• George R Washko, Laura A Colangelo, EstéparRaul San JoséRSJApplied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Mass; Department of Radiology, Brigham and Women's Hospital, Boston, Mass., Samuel Y Ash, Surya P Bhatt, Yuka Okajima, Kiang Liu, David R Jacobs, Carlos Iribarren, Bharat Thyagarajan, Cora E Lewis, Rajesh Kumar, MeiLan K Han, Mark T Dransfield, Mercedes R Carnethon, and Ravi Kalhan.
• Division of Pulmonary and Critical Care Medicine, Boston, Mass; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Mass. Electronic address: Gwashko@BWH.Harvard.edu.
• Am. J. Med. 2020 Feb 1; 133 (2): 222230.e11222-230.e11.

BackgroundPeak lung function and rate of decline predict future airflow obstruction and nonrespiratory comorbid conditions. Associations between lung function trajectories and emphysema have not been explored.MethodsUsing data from the population-based CARDIA Study, we sought to describe the prevalence of visually ascertained emphysema at multiple time points and contextualize its development based upon participant's adult life course measures of lung function. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. Trajectories for the change in percent-predicted forced expiratory volume in one second (FEV1) were determined by fitting a mixture model via maximum likelihood. Emphysema was visually identified on computed tomographic scans and its prevalence reported at mean ages of 40, 45, and 50 years.ResultsWe identified 5 trajectories describing peak and change in FEV1: "Preserved Ideal," "Preserved Good," "Preserved Impaired," "Worsening," and "Persistently Poor." Ever smokers comprised part of all 5 trajectories. The prevalence of emphysema was 1.7% (n = 46; mean age of 40 years), 2.5% (n = 67; mean age of 45 years), and 7.1% (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 18.0% were never smokers. Worsening and poor lung health trajectories were associated with increased odds of future emphysema independent of chronic tobacco smoke exposure (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44).ConclusionsLower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.Copyright © 2019. Published by Elsevier Inc.

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