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Original Research: COPD |

Rapid Lung Function Decline in Smokers Is a Risk Factor for COPD and Is Attenuated by Angiotensin-Converting Enzyme Inhibitor UseRapid FEV1 Decline Among Smokers

Hans Petersen, MS; Akshay Sood, MD, MPH, FCCP; Paula M. Meek, PhD, RN; Xian Shen, MS; Yan Cheng, MS; Steven A. Belinsky, PhD; Caroline A. Owen, MD, PhD; George Washko, MD; Victor Pinto-Plata, MD, FCCP; Emer Kelly, MD; Bartolome Celli, MD, FCCP; Yohannes Tesfaigzi, PhD
Author and Funding Information

From the COPD and Lung Cancer Programs (Mr Petersen and Drs Belinsky and Tesfaigzi), Lovelace Respiratory Research Institute, Albuquerque, NM; Department of Medicine (Dr Sood and Mss Shen and Cheng), University of New Mexico, Albuquerque, NM; University of Colorado-Denver (Dr Meek), Denver, CO; and Pulmonary Division (Drs Owen, Washko, Pinto-Plata, Kelly, and Celli), Brigham and Women’s Hospital, Boston, MA.

Correspondence to: Hans Petersen, MS, Lovelace Respiratory Research Institute, 2425 Ridgecrest Dr SE, Albuquerque, NM 87108; e-mail: hpeterse@lrri.org


For editorial comment see page 671

Funding/Support: This work was supported by funding from the State of New Mexico (appropriation from the Tobacco Settlement Fund) and the National Institutes of Health [P50-HL-107165 to Drs Celli and Tesfaigzi, HL-11835 to Dr Owen, K23-HL-094531-01 and 8UL1TR000041 to Dr Sood, R01-ES-015482 to Dr Tesfaigzi, and R01-CA-164782 to Drs Belinsky and Tesfaigzi].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):695-703. doi:10.1378/chest.13-0799
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Objective:  Cigarette smoking is the most important risk factor for COPD in the United States. Host factors that influence the rapid rate of FEV1 decline in smokers and how decline rate influences risk for developing COPD are unknown. The aim of this study was to characterize the rate of FEV1 decline in ever smokers, compare the risk of incident COPD between those with rapid decline and others, and determine the effect of selected drugs on rapid decline.

Methods:  A total of 1,170 eligible ever smokers from the longitudinal Lovelace Smokers Cohort with repeat spirometry tests over a minimum follow-up period of 3 years (mean follow-up, 5.9 years) were examined, including 809 ever smokers without a spirometric abnormality at baseline. Longitudinal absolute decline in postbronchodilator FEV1 from the slope of the spirometric values over all examinations was annualized and classified as rapid (≥ 30 mL/y), normal (0-29.9 mL/y), or no (> 0 mL/y) decline. Logistic regression and Kaplan-Meier survival curves were used for the analysis.

Results:  Approximately 32% of ever smokers exhibited rapid decline. Among ever smokers without a baseline spirometric abnormality, rapid decline was associated with an increased risk for incident COPD (OR, 1.88; P = .003). The use of angiotensin-converting enzyme (ACE) inhibitors at baseline examination was protective against rapid decline, particularly among those with comorbid cardiovascular disease, hypertension, or diabetes (ORs 0.48, 0.48, and 0.12, respectively; P ≤ .02 for all analyses).

Conclusions:  Ever smokers with a rapid decline in FEV1 are at higher risk for COPD. Use of ACE inhibitors by smokers may protect against this rapid decline and the progression to COPD.

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