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Familial correlation and segregation analysis of forced expiratory volume in one second (FEV1), with and without smoking adjustments, in a Tucson population.

BACKGROUND: Previous researchers have found significant familial aggregation but no evidence of Mendelian inheritance of forced expiratory volume in one second (FEV1) in general population studies. However, the influence of cigarette smoking on familial aggregation of FEV1 has been difficult to assess in these studies. OBJECTIVES: The main objective of our study was to attempt to discern the effects of smoking on familial correlation and segregation models of FEV1. SUBJECTS AND METHODS: In a randomly selected sample of white, non-Mexican American families in Tucson, Arizona, we performed two separate familial correlation and segregation analyses of FEV1, one adjusted for cigarette smoking and one unadjusted for smoking. In both, initial survey measures of FEV1 for 1329 females and 1291 males in 746 families were standardized for gender, age, height and height-squared using piecewise linear regression models. In the smoking-adjusted model, total number of pack-years smoked, current and ex-smoking status, and the interaction between total pack-years and current smoking status were also included. RESULTS: FEV1 was significantly correlated among sibling pairs and parent-offspring pairs (both p < 0.001), regardless of smoking adjustment, but sibling correlation was significantly higher than parent-offspring correlation (p < 0.05), suggesting additional effects beyond common parentage. Spousal correlations were not significant even when both spouses smoked. We found no evidence of major gene segregation of FEV1, with or without smoking adjustment, and all of the segregation models were significantly different from the unrestricted model. CONCLUSIONS: The best-fitting model was an environmental model with three distinct distributions of FEV1 and significant residual familial effects. A significant familial component suggests the presence of polygenic factors and/or effects due to a shared environment (multifactorial). That familial correlations of smoking-adjusted and smoking-unadjusted residuals were not appreciably different suggests that current smoking status and number of pack-years smoked do not account for the observed familial aggregation of FEV1.

Adolescent↗

Forced expiratory volume in one second and peak expiratory flow rate values in non-professional male tennis players.

AIM: Forced expiratory volume in 1 second (FEV1) is a reliable and easily measured lung function index, which is nowadays used for early detection of chronic obstructive pulmonary disease. It has also been established recently as an important predictor of all-cause, cardiovascular and cerebrovascular morbidity and mortality in the Western World. Similar implications have been made with regard to peak expiratory flow rate (PEFR). The present study was designed in order to compare the FEV1 and PEFR values of non-professional, smoking and non-smoking male athletes to those predicted for the general, non-athlete population. METHODS: A total of 141 non-professional tennis players aged 30-74 years were studied (99 smokers and 42 non-smokers). FEV1 and PEFR of all men were measured by means of a one flow spirometer, and compared to those predicted for their age and height, based on formulas for the non-athlete, healthy, non-smoking population. RESULTS: Non-professional tennis players had significantly higher FEV1 and PEFR values, compared to FEV1 and PEFR predicted, respectively. No statistically significant difference was observed between smokers and non-smokers. CONCLUSIONS: Our study confirms that even moderate physical activity, such as non-professional tennis, can improve FEV1 and PEFR values, maintaining a normal respiratory function, which is a strong predictor of reduced cardiovascular and overall morbidity and mortality. FEV1 and PEFR are easy to measure parameters that should be used more often for the assessment of general health status.

Adult↗

[Longitudinal decline of forced expiratory volume in one second in non-smoking Japanese women].

We prospectively studied 1,696 clinically healthy non-smoking women to assess the influence of aging on longitudinal decline in forced expiratory volume in one second (FEV10). All the subjects took an annually medical examination involving a pulmonary function test from 1995 to 2001. The mean value of annual decrease in FEV10 (slope) was 19.6 mL/year. Multiple regression analysis revealed that initial age, height, and FEV10 were significant parameters determining the slope. This study clearly showed the aging-related longitudinal decline in pulmonary function in non-smoking Japanese women.

Adult↗

Opposite changes in blood histamine and force expiratory volume during bronchial inhalation challenge.

Lack of in vivo data on blood histamine changes in subjects during induced attacks of asthma prompted serial determinations of blood histamine levels and of the forced expiratory volume of the first second (FEV1) in 2 asthmatic undergoing antigen (house dust) inhalation challenge and in 3 subjected to methacholine inhalation. In 1 of 2 dust-sensitive asthmatics inhaling house dust (10(4) pnu), a prominent histamine spike occurred 5 minutes after challenge termination, coinciding with a fall in FEV1 by about 15%. In the other, blood histamine had risen steeply at 7 minutes, FEV1 not falling, due presumably to increased bronchial tolerance acquired by hyposensitization therapy. In 1 of 3 asthmatics inhaling methacholine, 0.75 cumulative units/5 breaths (c.u.) entailed a blood histamine spike coinciding with a fall in FEV1 by 26%; after return of both variables to control levels, a second histamine rise preceded a second FEV1 fall. In another, a blood histamine spike coinciding with a fall in FEV1 by 19% occurred 6 1/2 minutes after the methacholine increment affording 99.15 c.u. In the third, FEV1 from the outset fell progressively before blood histamine rose steeply, reaching its lowest value (-26%) likewise with 99.15 c.u. The mechanisms and the source(s) of the histamine accounting for its short-lived increases in blood remain to be determined.

Adolescent↗

The UCLA population studies of chronic obstructive respiratory disease: XI. Impact of air pollution and smoking on annual change in forced expiratory volume in one second.

We assessed the relative impact of residential exposure to community air pollution and habitual cigarette smoking on lung function by comparing the annualized rate of change in forced expiratory volume in 1 s (FEV1) in current, former, and never-smokers 25 to 59 yr of age residing in three demographically similar areas of the Southern California air basin who had been chronically exposed to (1) moderate levels of photochemical oxidants and very low levels of other pollutants (Lancaster); (2) very high levels of photochemical oxidants, sulfates, and particulate matter (Glendora); and (3) high levels of sulfates, oxides of nitrogen, and probably hydrocarbons (Long Beach), together with moderate levels of sulfur dioxide. Of the 621 to 763 nonsmokers, 317 to 479 former smokers and 472 to 691 continuing smokers residing in the three areas who were studied initially, 53 to 64, 49 to 59, and 43 to 54%, respectively, were retested. For male residents, area of residence and smoking category each had highly significant effects on FEV1 decline (two-way ANCOVA; p < 0.001) without significant interaction (p > 0.4). After adjustment for baseline FEV1, age, height, and a history of allergy, the mean decline in FEV1 attributable to living in Long Beach compared with living in Lancaster was 23.6 ml/yr, which was 71% of the rate of decline in FEV1 (33.3 ml/yr), attributable to smoking > 1 pack of cigarettes per day. For female residents, a significant interaction was noted between area and smoking (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Influence of age and predicted forced expiratory volume in 1 s on prognosis following complete resection for non-small cell lung carcinoma.

OBJECTIVE: To evaluate age of the patient at the time of surgery and estimated postoperative forced expiratory volume in 1 s (FEV1%) as predictors of long-term survival following complete resection of non-small cell lung carcinoma (NSCLC). METHODS: Retrospective, observational study. Records of patients operated on for NSCLC between January 1994 and December 1997 were reviewed. One hundred and ninety three patients who underwent complete pathological resection and survived surgery were included for study. Patients were divided in groups depending on age at the time of surgery and predicted postoperative FEV1% calculated according to the number of resected segments. Values of the 75th percentile of age (70.29 years) and 50th percentile of predicted FEV1% (52.9) were the cut-points selected for group division. To increase the power of the analysis pathological staging was also converted in a binary variable and resumed to localized (stage I) or extended (stage II-IIIB). Univariate analysis of the effect of each variable on survival was assessed by Kaplan-Meier method and log-rank test. Relationship between variables was investigated using 2x2 tables and Fisher's exact test. Unrelated variables (extension, age and low estimated postoperative FEV1%) entered in a Cox-regression model to predict long-term survival following resection. RESULTS: Pathological stage (P<0.0001), age (P=0.01) and low estimated postoperative FEV1% (P=0.0007) showed independent value to predict the outcome. CONCLUSION: Advanced age and low predicted postoperative FEV1% play an adverse effect on survival of completely resected NSCLC.

Adult↗

Serum respiratory virus antibodies: predictor of reduced one-second forced expiratory volume (FEV1) in Norwegian adults.

BACKGROUND: The purpose of this cross-sectional study was to investigate whether the presence of serum complement antibodies was associated with reduced one-second forced expiratory volume (FEV1) in adults. METHODS: From a stratified random sample of 18-73 year old adults, we performed measurements of serum complement fixing virus antibodies against influenza type A and B, parainfluenza type 1, 2, and 3, respiratory syncytial virus and adenovirus on 82% (n = 1239). RESULTS: In the crude data, subjects having five of the seven virus antibodies had significantly lower lung function, given as sex-, age- and height-standardized residuals of FEV1 (SFEV1), compared with those without. After adjusting in addition for smoking habits, lifetime smoking consumption and season, the lung function levels were significantly lower in subjects with influenza type B and respiratory syncytial virus antibodies compared to those without (P < 0.01). Increasing influenza and respiratory syncytial virus antibody titres and increasing numbers of virus antibodies, respectively, were related to progressively lower lung function. Subjects with respiratory symptoms but without obstructive lung disease had lower antibody levels than subjects with obstructive lung disease, but higher levels than asymptomatic subjects. In a final multiple linear regression analysis adjusting in addition for respiratory symptom and disease status as well as for the other respiratory virus antibodies, the presence of respiratory syncytial virus antibodies was a significant predictor for reduced SFEV1 (regression coefficient: -0.226; SE = 0.112; P = 0.04). The magnitude of the effect on lung function remained after excluding subjects reporting symptoms of respiratory infection within 3 weeks prior to the examination (regression coefficient: -0.252; SE = -0.218; P = 0.25). CONCLUSIONS: This cross-sectional community study indicates that respiratory syncytial virus infection or re-infection is an independent predictor for reduced lung function in adults of a wide age range.

Adult↗

Bronchial responsiveness and the reproducibility of forced expiratory volume in one second.

Although poorly reproducible spirometric tests, "test failures," are associated with respiratory morbidity, it is not clear what causes them. Bronchial responsiveness was examined in relation to test failure for forced expiratory volume in 1 s (FEV1.0) (1979 definition of the American Thoracic Society) in 249 bakers, 165 chemical industry workers, and 204 office workers. The first two groups were studied by the same methods and were combined. Test failure was observed in 4%, and for 38% the provocative dose of inhaled methacholine causing a 20% fall in FEV1.0 relative to FEV1.0 after the inhalation of normal saline (PD20) was < or = 120 mumol (7% with a PD20 of < or = 8 mumol). Test failure was not related to the level of PD20. Of the office workers, 3% had test failure, 11% a PD20 of < or = 8 mumol of histamine, and no significant relation was observed. The study does not exclude the possibility that bronchial responsiveness might be related to test failure in patients with airway disease or that a clearer relation might be demonstrable in a larger study, but it does suggest that it is not a major determinant of test failure.

Adult↗

Effects of selection in a prospective study of forced expiratory volume in Vermont granite workers.

Granite workers lost to follow-up during a 5-yr study of pulmonary function were examined. We found that in workers who had left the industry for other employment, forced expiratory volume in one second (FEV1) values declined at a faster rate than in those who remained employed or retired during the study period. We investigated the application of a currently recommended repeatability criterion for pulmonary function tests by looking at different patterns of failing to satisfy the criterion (PFT-failure) over multiple testing sessions. Workers with persistent PFT-failure were found to have faster rates of FEV1 decline than did subjects with none or only intermittent failures. In a regression analysis, job termination was found to be more strongly associated with a steep FEV1 slope when it had been preceded by a pattern of persistent PFT-failure.

Adult↗

Relationship between reduced forced expiratory volume in one second and the risk of lung cancer: a systematic review and meta-analysis.

BACKGROUND: Individuals with severely impaired lung function have an increased risk of lung cancer. Whether milder reductions in forced expiratory volume in 1 second (FEV(1)) also increase the risk of lung cancer is controversial. Moreover, there is little consensus on whether men and women have similar risks for lung cancer for similar decreases in FEV(1). METHODS: A search was conducted of PubMed and EMBASE from January 1966 to January 2005 and studies that examined the relationship between FEV1 and lung cancer were identified. The search was limited to studies that were population based, employed a prospective design, were large in size (> or = 5000 participants), and adjusted for cigarette smoking status. RESULTS: Twenty eight abstracts were identified, six of which did not report FEV1 and eight did not adjust for smoking. Included in this report are four studies that reported FEV1 in quintiles. The risk of lung cancer increased with decreasing FEV1. Compared with the highest quintile of FEV1 (> 100% of predicted), the lowest quintile of FEV1 (< approximately 70% of predicted) was associated with a 2.23 fold (95% confidence interval (CI) 1.73 to 2.86) increase in the risk for lung cancer in men and a 3.97 fold increase in women (95% CI 1.93 to 8.25). Even relatively small decrements in FEV1 ( approximately 90% of predicted) increased the risk for lung cancer by 30% in men (95% CI 1.05 to 1.62) and 2.64 fold in women (95% CI 1.30 to 5.31). CONCLUSION: Reduced FEV1 is strongly associated with lung cancer. Even a relatively modest reduction in FEV1 is a significant predictor of lung cancer, especially among women.

Female↗

A comparison of the maximum voluntary ventilation with the forced expiratory volume in one second: an assessment of subject cooperation.

Poor subject cooperation during pulmonary function testing for disability evaluation can be detected by noting a reduction in maximum voluntary ventilation (MVV). The MVV was compared with the forced expiratory volume in one second (FEV1) from normal subjects and persons with airways obstructive diseases. The MVV was found to be related to the FEV1, and the MVV can be estimated by multiplying the FEV1 by 40. The actual MVV value can then be compared with the estimated value to assess subject cooperation. Since upper airway obstruction and restriction due to chest wall or neuromuscular disease can also reduce the actual MVV, subjects who have a decrease in MVV should have a more through evaluation of their ventilatory status.

Adult↗

[Pulmonary capacity and volume, forced expiratory flow measured by whole body plethysmography in acute pancreatitis: experimental study in rats].

Up to 70% of the patients with acute pancreatitis suffer a sort of pulmonary dysfunction. Twenty-nine rats with pancreatitis induced by 2.5% taurocholic and solution have been studied by whole body plethysmography in order to evaluate pulmonary volumes and expiratory flows. They were divided into three groups: a sham operation control group-10 rats,a two pancreatitis group-10 rats and eight hours pancreatitis group-9 rats. The results showed a significant decrease of expiratory reserve volumes and forced vital capacity (FVC) and also a significant increase of expiratory flow in the 2 and 8 hours pancreatitis groups. These findings indicate a restrictive pneumopathy.

Acute Disease↗

Application and evaluation of portable field instruments for measuring forced expiratory volume of children and adults in environmental health surveys.

In support of Health Effects Research Studies, pulmonary function tests are periodically administered to a large number of children. The ventilatory performance of these children is being evaluated by measuring the 0.75-sec forced expiratory volume (FEV(0.75)) with a waterless mechanical volume spirometer used in conjunction with an electronic timing unit. During a 1-yr testing period, operation with the volume spirometer and the EPA designed electronic timing unit proved to be highly successful. The volume spirometer was found to be more advantageous in conducting tests at remote field stations than the water spirometer and other electronic instruments which measure flow rate with a transducer element. The volume spirometer is lightweight, easy to operate, and has the capability of easy and accurate field calibration when used in conjunction with the electronic timing unit. Presently the volume spirometer and EPA designed electronic timing package are employed in all Community Health and Surveillance System (CHESS) pulmonary function testing studies.

Adult↗

Forced expiratory volume in 1 second percentage improves the classification of severity among children with asthma.

OBJECTIVE: Spirometry is an important component of the National Asthma Education and Prevention Program guidelines for asthma, yet published data show variable associations between forced expiratory volume in 1 second percentage (FEV1%) predicted, symptoms and health care utilization. The objective of this analysis was to examine the association between FEV1% and future risk of exacerbations among a well-characterized population of children with asthma. METHODS: Using data that are available from the Childhood Asthma Management Program, we examined the relationship between prebronchodilator FEV1% and important clinical outcomes. Multiple observations of FEV1 were available for each patient; multivariate regression analysis, using a general estimating equation approach, was used to control for the correlation between repeated measurements among individuals and potential confounders. FEV1% was categorized into 4 levels and as a continuous variable. Outcomes of interest included mean symptom score (0-3), episode-free days, and asthma-related events (oral steroid use, emergency department visits, and hospitalizations) during the ensuing 4-month period. Our analysis was limited to the placebo group (N = 417). RESULTS: We observed a clear relationship between prebronchodilator FEV1% and important clinical outcomes. In multivariable models that simultaneously controlled for covariates of interest, age at baseline, time, previous event history, and nocturnal awakenings, a significant relationship between FEV1% and asthma symptoms and serious asthma exacerbations (oral steroids, emergency department visits, and hospitalizations) was observed. Compared with children with an FEV1% > or = 100%, children with FEV1% 80% to 99%, 60% to 79%, and < 60% were 1.3, 1.8, and 4.8, respectively, more likely to have a serious asthma exacerbation during the ensuing 4 months. CONCLUSIONS. In children with mild to moderate asthma, FEV1% predicted is independently associated with future asthma symptoms and health care utilization. Previous asthma-related hospitalizations and nocturnal symptoms also were independently associated with risk for future adverse events. FEV1 is an important component of asthma health status and asthma severity classification.

Albuterol↗

Validity of the American Thoracic Society and other spirometric algorithms using FVC and forced expiratory volume at 6 s for predicting a reduced total lung capacity.

OBJECTIVES: (1) To compare the performance of three spirometric algorithms developed to predict whether the total lung capacity (TLC) is reduced vs normal or increased, (2) to determine if forced expiratory volume at 6 s (FEV(6)) can be substituted for FVC in these algorithms, and (3) to determine if ascertainment bias was present in patients referred for the measurement of spirometry and TLC compared to patients referred for spirometry only. METHODS: We analyzed the results of 219 consenting consecutive patients referred to a New Zealand tertiary hospital respiratory laboratory for spirometry and TLC measurements. Spirometry results from 370 patients referred for spirometry but not lung volumes were used to test for potential ascertainment bias. Spirometry results were analyzed using the lower limit of normal (LLN) values from the third National Health and Nutrition Examination Study reference equations. The equations of Goldman and Becklake, and Crapo were used to classify TLC as normal or abnormal. Receiver operator characteristic curves were used to produce an algorithm using the LLN for FVC and FEV(6). The performances of previous algorithms and our own algorithms were analyzed for predicting a reduced lung volume against the "gold standard," plethysmographic TLC. RESULTS: All three algorithms predicted a reduced TLC with an accuracy of approximately 50%. In contrast, all algorithms predicted TLC was either normal or increased with an accuracy of > or = 99% regardless of the reference set used. The algorithms based on FEV(6) performed equally as well as the FVC algorithms. No ascertainment bias was found. CONCLUSIONS: This study provides evidence that spirometry-based algorithms can accurately predict when TLC is either normal or increased, and can also increase the a priori probability that TLC is reduced to approximately 50%. FEV(6) is equivalent to FVC in these predictions.

Adult↗

Association of forced expiratory volume with disease duration and sputum neutrophils in chronic asthma.

Some patients with chronic asthma develop irreversible airflow obstruction. Our aim was to assess whether reported duration of asthma and induced sputum cell counts were associated with pulmonary function in patients with asthma who did not smoke. Maximal forced expiratory volume in the first second (FEV(1)) was determined following a steroid trial (oral prednisolone, 30 mg/d [n = 92 patients]; or inhaled fluticasone, 2000 microg/d [n = 5]; for 2 weeks) and 2.5 mg of nebulized albuterol. Asthma history was recorded with duration from first diagnosis. All subjects were nonsmokers, or were to have stopped smoking > or =5 years previously and smoked < or =5 pack-years (n = 12). Induced sputum was obtained from 59 subjects for analysis of airway cell counts. Maximal FEV(1) was inversely associated with asthma duration (r = -0.47, P <0.0001), age (r = -0.40, P <0.0001), and the proportion of sputum neutrophils (r(s) = -0.50, P = 0.00004). After adjusting for age, both duration of disease and sputum neutrophils were independently associated with maximal FEV(1). Neutrophil activation, as measured by sputum myeloperoxidase levels, was positively associated with the proportion of sputum neutrophils (r(s) = 0.45, P = 0.0004) and inversely associated with maximal FEV(1) (r(s) = -0.59, P <0.0001). Long disease duration may be a predisposing factor for the development of irreversible airflow obstruction in patients with chronic asthma. The negative associations of sputum neutrophil count and activation with maximal FEV(1) suggest that neutrophils may be involved in the pathophysiology of irreversible airflow obstruction in asthma.

Administration, Topical↗

The effects of adiposity and weight change on forced expiratory volume decline in a longitudinal study of adults.

OBJECTIVE: To investigate whether changes in anthropometric measures are related to lung function decline. DESIGN: A national 7-y follow up study in Great Britain. SUBJECTS: 3391 adults aged 18-73 y at baseline. MEASUREMENTS: The primary outcome measure was change in forced expiratory volume in one second (Delta FEV1), adjusted for age, height and sex. This was related to changes in weight, body mass index, waist circumference, hips circumference and waist to hip ratio. RESULTS: Changes in weight, body mass and waist circumference, adjusted for confounders including mean level, were all associated with changes in FEV1 (P<0.001), with all effects stronger in men than women (P<0.05). Change in waist to hip ratio was related in men (P=0.01), but not in women (P=0.34). A 10 kg weight increase induced an additional fall in FEV1 of 96 ml (95% confidence interval (95% CI 65-127 ml) in men, and 51 ml (95% CI. 27-75 ml) in women. In men, the effect increased with average weight and obesity and was more pronounced in middle age. This phenomenon was not present in women, possibly due to gender differences in weight distribution in later adult life. Smoking did not appear to influence the magnitude of effect in either sex. The detrimental effect of weight gain on FEV1 in subjects that stopped smoking between studies appeared small in comparison to the benefit of smoking cessation. CONCLUSION: Increases in adult body mass are predictors of FEV1 decline, especially among older and heavier men, where weight reduction may significantly slow lung function decline.

Adolescent↗