title: Health outcomes associated with lung function decline and respiratory symptoms and disease in a community cohort.
abstract: BACKGROUND
  In workplace respiratory disease prevention, a thorough understanding is needed of the relative contributions of lung function loss and respiratory symptoms in predicting adverse health outcomes.
  
  
  METHODS
  Copenhagen City Heart Study respiratory data collected at 4 examinations (1976-2003) and morbidity and mortality data were used to investigate these relationships. With 15 or more years of follow-up for a hospital diagnosis of chronic obstructive pulmonary disease (COPD) morbidity, COPD or coronary heart disease (CHD) mortality, and all-cause mortality, risks for these outcomes were estimated in relation to asthma, chronic bronchitis, shortness of breath, and lung function level at examination 2 (1981-1983) or lung function decline established from examinations 1 (1976-1978) to 2 using 4 measures (FEV(1) slope, FEV(1) relative slope, American College of Occupational and Environmental Medicine's Longitudinal Normal Limit [LNL], or a limit of 90 milliliters per year [ml/yr]). These risks were estimated by hazard ratios (HR) and 95% confidence intervals (CI) adjusted for age, height-adjusted baseline forced expiratory volume in 1 second (FEV(1)/height(2)), and height.
  
  
  RESULTS
  For COPD morbidity, the increasing trend in the HR (95% CI) by quartiles of the FEV(1) slope reached a maximum of 3.77 (2.76-5.15) for males, 6.12 (4.63-8.10) for females, and 4.14 (1.57-10.90) for never-smokers. Significant increasing trends were also observed for mortality, with females at higher risk.
  
  
  CONCLUSIONS
  Lung function decline was associated with increased risk of COPD morbidity and mortality emphasizing the need to monitor lung function change over time in at-risk occupational populations.
authors.affiliation: National Institute for Occupational Safety and Health, Division of Respiratory Disease Studies, Surveillance Branch, Morgantown, West Virginia 26505, USA. goz2@cdc.gov
authors.forename: Penelope
authors.initials: P
authors.lastname: Baughman
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Marott
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
authors.forename: Michael
authors.initials: M
authors.lastname: Andrew
authors.forename: Eva
authors.initials: E
authors.lastname: Hnizdo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000503:physiopathology*; D012307:Risk Factors