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0 t CTP -Y Influence of Cigarette Smoking on the Spirometric Evaluation of Employees of a Large Insurance Company"' CHARLES A. GRIMES add BERNARD HANES SUMMARY Forced expi»tory spirograms were performed on 1.059 healthy•emplorecs of a large insutance company coincident with their routine, periodic, health evaluation. Reliable prediction equations for forced vital capacity and forced expiratory volume in one second, 6ased on multiple ngre:asion arulysis. were derived ior this heaithy~ population representative of white•collar worlxrs tesiding and wotking in a iarge metropolitan area. .. Cigarette smoking among men was associated with lower forced vital capacity and forcM efRpira- tory volume in one second, and the Ictel of cigarette smoicing was related to the impairment of spirometric function. T'he data suggested reversibility of this impaitment on ccnation of cigarette amoking. Among wromen, there was little difference in forced viul apacity and forced expirstotY volume In one second between current cigarette smokers and those who had never smoked cigarettes. The younger, female ex•smokers exhibited greater forced vital capacities and forced expiratory volumes In one second than those of younger, female nonsmokers; howevsr, these differences disappeared rapidly with advancing age. Introduction The CurTent ecology movement, with its em• phasis on air pollution combined with a vig- orotu public health educ*ion program warn. ing of the deleterious effects of smoking, has stimulated public interest in the quality of atr and its potential induence on health; This interest and• physiLtians' awareness of the in- aeasing incidence of chronic obsttuctivk lung disease, has resulted in the widespread use of apirometry. The purpose of this study tvas Y•fotd: (1) to provide reliable ventilatory standards in the form of prediction equations based on a healthy population, and (2) to assen the role of smoking as it aEeets apirometrie test re- sults. Evidence has accumulated that tobacco (Rtetived in original (orm, July 27, l972 ared in r roised loras January 18,19i)) 1 From thc Employee Health Service, Medical Department, Prudential Insurance Co. of Ameri- a. Western home Office, Los Angeles, California. and tht Department of Health Seience. California State University at Korthridge, \orthridge, Cal• Ifomia. a Supported in part by the Council for Tobacco Research-U.S. A. ) smoking does have a deleterious effect on pul- monary tunction (i-5); tlserefore, it seemed appropriate to develop separate prediction equations for current smokera, those who have never smoAed, and ehose who had ditcon• tinued smoking. :73-- . A>•fERICAN RECIEW OP RESPtRATORr DtSEASL. VOLUME 109. t9)! 4': U 1N1 14433 i L ri i i ~ , , , t i

.. ~,.....,...,....- ,... ~,.' 274 GAta1tS AND NANi:S IYiateriels and Miethods Yh)ual exanSuracions ia~Quling pusmon~ry t mL• ti0n studies, a,erc peitormed on 1975 eemployees. $69 men and 706 watmm, most of whom wcrc actively employed by a hrge insurancc eompany, at the time of trou5i8tey periodic, health ecalua- tiotr. No subject whc was tested had disabling rapiratory, errculatory, or ncuromuscular discase. All participants tompleted an esctensiFe, self- administered questionnaire that was reviewed and amplified by the phpsitian at the time of the examinalion. Detailed imoking history was obtained by the ptcimdnarf function technician at the time di testing. Height wat measured with the subject standing in stocking feet; si:eight, with the :hoes and outer cldthing removed. Using the formulas of DuBois aind iktrpoB (6), the body aurface area was ehlculated and expiessed in tguare meters. A cornp'iete ph)yital estamination. with the exception of a rectal and pelvic evelur ti0n in women, wa's p'erEormed by a regularly assigned physician of the Employee Health Ser- vice. A standard 6-toot radiograph of the chest was obtained on eaeh subject. A standard 12•lead electrocardiogram was obtained of all subjects 40 years of age or oldei and a\faster's 2-step exer- cise test was perforaped if eoronary artery disease was suspected. Fich subject perfarmed a forced expiratory api- rogram and maximal voluntary ventilation All testing and raluired calculations were performed by one of 4 technicians. The tests were carried out with the subject in the standing poaition, and a nose clip was used. A.133•liter Collins spirometer ;rith all valves and the can- (ster removed was used throughout the survey. s The forced expiratory spirogram was obtained .1("n.n:.,.,ar.nin.andthe MV%' was performed with a record speed of 160 mm per min. The technique of performing the test procedures and the necessary calculations were as outlined in the Veterans Administra- tion-Army Cooperative Study (7). The folloN ing parameters were derived from the spitrognm: inspiratory vital capacity (iYC), forced vital capacity (FVC), forced eapiratory volume in 03 second (FEPo,i), forced e:pintory volume in I«aottd (FEYt)• forced eapiratory volume In g secorsds (FE1'3), volume of air ex• haled per minute during the middle half of the forced expiratnrp eurve (FEFy:.a,, or MM6), and volume of air exhaled per minute between the 200 ml and I.200 ml volumes of the forced expiratorc curyc (FEFV,s.,, or 1JEF). Using the resuits of these measurements, the FEVo.61 FVC, FEYI/FVC, and FE1'a(FVC were alculat• ed. A aingle )VV was calculated Imm the Vett- titograph tracing. Bemtru the primary objective of the staldy was to establish normal values for spirometric func• tions, the total male and female sample was di- .ided into normal and not normal aubsamples. To make this distinction, one of the invatiga• ton (CG) reviewed the detailed'emplo)ee health record, including laboratory procedures, ndio- graph, and electrocardiogram, of each subject in the study. Sised on this review of the health record and the results of the current history and ph.•sical examination, but without prior knowl- edge of the results of the pulmonary function tests, all subjects were placqd in either the normal or not nomtal category. The decision to setain or TABLE I MEAN 3SDPHYStCALCHARACTERISTICSOF HEALTHY EMPLOYEES OF AN INSURANCE COMPANY AIISubleen Nonsrnoker Current8moker Esc.raoker , No. n.4S3 n- 105 n•190 n. 100 MEASVREMENT Mean S.D. Meeh S.D. Mean B.D. Mean S..D. Men A9e, Years 44.69 12.110 41.45 12.77 42.19 11.28 49.43 12.19 Hsipht, Inches We10ht, pounds /g9.97 173.43 2.77 23.06 89.62 169.26 2.72 21.67 70.33 172.13 2,74 233.38 ' 69.94 176.61 2.88 .a R1.98 ti8r1, m1 1.96 0.18 1.93 0.14 1.96 0./6 1.98 0.15 Women Aa., years 39.29 13.56 . 39.84 13.88 '!7 7g 12.06 43.38 14,07 ltelpht,lncnsf 63.24 2.70 53.32 2.88 63.41 2.49 A3.11 2,67 Weipnt, pounos 1$9.34 19.14 129,68 20.98 125.41 17, 30 129.82 16.80 BSA, m2 1.60 0.13 1.60 0.14 1.60 0.12 1.61 0.11 1443'1

0 9NFLVENCI? OF CIGAKETIt SMUKING UN SPIRUS/ETBIC EVALUATION 275 TABLE 2 REGRESSION EGUATIQN5 FOR HEALTHY MALES i s Riotression Equsti0ns Regresston Coetfiaients Multit+le Smt . , ~ Neight /inClicj! A9a• [Yra•a~ -........... Correlntlon eCC Al/ subieeU; n o 453 FVC, mi 154.36 -25.82 -4828.74 0.71 564.91 FEVO.S, mI 67.06 -18•76 -776.~6 0.61 419.19 FEV l, ml 102.67 -29.94 -1943. 0 0.71 494.57 FEViIFVC,u -0.44 -0.20 4120.65 0.39 6.06 FE V3, mi 141.92 -32.36 -3864.18 0.74 064.30 FEF7S-7!%.Iiter/min 2.13 -2.68 •203.35 0.46 ti&79 FEFioo-t1o0; lit.r/min 12.90 -2.89 -182.00 0.33 168.40 MVV. Oter/min 1.91 -0.67 s1.65 0.32 30.60 Nonsmoker: n a 106 FVC, mi 170.36 -28.48 -6332.48 0.72 et2.99 FE Vos. mi 73.66 -19.33 -1129.94 0.60 l44.04 FEVt' ml 120.62' -32.36 -2964.98 0.72 836.36 FEVtIFVC. Ss -0.57 -0.18 a129.49 0.43 6.62 FEVy. mi 168.40 -34.85 -5472.50 0.74 605.33 FEF2S _7S%.IhW/min 1.75 -2.84 .260.03 0.60 64.88 FEF70o-t2oo, atur/euin 9,73 -1.77 -6t3 0.23 163A7 MVV, ilterlnoin 1.20 -0.90 .124.67 0.36 32.68 Current tmokeb; n ~ 190 FVC. mt 161.04 . -27.42 -5330.17 0.71 501.84 FEVO.S, mi 74.23 -22.03 •-1248.10 0.66 40.9.16 FEVI,m1 , 109.16 -34.49 -2358.77 1 0.73 466.33 FEVSIFVC.1: -0.36 -0.28 a117.47 0.49 5.69 FE V3, ml 149.94 -36.60 -484.90 0.76 645.01 FEFZS_7s%;litarfmtn 3.34 -3.47 a132.66 0.69 57.73 FEF1o0-12m0• IiWr/min 13.16 -3.82 -180.41 0.35 162.91 MVV,nterlmin 3.18 -0.50 -38.44 044 31.41 En-smoker; n - 100 FVC, ml 132.83 -26.20 -3272.63 0.76 485.35 FEVos, ml 66.66 ^19.50 .60.74 0.63 401.14 FEVS,mI 85.49 -28.76 -732.32 0.73 460.13 FEVI/FVC, tc -OA4 -0.18 +119.66 0.33 . 6.32 FEV3, ml 144.93 -30.76 -1971.71 0.75 502.14 FEF3s_7s%.Itterimio 1.46 -2.58 +256.23 0.40 75.63 FEF300-1200, Itter/min 12.70 -4.06 -91.65 0.42 163.06 MVV.liur/min 1.20 -1.03 .131.76 0.45 28.06 reject the subject a,s normal was based on the de• sire to exclude aiR subjects who had a history. physical 6ndings, or laboratory results that could have conceitably been associated with an aitera- tion ot pulmonary tuttlction. Bt• this ciassification. 453 men and 606 women were cansiderM to bc normal. and• theit data were submitted to de• tailed statistical uisdirs: 116 men and 100 tcomen were excluded. lkcaufe of lack of comprehetuion, latk ot cooperation. or inability to perform test ' procedures. 6 men and 8 women were nat in• eluded in thestudy. The following information on smoking habits wav obtained: type of tobacco used (dgarettes: pipe, dgar), duration of smoking, average daily consumption and duration of smoking•fttt inter- va: in the ex•dgateite smoker as well as the duta- don of smoking and avenge daily consumption before discontinuante. To establish Ahc cflects of cigarette smoking on spimmetric performnee, the notmal subjects were divided into the following categories on the basis of smoking history. "AU healthy subjeat" consisted of subjects whd showed no demonstrable disease, including smokers, nonsmoken. and ex• smoken: "never imoked" inriuded those subjects LIN 14435 i r : i I { , -- - I

0 276 GRIMES AND HANES TJ181.E 3 REGRESSION EQUATIL)NS FOR HEALTHY FEMALES Roprottlon Coortioionte MuttlOea Test Hdpht /inehesl. A8e (y4era) Conatent ConetaRion R 8EE All tubleate; n ° 606 FVC, ml 108-77 -10.33 -3106.67 0.66 >i94,17 FE Vos. ml 47.98 -11.48 -334A0 0.62 ;94,40 FE V t, ml 76.82 -19.09 -1287.72 0.73 A1tA8 FEVj/FVC, % -0-47 -0.28 +125,67 0.66 , 6.67 FE V7, ml 101.98 -14.90 -2577,80 0.70 379.62 FEF23-7S%,/lter/min 1.25 -241 +216.00 0.88 61,26 FEF7o0-lao0.llter/min 6:80 -1 A7 -26.67, 0.38 73.68 MVV,IIter/min 231 -0A6 -11,82 0.46 18.20 Nonarnoker; n ° 303 FVC, ml ' 112.65 -9.93 -3354.63 0.67 416.28 FEVo.6. mi 51:99 -11,23 -679.99 0,63 $93.18 FEVt.ml 81,81 -10.06 -1576.3!1 0.75 :07.87 FEV1lPVC,% -0.42, -0.29 +173.55 0.68 6.67 FE V3, ml 107.30 -14.49 -2909.96 - 0.71 387.99 FEF75 7S%,liter/man 1.83 -2A6 +186.42 0.56 82.62 liter/min FE F7o0-1100 8.21 -1.29 -122.88 0.42 70.58 J . MV, titer/mtn 2-47 -0.42 -28.07 0A9! 1111.915 ~ ~ Currerit tmoker; ri - 250 FVC, ml 101.25 -9.46 -2892.64 0.62 $76.93 FE V0-S, ml 43.28 -10.83 -83.07 0.67 *f4,30 FEVt,m1 49.43 i -17.44 -883.78 0.69 b24,68 FEVsIFVC.% -0.46 -0,29 +125.95 0.6a 6.77 FE V 3, ml 93.17 -14.02 -2083,12 9.66 360.63 FEF=S 7t%.11t.r/min 0.73 -2.33 +239.28 0.6: 50.41 llter/min FEF - 6 59 -1.31 +41.98 0.31 73.27 . go_17oo. MVV, liter/min . 1.78 -0A5 +18,38 0.40 18.22 r Ea•unoker; n + 53 FVC, ml 109.66 -19.19 -2735.08 0.80 ~e2,ll3 FE Vo.6 • ml 39.48 -17.34 +542.07 0.73 ;73.67 FEVS,mI 74.37 -23.73 -8b6.67 0.92 30&07 FEVa /FVC, % -d.SO -0.23 +131.04 0.47 , 6.67 FE V 3, mt 98,88 -23.29 -2046.96 0.82 346.78 FEF-1sa6lb,llter/min -0.12 -2,88 +325.62 0.66 48.08 FEFtoo-ltoo.literlmin 0.21 -3.78 +498.14 0.61 88.30 IIterlmin MVV 2.15 -0.67 +1.70 0.54 19A8 • , who denied any tobacco mnsumption in their lifetimc; "current amokera" eonsisted of those aub- Jecss who smoked eiparettes at the time of testing and who had mnaumed tigarettes for'a period of at least I year before the testing ptocedutes,; •'ea-anoken" included subjects who had atopped smoking cigatettes for a period of'at ksst 1}rar. Subjects tcho had discontinued the habit for leas tban I)car were included in the'Yurrent tmokei" atcgarl. Those Kho smoked a pipe, eigar, or both. as well as cigarettes, were categorized only on the basis of their cigarette consumption; those who •,r.ok°d eiga•ottes for a period of less than I year and those who smoked only a pipe, tpr, or both were conaidesed in the "all healthy aub- jects" ategory, but they were elimitaattd !rom the detailed analysia of the specific effects of tig• arette amoking. This trcsulted in the elimination Of 58 male subjects. All women were plaad in one ot the appropriate amoking subgroups,' Results The basic demographic data obtained on the populstion used in this.ctniy asr provided in table 1. 0 BZN 14436 r i

0 ., r atNfLVENCE AF CtGARE7Yt: 1UOtt1NG ON fPIROatETRIC EVALYATtON A pr+oduct•moment corkelation matrix (r) based OR each vt tuC pn);3udi and measurements of ventilarory functiori was derived. The resuits concurred with those previously reported (7) and demonstrated that age consistently correlated negatively wirh all of tlte pulmonary function tneasurementi hnd that height showed a consistently positive cor- relation with FVC and F1:Vs. In view of these tatercortelations and following the printSple of parsimony, namely, that only those funca tions that are independknt should be sised, the variables of age and height were ehfssfd-• , end smecessary and su/fikient to predict tha FVC and FEVt. Regression equations for the entire nttale and female normal sample with their reipea tire sdtbumples. based on smoking historf: are provided in tables 2 and S. $ased on the , multiple correlations (R), the FVC and FEVs could be predicted on the basis of age and height with greater assurance than a number of the other respiYatory function parameters. 217 Therefore, the influence of cigarette smoking .... -W rhnse narticutar pulmonary function tests was conaidered. Cflmpksuons among the different tegres• shm equations of Morris and associates (ii). Edelman and co•workers (9), and Ferris and associates (10) were diffiwlt to evaluate be• eause ot` lack of uniformity in instttunetuta• tion and inconsistency in tesahsinology a'nd de6nitions. Contitibution of smoking eqgoretter. iite- gteniori lines for a hypothetical subjett atith variotu smoking histories from the age of 20 to 70 years, with height held constant at 70 indes for men and 63 inches for Mromen, are compared graphically In 6gurts f and 2. Judging from figure 1, the generall pattern for the FVC in men was repeated but at a lower tevel for the FEVl. As would be, ex- petxed, the nonsmokers had the gte+}text,]FVC ' and FF.Vs, and the smokers, th*-lowest.,For the FV'C in the men, the diHerence beftaeen smokers and, norssmoken amounted to' ap• M !0 aD0 ~0 /Y aP O ~ m.- liarht4a9 Bng. 1. Predicted values for forced .itat capacity (Ft'C) and torced eapiratary volume In one gRtond (FEVt) for men S6 inches in bright aho (!) nerei smokrd tstbacco. (s) continued to smoke t:fgarettes, and (1) discontinued smoUng eigarcttes. /te;trasfon Equations: Nonsmotcr. F1'b; in 179.36 ht - 28.48 age - 6332,48: FE1'r x 120.62 ht - 32.36 age - YfW4.98. Ex•amoker: F1'C = 132B3 ht - 25.20 ap -1272.A9: Ff.Yt = R.1.i!t ht - 28,:fr age -~ 792.52. Smakers: Scc toxt. ht = height In inehes. 1 ~ f UzN1 14437 . i

i I 0 278 CRtairLa AND t1ANtS proximatcdy 250 ml at the younger ages, and this difference decreased slightly during the Sii•)'ear interval. For the tEl't, thc ddic.ence between sroale smokers and nonsmokers again amounted to approximately 250 mi at the younger agess however, contrary,to the FVC. this difference became greater during the pro• jected 50-year interval. This finding suggested that the duration of smoking exerts a de- leterious cffect on FEVI that is not demon- strated In the FVC. The male ex-smoker at the age of 20 years had a decrement of less than 200 reil in FVC and FEVt compared with the nonsmoker. With advancing age, this dec- rement gradually disappeared, srl that at ap• proximately 60 years the ex-smoker s'apiroa metric performance equaled that of the non- smoker. ' The predicted FVC and FEVt for the hypol thetio 69•Anch vaoman is presented in figure'2. As..rould be expected, the nonsmoker had a greater FV'C and FEVt than the smoker, how- ever. these differences in actual volume amounts were insignificant, measuring less att nta.n Ht Matn than SO ml. With increasing age, the- ditfer• ence in FVCand FEVt between female smok ,.,- :u,u though the actual diiferences in volume were insigni6cant. Thesc findings suggested that smoking and the duration of smoking has little efiect an the FVC and FEVt, In women. Unexpected results were obtained for the by- pothetfe. 63-inch female ex-stnoker. The FVC and FEVI Mtire greater, initially than those of eithrr the smoker or nonsmoker, and dur ing the ensuing years. there was a rapidly increasing decrement wben compared to either the smoker, or nonsmoker. Perhapa these peculiar findings were the result of a sampling error or the sample sire (n = S3), or perhapa the results were real. Role of eigorettes among smokers: The ex- pected results in a b)pothetic male smoker. 70 incties in height, who continued to smoke 10, 20, hnd 90 cigarettes per day are illustrated in 6gukr 3. It was assumed that the subject started smoking cigarettes at the age of 16 years. And by the age of 20. he had already .o - te .o r0 p ao to Fig. 2. Predicted values for forced vital tapacity (1•1'C) and totced eapiratory volume In one second (FE\•s) for women 63 inchet in height .. ho (J) newt smoked tobacco. (!) eoatinued to arooke cigarettes, and (3) discnntinucd smoking eigare:ic-t, -Ater"aiou Jcrjuetiens•. Nonsmoker. F1'C = 112.65 ht - 9.93 age - 3354.63; FEVI = 81.81 ht - 18.06 age - 157639. Fx-smoker: FVC = 109.Str ht - 19.19 agr- 2i SaAA: FEVI = 74.37 ht - 23.73 aak -(1,6.67. Smokerv Scc trs:t. ht = hrigh,! in inches. b7N I i 14438 t ! a 4 e

0 a I 4 IC b tNFLUEiVCE OF CIGARETTE SSfOKING ON SPlRO?ffTRtC EVALOATION tc.ao- eaa ow .m +o.+a..~+m.~: o-.- o ~p~p..~»na.en. sea4Y~t~ Ke 279 N b W 00 u e0 aer ht~bl , n b b ~~, 1e Fig.3. Predietad values for forced vital iapacity (FVC) and forced expiratory volume (n one sttond (F1:VS) for men 70 inches in height +rho (1) rerer smoked tobacco. (2) started smoking cigarcttei at the age of 18 and continue to smoke 10. 20, and 30 cigarettes per day. Rprression Equations: ron- stnoker: FVC = 179416 ht - 28.48 age - 6852.48: FEVt = 120.62 ht - 1236 age - 2964.98. Smoker: See text. ht = heigMt in inches. f smoked for 2 years. The expected resulcs, namely, that men seho smoke 30 cigarettes per day have a lower FVC and FEVt than those who smoke 10 cigarettes p:r day. arc t;nrroborated in figure 3. These differences in spirometric performance with time appeared to be dose•related, but tite actual diHercnces. approximately 160 ml for FVC and 140 ml forFEVt were not dramatic. I Regression equations for FVC and FEV, in milliliten, using tite additional smoking variables of amount and duration in years, are compared to the predicted formulas, using only the variables of age in years and height (ht) in inches. Regression Equations for dtaie SmoRers (N=190) R SEE FVC =161.04 ht - 27,42 age - $830.17 Q:71 582 pVC =163SY ht - 1428 age - 12.19 duration - 8.00 (cigarcttes per day) - 5583.78 0.79 b7/ FE V r=109.16 !l t- 34.49 age-2858.77 0.73 466 FEVr=110.55 ht-21.43 age -12.77 duration - 6.12 (cigarettes per day) - 25i6.b8 0.73 486 i The regression equations that used the rmoking 'variables of cigarettes smoked per day and the number of years smoked were slightly superior to tite other equations in view of the larger multiple correlations (R) and the lower standard erron of the estimates (SEE). - The hypothetic female smoker, 61-1 ituhes in height who at the age of 20 bad amoked for a prriod ^f-Tsza?% _-nd sontinued ta smoke 10. 20, and 5tt rigarettes per day for a period of years is pmented in egesre 4. The reaults appeared unessual, showing greater FVC with increased number of cigarettes smoked per day but remaining below tbe Fr suits obtained using the ••nonsmoker" prem diction formula. The results for the FEVs, on the other hand, showed the more expected i 1 14439 i 1 r r

11 Fry"n. 280 GatStE6 Atctr IiANES result in that the greater number of cigarettes consumed per day tDe lukcr s:Ls Wc XZi'y. Regression equations for FVC and FEVl, expressed in snilliliters, using the smoking vatiablet of amount and duration, were cobtw pared to tite predicted formulas using only the age and height variables, as follows: Regression Equations (or Femole Smoker.a (N=2Ni) R t6E 6vC = 101.25 hc - 9.26 age - 2692.64 0.62 376 FVC=I01.17 ht-8.5fi age - 1.24 duration + 1.74 (cigarettes per day) -2725.58 0•fi2 877 FEVt = 69.43 ht - 17.44 age - 883.78 0.68 b25 FEVt=72.40 ht-14.20 age = 4.24 duration - 1.62 (cigarettes per day)-1099.24 0.69 324 Discussion In the present study, acceptance of periodic !ns health 'exampnations by the employees has ,...,t•,.v.ry,n-.elkd satqple of the working population. The detailed eval• uation of ahe subject•s ntiedical history nom- hin¢d with the results of :9n extensive current physical and laboratory examination permit- ted confulena identification of a normal ttont• ple for statistical evaluation. The historical record of the subjea i smoking habits, am• plified by d'nrect questioning at the time of pulmoatary function testing ensured accuracy of the subjeet's smoking history. Having only 2 technicians performing all of the tests and ttequired cakulations contrfbuted to unifotta• ity of testing procedures and to consistency of tnt:asurefitenu. Among pulmonary tunG tion test8 Rosrter and associates (11) reporc• ed only stnbll intra• and interobsetver error in calculating the FVC and FEV3 from the forced expiPatory spirogram, giving credence to the mulu of the puhnonary function tests selected fot detailed consideration in the present study. The testdlu of parallel regression atta)yses on specific samples of current smokers, per- t . 2 . , ! uoc+s 0 ca..a.m a~ o.. -- . -- IDa6Nt~~tf n• a. apt+ucnits 014, Oa .-.-- .Otq.Kh[t #It10a r ttu.e eeaut*.c..cn eK ocrr.[tra rt. o.. [OOw.4tttt ~{.O.t ~...» pPW/Rnit~ttqF 0 l0 10 [0 !0 a0 40 t0 O .u tw..u ut oa.Ra Fig. 4. predictcd calues ba: :arced vital capacity (FR'C) and forced expiratory volume In one second (FEl't) tor females 69 inches in height who (1) never smot:ed tobacco. (2) started smoking eigaretta at the agc of 1 B and cvntitmr to smel.c 10, ?0, and 30 cigarcttes per day. Regrkuton Equationt: Non• smoker: FVC = 112.65 ht - 9.98 agr - 3954.68: FEVa = 81.81 h't - 18.06 age - 155699. Smoker: Sec text. ht = hcight in inchcs. I 14440 t

0 6 o L\fLUti\CE Or CIGARETTF b.UOKtaG UN aP1ikOktETR1C EVALL'A71/DS 281 sonc who have never smoked, and those who baet discondttued smoking have been report. ua it, uniy timttcu auUns. t nt nnatny, 01 EdeOman (9) are in essential agreement with the results of' the current study, whereas re• gresiion equations reported by Ferris (10) are diffecult to interpret. Other pertinent studies include the Berlin. New Hampshire (12), the Chilliwack, liritish Columbia (13). the Tecumseh, NtichiRan (14) respiratory dis- ease surveys and that of Peters and Ferris (5). On the basis of these studies and the present 6ndirigs. it Is suggested that current agarette contumption har,a dose•related ef- feet, and it is concluded that formale smokers. the use of the prediction equation including the variablesof smoking duration and amount are justifted. The use of the prediction equa- tions for male nonsmokers, derived frotn the current atudy. are recommended in view of the significant multiple correlations (FVC= 0.72, FEV1 =0.72). For male ex-smokers, re• gression equations, using the additional in• d: pendent variables of the number of ciq• arettes smoked and duration of smoking while pursuing the smoking habit, as well as the duration of the smoking•free intenal since discontinuing smoking, resulted in no signifi• cant improvement in multiple correlation. It is, therefoYC, recommended that the pre• diction equations including only the variables of age and height be used in the considera• tion of male eY-smokers. A review oQ the literature reveals no re- ported regresdion equations specifically for female smokers, nonsmokers, and ex•smokers for a single population; however, compari• aons of FVC and FEVt have' been done by Ferris and co•workers (10). the Tecumseh. Michigan study (14), the Berlin, New Hamp- ahire study (12), the CLilliwack, British Co. )umbia investigation (19). Lindall and co- workers (15), Huhti (16), and Woolf and Suero (1). In the current study, no signifi- eant diflerence in FVC and FEYs was found between female smokers and nonsmokers• The findings of the current study, which • show greater predicted.valua for FVC and FEVs for female cx-smokers than for female nonsmokers at, comparable younger ages and the rapid decline in these patameters with time. are controvenial and unexplained. The trend shown in female smokersm namely, the iuuca1cu II-utuLU a-t•t. a19oCJ.7tCA T:11tt Llac increasing nusnb'er of cigarettes currently smoked, was unexpected: there was, porhaps, a compensatory mechanism operating that increased the FVC with intreasing cigarette consumption. but without a mtmponding effect on d+e FEVy. .4aknowledgmknt The writers are Itddebted to thhe staff of the Medi- al Depanaient, $cudential Insurance Company of America. Western Home Office. and especially to Miss Joanne Honefanger and Mr. Thomas Wil- son who perforaoed all of the pulmonary fune• don tests. The terbnical assistitna of Dr. Martin Albaum, Direetor of Research, prudential Insur- anee C•ompan}. Rfr. Jack lsomaki and Mr. Nick Lombardo of the Health Sciente Department, Cal- ifomia State University At Yoidaridge, are aUo gready aektsowled,gM. Mrs. Satan Siple and Mrs. Annabelle Simonian are thanked for their assist- ance in the preparikion of the manuscript. References 1. Woolf. C. R..,sind Suero, j. T.: The respira• tory effects of regular cigarette smoking in womkn, Amer. Rev. Reip. Dis.,1971, J0), 26. 2. Andcnon, D. 0.: Smoking and respiratory diuare, Amer. J. Public Health, 1964, !I, 1656. !. Barker. G. S.: Lung functibn In elderly mile heav) smokers and nommi..ess, Amer. Rev. Rap. Dis.,1965,91.409. 4. Lsci. S., Goldman, H. I., and Levin, A.: Cig- arcttc smoking and pulmonary function in healthy Ivung sldults. Amer. Rev. Resp. Dis., 1964,89,78. S. Petere, J. X, and Ferris, B. G.. Jr.: Smoking, pulmonary funetion, and respiratory almp• toms 3u a eollege.age group. Amer. Rev. Rap. Dia., A961. 99, 774. E DrrBdis, D., and DuBois, E. F.: Clinical cal- orimetr j•: A tonnula to estimate the approxi• mate surface srea if height and weight be known, Arclr. intern. rted; (Chicago). 1916, 19.869. 2 Kory. R. C.. Callahan. R.,1Boren. H. G.; and Syner, J. G.: The t'eterant Administntion- Army Coopcratfs•c Study of pulmonary func- tion.;4mer. J. rtcd.. 19600.243. 8. Morri., j. F., Koski, A., and John:a, L C.: SplrOlnt'rnC iiN4tth fvt heat6l nonsmok- 14441 L L f P

^ 282 fiKeedEB MW HANES ing adudts. Amer. Rev. Resp. Dir„ 1971.10t, 57. !+. LciClla]au. 1\. 3~., 1 Lttmaz+. 4.. tv~rr::, as. t:.. Cohen, D. H., and Shock. N. W.: The a•Secds of cigarktte smoking upon spirotuetrit pex• tormancc of community dwelling men, Amer. Rev. Repp. Dia.,1966, 9I.41+1. 10. Fetrit.l3. G., Andersoa; D_ 0., and Zidcman. tel, R: Prediction values for teteening tesaa of pulmonary function.:Amer. Rev. Reap. Dis.. 1905,91.252. If. Rosner. S. W., Abraham. S., and Cstxres. C. A.: Obierver variation in splrometry, Dis. Cheu,1965,48.265. 12. Anderson. D. 0., and Ferris. B. J.. Jr.: Rolc of tobacco smoling in the causation of thron- ic mpiratnn• disease, New Eng. J. Med.. 1962, 267.767. 13. Andetson, D. 0.. Ferris, B. G., and Zidatoan. tei, R.: The ClriUiwlik tapimtory sutvey, ing on th4 psrvalenTe oEvrespiratory dia- aefe. Canad. Med. Astn. J., 1965, 02. 1086. 14. Payne. M., and lgjelsberg. M: RRSpiratt>t• aymptoms, lung ftinctimtt, and unokiug habits in an adult population, Amer. 1. Public Health,1964,JI.261. 15. Liadali, A.. Medii-a, h, and Grba;er, J. T.: A raewiua,tion of aormal pubaonary tunc• tion measutRment in the adult temdle, Amer. Rer. Retp. Dis.,106Y, 0f.1061. 1B. Huhti, E.: Prevalena! of respiratbry aymp• toms. chrodic bronchitis and pulmonary am• physcma in a Finnish ruml population. Acta Tuberc. Ptteumoi. Scand„ 1985 (Supplement at, p.11). ! r- I 4. • ON 14442 r