@article {1448, title = {Smoking and lung function in elderly men and women. The Cardiovascular Health Study.}, journal = {JAMA}, volume = {269}, year = {1993}, month = {1993 Jun 02}, pages = {2741-8}, abstract = {

OBJECTIVE: To investigate relationships between cigarette smoking and pulmonary function in elderly men and women.

DESIGN: Cross-sectional analysis of baseline data from a prospective, population-based study of risk factors, preclinical, and overt cardiovascular and pulmonary disease.

SETTING: Defined communities in Forsyth County, North Carolina; Pittsburgh, Pa; Sacramento County, California; and Washington County, Maryland.

POPULATION: A total of 5201 noninstitutionalized men and women 65 years of age and older.

MAIN OUTCOME MEASURES: Pulmonary function; means of forced expiratory volume in 1 second (FEV1) and forced vital capacity and prevalence of low FEV1 levels.

RESULTS: Prevalence of cigarette smoking was 10\% to 20\% and higher in women than men and in blacks than whites. Forced vital capacity and FEV1 levels were related positively to height and white race and negatively to age and waist girth. Age- and height-adjusted FEV1 means were 23\% and 18\% lower in male and female current smokers, respectively, than in never smokers but not reduced in never smokers currently living with a smoker. Smokers who quit before age 40 years had FEV1 levels similar to never smokers, but FEV1 levels were lower by 7\% and 14\% in smokers who quit at ages 40 to 60 years and older than 60 years, respectively. Lung function was related inversely to pack-years of cigarette use. Prevalence rates of impaired lung function were highest in current smokers and lowest in never smokers. Regression coefficients for the smoking variables were smaller in persons without cardiovascular or respiratory conditions than in the total cohort.

CONCLUSIONS: Cigarette smoking is associated with reduced pulmonary function in elderly men and women. However, smokers who quit, even after age 60 years, have better pulmonary function than continuing smokers.

}, keywords = {African Continental Ancestry Group, Aged, Aged, 80 and over, Anthropometry, Cardiovascular Diseases, Cross-Sectional Studies, European Continental Ancestry Group, Female, Forced Expiratory Volume, Humans, Lung Diseases, Male, Prevalence, Prospective Studies, Reference Values, Respiratory Function Tests, Risk Factors, Smoking, United States, Vital Capacity}, issn = {0098-7484}, author = {Higgins, M W and Enright, P L and Kronmal, R A and Schenker, M B and Anton-Culver, H and Lyles, M} } @article {1428, title = {Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study.}, journal = {Chest}, volume = {106}, year = {1994}, month = {1994 Sep}, pages = {827-34}, abstract = {

Spirometry was performed by 5,201 elderly participants of the Cardiovascular Health Study during their baseline examination and a subset of the ATS/DLD-78 respiratory questionnaire was administered by trained interviewers. In never smokers (46 percent of the cohort), the overall prevalence of chronic cough was 9 percent, chronic phlegm was 13 percent, attacks of wheezing with dyspnea were 8 percent, and grade 3 dyspnea on exertion was 10 percent. The prevalence of lung disease in current smokers (12 percent of the cohort) was 8/7 percent (men/women) with chronic bronchitis and 14/5 percent with emphysema. Overall, 6 percent reported asthma (a physician-confirmed history) and 12 percent reported hay fever. Using a logistic regression model, attacks of wheezing with dyspnea were strongly associated with a lower FEV1, coronary heart disease, heart failure, and a large waist size (in participants without a diagnosis of asthma, chronic bronchitis, or emphysema). Undiagnosed airways obstruction was twice as likely in women and those with lower income, and was associated with current and former smoking, pack-years of smoking, and chronic cough. Dyspnea on exertion (DOE) was three times or more likely if a participant reported heart failure, coronary heart disease, or emphysema; and much more likely if their FEV1 or FVC was substantially reduced. Dyspnea on exertion was also positively associated with older age, chronic bronchitis or asthma, a larger waist or hip size, pack-years of smoking, and less education. We conclude that DOE and attacks of wheezing with dyspnea are commonly associated with cardiovascular disease and a low FEV1 in those over 65 years and that airways obstruction frequently remains undiagnosed in the elderly.

}, keywords = {Aged, Aged, 80 and over, California, Cohort Studies, Female, Humans, Lung Diseases, Male, Maryland, Multivariate Analysis, North Carolina, Pennsylvania, Prevalence, Prognosis, Respiratory Tract Diseases, Spirometry, Surveys and Questionnaires}, issn = {0012-3692}, author = {Enright, P L and Kronmal, R A and Higgins, M W and Schenker, M B and Haponik, E F} } @article {1439, title = {Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular Health Study Research Group.}, journal = {Am J Respir Crit Care Med}, volume = {149}, year = {1994}, month = {1994 Feb}, pages = {430-8}, abstract = {

Maximal inspiratory pressure (MIP) was assessed in 4,443 ambulatory participants of the Cardiovascular Health Study, 65 yr of age and older, sampled from four communities. Maximal expiratory pressure (MEP) was also measured in 790 participants from a single clinic. Positive predictors of MIP included male sex, FVC, handgrip strength, and higher levels of lean body mass (or low bioelectric resistance). Negative predictors were age, current smoking, self-reported fair to poor general health, and waist size. Both participant and technician learning effects were noted, but there was no independent effect of race, hypertension, cardiovascular disease, or diabetes. A healthy subgroup was identified by excluding current smokers, those with fair to poor general health, or an FEV1 less than 65\% of predicted. Mean values determined from the healthy group were 57/116 cm H2O (MIP/MEP) for women, and 83/174 for men. Lower limits of the normal range (fifth percentiles) were 45 to 60\% of the mean predicted values. The reference equations derived from this group of healthy 65 to 85-yr-olds may be used by pulmonary function laboratories and respiratory therapists who evaluate the respiratory muscle strength of elderly patients.

}, keywords = {Aged, Aged, 80 and over, Aging, Body Constitution, Cardiovascular Diseases, Female, Humans, Male, Prospective Studies, Reference Values, Respiratory Function Tests, Respiratory Muscles, Risk Factors, Sex Characteristics, Smoking}, issn = {1073-449X}, doi = {10.1164/ajrccm.149.2.8306041}, author = {Enright, P L and Kronmal, R A and Manolio, T A and Schenker, M B and Hyatt, R E} } @article {1419, title = {Reduced vital capacity in elderly persons with hypertension, coronary heart disease, or left ventricular hypertrophy. The Cardiovascular Health Study.}, journal = {Chest}, volume = {107}, year = {1995}, month = {1995 Jan}, pages = {28-35}, abstract = {

The Cardiovascular Health Study provided the opportunity to determine the association of subclinical and clinical cardiovascular disease with pulmonary function in a population sample of elderly adults. Included were 2,955 women and 2,246 men over age 64 years who were recruited for this observational study from four communities and completed extensive examinations that included spirometry, echocardiograms, and blood pressure. Current smokers, past smokers with >20 pack-years of smoking, and persons with a history of asthma, chronic bronchitis, or emphysema were excluded from this analysis, leaving 2,784 (55\%) of the cohort. Systolic hypertension or coronary artery disease was associated with 40- to 100-mL decrements in FEV1, and 50- to 150-mL decrements in FVC, while a history of congestive heart failure was associated with 200 to 300 mL lower FEV1 and FVC values (p < 0.0001), after correcting for age, height, and waist size. Higher left ventricular (LV) mass was also significantly associated with a decrease in FEV1 and FVC in multivariate models. This relationship was strongest with the end-diastolic LV posterior wall thickness component of LV mass. In summary, FEV1 and FVC are reduced in elderly persons with hypertension, ischemic heart disease, higher disease, higher LV mass, and congestive heart failure, though the magnitude of these associations is relatively small unless heart failure supervenes. Substantial decrements in percent predicted FEV1 and FVC should not be attributed to the presence of uncomplicated ischemic heart disease or hypertension alone.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Coronary Disease, Female, Forced Expiratory Volume, Humans, Hypertension, Hypertrophy, Left Ventricular, Male, Middle Aged, Ventricular Function, Left, Vital Capacity}, issn = {0012-3692}, author = {Enright, P L and Kronmal, R A and Smith, V E and Gardin, J M and Schenker, M B and Manolio, T A} }