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

Rapid FEV ₁ /FVC Decline Is Related With Incidence of Obstructive Lung Disease and Mortality in General Population

• Choi KY
• Lee HJ
• Lee JK
• Park TY
• Heo EY
• Kim DK
• Lee HW

• KMID: 2537447
• DOI: http://doi.org/10.3346/jkms.2023.38.e4

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.

Keyword

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

Figure

• 

  Fig. 1 Cumulative incidence of OLD according to quartiles of FEV1/FVC decline rate measured at two-year intervals. Cumulative incidence of OLD for 18 years was 35.03% in 1st quartile group, 16.67% in 2nd quartile group, 6.59% in 3rd quartile group, and 1.39% in 4th quartile group. There was a linear trend of cumulative incidence of OLD according to quartiles of FEV1/FVC decline rate (P = 0.034).FEV1 = forced expiratory volume in 1 second, FVC = forced vital capacity, OLD = obstructive lung disease.

• 

  Fig. 2 Kaplan−Meier survival curve for all-cause and respiratory mortality. Survival probability was compared between non-rapid FEV1/FVC decliner and rapid FEV1/FVC decliner in terms of (A) all-cause mortality and (B) respiratory mortality.FEV1 = forced expiratory volume in 1 second, FVC = forced vital capacity.

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