Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes

• Published in: The European respiratory journal Vol. 30; no. 4; pp. 616 - 622
• Main Authors: Young, R. P, Hopkins, R, Eaton, T. E
• Format: Journal Article
• Language: English
• Published: Leeds Eur Respiratory Soc 01.10.2007; Maney
• Subjects: Adult; Aged; Biological and medical sciences; Cardiovascular Diseases - diagnosis; Chronic obstructive pulmonary disease, asthma; Coronary Artery Disease - diagnosis; Forced Expiratory Volume; Humans; Lung Diseases - diagnosis; Lung Diseases - epidemiology; Lung Neoplasms - diagnosis; Medical sciences; Middle Aged; Pneumology; Pulmonary Disease, Chronic Obstructive - diagnosis; Risk; Risk Assessment; Smoking; Spirometry - methods; Stroke - diagnosis; Time Factors; Premature; Spirometry; Prognosis; Biological marker; Risk; premature death; Epidemiology; Lung function; Cause; Bronchus disease; Obstructive pulmonary disease; Public health; Pneumology; Lung disease; Respiratory disease; Chronic disease; Mortality; Exploration; Baseline risk; Chronic; Volume; Risk factor; Death; Causality; chronic obstructive pulmonary disease
• ISSN: 0903-1936; 1399-3003; 1399-3003
• DOI: 10.1183/09031936.00021707

The clinical utility of spirometric screening of asymptomatic smokers for early signs of air flow limitation has recently come under review. The current authors propose that reduced forced expiratory volume in one second (FEV 1 ) is more than a measure of airflow limitation, but a marker of premature death with broad utility in assessing baseline risk of chronic obstructive pulmonary disease (COPD), lung cancer, coronary artery disease and stroke, collectively accounting for 70–80% of premature death in smokers. Reduced FEV 1 identifies undiagnosed COPD, has comparable utility to that of serum cholesterol in assessing cardiovascular risk and defines those smokers at greatest risk of lung cancer. As such, reduced FEV 1 should be considered a marker that identifies smokers at greatest need of medical intervention. Smoking cessation has been shown to attenuate FEV 1 decline and, if achieved before the age of 45–50 yrs, may not only preserve FEV 1 within normal values but substantially reduce cardiorespiratory complications of smoking. Recent findings suggest inhaled drugs (bronchodilators and corticosteroids), and possibly statins, may be effective in reducing morbidity and mortality in patients with chronic obstructive pulmonary disease. The current authors propose that spirometry has broad utility in identifying smokers who are at greatest risk of cardiorespiratory complications and greatest benefit from targeted preventive strategies, such as smoking cessation, prioritised screening and effective pharmacotherapy.