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Respiratory Impairment and Mortality in Older Persons
  1. Carlos A. Vaz Fragoso, MD*†,
  2. Thomas M. Gill, MD,
  3. Gail McAvay, PhD,
  4. Henry Klar Yaggi, MD*†,
  5. Peter H. Van Ness, PhD,
  6. John Concato, MD*†
  1. From the *Veterans Affairs Clinical Epidemiology Research Center, West Haven; and †Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
  1. Received February 28, 2011, and in revised form June 9, 2011.
  2. Accepted for publication June 9, 2011.
  3. Reprints: Carlos A. Vaz Fragoso, MD, Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave, Mailcode 151B, West Haven, CT. E-mail: carlos.fragoso{at}
  4. Dr. Vaz Fragoso is currently a recipient of a Career Development Award from the Department of Veterans Affairs and an R03 award from the National Institute on Aging (R03AG037051). Dr. Gill is the recipient of an NIA Midcareer Investigator Award in Patient-Oriented Research (K24AG021507). Dr. Yaggi is supported by a Career Development Transition Award from the Department of Veterans Affairs Clinical Science Research and Development Service. Dr. Concato is supported by the Department of Veterans Affairs Cooperative Studies Program.
  5. Dr. Vaz Fragoso had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors made substantial contributions to study concept and design, to data acquisition, analysis and interpretation, and to drafting the submitted article.
  6. This study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (P30AG21342) and the Veterans Affairs Clinical Epidemiology Research Center.
  7. The investigators retained full independence in the conduct of this research.
  8. The Cardiovascular Health Study (CHS) was conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the CHS Study Investigators, respectively. This article was prepared using a limited access data set obtained from the NHLBI and does not necessarily reflect the opinions or views of the CHS or the NHLBI.
  9. The authors report no conflicts of interest.

A Novel Spirometric Approach


Background The Lambda-Mu-Sigma (LMS) method calculates the lower limit of normal for spirometric measures of pulmonary function as the fifth percentile of the distribution of z scores, suitably accounting for age-related changes in pulmonary function. Extending prior work, and to assess whether the LMS method is clinically valid when evaluating respiratory impairment in the elderly, our current objective was to evaluate the association of LMS-defined respiratory impairment (airflow limitation and restrictive pattern) with all-cause mortality and respiratory symptoms (chronic bronchitis, dyspnea, or wheezing) in older persons.

Methods Spirometric data and outcome data on white participants aged 65 to 80 years were obtained from the Third National Health and Nutrition Examination Survey (NHANES-III, n = 1497) and the Cardiovascular Health Study (CHS, n = 3583). Multivariable analyses determined the corresponding associations, adjusting for important covariates.

Results In the NHANES-III and CHS populations, respectively, LMS-defined airflow limitation had adjusted hazard ratios (95% confidence interval) of 1.64 (1.28-2.11) and 1.69 (1.48-1.92) for mortality; adjusted odds ratios for respiratory symptoms were 2.71 (1.92-3.83) and 2.63 (2.11-3.27). The LMS-defined restrictive pattern was also significantly associated with mortality (adjusted hazard ratios of 1.98 [1.54-2.53] and 1.68 [1.44-1.95]), as well as with respiratory symptoms (adjusted odds ratios of 1.55 [1.03-2.34] and 1.37 [1.07-1.75]) in NHANES-III and CHS, respectively.

Conclusions The LMS-defined airflow limitation and restrictive pattern confers a significantly increased risk of death and likelihood of having respiratory symptoms. These results support the use of LMS-derived spirometric z scores as a basis for evaluating respiratory impairment in older persons.

Key Words
  • respiratory impairment
  • airflow limitation
  • restrictive pattern
  • mortality
  • respiratory symptoms

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