Characteristics of individuals with accelerated declines in lung function

In only 2 of the 12 subjects, both of whom had extremely abnormal FEV₁ values, was loss of lung elastic recoil detected. These 2 subjects also had the lowest D/Va values and were the only subjects with a physician's diagnosis of emphysema. In other subjects, tests purported to show small airways dysfunction were abnormal. Pulmonary resistance associated with abnormalities in large airways was elevated in some subjects. From these preliminary data, we conclude that several pathophysiologic mechanisms involving lung parenchyma, small airways, and large airways, acting singly or in combination, may explain accelerated declines in FEV₁. We also observed that a rapid decline in ventilatory function is often associated with nonrespiratory medical problems, primarily severe cardiovascular disease.