Am. J. Respir. Crit. Care Med., Volume 157, Number 5, May 1998, 1390-1396

Bronchial Responsiveness and Five-year FEV₁ Decline
A Study in Miners and Nonminers

PAUL HODGINS, PAUL K. HENNEBERGER, MEI-LIN WANG, and EDWARD L. PETSONK

Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia; and Section of Pulmonary and Critical Care Medicine and Department of Community Medicine, West Virginia University School of Medicine, Morgantown, West Virginia

Increased nonspecific bronchial responsiveness (NSBR) may be a risk factor for the development of chronic airflow obstruction. We evaluated this hypothesis in a cohort of 378 underground coal miners and working nonminers. Methacholine testing was performed at the beginning and end of a 5-yr study period. Spirometry was repeated at 6-mo intervals and individual 5-yr FEV₁ slopes were calculated by linear regression. Relationships between FEV₁ slopes and NSBR were examined using multiple linear regression models, controlling for FEV₁ level, smoking, and mining. Increasing NSBR at the initial survey was associated with a somewhat greater rate of subsequent FEV₁ decline. Methacholine responders at the final survey had a considerably increased rate of decline during the previous years. Responsiveness status changed over the 5 yr in 22% of the subjects. Both the development and persistence of increased NSBR were strongly associated with higher rates of FEV₁ decline. In contrast, FEV₁ declines were not accelerated among workers with increased NSBR that reverted to normal. Smoking and mining were both independently associated with FEV₁ declines, but did not substantially modify the effect of NSBR. Due to its variability over time, NSBR testing predicts lung function decline only in some individuals, and its value as a prognostic test for chronic airway disorders is limited. Because improvement in bronchial hyperresponsiveness was associated with a reduction in the rate of FEV₁ loss, interventions directed at preventing or reducing nonspecific airway hyperresponsiveness should be investigated.

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