Rapid FEV1/FVC Decline Is Related With Incidence of Obstructive Lung Disease and Mortality in General Population

Kwang Yong Choi; Hyo Jin Lee; Jung-Kyu Lee; Tae Yun Park; Eun Young Heo; Deog Kyeom Kim; Hyun Woo Lee

doi:10.3346/jkms.2023.38.e4

Rapid FEV₁/FVC Decline Is Related With Incidence of Obstructive Lung Disease and Mortality in General Population

J Korean Med Sci. 2023 Jan 2;38(1):e4. doi: 10.3346/jkms.2023.38.e4.

Authors

Kwang Yong Choi¹, Hyo Jin Lee¹, Jung-Kyu Lee¹, Tae Yun Park¹, Eun Young Heo¹, Deog Kyeom Kim¹, Hyun Woo Lee²

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea. athrunzara86@snu.ac.kr.

Abstract

Background: Forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) naturally decreases with age; however, an excessive decline may be related with increased morbidity and mortality. This study aimed to evaluate the FEV₁/FVC decline rate in the Korean general population and to identify whether rapid FEV₁/FVC decline is a risk factor for obstructive lung disease (OLD) and all-cause and respiratory mortality.

Methods: We evaluated individuals aged 40-69 years who underwent baseline and biannual follow-up spirometric assessments for up to 18 years, excluding those with airflow limitations at baseline. Based on the quartiles of the annual FEV₁/FVC decline rate, the most negative FEV₁/FVC change (1^st quartile of annual FEV₁/FVC decline rate) was classified as rapid FEV₁/FVC decline. We investigated the risk of progression to OLD and all-cause and respiratory mortality in individuals with rapid FEV₁/FVC decline.

Results: The annual FEV₁/FVC decline rate in the eligible 7,768 patients was 0.32 percentage point/year. The incidence rate of OLD was significantly higher in patients with rapid FEV₁/FVC decline than in those with non-rapid FEV₁/FVC decline (adjusted incidence rate, 2.119; 95% confidence interval [CI], 1.932-2.324). Rapid FEV₁/FVC decline was an independent risk factor for all-cause mortality (adjusted hazard [HR], 1.374; 95% CI, 1.105-1.709) and respiratory mortality (adjusted HR, 1.353; 95% CI, 1.089-1.680).

Conclusion: The annual FEV₁/FVC decline rate was 0.32%p in the general population in Korea. The incidence rate of OLD and the hazards of all-cause and respiratory mortality were increased in rapid FEV₁/FVC decliners.

Keywords: Cohort Studies; Forced Expiratory Volume; Forced Vital Capacity; Mortality; Respiratory Function Tests; Risk Factors.

MeSH terms

Forced Expiratory Volume
Humans
Incidence
Lung Diseases, Obstructive*
Lung*
Spirometry
Vital Capacity