Rate of normal lung function decline in ageing adults: A systematic review of prospective cohort studies

Elizabeth T. Thomas, Michelle Guppy, Sharon E. Straus, Katy J.L. Bell, Paul Glasziou

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Abstract

OBJECTIVE: To conduct a systematic review investigating the normal age-related changes in lung function in adults without known lung disease.

DESIGN: Systematic review.

DATA SOURCES: MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible studies from inception to February 12, 2019, supplemented by manual searches of reference lists and clinical trial registries.

ELIGIBILITY CRITERIA: We planned to include prospective cohort studies and randomised controlled trials (control arms) that measured changes in lung function over time in asymptomatic adults without known respiratory disease.

DATA EXTRACTION AND SYNTHESIS: Two authors independently determined the eligibility of studies, extracted data and assessed the risk of bias of included studies using the modified Newcastle-Ottawa Scale.

RESULTS: From 4385 records screened, we identified 16 cohort studies with 31 099 participants. All included studies demonstrated decline in lung function-forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with age. In studies with longer follow-up (>10 years), rates of FEV1 decline ranged from 17.7 to 46.4 mL/year (median 22.4 mL/year). Overall, men had faster absolute rates of decline (median 43.5 mL/year) compared with women (median 30.5 mL/year). Differences in relative FEV1 change, however, were not observed between men and women. FEV1/FVC change was reported in only one study, declining by 0.29% per year. An age-specific analysis suggested the rate of FEV1 function decline may accelerate with each decade of age.

CONCLUSIONS: Lung function-FEV1, FVC and PEFR-decline with age in individuals without known lung disease. The definition of chronic airway disease may need to be reconsidered to allow for normal ageing and ensure that people likely to benefit from interventions are identified rather than healthy people who may be harmed by potential overdiagnosis and overtreatment. The first step would be to apply age, sex and ethnicity-adjusted FEV1/FVC thresholds to the disease definition of chronic obstructive pulmonary disease.

PROSPERO REGISTRATION NUMBER: CRD42018087066.

Original languageEnglish
Article numbere028150
JournalBMJ Open
Volume9
Issue number6
DOIs
Publication statusPublished - 27 Jun 2019

Fingerprint

Forced Expiratory Volume
Cohort Studies
Prospective Studies
Vital Capacity
Lung
Peak Expiratory Flow Rate
Lung Diseases
MEDLINE
Chronic Obstructive Pulmonary Disease
Registries
Nursing
Chronic Disease
Randomized Controlled Trials
Clinical Trials
Health

Cite this

Thomas, Elizabeth T. ; Guppy, Michelle ; Straus, Sharon E. ; Bell, Katy J.L. ; Glasziou, Paul. / Rate of normal lung function decline in ageing adults : A systematic review of prospective cohort studies. In: BMJ Open. 2019 ; Vol. 9, No. 6.
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abstract = "OBJECTIVE: To conduct a systematic review investigating the normal age-related changes in lung function in adults without known lung disease.DESIGN: Systematic review.DATA SOURCES: MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible studies from inception to February 12, 2019, supplemented by manual searches of reference lists and clinical trial registries.ELIGIBILITY CRITERIA: We planned to include prospective cohort studies and randomised controlled trials (control arms) that measured changes in lung function over time in asymptomatic adults without known respiratory disease.DATA EXTRACTION AND SYNTHESIS: Two authors independently determined the eligibility of studies, extracted data and assessed the risk of bias of included studies using the modified Newcastle-Ottawa Scale.RESULTS: From 4385 records screened, we identified 16 cohort studies with 31 099 participants. All included studies demonstrated decline in lung function-forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with age. In studies with longer follow-up (>10 years), rates of FEV1 decline ranged from 17.7 to 46.4 mL/year (median 22.4 mL/year). Overall, men had faster absolute rates of decline (median 43.5 mL/year) compared with women (median 30.5 mL/year). Differences in relative FEV1 change, however, were not observed between men and women. FEV1/FVC change was reported in only one study, declining by 0.29{\%} per year. An age-specific analysis suggested the rate of FEV1 function decline may accelerate with each decade of age.CONCLUSIONS: Lung function-FEV1, FVC and PEFR-decline with age in individuals without known lung disease. The definition of chronic airway disease may need to be reconsidered to allow for normal ageing and ensure that people likely to benefit from interventions are identified rather than healthy people who may be harmed by potential overdiagnosis and overtreatment. The first step would be to apply age, sex and ethnicity-adjusted FEV1/FVC thresholds to the disease definition of chronic obstructive pulmonary disease.PROSPERO REGISTRATION NUMBER: CRD42018087066.",
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Rate of normal lung function decline in ageing adults : A systematic review of prospective cohort studies. / Thomas, Elizabeth T.; Guppy, Michelle; Straus, Sharon E.; Bell, Katy J.L.; Glasziou, Paul.

In: BMJ Open, Vol. 9, No. 6, e028150, 27.06.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Rate of normal lung function decline in ageing adults

T2 - A systematic review of prospective cohort studies

AU - Thomas, Elizabeth T.

AU - Guppy, Michelle

AU - Straus, Sharon E.

AU - Bell, Katy J.L.

AU - Glasziou, Paul

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/6/27

Y1 - 2019/6/27

N2 - OBJECTIVE: To conduct a systematic review investigating the normal age-related changes in lung function in adults without known lung disease.DESIGN: Systematic review.DATA SOURCES: MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible studies from inception to February 12, 2019, supplemented by manual searches of reference lists and clinical trial registries.ELIGIBILITY CRITERIA: We planned to include prospective cohort studies and randomised controlled trials (control arms) that measured changes in lung function over time in asymptomatic adults without known respiratory disease.DATA EXTRACTION AND SYNTHESIS: Two authors independently determined the eligibility of studies, extracted data and assessed the risk of bias of included studies using the modified Newcastle-Ottawa Scale.RESULTS: From 4385 records screened, we identified 16 cohort studies with 31 099 participants. All included studies demonstrated decline in lung function-forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with age. In studies with longer follow-up (>10 years), rates of FEV1 decline ranged from 17.7 to 46.4 mL/year (median 22.4 mL/year). Overall, men had faster absolute rates of decline (median 43.5 mL/year) compared with women (median 30.5 mL/year). Differences in relative FEV1 change, however, were not observed between men and women. FEV1/FVC change was reported in only one study, declining by 0.29% per year. An age-specific analysis suggested the rate of FEV1 function decline may accelerate with each decade of age.CONCLUSIONS: Lung function-FEV1, FVC and PEFR-decline with age in individuals without known lung disease. The definition of chronic airway disease may need to be reconsidered to allow for normal ageing and ensure that people likely to benefit from interventions are identified rather than healthy people who may be harmed by potential overdiagnosis and overtreatment. The first step would be to apply age, sex and ethnicity-adjusted FEV1/FVC thresholds to the disease definition of chronic obstructive pulmonary disease.PROSPERO REGISTRATION NUMBER: CRD42018087066.

AB - OBJECTIVE: To conduct a systematic review investigating the normal age-related changes in lung function in adults without known lung disease.DESIGN: Systematic review.DATA SOURCES: MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible studies from inception to February 12, 2019, supplemented by manual searches of reference lists and clinical trial registries.ELIGIBILITY CRITERIA: We planned to include prospective cohort studies and randomised controlled trials (control arms) that measured changes in lung function over time in asymptomatic adults without known respiratory disease.DATA EXTRACTION AND SYNTHESIS: Two authors independently determined the eligibility of studies, extracted data and assessed the risk of bias of included studies using the modified Newcastle-Ottawa Scale.RESULTS: From 4385 records screened, we identified 16 cohort studies with 31 099 participants. All included studies demonstrated decline in lung function-forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with age. In studies with longer follow-up (>10 years), rates of FEV1 decline ranged from 17.7 to 46.4 mL/year (median 22.4 mL/year). Overall, men had faster absolute rates of decline (median 43.5 mL/year) compared with women (median 30.5 mL/year). Differences in relative FEV1 change, however, were not observed between men and women. FEV1/FVC change was reported in only one study, declining by 0.29% per year. An age-specific analysis suggested the rate of FEV1 function decline may accelerate with each decade of age.CONCLUSIONS: Lung function-FEV1, FVC and PEFR-decline with age in individuals without known lung disease. The definition of chronic airway disease may need to be reconsidered to allow for normal ageing and ensure that people likely to benefit from interventions are identified rather than healthy people who may be harmed by potential overdiagnosis and overtreatment. The first step would be to apply age, sex and ethnicity-adjusted FEV1/FVC thresholds to the disease definition of chronic obstructive pulmonary disease.PROSPERO REGISTRATION NUMBER: CRD42018087066.

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