Accelerated decline in lung function in adults with a history of remitted childhood asthma

2021 ◽  
pp. 2100305
Author(s):  
Shinichiro Miura ◽  
Hiroshi Iwamoto ◽  
Keitaro Omori ◽  
Kakuhiro Yamaguchi ◽  
Shinjiro Sakamoto ◽  
...  
Keyword(s):  
Lung Function ◽  
Childhood Asthma ◽  
Later Life ◽  
Forced Expiratory Volume ◽  
Normal Lung ◽  
Rapid Decline ◽  
Chronic Obstructive ◽  
Healthy Controls ◽  
History Of

AimA significant number of children with asthma show remission in adulthood. Although these adults are often diagnosed with chronic obstructive pulmonary disease in later life, the effect of clinically remitted childhood asthma on the decline in lung function during adulthood is uncertain. We examined whether clinical remission of childhood asthma was associated with an accelerated decline in lung function in apparently non-asthmatic adults.MethodsHere, 3584 participants (mean age, 48.1 years; range, 35–65 years) who did not have adulthood asthma and other lung diseases and had normal lung function at the baseline visit were included. They were categorised as follows: those with remitted childhood asthma (n=121) and healthy controls (n=3463) according to their self-reported childhood asthma history. Spirometry was performed at baseline and follow-up visits.ResultsThe mean follow-up time was 5.3 years. Multivariate regression analysis showed that remitted childhood asthma and smoking were independently associated with a rapid decline in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Besides, smoking was an independent predictor of a rapid decline in the FEV1/FVC. The annual decline in FEV1 and FVC was significantly greater in participants with remitted childhood asthma than in healthy controls, and the differences remained significant after adjusting for the propensity score.ConclusionA history of clinically remitted childhood asthma is an independent risk factor for accelerated decline in lung function in adults. Remitted childhood asthma and smoking may additively accelerate the development of obstructive lung disease.

scholarly journals Newborn DNA-methylation, childhood lung function, and the risks of asthma and COPD across the life course

2019 ◽  
Vol 53 (4) ◽  
pp. 1801795 ◽  
Author(s):  
Herman T. den Dekker ◽  
Kimberley Burrows ◽  
Janine F. Felix ◽  
Lucas A. Salas ◽  
Ivana Nedeljkovic ◽  
...  
Keyword(s):  
Gene Expression ◽  
Lung Function ◽  
Life Course ◽  
Cord Blood ◽  
Childhood Asthma ◽  
Respiratory Health ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Life Course

RationaleWe aimed to identify differentially methylated regions (DMRs) in cord blood DNA associated with childhood lung function, asthma and chronic obstructive pulmonary disease (COPD) across the life course.MethodsWe meta-analysed epigenome-wide data of 1688 children from five cohorts to identify cord blood DMRs and their annotated genes, in relation to forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC) ratio and forced expiratory flow at 75% of FVC at ages 7–13 years. Identified DMRs were explored for associations with childhood asthma, adult lung function and COPD, gene expression and involvement in biological processes.ResultsWe identified 59 DMRs associated with childhood lung function, of which 18 were associated with childhood asthma and nine with COPD in adulthood. Genes annotated to the top 10 identified DMRs were HOXA5, PAOX, LINC00602, ABCA7, PER3, CLCA1, VENTX, NUDT12, PTPRN2 and TCL1A. Differential gene expression in blood was observed for 32 DMRs in childhood and 18 in adulthood. Genes related with 16 identified DMRs were associated with respiratory developmental or pathogenic pathways.InterpretationOur findings suggest that the epigenetic status of the newborn affects respiratory health and disease across the life course.

scholarly journals Lung function, forced expiratory volume in 1 s decline and COPD hospitalisations over 44 years of follow-up

2015 ◽  
Vol 47 (3) ◽  
pp. 742-750 ◽  
Author(s):  
Suneela Zaigham ◽  
Per Wollmer ◽  
Gunnar Engström
Keyword(s):  
Lung Function ◽  
Airflow Obstruction ◽  
Fixed Ratio ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Lung Function Decline ◽  
Obstructive Pulmonary Disease ◽  
Hazard Ratios

The use of baseline lung function in the prediction of chronic obstructive pulmonary disease (COPD) hospitalisations, all-cause mortality and lung function decline was assessed in the population-based “Men Born in 1914” cohort.Spirometry was assessed at age 55 years in 689 subjects, of whom 392 had spirometry reassessed at age 68  years. The cohort was divided into three groups using fixed ratio (FR) and lower limit of normal (LLN) criterion: forced expiratory volume in 1 s (FEV1)/vital capacity (VC) ≥70%, FEV1/VC <70% but ≥LLN (FR+LLN−), and FEV1/VC <70% and <LLN (FR+LLN+).Over 44 years of follow-up, 88 men were hospitalised due to COPD and 686 died. Hazard ratios (95% CI) for incident COPD hospitalisation were 4.15 (2.24–7.69) for FR+LLN− and 7.88 (4.82–12.87) for FR+LLN+ (reference FEV1/VC ≥70%). Hazard ratios for death were 1.30 (0.98–1.72) for FR+LLN− and 1.58 (1.25–2.00) for FR+LLN+. The adjusted FEV1 decline between 55 and 68 years of age was higher for FR+LLN− and FR+LLN+ relative to the reference. Of those with FR+LLN− at 55 years, 53% had progressed to the FR+LLN+ group at 68 years.Airflow obstruction at age 55 years is a powerful risk factor for future COPD hospitalisations. The FR+LLN− group should be carefully evaluated in clinical practice in relation to future risks and potential benefit from early intervention. This is reinforced by the increased FEV1 decline in this group.

scholarly journals Predictive Modelling of Lung Function using Emphysematous Density Distribution

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kuo-Lung Lor ◽  
Cheng-Pei Liu ◽  
Yeun-Chung Chang ◽  
Chong-Jen Yu ◽  
Cheng-Yi Wang ◽  
...  
Keyword(s):  
Lung Function ◽  
Predictive Model ◽  
Lung Volume ◽  
Model Fitting ◽  
Chronic Obstructive Lung Disease ◽  
Correlation Study ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Normal Lung ◽  
Chronic Obstructive

AbstractTarget lung tissue selection remains a challenging task to perform for treating severe emphysema with lung volume reduction (LVR). In order to target the treatment candidate, the percentage of low attenuation volume (LAV%) representing the proportion of emphysema volume to whole lung volume is measured using computed tomography (CT) images. Although LAV% have shown to have a correlation with lung function in patients with chronic obstructive pulmonary disease (COPD), similar measurements of LAV% in whole lung or lobes may have large variations in lung function due to emphysema heterogeneity. The functional information of regional emphysema destruction is required for supporting the choice of optimal target. The purpose of this study is to develop an emphysema heterogeneity descriptor for the three-dimensional emphysematous bullae according to the size variations of emphysematous density (ED) and their spatial distribution. The second purpose is to derive a predictive model of airflow limitation based on the regional emphysema heterogeneity. Deriving the bullous representation and grouping them into four scales in the upper and lower lobes, a predictive model is computed using the linear model fitting to estimate the severity of lung function. A total of 99 subjects, 87 patients with mild to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I~IV) and 12 control participants with normal lung functions (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) > 0.7) were evaluated. The final model was trained with stratified cross-validation on randomly selected 75% of the dataset (n = 76) and tested on the remaining dataset (n = 23). The dispersed cases of LAV% inconsistent with their lung function outcome were evaluated, and the correlation study suggests that comparing to LAV of larger bullae, the widely spread smaller bullae with equivalent LAV has a larger impact on lung function. The testing dataset has the correlation of r = −0.76 (p < 0.01) between the whole lung LAV% and FEV1/FVC, whereas using two ED % of scales and location-dependent variables to predict the emphysema-associated FEV1/FVC, the results shows their correlation of 0.82 (p < 0.001) with clinical FEV1/FVC.

scholarly journals Predictors of impaired pulmonary function in people living with HIV in an urban African setting

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sarah E. Van Riel ◽  
Kerstin Klipstein-Grobusch ◽  
Roos E. Barth ◽  
Diederick E. Grobbee ◽  
Charles Feldman ◽  
...  
Keyword(s):  
Lung Function ◽  
Characteristic Curve ◽  
Cross Sectional Study ◽  
Forced Expiratory Volume ◽  
Normal Lung ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Increased Risk ◽  
Impaired Lung Function ◽  
History Of

Background: Studies have associated HIV with an increased risk of obstructive lung disease (OLD).Objectives: We aimed to identify the predictive factors for impaired lung function in an urban, African, HIV-positive population.Method: A cross-sectional study was performed in Johannesburg, South Africa, from July 2016 to November 2017. A questionnaire was administered and pre- and post-bronchodilator spirometry conducted. The predictors investigated included age, sex, antiretroviral treatment (ART) duration, body mass index, history of tuberculosis (TB) or pneumonia, occupational exposure, environmental exposure, smoking and symptoms of OLD (cough, wheeze, mucus and dyspnoea). Impaired lung function was defined as a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of 0.70, or below the 20th percentile of normal.Results: The 98 ART-naïve participants (mean age = 34.0, standard deviation [s.d.] = 8.2), 85 participants on first-line ART (mean age = 36.9, s.d. = 6.6) and 189 participants on second-line ART (mean age = 43.5, s.d. = 7.9) were predominantly female (65.6%). Of the participants, 64 (17.2%) had impaired lung function and 308 had normal lung function. Linear regression identified age (β = –0.003, P 0.01), male sex (β = –0.016, P = 0.03) and history of TB or pneumonia (β = –0.024, P 0.01) as independent predictors of a lower FEV1/FVC ratio. Following logistic regression, only a history of TB or pneumonia (odds ratio = 2.58, 95% confidence interval = 1.47–4.52) was significantly related to impaired lung function (area under the receiver operating characteristic curve = 0.64).Conclusion: Our data show that a history of TB or pneumonia predicts impaired lung function. In order to improve timely access to spirometry, clinicians should be alert to the possibility of impaired lung function in people with a history of TB or pneumonia.

scholarly journals Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study

2019 ◽  
Vol 55 (1) ◽  
pp. 1901217 ◽  
Author(s):  
Sara Renata Alex Wijnant ◽  
Emmely De Roos ◽  
Maryam Kavousi ◽  
Bruno Hugo Stricker ◽  
Natalie Terzikhan ◽  
...  
Keyword(s):  
Lung Function ◽  
Chronic Obstructive Lung Disease ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Rotterdam Study ◽  
Lung Function Decline ◽  
Cardiovascular Comorbidities ◽  
Age Related

Preserved ratio impaired spirometry (PRISm) is a heterogeneous condition but its course and disease progression remain to be elucidated. We aimed to examine its prevalence, trajectories and prognosis in the general population.In the Rotterdam Study (population-based prospective cohort) we examined prevalence, trajectories and prognosis of subjects with normal spirometry (controls; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7, FEV1  ≥80%), PRISm (FEV1/FVC ≥0.7, FEV1 <80%) and chronic obstructive pulmonary disease (COPD) (FEV1/FVC <0.7) at two study visits. Hazard ratios with 95% confidence intervals for mortality (until December 30, 2018) were adjusted for age, sex, body mass index, current smoking and pack-years.Of 5487 subjects (age 69.1±8.9 years; 7.1% PRISm), 1603 were re-examined after 4.5 years. Of the re-examined PRISm subjects, 15.7% transitioned to normal spirometry and 49.4% to COPD. Median lung function decline was highest in subjects with incident PRISm (FEV1 −92.8 mL·year−1, interquartile range (IQR) −131.9– −65.8 mL·year−1; FVC −93.3 mL·year−1, IQR −159.8– −49.1 mL·year−1), but similar in persistent PRISm (FEV1 −30.2 mL·year−1, IQR −67.9– −7.5 mL·year−1; FVC −20.1 mL·year−1, IQR −47.7–21.7 mL·year−1) and persistent controls (FEV1 −39.6 mL·year−1, IQR −64.3–−12.7 mL·year−1; FVC −20.0 mL·year−1, IQR −55.4–18.8 mL·year−1). Of 5459 subjects with informed consent for follow-up, 692 (12.7%) died during 9.3 years (maximum) follow-up: 10.3% of controls, 18.7% of PRISm subjects and 20.8% of COPD subjects. Relative to controls, subjects with PRISm and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2–4 had increased all-cause mortality (PRISm: HR 1.6, 95% CI 1.2–2.0; COPD GOLD 2–4: HR 1.7, 95% CI 1.4–2.1) and cardiovascular mortality (PRISm: HR 2.8, 95% CI 1.5–5.1; COPD 2–4: HR 2.1, 95% CI 1.2–3.6). Mortality within <1 year was highest in PRISm, with patients often having cardiovascular comorbidities (heart failure or coronary heart disease; 70.0%).PRISm is associated with increased mortality and this population encompasses at least three distinct subsets: one that develops COPD during follow-up, a second with high cardiovascular burden and early mortality, and a third with persistent PRISm and normal age-related lung function decline.

Abstract P215: Association Of Lung Function In Mid-life With Central Artery Stiffness Later In Life, The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Kennedy Peter ◽  
James R Pike ◽  
John Preisser ◽  
Anna Kucharska-newton ◽  
Michelle Meyer ◽  
...  
Keyword(s):  
Lung Function ◽  
Arterial Stiffness ◽  
Smoking Status ◽  
Later Life ◽  
Forced Expiratory Volume ◽  
Sensitivity Analyses ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Central Artery ◽  
Artery Stiffness

Introduction: Poor lung function and aortic stiffness often co-occur, but causal and temporal relationships are equivocal. Investigating relationships between mid-life lung function and arterial stiffness later in life may highlight modifiable targets to slow arterial aging. Objective: Assess whether lung function in mid-life is associated with central artery stiffness later in life, and whether this relationship is modified by baseline smoking status, hypertension, or diabetes. Methods: We included 3,529 ARIC cohort participants (60% women; 22% Black; mean baseline age 51.4 (SD: 4.9)) who attended visits 1 (1987-1989) and 5 (2011-2013). Spirometry included forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) of high-quality grades. Central artery stiffness (carotid-femoral pulse wave velocity (cfPWV)) was measured at visit 5. Associations of mid-life lung function with later-life central artery stiffness (cfPWV>75 th percentile) were evaluated by multivariable Poisson and logistic regressions adjusted for covariates. Sensitivity analyses excluded participants with chronic obstructive pulmonary disease identified from surveillance of hospitalizations occurring in follow up (N=109). Results: Mean FEV1 at visit 1 was 3.04 L (SD: 0.73) and FVC was 3.99 L (SD: 0.96). Lung function varied by thoracic height. Visits 1 and 5 were a mean of 23.8 years apart, and mean cfPWV at visit 5 was 1167 cm/s (SD: 379). Lung function at visit 1 was inversely associated with adjusted prevalence and odds of later cfPWV>75 th percentile among those present at visit 5 (Table). Stratum-specific estimates suggested modification by baseline smoking status, hypertension, and diabetes, but were not nominally statistically different. Sensitivity analyses did not alter inferences. Conclusion: Lung function at mid-life is inversely associated with central artery stiffness in later life. Whether change in mid-life pulmonary function is associated with arterial stiffness later in life warrants further examination.

scholarly journals An exploratory study of the associations between maternal iron status in pregnancy and childhood wheeze and atopy

2014 ◽  
Vol 112 (12) ◽  
pp. 2018-2027 ◽  
Author(s):  
Bright I. Nwaru ◽  
Helen Hayes ◽  
Lorraine Gambling ◽  
Leone C. A. Craig ◽  
Keith Allan ◽  
...  
Keyword(s):  
Lung Function ◽  
Childhood Asthma ◽  
Iron Status ◽  
Atopic Disease ◽  
First Trimester ◽  
Forced Expiratory Volume ◽  
Maternal Serum ◽  
Fetal Ultrasound ◽  
Increased Risk

Maternal nutritional status during pregnancy has been reported to be associated with childhood asthma and atopic disease. The Avon Longitudinal Study of Parents and Children has reported associations between reduced umbilical cord Fe status and childhood wheeze and eczema; however, follow-up was short and lung function was not measured. In the present study, the associations between maternal Fe status during pregnancy and childhood outcomes in the first 10 years of life were investigated in a subgroup of 157 mother–child pairs from a birth cohort with complete maternal, fetal ultrasound, blood and child follow-up data. Maternal Fe intake was assessed using FFQ at 32 weeks of gestation and Hb concentrations and serum Fe status (ferritin, soluble transferrin receptor and TfR-F (transferrin receptor:ferritin) index) were measured at 11 weeks of gestation and at delivery. Maternal Fe intake, Hb concentrations and serum Fe status were found to be not associated with fetal or birth measurements. Unit increases in first-trimester maternal serum TfR concentrations (OR 1·44, 95 % CI 1·05, 1·99) and TfR-F index (OR 1·42, 95 % CI 1·10, 1·82) (i.e. decreasing Fe status) were found to be associated with an increased risk of wheeze, while unit increases in serum ferritin concentrations (i.e. increasing Fe status) were found to be associated with increases in standardised mean peak expiratory flow (PEF) (β 0·25, 95 % CI 0·09, 0·42) and forced expiratory volume in the first second (FEV1) (β 0·20, 95 % CI 0·08, 0·32) up to 10 years of age. Increasing maternal serum TfR-F index at delivery was found to be associated with an increased risk of atopic sensitisation (OR 1·35, 95 % CI 1·02, 1·79). The results of the present study suggest that reduced maternal Fe status during pregnancy is adversely associated with childhood wheeze, lung function and atopic sensitisation, justifying further studies on maternal Fe status and childhood asthma and atopic disease.

scholarly journals Metabolomics analysis identifies sex-associated metabotypes of oxidative stress and the autotaxin–lysoPA axis in COPD

2017 ◽  
Vol 49 (6) ◽  
pp. 1602322 ◽  
Author(s):  
Shama Naz ◽  
Johan Kolmert ◽  
Mingxing Yang ◽  
Stacey N. Reinke ◽  
Muhammad Anas Kamleh ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Lung Function ◽  
High Resolution Mass Spectrometry ◽  
Forced Expiratory Volume ◽  
Normal Lung ◽  
Chronic Obstructive ◽  
Targeted Metabolomics ◽  
Metabolomics Data ◽  
Mortality And Morbidity ◽  
Multivariate Modelling

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and a leading cause of mortality and morbidity worldwide. The aim of this study was to investigate the sex dependency of circulating metabolic profiles in COPD.Serum from healthy never-smokers (healthy), smokers with normal lung function (smokers), and smokers with COPD (COPD; Global Initiative for Chronic Obstructive Lung Disease stages I–II/A–B) from the Karolinska COSMIC cohort (n=116) was analysed using our nontargeted liquid chromatography–high resolution mass spectrometry metabolomics platform.Pathway analyses revealed that several altered metabolites are involved in oxidative stress. Supervised multivariate modelling showed significant classification of smokers from COPD (p=2.8×10−7). Sex stratification indicated that the separation was driven by females (p=2.4×10−7) relative to males (p=4.0×10−4). Significantly altered metabolites were confirmed quantitatively using targeted metabolomics. Multivariate modelling of targeted metabolomics data confirmed enhanced metabolic dysregulation in females with COPD (p=3.0×10−3) relative to males (p=0.10). The autotaxin products lysoPA (16:0) and lysoPA (18:2) correlated with lung function (forced expiratory volume in 1 s) in males with COPD (r=0.86; p<0.0001), but not females (r=0.44; p=0.15), potentially related to observed dysregulation of the miR-29 family in the lung.These findings highlight the role of oxidative stress in COPD, and suggest that sex-enhanced dysregulation in oxidative stress, and potentially the autotaxin–lysoPA axis, are associated with disease mechanisms and/or prevalence.

scholarly journals Preoperative pulmonary function in all comers for cardiac surgery predicts mortality

2019 ◽  
Vol 29 (2) ◽  
pp. 244-251
Author(s):  
Emilie C Risom ◽  
Katrine B Buggeskov ◽  
Ulla B Mogensen ◽  
Martin Sundskard ◽  
Jann Mortensen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Lung Function ◽  
Airflow Obstruction ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Clinical Trial Registration ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract OBJECTIVES Although reduced lung function and chronic obstructive pulmonary disease (COPD) is associated with higher risk of death following cardiac surgery, preoperative spirometry is not performed routinely. The aim of this study was to investigate the relationship between preoperative lung function and postoperative complications in all comers for cardiac surgery irrespective of smoking or COPD history. METHODS Preoperative spirometry was performed in elective adult cardiac surgery patients. Airflow obstruction was defined as the ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio below the lower limit of normal (LLN) and reduced forced ventilatory capacity defined as FEV1 <LLN. RESULTS A history of COPD was reported by 132 (19%) patients; however, only 74 (56%) had spirometry-verified airflow obstruction. Conversely, 64 (12%) of the 551 patients not reporting a history of COPD had spirometry-verified airflow obstruction. The probability of death was significantly higher in patients with airflow obstruction (8.8% vs 4.5%, P = 0.04) and in patients with a FEV1 <LLN (8.7% vs 3.7%, P = 0.007). In the multivariate analysis were age [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.0–2.5; P = 0.04], prolonged cardiopulmonary bypass time (HR 1.2, 95% CI 1.02–1.3; P = 0.03), reduced kidney function (HR 2.5, 95% CI 1.2–5.6; P = 0.02) and FEV1 <LLN (HR 2.4, 95% CI 1.1–5.2; P = 0.03) all independently associated with an increased risk of death. CONCLUSIONS Preoperative spirometry reclassified 18% of the patients. A reduced FEV1 independently doubled the risk of death. Inclusion of preoperative spirometry in routine screening of cardiac surgical patients may improve risk prediction and identify high-risk patients. Clinical trial registration number NCT01614951 (ClinicalTrials.gov).

scholarly journals Risk Factors of Rapid Lung Function Decline in COPD Patients of Real World

2021 ◽  
Author(s):  
Hyun Woo Lee ◽  
Jung-Kyu Lee ◽  
Myung Goo Lee ◽  
Kyung-Chul Shin ◽  
Seung Won Ra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Function ◽  
Forced Expiratory Volume ◽  
Current Smoker ◽  
Rapid Decline ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Lung Function Decline ◽  
Obstructive Pulmonary Disease ◽  
Triple Combination Therapy

Abstract Background: Rapid lung function decliners have been considered a unique subgroup of patients with chronic obstructive pulmonary disease (COPD). A rapid decline manifests early and is related with a poor prognosis. Therefore, pre-emptive identification of risk factors for rapid decliner is necessary. We aimed to determine those risk factors in Korean patients.Methods: A longitudinal, observational study was conducted on the KOCOSS cohort (NCT02800499), consisting of patients assessed from January 2012 to December 2019 at 54 medical centers in South Korea. Eligible patients were adults followed up for 3 years with serial spirometric tests. We calculated the annualized percentage change in lung function from baseline. Rapid decliners were defined as the quartile of patients with the highest annualized percentage decline in lung function. Results: Among the 518 included patients, 130 were rapid decliners. Rapid decliners lost 6.2%/year and 100 ml/year of forced expiratory volume in 1 second from baseline. Rapid decliners had a higher rate of severe exacerbations than non-rapid decliners (0.2/year vs. 0.1/year, P=0.032). Upon multivariable logistic regression, male sex, being a current smoker, a blood eosinophil count <150/µl, and a high forced vital capacity were independent risk factors for a rapid decline. In rapid decliners, lung function deteriorated more rapidly in current smokers and patients with more severe dyspnea, while triple combination therapy attenuated lung function decline compared to mono-bronchodilator therapy.Conclusions: Identification of risk and aggravating factors for rapid lung function decline may assist physicians in providing earlier intervention for high-risk patients with COPD.

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