The Darlington and Northallerton long term asthma study: pulmonary function.
BACKGROUND
The Darlington and Northallerton Asthma Study is an observational cohort study started in 1983. At that time little was published about long term outcome in asthma and the contribution of change in reversible disease or airway remodelling to any excess deterioration in function. The study design included regular review of overall and fixed function lung. We report the trends over fifteen years.


METHODS
All asthmatics attending secondary care in 1983, 1988 and 1993 were recruited. Pulmonary function was recorded at attendance and potential best function estimated according to protocol. Rate of decline was calculated over each 5-year period and by linear regression analysis in those seen every time. The influence of potential explanatory variables on this decline was explored.


RESULTS
1724 satisfactory 5-year measurements were obtained in 912 subjects and in 200 subjects on all occasions. Overall rate of decline (ml/year (95%CI)) calculated from 5-year periods was FEV1 male 41.0 (34.7-47.3), female 28.9 (23.2-34.6) and best FVC male 63.1 (55.1-71.2)ml/year, female 45.8 (40.0-51.6). The principal association was with age. A dominant cubic factor suggested fluctuations in the rate of change in middle life with less rapid decline in youth and more rapid decline in the elderly. Rapid decline was possibly associated with short duration. Treatment step did not predict rate of deterioration.


CONCLUSIONS
Function declined non-linearly and more rapidly than predicted from normal subjects. It reports for the first time a cubic relationship between age and pulmonary function. This should be taken into account when interpreting other articles reporting change in function over time.
Connolly
C Kevin
CK
The Department of Medicine, The Memorial Hospital, Darlington, DL3 6HX, UK. ck-r.connolly@medix-uk.com
Prescott
Robin J
RJ
D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests