Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1990 Aug;45(8):579–585. doi: 10.1136/thx.45.8.579

Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes.

P Lange 1, J Nyboe 1, M Appleyard 1, G Jensen 1, P Schnohr 1
PMCID: PMC462624  PMID: 2402719

Abstract

The relation of ventilatory impairment and chronic mucus hypersecretion to death from all causes and death from obstructive lung disease (chronic bronchitis, emphysema and asthma) was studied in 13,756 men and women randomly selected from the general population of the City of Copenhagen. During the 10 year follow up 2288 subjects died. In 164 subjects obstructive lung disease was considered to be an underlying or a contributory cause of death (obstructive lung disease related death); in 73 subjects it was considered to be the underlying cause of death (obstructive lung disease death). Forced expiratory volume in one second, expressed as a percentage of the predicted value (FEV1% pred), and the presence of chronic phlegm were used to characterise ventilatory function and chronic mucus hypersecretion respectively. For mortality analysis the proportional hazards regression model of Cox was used; it included age, sex, pack years, inhalation habit, body mass index, alcohol consumption, and the presence or absence of asthma, heart disease, and diabetes mellitus as confounding factors. By comparison with subjects with an FEV1 of 80% pred or more, subjects with an FEV1 below 40% pred had increased risk of dying from all causes (relative risk (RR) = 5.0 for women, 2.7 for men), a higher risk of obstructive lung disease related death (RR = 57 for women, 34 for men), and a higher risk of obstructive lung disease death (RR = 101 for women, 77 for men). Chronic mucus hypersecretion was associated with only a slightly higher risk of death from all causes (RR = 1.1 for women, 1.3 for men). The association between chronic mucus hypersecretion and obstructive lung disease death varied with the level of ventilatory function, being weak in subjects with normal ventilatory function (for an FEV1 of 80% pred the RR was 1.2), but more pronounced in subjects with reduced ventilatory function (for an FEV1 of 40% pred the RR was 4.2). A similar though statistically non-significant trend was observed with regard to obstructive lung disease related death. This study shows that impaired lung function is very strongly related to total mortality, obstructive lung disease related mortality, and obstructive lung disease mortality and suggests that chronic mucus hypersecretion, in those with impaired ventilatory function, is also a significant risk factor for death from obstructive lung disease.

Full text

PDF
579

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alderson M., Loy R. M. Mortality from respiratory disease at follow-up of patients with asthma. Br J Dis Chest. 1977 Jul;71(3):198–202. doi: 10.1016/0007-0971(77)90110-3. [DOI] [PubMed] [Google Scholar]
  2. Annesi I., Kauffmann F. Is respiratory mucus hypersecretion really an innocent disorder? A 22-year mortality survey of 1,061 working men. Am Rev Respir Dis. 1986 Oct;134(4):688–693. doi: 10.1164/arrd.1986.134.4.688. [DOI] [PubMed] [Google Scholar]
  3. Ashley F., Kannel W. B., Sorlie P. D., Masson R. Pulmonary function: relation to aging, cigarette habit, and mortality. Ann Intern Med. 1975 Jun;82(6):739–745. doi: 10.7326/0003-4819-82-6-739. [DOI] [PubMed] [Google Scholar]
  4. Backhouse A., Holland W. W. Trends in mortality from chronic obstructive airways disease in the United Kingdom. Thorax. 1989 Jul;44(7):529–532. doi: 10.1136/thx.44.7.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Beaty T. H., Cohen B. H., Newill C. A., Menkes H. A., Diamond E. L., Chen C. J. Impaired pulmonary function as a risk factor for mortality. Am J Epidemiol. 1982 Jul;116(1):102–113. doi: 10.1093/oxfordjournals.aje.a113385. [DOI] [PubMed] [Google Scholar]
  6. Beaty T. H., Newill C. A., Cohen B. H., Tockman M. S., Bryant S. H., Spurgeon H. A. Effects of pulmonary function on mortality. J Chronic Dis. 1985;38(8):703–710. doi: 10.1016/0021-9681(85)90024-4. [DOI] [PubMed] [Google Scholar]
  7. Braun S. R., Dixon R. M., Keim N. L., Luby M., Anderegg A., Shrago E. S. Predictive clinical value of nutritional assessment factors in COPD. Chest. 1984 Mar;85(3):353–357. doi: 10.1378/chest.85.3.353. [DOI] [PubMed] [Google Scholar]
  8. Burrows B., Bloom J. W., Traver G. A., Cline M. G. The course and prognosis of different forms of chronic airways obstruction in a sample from the general population. N Engl J Med. 1987 Nov 19;317(21):1309–1314. doi: 10.1056/NEJM198711193172103. [DOI] [PubMed] [Google Scholar]
  9. Burrows B., Earle R. H. Prediction of survival in patients with chronic airway obstruction. Am Rev Respir Dis. 1969 Jun;99(6):865–871. doi: 10.1164/arrd.1969.99.6.865. [DOI] [PubMed] [Google Scholar]
  10. Cole T. J., Gilson J. C., Olsen H. C. Bronchitis, smoking and obesity in an English and a Danish town. Male deaths after a 10-year follow-up. Bull Physiopathol Respir (Nancy) 1974 Sep-Oct;10(5):657–679. [PubMed] [Google Scholar]
  11. Ebi-Kryston K. L. Predicting 15 year chronic bronchitis mortality in the Whitehall Study. J Epidemiol Community Health. 1989 Jun;43(2):168–172. doi: 10.1136/jech.43.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ebi-Kryston K. L. Respiratory symptoms and pulmonary function as predictors of 10-year mortality from respiratory disease, cardiovascular disease, and all causes in the Whitehall Study. J Clin Epidemiol. 1988;41(3):251–260. doi: 10.1016/0895-4356(88)90129-1. [DOI] [PubMed] [Google Scholar]
  13. Ferris B. G., Jr, Speizer F. E., Worcester J., Chen H. Y. Adult mortality in Berlin, NH, from 1961 to 1967. Arch Environ Health. 1971 Dec;23(6):434–439. doi: 10.1080/00039896.1971.10666032. [DOI] [PubMed] [Google Scholar]
  14. Fletcher C. M., Pride N. B. Definitions of emphysema, chronic bronchitis, asthma, and airflow obstruction: 25 years on from the Ciba symposium. Thorax. 1984 Feb;39(2):81–85. doi: 10.1136/thx.39.2.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Garcia M. J., McNamara P. M., Gordon T., Kannel W. B. Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow-up study. Diabetes. 1974 Feb;23(2):105–111. doi: 10.2337/diab.23.2.105. [DOI] [PubMed] [Google Scholar]
  16. Higgins M. W., Keller J. B. Predictors of mortality in the adult population of Tecumseh. Arch Environ Health. 1970 Sep;21(3):418–424. doi: 10.1080/00039896.1970.10667260. [DOI] [PubMed] [Google Scholar]
  17. Hubert H. B., Feinleib M., McNamara P. M., Castelli W. P. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983 May;67(5):968–977. doi: 10.1161/01.cir.67.5.968. [DOI] [PubMed] [Google Scholar]
  18. Huhti E., Ikkala J., Hakulinen T. Chronic respiratory disease, smoking and prognosis for life. An epidemiological study. Scand J Respir Dis. 1977 Jun;58(3):170–180. [PubMed] [Google Scholar]
  19. Johnston R. N., McNeill R. S., Smith D. H., Legge J. S., Fletcher F. Chronic bronchitis--measurements and observations over 10 years. Thorax. 1976 Feb;31(1):25–29. doi: 10.1136/thx.31.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kauffmann F., Drouet D., Lellouch J., Brille D. Twelve years spirometric changes among Paris area workers. Int J Epidemiol. 1979 Sep;8(3):201–212. doi: 10.1093/ije/8.3.201. [DOI] [PubMed] [Google Scholar]
  21. Krzyzanowski M., Wysocki M. The relation of thirteen-year mortality to ventilatory impairment and other respiratory symptoms: the Cracow Study. Int J Epidemiol. 1986 Mar;15(1):56–64. doi: 10.1093/ije/15.1.56. [DOI] [PubMed] [Google Scholar]
  22. Lange P., Nyboe J., Appleyard M., Jensen G., Schnohr P. Ventilatory function and chronic mucus hypersecretion as predictors of death from lung cancer. Am Rev Respir Dis. 1990 Mar;141(3):613–617. doi: 10.1164/ajrccm/141.3.613. [DOI] [PubMed] [Google Scholar]
  23. Markowe H. L., Bulpitt C. J., Shipley M. J., Rose G., Crombie D. L., Fleming D. M. Prognosis in adult asthma: a national study. Br Med J (Clin Res Ed) 1987 Oct 17;295(6604):949–952. doi: 10.1136/bmj.295.6604.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Marmot M. G., Rose G., Shipley M. J., Thomas B. J. Alcohol and mortality: a U-shaped curve. Lancet. 1981 Mar 14;1(8220 Pt 1):580–583. doi: 10.1016/s0140-6736(81)92032-8. [DOI] [PubMed] [Google Scholar]
  25. Menkes H. A., Beaty T. H., Cohen B. H., Weinmann G. Nitrogen washout and mortality. Am Rev Respir Dis. 1985 Jul;132(1):115–119. doi: 10.1164/arrd.1985.132.1.115. [DOI] [PubMed] [Google Scholar]
  26. Merrilees M. A., Scott P. J., Norris R. M. Prognosis after myocardial infarction: results of 15 year follow up. Br Med J (Clin Res Ed) 1984 Feb 4;288(6414):356–359. doi: 10.1136/bmj.288.6414.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Monto A. S., Higgins M. W., Ross H. W. The Tecumseh study of respiratory illness. VIII. Acute infection in chronic respiratory disease and comparison groups. Am Rev Respir Dis. 1975 Jan;111(1):27–36. doi: 10.1164/arrd.1975.111.1.27. [DOI] [PubMed] [Google Scholar]
  28. Olofson J., Skoogh B. E., Bake B., Svärdsudd K. Mortality related to smoking habits, respiratory symptoms and lung function. Eur J Respir Dis. 1987 Aug;71(2):69–76. [PubMed] [Google Scholar]
  29. Peto R., Speizer F. E., Cochrane A. L., Moore F., Fletcher C. M., Tinker C. M., Higgins I. T., Gray R. G., Richards S. M., Gilliland J. The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease. Results from 20 years of prospective observation. Am Rev Respir Dis. 1983 Sep;128(3):491–500. doi: 10.1164/arrd.1983.128.3.491. [DOI] [PubMed] [Google Scholar]
  30. Petty T. L., Pierson D. J., Dick N. P., Hudson L. D., Walker S. H. Follow-up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction. Am Rev Respir Dis. 1976 Nov;114(5):881–890. doi: 10.1164/arrd.1976.114.5.881. [DOI] [PubMed] [Google Scholar]
  31. Reid D. D., Fletcher C. M. International studies in chronic respiratory disease. Br Med Bull. 1971 Jan;27(1):59–64. doi: 10.1093/oxfordjournals.bmb.a070816. [DOI] [PubMed] [Google Scholar]
  32. Robinette C. D., Fraumeni J. F., Jr Asthma and subsequent mortality in World War II veterans. J Chronic Dis. 1978;31(9-10):619–624. doi: 10.1016/0021-9681(78)90022-x. [DOI] [PubMed] [Google Scholar]
  33. Sorlie P. D., Kannel W. B., O'Connor G. Mortality associated with respiratory function and symptoms in advanced age. The Framingham Study. Am Rev Respir Dis. 1989 Aug;140(2):379–384. doi: 10.1164/ajrccm/140.2.379. [DOI] [PubMed] [Google Scholar]
  34. Speizer F. E., Fay M. E., Dockery D. W., Ferris B. G., Jr Chronic obstructive pulmonary disease mortality in six U.S. cities. Am Rev Respir Dis. 1989 Sep;140(3 Pt 2):S49–S55. doi: 10.1164/ajrccm/140.3_Pt_2.S49. [DOI] [PubMed] [Google Scholar]
  35. Todd G. F., Hunt B. M., Lambert P. M. Four cardiorespiratory symptoms as predictors of mortality. J Epidemiol Community Health. 1978 Dec;32(4):267–274. doi: 10.1136/jech.32.4.267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Traver G. A., Cline M. G., Burrows B. Predictors of mortality in chronic obstructive pulmonary disease. A 15-year follow-up study. Am Rev Respir Dis. 1979 Jun;119(6):895–902. doi: 10.1164/arrd.1979.119.6.895. [DOI] [PubMed] [Google Scholar]
  37. Vandenbergh E., Van de Woestijne K. P., Gyselen A. Weight changes in the terminal stages of chronic obstructive pulmonary disease. Relation to respiratory function and prognosis. Am Rev Respir Dis. 1967 Apr;95(4):556–566. doi: 10.1164/arrd.1967.95.4.556. [DOI] [PubMed] [Google Scholar]
  38. Vestbo J., Knudsen K. M., Rasmussen F. V. The value of mucus hypersecretion as a predictor of mortality and hospitalization. An 11-year register based follow-up study of a random population sample of 876 men. Respir Med. 1989 May;83(3):207–211. doi: 10.1016/s0954-6111(89)80033-2. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES