 20-70 years. Dutch ECRHS Group, European Community Respiratory Health Study.
To describe the distribution of serum total IgE and specific IgE to common aeroallergens by sex and age and to study their relationship to each other, we measured serum total IgE and specific IgE (CAP) to house-dust mite, timothy grass, cat, birch, and Cladosporium in a random sample of 2496 subjects, aged 20-70 years from the Dutch general population. We found that total IgE was higher in men, independently of smoking, and that total IgE had no relationship with age after adjustment for specific IgE and smoking in linear regression analysis. At least one positive specific IgE test was found in 32% in both sexes. Men had higher prevalences of specific IgE to house-dust mite and lower prevalences of specific IgE to birch than women. The proportion with positive specific IgE decreased with age. The mean total IgE increased with the number of positive specific IgE tests. Thus, total IgE is higher in men and has no relationship with age if specific IgE is taken into account. The prevalences of specific IgE to aeroallergens are high and decrease with increasing age. We suggest that sex differences in total IgE should be considered when using total IgE.
Adult↗
PEF variability, bronchial responsiveness and their relation to allergy markers in a random population (20-70 yr).
We investigated the coherence of bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability in their relation to allergy markers and respiratory symptoms in 399 subjects (20-70 yr). Bronchial hyperresponsiveness to methacholine was defined by both the provocative dose causing a fall in FEV1 of 20%, and the dose-response slope. PEF variability was determined as diurnal PEF variation (amplitude percent mean) and between-day PEF variation. Skin tests positivity, serum total IgE, and specific IgE (RAST) for house-dust mite (HDM), cat, timothy grass, and birch ("pollen") were determined, as well as the number of peripheral blood eosinophils. Wheeze and nocturnal dyspnea were defined as asthma-like symptoms; dyspnea > or = grade 3, cough and phlegm as chronic obstructive pulmonary disease (COPD)-like symptoms. The reciprocal of the dose-response slope and PEF variability were significantly correlated (r = -0.39). Subjects with a positive skin test for HDM (odds ratio [OR] = 3.9), cat (OR = 8.3), or pollen (OR = 3.6), or specific IgE for HDM (OR = 2.3), cat (OR = 3.4), or pollen (OR = 1.9) had increased risk of BHR compared with the reference group (all p values < 0.05). Higher levels of serum total IgE were significantly associated with higher odds for BHR (OR = 2.5 per log unit). There was no significant association between skin test positivity, serum total IgE, or presence of specific IgE and PEF variability. Neither BHR nor PEF variability were associated with higher numbers of peripheral blood eosinophils. There are different associations of BHR and PEF variability with allergy markers. Although BHR and PEF variability are significantly correlated, they cannot be used interchangeably in epidemiologic settings.
Adult↗
Longitudinal analyses of airway responsiveness and pulmonary function decline.
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Adult↗
Evaluation of methacholine dose-response curves by linear and exponential mathematical models: goodness-of-fit and validity of extrapolation.
Several models have been proposed to analyse dose-response curves recorded in bronchoprovocation challenge tests. The aims of the present work were: 1) to investigate which model (linear vs exponential) and which minimization method (trials and errors vs Levenberg-Marquardt) gives better results in terms of data interpolation (goodness-of-fit); and 2) to verify the validity of extrapolation by comparing forced expiratory volume in one second (FEV1) observed after 4 mg methacholine with values extrapolated after truncation of the curves at 2 mg. For these purposes, methacholine dose-response curves were obtained in 832 subjects from a random population sample, as part of the European Community Respiratory Health Survey (ECRHS) in Italy. Methacholine was inhaled up to a maximum dose of 6 mg by dosimeter technique. The coefficient of determination (r2) was significantly higher with the exponential model (0.81 +/- 0.22; mean +/- SD) than with the linear model (0.69 +/- 0.27). With both models, extrapolated values were usually lower than observed values. As a consequence, a 20% fall in FEV1 with respect to postsaline FEV1 was observed in only 24% and 21% of the tests, where a 20% fall had been predicted, respectively, according to the linear and exponential model. In conclusion, exponential models are better than linear models with respect to data interpolation of methacholine dose-response curves. However, they are worse with respect to extrapolation to higher doses. With any model, extrapolation of dose-response curves by one doubling-dose should be avoided.
Adult↗
Age, period, and cohort effects on pulmonary function in a 24-year longitudinal study.
This paper proposes the use of two-factor models (age-period and age-cohort models) to estimate age, period, and cohort effects on pulmonary function by using the data collected in a 24-year longitudinal study in the Netherlands from 1965 to 1990. The analysis included 18,363 pulmonary function measurements on 6,148 subjects aged 20-54 years at the initial visit. The subjects were grouped into four birth cohorts (before 1923, 1923-1934, 1935-1946, and after 1946) and four survey periods (1965-1972, 1973-1978, 1979-1984, and 1985-1990). In the age-cohort model, the decrement in forced expiratory volume in 1 second (FEV1) associated with a yearly increase in age was 28.3 +/- 3.7 ml/year for a man 176 cm tall and 16.0 +/- 1.9 ml/year for a woman 163 cm tall. The estimated acceleration of decline with aging was significant for both men (beta = -0.212; standard error = 0.079 ml) and women (beta = -0.346; standard error = 0.058 ml). Compared with that of the cohort born before 1923, the average level of FEV1 was estimated to increase by 156, 277, and 379 ml, respectively, for the three younger cohorts in men (p = 0.01) and by 133, 213, and 328 ml for the three younger cohorts in women (p < 0.01). In the age-period model, the estimated linear age effect on FEV1 was 36.2 +/- 4.2 ml/year for a man and 30.5 +/- 2.3 ml/year for a woman. The age quadratic term was significant for women, but not for men. Average FEV1 was estimated to be increased by 141, 169, and 250 ml, respectively, for the periods 1973-1978, 1979-1984, and 1985-1990 in men and by 131, 138, and 219 ml in women. These period effects were significant for both men and women. In summary, this study applied the two-factor models to estimate cross-sectional and longitudinal effects of aging on FEV1 and demonstrated significant period and cohort effects, which could be attributed in part to changes in air pollutants, respiratory infections, vaccinations, types of cigarettes, diet, and lifestyles over time.
Age Factors↗
Interstitial cystitis in The Netherlands: prevalence, diagnostic criteria and therapeutic preferences.
PURPOSE: We determine the prevalence of interstitial cystitis in The Netherlands, and analyze the most common diagnostic and therapeutic approaches among Dutch urologists. MATERIALS AND METHODS: A questionnaire was completed by urologists and analyzed with the help of a statistical computer program. RESULTS: The prevalence of interstitial cystitis was calculated to be 8 to 16/100,000 female patients. Pathology of bladder biopsies and the presence of mast cells were the main diagnostic criteria. Dimethyl sulfoxide instillations, bladder hydrodistension and surgery were the most frequently applied therapies. CONCLUSIONS: The prevalence of interstitial cystitis in The Netherlands is in line with that of other reports from Europe but low compared to the United States findings. The importance of pathology and the presence of mast cells in the diagnosis, as well as less awareness might contribute to this difference.
Cystitis, Interstitial↗
Relation between respiratory symptoms, pulmonary function and peak flow variability in adults.
BACKGROUND: A study was carried out to determine whether subjects with respiratory symptoms are more likely to have impaired lung function or increased airway lability, and to quantify these relationships in a population of adults. METHODS: Data were collected from 511 participants (aged 20-70 years) from the Dutch part of the European Community Respiratory Health Survey (ECRHS). The symptoms analysed were: wheeze, dyspnoea > or = grade 3, nocturnal dyspnoea, cough and phlegm, and history of allergy. Lung function was measured by peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1). PEF variability was used as an index for bronchial lability. RESULTS: Both FEV1 and PEF were decreased with increasing numbers of symptoms. Subjects with one symptom had an increased risk of having an FEV1 value of < 70% (OR = 4.2) and this risk increased with an increasing number of symptoms. Subjects with three or more symptoms had an increased risk of having a PEF value of < 70%, a diurnal variation in PEF of > 10% (both OR = 4.4), and an increased risk of high between day variation (OR = 6.6). CONCLUSIONS: Subject-reported symptoms are related to impaired lung function and to increased variability of peak flow.
Adult↗
Airway hyperresponsiveness to histamine associated with accelerated decline in FEV1.
An increased level of airway responsiveness has been proposed as a risk factor associated with the onset and prognosis of chronic airway obstruction. To determine this, longitudinal studies are necessary, with measurement of both the level of airway responsiveness and of additional risk factors, such as cigarette smoking, made before measurement of pulmonary function decline. The association of airways responsiveness with decline in FEV1 has been prospectively studied in a random sample of the Dutch population. Longitudinal data from 921 males, providing 2,376 paired observations, and 698 females, providing 1,682 paired observations, were used for analysis. Differences between responders and nonresponders (PC10 < or = 16 mg/ml of histamine) were estimated from linear regression analyses stratified by gender and smoking status, with adjustment for age, residential area, the presence of respiratory symptoms, indicators for each interval, and residuals of FEV1 at the beginning of the interval. Responders had a greater mean yearly decline in FEV1, and the differences between responders and nonresponders were similar for all gender and smoking subgroups. In an overall regression model, subjects with airway hyperresponsiveness had a significantly steeper decline in FEV1, independent of the other variables (males: beta = -12.5 ml/yr, SEM = 3.22, p < 0.001; females: beta = -11.50 ml/yr, SEM = 2.98, p < 0.001). The current analyses conclusively demonstrated that increased airway responsiveness is an independent risk factor for an accelerated decline in FEV1 and, hence, for the development of chronic obstructive lung disease. The mechanisms by which increased airway responsiveness leads to an accelerated decline in FEV, are imperfectly understood and require further study.
Adolescent↗
Airway hyperresponsiveness in workers exposed to low levels of irritants.
The purpose of this study was to assess the association between occupational exposure to low levels of airway irritants, and airway responsiveness to histamine. In 688 male workers, symptom prevalence was assessed according to the British Medical Research Council (BMRC) questionnaire. All subjects performed a 30 s tidal breathing challenge test. Airway hyperresponsiveness (AHR) was defined as a 20% fall in forced expiratory volume in one second (FEV1) at < or = 32 mg.ml-1 histamine. On the basis of job titles and working department, the exposure status of all workers was characterized into seven groups: 1) reference group; 2) white collars; 3) SO2, HCl, SO4(2-); 4) polyester vapour; 5) oil mist and oil vapour; 6) polyamide and polyester vapour; and 7) multiple exposures. Using multiple logistic regression, no association was found between the exposure groups and a higher prevalence of AHR. A higher prevalence was significantly associated with a low FEV1, a history of allergy, and the presence of chronic respiratory symptoms. Subjects in the SO2 group and the oil mist group with < or = 5 exposure years had a lower prevalence of AHR, probably due to pre-employment selection procedures. There was some trend for subjects with more than 5 yrs exposure to polyester vapour and to oil mist and to oil vapour to have a higher prevalence of AHR. Analyses using the dose-response slope according to O'Connor, revealed similar results and provides no additional information. We conclude that no association could be demonstrated between low grade exposure to airway irritants and airway hyperresponsiveness, and that further research is needed to elucidate this relationship.
Adult↗
Chronic respiratory symptoms and airway responsiveness to methacholine are associated with eosinophilia in older men: the Normative Aging Study.
Identification of subsets of patients with chronic obstructive lung disease (COLD) in order to determine disease outcomes and, possibly, the effects of treatment is an area of clinical interest. At present, it remains unclear which patients with COLD are most likely to benefit from anti-inflammatory therapy. We investigated this question in a community-dwelling sample of men. In this study, the relationship of chronic respiratory symptoms, airway responsiveness to methacholine, and skin test reactivity to peripheral-blood eosinophil and neutrophil counts was examined among 894 male participants in the Normative Aging Study (mean age 60 yrs; range 41-90 yrs). The symptoms considered were asthma, persistent wheeze, dyspnoea, chronic cough and phlegm. Responsiveness to methacholine was defined as a provocative dose producing a 20% fall in forced expiratory volume in one second (PD20FEV1) of < or = 8.6 mumol, a positive skin test as a wheal diameter of > or = 5 mm after subtraction of the diameter of any wheal reaction to a glycerin control, and eosinophilia as an eosinophil count of > or = 275 cells.mm-3 in peripheral blood. Chronic symptoms (odds ratio (OR) 2.0; 95% confidence interval (CI) 1.4-2.7), airway responsiveness (OR 1.7; CI 1.1-2.7), and the combination of symptoms and airway responsiveness (OR 3.4; CI 2.0-5.6) were positively and significantly related to peripheral-blood eosinophil counts. These relationships remained significant after adjustment for the effects of age and smoking, and after exclusion of asthmatic subjects. Symptoms and airway responsiveness combined were not significantly related to neutrophil counts.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Comparing FEV1 in adults in two community-based studies.
Data collected in two large-scale longitudinal respiratory studies were analyzed to estimate age-related changes in FEV1 and to determine the between-study differences in change in FEV1 among nonsmoking participants. Two adult cohorts in the Netherlands were followed up for 21 years at 3-year intervals and a cohort of adults in 6 cities in the eastern United States was followed up for 6 years. The age distributions and follow-up rate differed for the two studies. The mean rates of decline in FEV1 for 50-year old male and female never smokers were 27.9 +/- 2.8 mL/yr and 22.1 +/- 0.9 mL/yr, respectively, in the Netherlands cohort. The estimates for men and women in the Six Cities cohort were 33% and 32% greater, respectively, than those for the Netherlands cohort (p < 0.01). The estimated rate of decline in FEV1 associated with each 1-year increase in age was 0.50 +/- 0.12 mL/yr for men and 0.61 +/- 0.08 mL/yr for women in the Netherlands cohort. This estimate was comparable for the Six Cities women and the Netherlands women but significantly different for the two cohorts of men. Inclusion of survey (period) effect in the regression model had only a trivial influence on accelerated rate of decline in FEV1 and did not alter the more rapid acceleration of decline in FEV1 among the Six Cities men. The present study also showed that use of a "prediction equation" for age adjustment to compare across population samples may produce a biased conclusion if the estimated rate of decline in FEV1 associated with age is different and the age distributions are different for the two populations. In addition, height adjustment for FEV1 was found to have a negligible influence on the longitudinal estimates of FEV1 decline in both study samples. In conclusion, substantial between study variation in decline in FEV1 occurs despite use of similar data analysis techniques. Differences in the initial age distributions and loss to follow-up appeared to be important factors in this analysis.
Adult↗
Use and safety of a shortened histamine challenge test in an occupational study.
A shortened histamine challenge test was used in a study of occupational airway disease. We evaluated the safety, defined as the absence of a decrease in forced expiratory volume in one second (FEV1) of greater than 40%. The occurrence of complaints, the repeatability of test results, and the average amount of time saved were measured. A standard protocol was used comprising 30 s tidal breathing with sequential doubling concentrations from 1 to 32 mg.ml-1 histamine. Subjects with no indication of hyperresponsive airways started at 4 mg.ml-1. If the decrease in FEV1 was < 6%, a concentration step was skipped (fourfold increase in concentration). The test was terminated when the decrease in FEV1 was at least 18%. A total of 697 subjects performed a test. All subjects with a provocative concentration of histamine producing a 20% decrease in FEV1 (PC20) value of < or = 4 mg.ml-1 (n = 16) started at the lowest concentration. Six subjects reached a > or = 20% decrease in FEV1 (range 21-24%) after a fourfold increase in concentration. Five subjects had a decrease in FEV1 of greater than 40%, and this decrease occurred after a doubling concentration. Cough, flushing, and chest tightness were noted in 18% of the subjects. In 56% of the tested subjects, the shortest provocation scheme (phosphate solution followed by 4, 16 and 32 mg.ml-1 histamine) was applied, resulting in a time reduction of nearly 50% per test, and reducing the time needed to complete the study from 5 to 3 months. The shortened test was repeatable within one concentration difference.(ABSTRACT TRUNCATED AT 250 WORDS)
Bronchial Provocation Tests↗
Airway hyper-responsiveness and the prevalence of work-related symptoms in workers exposed to irritants.
The association between exposure to airway irritants and the presence of work-related symptoms and whether this association was modified by airway hyper-responsiveness, smoking, and allergy by history was studied in 668 workers of synthetic fiber plants. A Dutch version of the British Medical Research Council (BMRC) questionnaire with additional questions on allergy and work-related symptoms was used to assess symptoms, and a standardized histamine challenge test of airway hyper-responsiveness (AHR) was employed. Work-related symptoms were defined as having more than usual eye and respiratory symptoms during work. On the basis of job titles and working department, the exposure status of all workers was characterized into seven groups: (1) reference group; (2) white collars; (3) SO2, HCl, SO4(2-); (4) polyester vapor; (5) oil mist and oil vapor; (6) polyamide and polyester vapor; and (7) multiple exposure. The association between exposure groups and work-related symptom prevalence was estimated by means of multiple logistic regression. The overall prevalence of the work-related symptoms were: cough 9%; phlegm 6%; dyspnea 7%; wheeze 2%; eye symptoms 16%; nasal symptoms 15%. Exposure to airway irritants was significantly associated with work-related symptoms, independent of AHR, smoking, allergy by history, and chronic respiratory symptoms. The association of exposure group with work-related symptoms was stronger for subjects with AHR than for subjects with no AHR. The association with dyspnea and/or wheeze was also stronger for smokers than for nonsmokers and ex-smokers. In contrast, the association between exposure and a higher prevalence of work-related symptoms was stronger in subjects with no history of allergy than in subjects with history of allergy. This is most likely due to the relatively high prevalence of background symptoms in (nonexposed) allergic subjects. It is concluded that exposure to irritants in the working environment might lead to respiratory symptoms, even if exposure levels are relatively low.
Adult↗
Host factors and environmental determinants associated with skin test reactivity and eosinophilia in a community-based population study.
We examined the relationship of host factors (age, gender) and environmental determinants (smoking status, area of residence) to indicators of allergy (skin test reactivity and eosinophil count) in a random population sample in the Netherlands. Positive skin test reactivity was associated with age (decreasing with increasing age), with male gender (versus female gender), and with urban residence (versus rural residence). Positive skin test reactivity was not associated with smoking. Elevated eosinophil counts were associated with male gender (versus female gender), with urban residence (versus rural residence), and with current smoking (versus never smoking). Elevated eosinophil counts were not clearly associated with age (if adjusted for the age-related effects of skin test reactivity). Additionally, this study specifically demonstrates that skin test reactivity increases with increasing eosinophil count and vice versa, indicating that the two traits are interrelated. Furthermore, this interrelationship was demonstrated to be age-dependent (decreasing with increasing age).
Adolescent↗