In 1977, Fletcher and Peto 1 published a prospective study that monitored decline in FEV 1 and made several key observations. THE NATURAL HISTORY OF LUNG FUNCTION DECLINE For the purposes of the present study, the current authors have focused on the clinical utility of spirometry in smokers where obstructive lung disease is most relevant. It has been noted that reduced FEV 1 may also reflect restrictive lung disease that: 1) is not infrequently found in population studies 2) may in part be due to nonpulmonary factors such as obesity and heart failure (particularly in nonsmokers) and 3) remains a marker of overall mortality 12. The current authors argue that FEV 1 is more than a test of lung function essential in quantifying airflow limitation, it is a marker of premature death with broad clinical utility in baseline risk assessment and possible prevention of both respiratory (COPD and lung cancer) and cardiovascular (coronary artery disease (CAD) and stroke) diseases. Importantly, if susceptible smokers quit before reaching a critical threshold, this accelerated decline in FEV 1 could be attenuated to that of nonsmokers, thereby preserving lung function, reducing morbidity and preventing premature death 1, 11. Subsequent studies have shown that reduced FEV 1 in smokers is not only associated with a significantly increased risk of COPD, but also lung cancer, acute coronary syndromes and stroke 2– 8, which collectively account for 70–80% of premature death in smokers 9, 10. With continued smoking, these smokers developed chronic obstructive pulmonary disease (COPD) and died prematurely. In 1977, Fletcher and Peto 1 published their seminal paper in the British Medical Journal, demonstrating the existence of a subgroup of smokers highly susceptible to accelerated decline in lung function, as measured by forced expiratory volume in one second (FEV 1). The current authors propose that spirometry has broad utility in identifying smokers who are at greatest risk of cardiorespiratory complications and greatest benefit from targeted preventive strategies, such as smoking cessation, prioritised screening and effective pharmacotherapy. Recent findings suggest inhaled drugs (bronchodilators and corticosteroids), and possibly statins, may be effective in reducing morbidity and mortality in patients with chronic obstructive pulmonary disease. Smoking cessation has been shown to attenuate FEV 1 decline and, if achieved before the age of 45–50 yrs, may not only preserve FEV 1 within normal values but substantially reduce cardiorespiratory complications of smoking. As such, reduced FEV 1 should be considered a marker that identifies smokers at greatest need of medical intervention. Reduced FEV 1 identifies undiagnosed COPD, has comparable utility to that of serum cholesterol in assessing cardiovascular risk and defines those smokers at greatest risk of lung cancer. The current authors propose that reduced forced expiratory volume in one second (FEV 1) is more than a measure of airflow limitation, but a marker of premature death with broad utility in assessing baseline risk of chronic obstructive pulmonary disease (COPD), lung cancer, coronary artery disease and stroke, collectively accounting for 70–80% of premature death in smokers. The clinical utility of spirometric screening of asymptomatic smokers for early signs of air flow limitation has recently come under review.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |