Background: Little isknownabout risk factors forthe progression ofdisease inindividuals withnewly devel¬ oped chronic bronchitis (CB). Inaddition totheeffects ofsmoking, there was specific clinical andepidemio¬ logic interest intheimportance oftraits such aseosino¬ philia andwheezing, more commonly associated with asthma, intheprogression ofthis disease. Methods: We evaluated adult individuals withand without diagnosed CBlongitudinally inarepresentative community population inTucson, Ariz. Thesesubjects were followed upfor13yearssince 1972. Because we were interested inCBspecifically, those withdiagnoses ofemphysema andasthma were removed fromthedata set.Initial level ofFEVi(%FEVi) andslopes inFEVi were corrected forcovariates andother important vari¬ ables. Results: Asexpected, persistent andnewly diagnosed CB was significantly more common incurrentand ex-smokers. Furthermore, initial lung function was lower, anddecline inFEVi was steeper insmokers with persistent andnewly diagnosed CB.Newly diagnosed caseshadsteeper declines inFEVi(.6.84 mL/yr below grand mean of.11.18mL/yr) thannormalsubjects (+0.95 mL/yr). Theincidence rateofnewly diagnosed CB was significantly higher inthose witheosinophilia (13.7%) thanwithout eosinophilia (6.7%). Finally, new cases witheosinophilia hadsimilar initial %FEVi (95.4 ±1%)butmuchlarger declines infunction than new cases without eosinophilia: -24.5 versus -16.6 mL/yr. Adverse effects ofwheeze were largely ex¬ plained bysmoking andeosinophilia. Conclusion: Eosinophilia isan important aspect ofCB inaddition tosmoking, anditshould beconsidered in itsevaluation. Thepresence ofeosinophilia innewly diagnosed CB,with orwithout wheeze, may warn the clinician ofthepossibility ofarapid decline inFEVi. (CHEST 1995; 108:55-61)

Predictors of chronic obstructive pulmonary disease (COPD) have been identified in the prospective epidemiologic study of the population of Tecumseh, Michigan. Risk of developing COPD within 10 yr can be estimated from a profile that includes as risk factors age, sex, cigarette smoking habits, and forced expiratory volume in one second (FEV1. The index of risk placed 63% of male incidence cases and 64% of female incidence cases in the top 10% of the risk distribution and 81% of male and 86% of female COPD cases in the top 20% of the risk distribution for Tecumseh. The validity of the Tecumseh index of risk for other populations was determined in a collaborative investigation of data collected in longitudinal epidemiologic studies in Baltimore, Boston, Framingham, Louisiana, Staveley, and Tucson. The extent to which the risk model fitted these data sets was assessed by comparing predicted (or expected) onsets of COPD in each population with observations made in each study. The predictors of COPD identified...

From a randomly selected population representative of the white population of Tucson, Ariz., satisfactory flow-volume data were obtained for 3,115 persons. Data from the 746 subjects who were totally free of symptoms or history of cardiorespiratory disease and who had never smoked were used in determining “normal” prediction equations for spirometric parameters and maximal expiratory flows. The maximal expiratory flow-volume curve showed considerable intersubject variability, but little change in shape of the mean maximal expiratory flow-volume curve was seen with advancing age when the effects of disease, insult, or injury were excluded.

"Guidelines For The Approach To The Patient With Severe Hereditary Alpha-1-Antitrypsin Deficiency." American Review of Respiratory Disease, 140(5), pp. 1494–1497

The data from a longitudinal population study in Tucson, Arizona, were used to describe the development and decline with age of the peak expiratory flows (PEF) from maximum expiratory flow-volume (MEFV) curves derived using a computer-linked pneumotachometer.Subjects had performed at least one technically acceptable MEFV test in 9 of the first 11 surveys (1972-1989), There were 2,724 subjects with adequate MEFV curves, and thus PEF, in the first survey, but only 1315 in the 11th survey. The subjects were stratified based on responses to questionnaires into nonsmoking healthy subjects and others. The PEF were analysed cross-sectionally and longitudinally using data from the 6th-11th surveys (1979-1989). For longitudinal analysis, the reference population had 397 males with 1,153 observations, and 534 females with 1,700 observations. The resulting equations were compared, evaluating differences between the longitudinal and cross-sectional equations, and between reference and nonreference longitudinal populations.The results show that there were effort-dependent effects in absolute values of PEF, even after editing, Nevertheless, as with most MEFV measures in reference populations, PEF had an early increase in the rate of development, followed by a plateau phase, followed by a constant rate of decline. The ages at which changes in growth rates of PEF occurred differed by gender, The longitudinal data in adults showed a less steep decline with age compared to the cross-sectional data, as found previously for the other MEFV variables. Males in the nonreference group did not reach the same maximum level and had a steeper decline throughout adult life than did males in the reference group; females were similar, Asthmatics of both genders had slightly greater declines compared to the other nonreference subjects.

Background: Respiratory symptoms are frequent in very young children, and the relation of these symptoms to later asthma in some of these children is unknown. Objective: The aim of the study was to describe the natural history of respiratory symptoms in a community-based sample of young children who were prospectively observed for as long as 11 years. Methods: Subjects were participants in the Tucson Epidemiologic Study of Airways Obstructive Disease. They were under 5 years of age at enrollment and were studied by means of a parent-administered mail survey instrument every 1 to 2 years for 3 to 11 years. Results: Among subjects younger than 1 year of age, no single respiratory symptom, such as cough or wheeze only with colds, significantly increased the risk of a subsequent diagnosis of asthma. Among 1- and 2-year-olds, however, those with wheeze only with colds and those with attacks of shortness of breath with wheeze were more likely to be diagnosed with asthma later when compared with children without those symptoms (odds ratio = 2.1; p < 0.05 for wheeze only with colds). At ages 3 to 4 years, symptoms were even more strongly associated with subsequent asthma (odds ratio = 7.2; p < 0.0001 for attacks of shortness of breath with wheeze). Conclusion: Although respiratory symptoms reported by parents very early in life are not significantly associated with future asthma, those symptoms that begin at or persist through ages 3 to 4 years are. (J ALLERGY CLIN IMMUNOL 1996;98:48-54.)

Several studies have demonstrated that smokers who are able to break the habit generally experience reductions in respiratory symptoms and improvement in pulmonary function; however, far less attention has been given to smokers who are unsuccessful in their attempts at quitting. Recent reports have suggested that these subjects (restarters) may have steeper rates of decline in pulmonary function than subjects never attempting to quit smoking. In this study, we compared rates of decline in FEV1 between restarters and subjects who remained current, ex-smokers, or never-smokers throughout the observation period. The results showed that, in both sexes, subjects who attempt to quit the habit and then restart have significantly steeper rates of decline in their FEV1 than subjects who continue smoking uninterrupted. Female restarters also have significantly steeper rates of decline in FEV1 than ex-smokers. These effects were independent of the amount smoked and respiratory diseases.

The role of immunoglobulin E (IgE) in the development and course of impaired ventilatory function and chronic obstructive pulmonary disease (COPD) required further study. This role has been examined in the longitudinal Tucson Epidemiological Study of Airways Obstructive Disease, which started in 1972. The association between IgE and longitudinal changes in pulmonary function measures was examined in subjects in the community population sample in Tucson who had an initial age of 35 or more. There were a total of 1,533 such subjects with lung function tests over the 20 yr period who also had IgE determinations. A significant inverse association was found between total serum IgE and FEV1/FVC that was independent of smoking and asthma status. The finding was statistically separate from the relation with age in all but elderly current smokers (age > 55). The magnitude of this effect in nonasthmatic subjects was relatively small. For asthmatic subjects, however, the inverse association was larger in both current and never smokers. Subjects excluded from the current analysis either did not have an IgE measurement and/or had no pulmonary function values after 35 yr of age. These findings suggest that higher IgE levels may indicate the presence of a disease process that may involve inflammation and/or other mechanisms related to IgE production, which impair lung function over time. However, in this study we were not able to account for possible parental or inheritance contributions to increases in total IgE, which have been shown to be important.

This paper examines the familial aggregation of physician-diagnosed asthma in relation to the age- and sex-standardized total serum IgE levels of children and their parents in a sample of the general population in Tucson, Arizona, that has been followed in a longitudinal study for over 20 yr. There were 591 nuclear families containing 1,177 children who provided information about the presence or absence of a physician diagnosis of asthma. The serum IgE data were less complete: both parents and one or more of their children in 251 of the nuclear families, containing 468 children, had serum IgE levels measured. There was a very strong tendency for asthmatic patients to have asthmatic children, but only a small part of this appeared to be related to the familial aggregation of total serum IgE. In the absence of an asthmatic parent, there was a slight but significantly higher prevalence of asthma in children of whom both parents had IgE levels in the highest tertile. Very high rates of children's asthma depended on there being an asthmatic parent who also had at least moderate levels of serum IgE. It was also shown that asthmatic children have considerably higher total IgE levels than would be expected on the basis of their parents' IgE levels alone. The data appear compatible with several familial-aggregation hypotheses and a strong environmental influence determining which children are likely to develop asthma. We speculate that the inflammation in the airways of asthmatic patients itself tends to increase the serum IgE level, possibly secondary to mediators that it generates.

Clinical & Experimental AllergyVolume 25, Issue s2 p. 15-16 Allergy and the development of asthma and bronchial hyperresponsiveness B. BURROWS, Corresponding Author B. BURROWS University of Arizona College of Medicine, Respiratory Sciences Center, Tucson, Arizona, USAProfessor B. Burrows, University of Arizona College of Medicine, Respiratory Sciences Center, 1501N. Campbell Avenue, Tucson, AZ 85724, USA.Search for more papers by this author B. BURROWS, Corresponding Author B. BURROWS University of Arizona College of Medicine, Respiratory Sciences Center, Tucson, Arizona, USAProfessor B. Burrows, University of Arizona College of Medicine, Respiratory Sciences Center, 1501N. Campbell Avenue, Tucson, AZ 85724, USA.Search for more papers by this author First published: November 1995 https://doi.org/10.1111/j.1365-2222.1995.tb00411.xCitations: 11AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume25, Issues2November 1995Pages 15-16 RelatedInformation

Background: Many factors have been found to relate univariately to bronchial responsiveness (BR), but their independent relationships are often unclear because many are interrelated. Objective: The purpose of this study was to present a multivariate analysis of the closeness of the association of various factors that are related univariately to BR, including allergy skin tests. Methods: The results of methacholine challenge were transformed into a continuous variable (BRindex), which has a nearly Gaussian distribution. With stepwise multiple regression, the closeness of the association of the independent variables with BRindex was evaluated. Results: Of the 11 skin tests applied, four showed independent relationships to BRindex (mite, cat, dog, and Aspergillus species). The sizes of these skin test reactions were correlated with BRindex, and their sum appeared to maximize the overall correlation of allergy skin tests with BRindex (r = 0.516). The lowness of the ratio of forced expiratory volume in 1 second to vital capacity and of percent predicted forced expiratory volume in 1 second added significantly to the skin tests in correlating with BRindex, (multiple r = 0.621). Adding diagnoses and symptoms increased the multiple r to 0.685. Conclusions: The size of the reactions to the four skin tests noted above showed much closer correlations with BR than total serum IgE had shown at age 11, and the relationship was present in asthmatic and nonasthmatic subjects. (J ALLERGY CLIN IMMUNOL 1995;95:548-56.)

Bronchial responsiveness to methacholine was measured in a birth cohort of New Zealand children at ages 9, 11, 13, and 15. Overall bronchial hyperresponsiveness (BHR) decreased with age. While the response at age 9 was significantly related to responsiveness, symptom severity, and low lung function at age 15, these relationships were much closer when bronchial response levels after age 9 were taken into account. Also, among children who were unresponsive to methacholine at age 15, those with previous BHR had more frequent wheeze and lower lung function than those whose previous tests were all unresponsive. Both the overall tendency to BHR and the tendency to retain BHR were closely related to high serum IgE levels (determined at age 11) and to positive allergy skin tests (determined at age 13). These evidences of allergy, closely related to the severity and course of methacholine response, appeared to be important determinants of the frequency of wheeze and the degree of impairment of lung function at the end of follow-up. In view of the variability in BHR, a single estimate of bronchial responsiveness taken at an arbitrary point in time may not be an accurate index of the overall tendency to BHR.

Background: A number of cross-sectional studies have demonstrated that higher levels of IgE are found in subjects who currently smoke cigarettes and/or who are atopic and that IgE levels decline with age. Objective: This report examines the interactions among atopic status, smoking, and IgE with longitudinal data and methods. Methods: Subjects were participants in the Tucson Epidemiological Study of Airways Obstructive Disease and were 6 years of age and older. Total serum IgE measures and allergen skin test results were obtained during three surveys spanning a period of up to 20 years. Results: The results showed no significant gender differences between nonatopic nonsmoking subjects, who were considered the reference group. Nonatopic current smokers had IgE levels similar to those of the reference subjects initially, but IgE levels did not decline with age at the same rate as in the reference subjects, causing significant differences at older ages. There was a significant relationship between number of cigarettes smoked and IgE level. Conclusions: Atopy and smoking are both associated with elevated total serum IgE levels. Although the exact mechanism for elevated IgE levels in smokers is not known, the significant dose relationship is suggestive of a causal association. (J ALLERGY CLIN IMMUNOL 1994;94:954-62.)

Background: Asthma is a poorly understood disease. Risk factors are not established, and the natural history of the disease is unknown.Objective: Using subjects of a community-based study, we have prospectively compared young adults destined to develop asthma with control subjects to determine differences between them before diagnosis.Methods: Subjects were participants of the Tucson Epidemiologic Study of Airways Obstructive Disease. They were studied between the ages of 15 and 19 and subsequently every 1 to 2 years until they were at least 21 years old with questionnaires, spirometry, allergy skin testing and serum IgE testing.Results: Logistic regression showed chat ''wheeze'' and ''attacks of shortness of breath with wheeze'' were independently predictive of asthma. Positive allergy skin test results occurred more frequently among subjects who later received a diagnosis of asthma, and initially these subjects had higher serum IgE levels than control subjects (geometric mean IgE = 173.8 IU/ml vs 52.5 IU/ml for control subjects; p < 0.005). Although initial spirometric testing did not distinguish between future asthmatic subjects and control subjects, repeat testing after diagnosis did show significant differences in flows at low lung volumes.Conclusions: These data suggest chat symptoms and findings suggestive of asthma may be present for many years before diagnosis.

We examined the effects of smoking onset and cessation on FEV1 in participants in the Tucson Epidemiological Study of Airways Obstructive Disease 18 yr of age or older who reported a change in smoking habits during 17 yr of follow-up. Subjects were classified as "new quitters" (n = 288) and "new starters" (n = 45) at each survey on the basis of questionnaire responses concerning current smoking habits. The pulmonary function data were analyzed using a mixed longitudinal or random effects model (REM). We compared FEV1 before and after changing smoking habits in the same subjects while adjusting for important covariables such as height, pack-years, and respiratory symptoms and diseases. The results for smoking cessation showed a beneficial effect related to quitting that was largest for younger subjects and decreased linearly with age. For women, quitting resulted in an improvement in FEV1 of 4.3% at 20 yr of age which decreased to 2.5% by 80 yr of age. Men had an improvement of only 1.2% at 20 yr of age and no improvement at 80 yr of age. After excluding subjects with low initial function (FEV1/FVC in the lowest quartile) and those with only a single observation after quitting, men (n = 70) showed a significantly higher FEV1 improvement of 4% at 20 yr of age that decreased linearly to zero by age 80 yr. In contrast, women in this subgroup (n = 89) had nearly the same degree of improvement at all ages. The onset results showed mean FEV1 values after starting smoking that were higher at the younger ages (< 23 yr) and that decreased more rapidly with age, compared with nonsmoking mean estimates, in both sexes.

We analyzed the determinants of the percent predicted FEV1 of a large group of diagnosed asthmatic subjects in the Tucson Study of Airway Obstructive Diseases. The 261 subjects were 6 to 88 years old, and 150 (57.5 percent) were female. Although 29.1 percent of the subjects were current smokers and 24.1 percent were ex-smokers, we found that pack-years of smoking was not related to lung function. In addition, age of onset of disease, duration of asthma, eosinophil count, serum IgE level, and allergy skin test reactivity status did not influence the %FEV1. We did find that both severity of wheezing and age of the subject related significantly to %FEV1, and an interaction term of these two variables replaced wheeze and age in the multiple regression equation. Current physician-diagnosed chronic bronchitis and the reported severity of exertional dyspnea also related to %FEV1.