Archives of Environmental Health: An International Journal
ISSN: 0003-9896 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/vzeh20
Age, Smoking Inhalation, and Pulmonary Function Raymond Bossé PhD , Paul Costa PhD , Michael Cohen & Stephen Podolsky MD To cite this article: Raymond Bossé PhD , Paul Costa PhD , Michael Cohen & Stephen Podolsky MD (1975) Age, Smoking Inhalation, and Pulmonary Function, Archives of Environmental Health: An International Journal, 30:10, 495-498, DOI: 10.1080/00039896.1975.10666760 To link to this article: http://dx.doi.org/10.1080/00039896.1975.10666760
Published online: 02 May 2013.
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Date: 25 June 2016, At: 03:53
Age, Smoking Inhalation, and Pulmonary Function
Downloaded by [New York University] at 03:53 25 June 2016
Raymond Bosse, PhD; Paul Costa, PhD; Michael Cohen; Stephen Podolsky, MD
• This study examined the relative effects of age and smoking on pulmonary function. Smoking was measured by six smoking variables, taken singly and as a composite. Subjects were 1,516 .male participants in the Normative Aging Study. A stepwise multiple regression with vital capacity (VC) and forced expiratory volume alone second (FEV,.,,) as the criteria accounted for 24.4% and 28.3% of the variance, respectively. Two-way analyses of variance showed that the age decline in pulmonary function was substantially greater for high inhalers than it was for low inhalers or nonsmokers. Age and the inhalation index were also noticeably and independenlly related to a decline in pulmonary function. (Arch Environ Health 30:495-498,1975)
he decline of pulmonary function with age, as measured by pneometric tests such as vital capacity (VC) or forced expiratory volume one second (FEV 10), has been amply demonstrated. This normal age-related reduction in pulmonary function has been attributed to a loss of muscle strength and chest wall compliance.' Many other factors may also contribute to the decline of pulmonary function with age, among them the loss of lung tissue and air pollution. This study examines smoking inhalation as another possible contributory factor.
T
Submitted for publication Dec 12, 1974; ac· cepted Feb 11, 1975. From the Normative Aging Study, Boston (Drs Bosse and Podolsky and Mr Cohen), the Hellenic College, Brookline, Mass (Dr Bosse), and the University of Massachusetts,Boston (Dr Costa). Adapted from a study read before the 27th an· nual meeting of the Gerontological Society, Portland, Ore, Oct 29, 1974. Reprint requests to Normative Aging Study, Veterans Administration Outpatient Clinic, 17 Court St, Boston, MA 02108 (Dr. Bosse).
Arch Environ Health-Vol 30, Oct 1975
Although the decline of pulmonary function with age is a well-recognized fact, the relationship between smoking and pulmonary function in healthy individuals remains uncertain. A number of publications have shown cigarette smoking to be generally associated with a decrease in pulmonary function."" In a cross-sectional study, Densen et al'2 more specifically found a constant decrease in FEV,.o values for all men between the ages of 30 and 65. However, the decline in FEV"o values was smallest for nonsmokers, and it became progressively more pronounced for smokers as they smoked more cigarettes per day. Similar findings had been previously reported by Higgins and Kjelsberg.';; These studies failed to examine the differences between smokers by the number of cigarettes smoked, or by some other quantitative index that would reflect individual variation in smoking inhalation. A few studies have reported no substantial differences between nonsmokers and smokers in VC or FEV 1.0 when comparing various age groups. H. ", However, these studies involved a very small population or a limited age range. Another study by Michie lH found heavy smokers to have slightly better FEV 1.0 values than nonsmokers. His population ranged between the ages of 60 and 94 years, and the fact that he does not specify the age of the heavy smokers raises the possibility that they may have been younger. Furthermore, since this study dealt with an older population, there may have been a survivor effect in which the more susceptible heavy smokers had previously died, leaving survivors who were unusually resistant to any
deleterious effects of heavy smoking. Evidence of a comparable survivor effect was suggested by Milne and Williamson," who found a lower prevalence of chronic bronchitis in the older men they studied in a random sample of 215 men, age 62 to 90. While inconclusive, the weight of the data in the literature suggests that smoking is related to a decline in pulmonary function above and beyond the aging effect. This study attempted to specify the amount of variance accounted for by age in the decline of VC and FEV LU' and the amount of variance accounted for by smoking. A more important and plausible reason for the lack of a clearcut pattern of difference between smokers and nonsmokers may result from not taking into account the amount of total smoke inhalation rather than merely the number of cigarettes smoked. A more sensitive, continuous measure of variation in smoking inhalation might reveal relationships otherwise obscured by employing a gross or simple dichotomy. Therefore, a special smoking index was generated, made up of six smoking components that are described in detail below. SUBJECTS AND METHODS The population used for this study were 2,000 volunteer subjects of the Normative Aging Study, a longitudinal interdisciplinary study being carried out at the Boston Veterans Administrfl.tion Outpatient Clinic." For the purpose of this research, this population had the important advantage of having been selected according to specific health criteria a decade earlier (1963). Included among the thorough screening criteria were pulmonary function testing and chest roentgenograms. The selection of subjects on the basis of health criteria was intended to allow the study of "normal" aging, unaffected by previous, even asymptomatic chronic conditions. Due to selection criteria that eliminated all subjects with any prior pathologic findings, any observed declines in pulmonary function might be more readily ascribable to other factors, such as age or amount of smoking. One negative consequence of the selection of only completely healthy subjects is the reduced vfl.rifl.tion in pulmonary function values between smokers fl.nd nonsmokers within the same age group at time of
Age, Smoking and Pulmonary Function-Bosse et al
495
No. of Cigarettes Per Day
< 1-15
1,6
16-24 25-30 31+
4.4
% 1
Fraction of Cigarette Smoked ~ or % of each 1"'.1 Cfarptt.p
% of each cigarette More than % of each cigarette Depth of Inhalation
Just puffed/ only into mouth As far back as throat As far back as chest As deeply into chest as possible No. of Puffs Inhaled
Downloaded by [New York University] at 03:53 25 June 2016
Not at all A few puffs of some cIgarElttElS A few puffs of each cigarette Almost every puff of each cigarette No. of Years Since Quitting
3.6
Score
1/3 %
Score ~
% % 1 Score ~
% % 1 Score
16 or more 10-15 5-9 < 1-4 % Current smokers (who have not quit) 1
Overall Inhalation N= 493 N= 427
Never
Low High 3.4
N= 596
YEARS: Under 44
Score lit
45-54
55 and Over
AGE GROUPS Fig 1.-Mean vital capacity (VC) values by age groups and overall smoking inhalatioh.
In this index, % would receive .2, % would receive .5, % would receive .7, etc. Values for each of the six variables were then added, and the arithmetic mean of the six was defined as a subject's overall inhalation score, an index of the cumulative amount of cigarette smoke brought into the lungs. The relationship of height to pulmonary function was not considered because a previous analysis, which compared the actual height and VC values of each subject with the predicted values for that height and age,IH showed that the Normative Aging Study population invariably did either as well as or better than predicted. RESULTS
entry into the study. Increased variation can be expected as time passes and serial observations are made. The pulmonary function values used in this analysis were collected between 1969 and 1973, an average of eight years after a subject's entry into the Normative Aging Study. Pulmonary function data are collected using a standard 6-liter vitalometer with the subject standing erect. After being carefully instructed. in the procedure, the subjects are given a practice run that is not recorded. The subsequent tracing on the kymograph drum that rotates at 1 cm/sec is then kept as part of the subject's permanent record. Smoking Inhalation Index The six components of the smoking inha496
Arch Environ Health-Vol 30, Oct 1975
lation index were as follows: (1) number of years the subject smoked; (2) number of cigarettes per day; (3) fraction of each cigarette smoked; (4) depth of inhalation; (5) number of puffs inhaled; and (6) number of years since quitting. Each component of the smoking inhalation index was arranged into categories that were then rated on a scale of .2 to 1, as a measure of low to high inhalation. Each of the six components of overall inhalation were categorized and scored as follows: No. of Years Subject Smoked
ISSN: 0003-9896 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/vzeh20
Age, Smoking Inhalation, and Pulmonary Function Raymond Bossé PhD , Paul Costa PhD , Michael Cohen & Stephen Podolsky MD To cite this article: Raymond Bossé PhD , Paul Costa PhD , Michael Cohen & Stephen Podolsky MD (1975) Age, Smoking Inhalation, and Pulmonary Function, Archives of Environmental Health: An International Journal, 30:10, 495-498, DOI: 10.1080/00039896.1975.10666760 To link to this article: http://dx.doi.org/10.1080/00039896.1975.10666760
Published online: 02 May 2013.
Submit your article to this journal
Article views: 1
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=vzeh20 Download by: [New York University]
Date: 25 June 2016, At: 03:53
Age, Smoking Inhalation, and Pulmonary Function
Downloaded by [New York University] at 03:53 25 June 2016
Raymond Bosse, PhD; Paul Costa, PhD; Michael Cohen; Stephen Podolsky, MD
• This study examined the relative effects of age and smoking on pulmonary function. Smoking was measured by six smoking variables, taken singly and as a composite. Subjects were 1,516 .male participants in the Normative Aging Study. A stepwise multiple regression with vital capacity (VC) and forced expiratory volume alone second (FEV,.,,) as the criteria accounted for 24.4% and 28.3% of the variance, respectively. Two-way analyses of variance showed that the age decline in pulmonary function was substantially greater for high inhalers than it was for low inhalers or nonsmokers. Age and the inhalation index were also noticeably and independenlly related to a decline in pulmonary function. (Arch Environ Health 30:495-498,1975)
he decline of pulmonary function with age, as measured by pneometric tests such as vital capacity (VC) or forced expiratory volume one second (FEV 10), has been amply demonstrated. This normal age-related reduction in pulmonary function has been attributed to a loss of muscle strength and chest wall compliance.' Many other factors may also contribute to the decline of pulmonary function with age, among them the loss of lung tissue and air pollution. This study examines smoking inhalation as another possible contributory factor.
T
Submitted for publication Dec 12, 1974; ac· cepted Feb 11, 1975. From the Normative Aging Study, Boston (Drs Bosse and Podolsky and Mr Cohen), the Hellenic College, Brookline, Mass (Dr Bosse), and the University of Massachusetts,Boston (Dr Costa). Adapted from a study read before the 27th an· nual meeting of the Gerontological Society, Portland, Ore, Oct 29, 1974. Reprint requests to Normative Aging Study, Veterans Administration Outpatient Clinic, 17 Court St, Boston, MA 02108 (Dr. Bosse).
Arch Environ Health-Vol 30, Oct 1975
Although the decline of pulmonary function with age is a well-recognized fact, the relationship between smoking and pulmonary function in healthy individuals remains uncertain. A number of publications have shown cigarette smoking to be generally associated with a decrease in pulmonary function."" In a cross-sectional study, Densen et al'2 more specifically found a constant decrease in FEV,.o values for all men between the ages of 30 and 65. However, the decline in FEV"o values was smallest for nonsmokers, and it became progressively more pronounced for smokers as they smoked more cigarettes per day. Similar findings had been previously reported by Higgins and Kjelsberg.';; These studies failed to examine the differences between smokers by the number of cigarettes smoked, or by some other quantitative index that would reflect individual variation in smoking inhalation. A few studies have reported no substantial differences between nonsmokers and smokers in VC or FEV 1.0 when comparing various age groups. H. ", However, these studies involved a very small population or a limited age range. Another study by Michie lH found heavy smokers to have slightly better FEV 1.0 values than nonsmokers. His population ranged between the ages of 60 and 94 years, and the fact that he does not specify the age of the heavy smokers raises the possibility that they may have been younger. Furthermore, since this study dealt with an older population, there may have been a survivor effect in which the more susceptible heavy smokers had previously died, leaving survivors who were unusually resistant to any
deleterious effects of heavy smoking. Evidence of a comparable survivor effect was suggested by Milne and Williamson," who found a lower prevalence of chronic bronchitis in the older men they studied in a random sample of 215 men, age 62 to 90. While inconclusive, the weight of the data in the literature suggests that smoking is related to a decline in pulmonary function above and beyond the aging effect. This study attempted to specify the amount of variance accounted for by age in the decline of VC and FEV LU' and the amount of variance accounted for by smoking. A more important and plausible reason for the lack of a clearcut pattern of difference between smokers and nonsmokers may result from not taking into account the amount of total smoke inhalation rather than merely the number of cigarettes smoked. A more sensitive, continuous measure of variation in smoking inhalation might reveal relationships otherwise obscured by employing a gross or simple dichotomy. Therefore, a special smoking index was generated, made up of six smoking components that are described in detail below. SUBJECTS AND METHODS The population used for this study were 2,000 volunteer subjects of the Normative Aging Study, a longitudinal interdisciplinary study being carried out at the Boston Veterans Administrfl.tion Outpatient Clinic." For the purpose of this research, this population had the important advantage of having been selected according to specific health criteria a decade earlier (1963). Included among the thorough screening criteria were pulmonary function testing and chest roentgenograms. The selection of subjects on the basis of health criteria was intended to allow the study of "normal" aging, unaffected by previous, even asymptomatic chronic conditions. Due to selection criteria that eliminated all subjects with any prior pathologic findings, any observed declines in pulmonary function might be more readily ascribable to other factors, such as age or amount of smoking. One negative consequence of the selection of only completely healthy subjects is the reduced vfl.rifl.tion in pulmonary function values between smokers fl.nd nonsmokers within the same age group at time of
Age, Smoking and Pulmonary Function-Bosse et al
495
No. of Cigarettes Per Day
< 1-15
1,6
16-24 25-30 31+
4.4
% 1
Fraction of Cigarette Smoked ~ or % of each 1"'.1 Cfarptt.p
% of each cigarette More than % of each cigarette Depth of Inhalation
Just puffed/ only into mouth As far back as throat As far back as chest As deeply into chest as possible No. of Puffs Inhaled
Downloaded by [New York University] at 03:53 25 June 2016
Not at all A few puffs of some cIgarElttElS A few puffs of each cigarette Almost every puff of each cigarette No. of Years Since Quitting
3.6
Score
1/3 %
Score ~
% % 1 Score ~
% % 1 Score
16 or more 10-15 5-9 < 1-4 % Current smokers (who have not quit) 1
Overall Inhalation N= 493 N= 427
Never
Low High 3.4
N= 596
YEARS: Under 44
Score lit
45-54
55 and Over
AGE GROUPS Fig 1.-Mean vital capacity (VC) values by age groups and overall smoking inhalatioh.
In this index, % would receive .2, % would receive .5, % would receive .7, etc. Values for each of the six variables were then added, and the arithmetic mean of the six was defined as a subject's overall inhalation score, an index of the cumulative amount of cigarette smoke brought into the lungs. The relationship of height to pulmonary function was not considered because a previous analysis, which compared the actual height and VC values of each subject with the predicted values for that height and age,IH showed that the Normative Aging Study population invariably did either as well as or better than predicted. RESULTS
entry into the study. Increased variation can be expected as time passes and serial observations are made. The pulmonary function values used in this analysis were collected between 1969 and 1973, an average of eight years after a subject's entry into the Normative Aging Study. Pulmonary function data are collected using a standard 6-liter vitalometer with the subject standing erect. After being carefully instructed. in the procedure, the subjects are given a practice run that is not recorded. The subsequent tracing on the kymograph drum that rotates at 1 cm/sec is then kept as part of the subject's permanent record. Smoking Inhalation Index The six components of the smoking inha496
Arch Environ Health-Vol 30, Oct 1975
lation index were as follows: (1) number of years the subject smoked; (2) number of cigarettes per day; (3) fraction of each cigarette smoked; (4) depth of inhalation; (5) number of puffs inhaled; and (6) number of years since quitting. Each component of the smoking inhalation index was arranged into categories that were then rated on a scale of .2 to 1, as a measure of low to high inhalation. Each of the six components of overall inhalation were categorized and scored as follows: No. of Years Subject Smoked
