Smoking and Lung Function in Elderly Men and Women The Cardiovascular Health Study Millicent W. Higgins, MD; Paul L. Enright, MD; Richard A. Kronmal, PhD; Marc B. Schenker, MD; Hoda Anton-Culver, PhD; Mary Lyles, MD; for the Cardiovascular Health Study Research Group Objective.\p=m-\Toinvestigate relationships between cigarette smoking and pul- monary function in elderly men and women. Design.\p=m-\Cross-sectional analysis of baseline data from a prospective, population-based study of risk factors, preclinical, and overt cardiovascular and pulmonary disease. Setting.\p=m-\Defined communities in Forsyth County, North Carolina; Pittsburgh, Pa; Sacramento County, California; and Washington County, Maryland. Population.\p=m-\A total of 5201 noninstitutionalized men and women 65 years of age and older. Main Outcome Measures.\p=m-\Pulmonary function; means of forced expiratory volume in 1 second (FEV1) and forced vital capacity and prevalence of low FEV1 levels. Results.\p=m-\Prevalenceof cigarette smoking was 10% to 20% and higher in women than men and in blacks than whites. Forced vital capacity and FEV1 levels were related positively to height and white race and negatively to age and waist girth. Age- and height-adjusted FEV1 means were 23% and 18% lower in male and fe- male current smokers, respectively, than in never smokers but not reduced in nev- er smokers currently living with a smoker. Smokers who quit before age 40 years had FEV1 levels similar to never smokers, but FEV1 levels were lower by 7% and 14% in smokers who quit at ages 40 to 60 years and older than 60 years, respec- tively. Lung function was related inversely to pack-years of cigarette use. Preva- lence rates of impaired lung function were highest in current smokers and lowest in never smokers. Regression coefficients for the smoking variables were smaller in persons without cardiovascular or respiratory conditions than in the total cohort. Conclusions.\p=m-\Cigarettesmoking is associated with reduced pulmonary func- tion in elderly men and women. However, smokers who quit, even after age 60 years, have better pulmonary function than continuing smokers. (JAMA. 1993;269:2741-2748) From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Hig- gins), Respiratory Sciences Center, University of Ari- zona, Tucson (Dr Enright), Cardiovascular Health Study Coordinating Center, Seattle, Wash (Dr Kron- mal), California College of Medicine, University of Cal- ifornia, Irvine (Dr Anton-Culver), Division of Occupa- tional and Environmental Medicine, University of California, Davis (Dr Schenker), and Department of Geriatric Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (Dr Lyles). A complete list of the participants in this research study appears at the end of this article. Reprint requests to National Institutes of Health, Na- tional Heart, Lung, and Blood Institute, Federal Bldg, Room 2C08, 7550 Wisconsin Ave, Bethesda, MD 20892 (Dr Higgins). CIGARETTE smoking is known to im¬ pair pulmonary function in young and middle-aged adults,1·2 but less is known about the more complex relationships between smoking habits and pulmonary function in elderly men and women. At ages 65 years and older, study popula¬ tions consist to an increasing extent of survivors who are healthy enough to attend a clinic and provide forced expi¬ ratory spirograms. Because cigarette smokers are more likely to die prema¬ turely or to stop smoking when their health is poor, elderly smokers are like¬ ly to be a healthy subset of the original cohort of smokers. Elderly former smok¬ ers are likely to be a heterogeneous group, including some who stopped smoking recently for reasons of ill health and some who quit long ago after min¬ imal exposure. For editorial comment see 2785. The purpose of this report is to com¬ pare pulmonary function in elderly smok¬ ers, former smokers, and never smok¬ ers to answer the following questions: Is pulmonary function reduced in cur¬ rent and former smokers and related to measures of exposure, such as number of cigarettes smoked per day, pack-years of exposure, age at starting to smoke, and duration of smoking? In former smokers, is pulmonary function related to age at stopping or years since quit¬ ting? Among elderly never smokers, is pulmonary function better in those who Downloaded From: http://jama.jamanetwork.com/ by a University of California - Davis User on 02/26/2014