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. 2018 Jun 15;197(12):1616-1624.
doi: 10.1164/rccm.201710-2108OC.

Respiratory Symptoms in Young Adults and Future Lung Disease. The CARDIA Lung Study

Ravi Kalhan  1   2 , Mark T Dransfield  3 , Laura A Colangelo  2 , Michael J Cuttica  1 , David R Jacobs Jr  4 , Bharat Thyagarajan  5 , Raul San Jose Estepar  6 , Rola Harmouche  6 , Jorge Onieva Onieva  6 , Samuel Y Ash  6   7 , Yuka Okajima  6 , Carlos Iribarren  8 , Stephen Sidney  8 , Cora E Lewis  9 , David M Mannino  10 , Kiang Liu  2 , Lewis J Smith  1   2 , George R Washko  6   7
Affiliations

Respiratory Symptoms in Young Adults and Future Lung Disease. The CARDIA Lung Study

Ravi Kalhan et al. Am J Respir Crit Care Med. .

Abstract

Rationale: There are limited data on factors in young adulthood that predict future lung disease.

Objectives: To determine the relationship between respiratory symptoms, loss of lung health, and incident respiratory disease in a population-based study of young adults.

Methods: We examined prospective data from 2,749 participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who completed respiratory symptom questionnaires at baseline and 2 years later and repeated spirometry measurements over 30 years.

Measurements and main results: Cough or phlegm, episodes of bronchitis, wheeze, shortness of breath, and chest illnesses at both baseline and Year 2 were the main predictor variables in models assessing decline in FEV1 and FVC from Year 5 to Year 30, incident obstructive and restrictive lung physiology, and visual emphysema on thoracic computed tomography scan. After adjustment for covariates, including body mass index, asthma, and smoking, report of any symptom was associated with -2.71 ml/yr excess decline in FEV1 (P < 0.001) and -2.18 in FVC (P < 0.001) as well as greater odds of incident (prebronchodilator) obstructive (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.24-2.14) and restrictive (OR, 1.40; 95% CI, 1.09-1.80) physiology. Cough-related symptoms (OR, 1.56; 95% CI, 1.13-2.16) were associated with greater odds of future emphysema.

Conclusions: Persistent respiratory symptoms in young adults are associated with accelerated decline in lung function, incident obstructive and restrictive physiology, and greater odds of future radiographic emphysema.

Keywords: chronic obstructive pulmonary disease; respiratory epidemiology; respiratory function tests; respiratory symptoms.

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Figures

Figure 1.
Figure 1.
Numbers of participants included in the analyses presented in Tables 2 and 3 based on availability of baseline and Year 2 symptom questionnaires, covariates, pulmonary function measurements, and thoracic computed tomography scans. CT = computed tomography.
Figure 2.
Figure 2.
Relationships between baseline respiratory symptoms and age-related decline in lung function modeled through generalized estimating equations. Lung function performed at CARDIA (Coronary Artery Risk Development in Young Adults) study visits at Years 5, 10, 20, and 30 were used to determine mean lung function for each age according to whether symptoms were present at both the baseline and Year 2 examinations. Model covariates include: race–sex group, baseline height, body mass index, smoking status, and physician-diagnosed asthma. Tests of statistical significance reflect a difference in the slopes of age-related change in lung function between the symptom-present versus symptom-absent groups.
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