Prevalence and Correlates of Respiratory Symptoms and Disease in the Elderly* Paul L. Enright, M.D.; Richard A. Kronmal, Ph.D.; Millicent W. Higgins, M.D., F.C.C.P.; Marc B. Schenker, M.D.; and Edward F. Haponik, M.D., F.C.C.P. Spirometry was performed by 5,201 elderly participants of the Cardiovascular Health Study during their base- line examination and a subset of the ATS/DLD-78 res- piratory questionnaire was administered by trained in- terviewers. In never smokers (46 percent of the cohort), the overall prevalence of chronic cough was 9 percent, chronic phlegm was 13 percent, attacks of wheezing with dyspnea were 8 percent, and grade 3 dyspnea on exertion was 10 percent. The prevalence of lung disease in current smokers (12 percent of the cohort) was 8/7 percent (men/women) with chronic bronchitis and 14/5 percent with emphysema. Overall, 6 percent reported asthma (a physician-confirmed history) and 12 percent reported hay fever. Using a logistic regression model, attacks of wheezing with dyspnea were strongly associ- ated with a lower FEVI, coronary heart disease, heart failure, and a large waist size (in participants without a diagnosis of asthma, chronic bronchitis, or emphysema). Undiagnosed airways obstruction was twice as likely in women and those with lower income, and was associ- ated with current and former smoking, pack-years of Lung diseases are a major cause of illness, disability, and death among those 65 years of age and older. Accurate information on the prevalence of lung disease among older adults is needed for med- ical and public health planning purposes. The Car- diovascular Health Study (CHS) is a multicenter, prospective study of cardiovascular risk factors in persons 65 years and older. Spirometry testing and questions regarding respiratory disease are included in cardiovascular epidemiology studies such as the CHS because the FEV, is an excellent predictor of cardiovascular morbidity and mortality."12 Many previous epidemiologic studies of lung disease in the United States either did not include a population sample of elderly subjects or did not separately report the prevalence of respiratory symptoms and diagnoses in those older than 65 years. Studies performed before 1970 studied a pop- ulation whose exposures to childhood respiratory diseases and workplace exposures were different from those experienced by the current cohort of elderly people. *From the Cardiovascular Health Study. Supported by the National Heart, Lung, and Blood Institute contracts N01-87079 to N01-87086. Manuscript received October 21, 1993; revision accepted January 13, 1994 Reprint requests: Dr. Kronmal, CHS Coordinating Center, Century Square, Suite 2025, 1501 Fourth Ave, Seattle 98101 smoking, and chronic cough. Dyspnea on exertion (DOE) was three times or more likely if a participant reported heart failure, coronary heart disease, or em- physema; and much more likely if their FEV, or FVC was substantially reduced. Dyspnea on exertion was also positively associated with older age, chronic bron- chitis or asthma, a larger waist or hip size, pack-years of smoking, and less education. We conclude that DOE and attacks of wheezing with dyspnea are commonly asso- ciated with cardiovascular disease and a low FEV1 in those over 65 years and that airways obstruction fre- quently remains undiagnosed in the elderly. (Chest 1994; 106:827-34) Key words: abnormality rates; elderly; respiratory symp- toms The 1989 to 1990 CHS baseline examination pro- vided standardized questionnaire and spirometry results from a representative sample of 5,201 elderly persons from four US communities. In addition to providing prevalence rates for major respiratory symptoms and lung diseases from this cohort by smoking status, we identified the correlates of respi- ratory conditions using multivariate models. METHODS Recruitment Participants in the CHS were selected using a Medicare eligi- bility list provided by the US Health Care Financing Adminis- tration (HCFA) for the four participating communities. These communities are Forsyth County, NC; Pittsburgh, Pa; Sacra- mento County, Calif; and Washington County, Md. Potential participants were randomly sampled from the four communities to fill eight subgroups, stratified by age and sex. The study also attempted to recruit all age-eligible persons in the household of the sampled individual (usually a spouse). Eligibility The following were exclusion factors: institutionalization, ter- minal illness, inability to walk, communicate, or give informed consent, or likely to move from the area the next 3 years. Poten- tial participants were sent an explanatory letter, interviewed by telephone to determine eligibility, and then scheduled for the baseline clinic examination at the field center. Among those con- CHEST / 106 / 3 / SEPTEMBER, 1994 827 ATS=American Thoracic Society; BMI=body mass index; CAD=coronary artery disease; CHF=congestive heart fail- ure; CHS=Cardiovascular Health Study; CS=current smoker; DOE=dyspnea on exertion; FS=former smoker; ln=natural log; NS=never smoker; OR=odds ratio; PF=pulmonary function; QC=quality control; Downloaded From: http://journal.publications.chestnet.org/ by a UC Davis User on 02/26/2014