{"doi":"10.17615/j5b2-qe76","title":"Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study","abstract":"Background: Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease. Methods: We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption. Findings: 25 352 participants (ages 17–93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3–20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66–31·37) in sustained never-smokers, 34·97 mL per year (34·36–35·57) in former smokers, and 39·92 mL per year (38·92–40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95% CI 1·24–2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35–10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV1 decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21–9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86–12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00–2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results. Interpretation: Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage. Funding: National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.","journal":"UNC Libraries","year":2024,"id":499315,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9625,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":106993,"name":"Joseph E. Schwartz","orcid":"0000-0002-8944-3566","position":1,"is_corresponding":false},{"id":91957,"name":"George O'connor","orcid":"0000-0002-6476-3926","position":2,"is_corresponding":false},{"id":295493,"name":"Sachin Yende","orcid":"0000-0002-6596-8034","position":3,"is_corresponding":false},{"id":605419,"name":"S.P Bhatt","orcid":null,"position":4,"is_corresponding":false},{"id":447122,"name":"Richard A. Kronmal","orcid":"0000-0002-9897-7076","position":5,"is_corresponding":false},{"id":447120,"name":"Patricia A. Cassano","orcid":"0000-0003-4827-5073","position":6,"is_corresponding":false},{"id":1346346,"name":"Lesley Smith","orcid":"0000-0002-4280-6323","position":7,"is_corresponding":false},{"id":5170,"name":"Stephanie J. London","orcid":"0000-0003-4911-5290","position":8,"is_corresponding":false},{"id":1293207,"name":"L.R Loehr","orcid":null,"position":9,"is_corresponding":false},{"id":454944,"name":"William B. White","orcid":"0000-0001-8936-967X","position":10,"is_corresponding":false},{"id":1347334,"name":"A.R Mathew","orcid":null,"position":11,"is_corresponding":false},{"id":1347186,"name":"P.P Balte","orcid":null,"position":12,"is_corresponding":false},{"id":365707,"name":"E.C. Oelsner","orcid":null,"position":13,"is_corresponding":false},{"id":1232932,"name":"A.R Folsom","orcid":null,"position":14,"is_corresponding":false},{"id":57360,"name":"Anne B. Newman","orcid":"0000-0002-0106-1150","position":15,"is_corresponding":false},{"id":1347335,"name":"J C Jacobs","orcid":null,"position":16,"is_corresponding":false},{"id":233262,"name":"Ravi Kalhan","orcid":"0000-0003-2443-0876","position":17,"is_corresponding":false},{"id":241828,"name":"Neal D. Freedman","orcid":"0000-0003-0074-1098","position":18,"is_corresponding":false},{"id":250083,"name":"David Couper","orcid":"0000-0002-4313-9235","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T02:09:45.971055Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}