Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study
Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study
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DOI：
10.1016/s2213-2600(19)30276-0
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发表时间：
2020-01-01
影响因子：
76.2
通讯作者：
London, Stephanie J.
中科院分区：
文献类型：
--
作者：
Oelsner, Elizabeth C.;Balte, Pallavi P.;London, Stephanie J.
背景在许多发达国家，曾经吸烟的人数现在超过了现在吸烟的人数，现在吸烟的人每天吸烟的数量也在减少。一些数据表明，肺功能下降随着戒烟而正常化;然而，机制研究表明，肺功能下降可能会继续。我们假设，前吸烟者和低强度的当前吸烟者加速肺功能下降与从不吸烟者相比，包括那些没有流行的肺部疾病。方法我们使用的数据在六个美国人口为基础的队列中包括NHLBI汇总队列研究。我们将样本限制为在两次或多次检查中进行有效肺量测定的参与者。两个队列招募了年轻人（>= 17岁），两个招募了中年和老年人（>= 45岁），两个仅招募了老年人（>= 65岁），并在1983年至2014年期间进行了检查。通过使用调整社会人口学和人体测量学因素的混合模型，比较了持续既往吸烟者和当前吸烟者与从不吸烟者的FEV 1下降。差异FEV 1下降也进行了评估，根据戒烟的持续时间和累积（包年数）和当前（每天的香烟数量）cigarettesconsumption.Findings 25 352参与者（年龄17-93岁）完成了70 228有效spirornetry考试。在中位随访7年（IQR 3-20）期间，中位年龄（57岁）时，持续不吸烟者的FEV 1下降为31.01 mL/年（95% CI 30.66-31.37），既往吸烟者为34.97 mL/年（34.36-35.57），当前吸烟者为39.92 mL/年（38.92-40.92）。经调整后，与从不吸烟者相比，既往吸烟者的FEV 1加速下降1.82 mL/年（95% CI 1- 24-2- 40），约为当前吸烟者效应估计值的20%（9.21 mL/年; 95% CI 8.35-10.08）。与从不吸烟者相比，在戒烟后数十年的前吸烟者和低累积香烟消费量的当前吸烟者中观察到FEV 1加速下降（
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 spirornetry 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 (