Clinical relevance of lung function trajectory clusters in middle-aged and older adults

Abstract

BackgroundThe determinants and health outcomes of lung function trajectories in adults among the general population are poorly understood. We aimed to identify and characterise clusters of lung function trajectories in adults aged ≥45 years.MethodsGaussian finite-mixture modelling was applied to baseline and annualised change of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio z-scores in participants of the Rotterdam Study, a prospective population-based cohort study, with repeated spirometry (n=3884; mean±sdage 64.7±8.9 years). Longitudinal outcomes were all-cause mortality, respiratory outcomes (symptoms, COPD (FEV1/FVC <0.7 in absence of asthma), preserved ratio impaired spirometry (PRISm; FEV1/FVC ≥0.7 and FEV1or FVC <80%)), smoking cessation and weight changes. Independent risk factors, including genetics, were identified by multiple logistic regression.ResultsWe identified eight trajectory clusters, with the reference group having persistently normal spirometry (prevalence 42.8%). Three clusters showed higher mortality, adjusted for confounders: 1) the persistently low FEV1cluster (prevalence 6.8%, hazard ratio (HR) 1.71, 95% CI 1.37–2.13); 2) rapid FEV1decliners (prevalence 4.6%, HR 1.48, 95% CI 1.10–1.99); and 3) FVC decliners (prevalence 3.7%, HR 1.49, 95% CI 1.09–2.03). In contrast, FVC improvers (prevalence 6.7%, HR 0.61, 95% CI 0.41–0.90) and persistently high FEV1(prevalence 29.2%, HR 0.82, 95% CI 0.69–0.98) were protective trajectory clusters. Clusters were characterised by differences in genetic predisposition (polygenic scores of FEV1and FEV1/FVC), demographics, cigarette smoking, respiratory symptoms (chronic cough, wheezing and dyspnoea), cardiovascular factors (body mass index, hypertension and heart failure) and serum C-reactive protein levels. Frailty, weight changes and the development of respiratory symptoms, COPD and PRISm were significantly associated with trajectory clusters.ConclusionsThis study reveals clinically relevant lung function trajectory clusters in older adults of the general population.