@article {1675146,
	title = {Adult Life-Course Trajectories of Lung Function and the Development of Emphysema: The CARDIA Lung Study},
	journal = {Am J Med},
	volume = {133},
	number = {2},
	year = {2020},
	month = {2020 Feb},
	pages = {222-230.e11},
	abstract = {BACKGROUND: Peak 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.

METHODS: Using 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{\textquoteright}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.

RESULTS: We 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).

CONCLUSIONS: Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.},
	keywords = {Adult, Cohort Studies, Female, Forced Expiratory Volume, Humans, Longitudinal Studies, Male, Middle Aged, Odds Ratio, Pulmonary Emphysema, Respiratory Function Tests, Risk Factors, Spirometry},
	issn = {1555-7162},
	doi = {10.1016/j.amjmed.2019.06.049},
	author = {Washko, George R and Colangelo, Laura A and San Jos{\'e} Est{\'e}par, Raul and Ash, Samuel Y and Bhatt, Surya P and Okajima, Yuka and Liu, Kiang and Jacobs, David R and Iribarren, Carlos and Thyagarajan, Bharat and Lewis, Cora E and Kumar, Rajesh and Han, MeiLan K and Dransfield, Mark T and Carnethon, Mercedes R and Kalhan, Ravi}
}