Abstract
Debate continues about what constitutes significant and meaningful change in health status of individuals and populations. More importantly, the basic biological and medical criteria that are used for clinical and environmental judgments require further discussion and clarification. What proportion of loss of cardio-pulmonary function, overt disability, or mortality is sufficient to determine an ≫ adverse health effect ≫? Health-oriented individuals, including researchers and clinicians, may choose to adhere to different criteria than other professional groups (e.g., legal, social). It is proposed in this paper that criteria for defining adverse health effects should represent clinically meaningful, as distinct from only statistically significant, responses. These include pulmonary function test results that indicate obstructive or restrictive diseases, and electrocardiogram results indicating coronary artery disease. Intraindividual changes that predict a meaningful medical change would be included; these changes should meet specific requirements in terms of what constitute normal vs. abnormal ranges of variation. Further, the proportion of the population defined to be impaired should be considered. These issues are the focus of this paper.
References
American 'Thoracic Society (1978): Epidemiology Standardization Project. ARRD, 118 (Suppl.)
BerglundB. et al. (1982): Olfactory and chemical characterization of indoor air. Towards a psychophysical model for air quality. - Environ. Internatl., 8 (1–6): 327–332.
Berry G. (1974): Longitudinal observations. Their usefulness and limitations with special reference to the forced expiratory volume. - Bull. Physio. Path, Resp., 10: 643–656.
Bloom J.W., Sugihara S., Garfield M.D., Abraham T.A. and Knudson R.J. (1984): Characteristics of individuals with accelerated declines in lung function. -Chest, 85S: 18S–19S.
Burge P.S., O'Brien I.M. and Harries M.G. (1979): Peak Flow Records in the Diagnosis of Occupational Asthma Due to Colophony. Thorax, 34: 308–312.
Burrows B. and Taussig L. (1980): As the twig is bent, the tree inclines (perhaps). - (Editorial) Am. Rev. Respir. Dis., 122: 813–816.
Burrows B., Knudson R.J., Camilli A.E., Lyle S. and Lebowitz M.D. (1986): The ≫ horse-racking effect ≫ and predicting decline in FEV, from screening spirometry. - Am. Rev. Respir. Dis., 135: 788–793.
Cain W.S. (1981): Ventilation and odor control: prospects for energy efficiency. - Berkeley, CA, Lawrence Berkeley Laboratory, (document UCLBL-4622602).
Camilli A., Burrows B., Knudson R.J., Lyle S., Lebowitz M. (1987): Longitudinal changes in FEV, in adults: effects of smoking and smoking cessation. -Am. Rev. Respir: Dis., 135: 794–799.
Case G.S., Dixon K.S. and Schooley J.C. (1979): Interactions of blood metalloproteins with nitrogen oxides and oxidant air pollutions. - Environ. Res., 20: 43.
Davies R.J. and Blainev A.D. (in ibid.): Occupational Asthma. pp, 205–213, 228–230.
Fletcher C., Peto R., Tinker C. and Speizer F.E. (1976): The natural history of chronic bronchitis and pneumonia. Oxford: Oxford University Press.
Goldsmith J.R. (1968): Effects of air pollution on human health. in: Air Pollution, A.C. Stern (Ed.), Vol. 1: 557, 582, Academic Press, NY.
Gregg I. (1964): The measurement of peak expiratory flow rate and its application in general practice. -J. Coll. Gen. Pract., 7: 199–214.
Gregg I. and Nunn A.J. (1973): Peak expiratory flow in normal subjects. - Br, Med. J., 228–284.
Harm D.L., Marion R.J., Creer T.L. and Kotses H. (1985): Effects of instructions on pulmonary function values. - J. of Asthma., 22 (6): 289–294.
Harries M.G., Tee R.D., Lacey J., Cayley G.R. and Newman-Taylor A.J. (11 May 1985): Lancet, i 1063–1466.
Hertzel M.R. and Clark T.J.H. (1983): Adult Asthma. In T.J.H. Clark. and S. Godfrey (eds.), op. cit., pp. 473–481.
Higgins M.W., Keller L.B., Landis J.R., Beaty T.H., Burrows B. et al. (1984): Risk of chronic lung disease: collaborative assessment of the validity of the Tecumseh Index of Risk. - Am. Rev. Respir. Dis., 13 0 : 380–385.
Hoffmann D., Haley N.J., Adams J.D. and Brunnemann K.D. (1984): Tobacco sidestream smoke: uptake by non-smokers. - Preventive Med., 13 (6): 608–617.
Holberg C.J., O'Rourke M.K. and Lebowitz M.D. (1987): Multivariate analysis of ambient environmental factors and respiratory effects. - Int. J. of Epidemiol., 16 (3): 399–410.
Hruby J. and Butler J. (1975): Variability of routine pulmonary function tests. - Thorax, 30: 548.
Jarvis M.J. and Russell H.A.H. (1984): Measurement and estimation of smoke dosage to no-smokers from environmental tobacco smoke. - Eur. J. Respir. Dis., 65 (Suppl. 133): 68–75.
Kory R.C., Callahan R., Boren H.G. and Synder J.C. (1961): The Veterans Administration-Army cooperative study of pulmonary function. - Am. J. Med., 30: 243.
Knudson R.J., Slatin R.C., Lebowitz M.D. and Burrows B. (1976): The maximal expiratory flow-volume curve: normal standards, variability and effects of age, - Am. Rev. Respir. Dis., 113: 587.
Knudson R.J., Arrnet D.B. and Lebowitz M.D. (1980): Reevaluation of tests of small airways function. - Chest, 77S: 284S–286S.
Korn E.L. and Wittemore A.S. (1979): Methods for analyzing panel studies of acute health effects of air pollution. - Biometrics, 35: 798–802.
Lebowitz Knudson R.J., Robertson G., Burrows B. (1932): Significance of intraindividual changes in maximum expiratory flow volume and peak expiratory flow measurements. - Chest, 81: 566–570.
Lebowitz M.D., Holberg C.J. and Dodge R.R. (1983): Respiratory effects on populations from low-level exposure to ozone. In: Proceedings of the Annual Meeting-Air Pollution Control Assn., JAPCA, Vol. 1: 83–12.5 Pittsburgh.
Lebowitz M.D., Holberg C.J., Boyer B. and Haves C. (1985): Respiratory symptoms and peak flow associated with indoor and outdoor air pollutants in the Southwest. - JAPCA, 35 (11): 1154–1158.
Lebowitz M.D. (1985): Airway responses in children related to environmental irritants. - (Editorial) Ped Pulmology 1: 235–236.
Lebowitz M.D., Phibbs B., Robertson G., Holberg C., Knudson R.J. and Burrows B. (1986): Vector-cardiographic and blood pressure correlates of obstructive lung diseases in a community population. -Chest, 89: 78–84.
Lebowitz M.D., Collins L. and Holberg C. (1987): Time series analysis of respiratory responses to indoor and outdoor environmental phenomena. -Environ. Res., 43: 332–341.
Lebowitz M.D., Holberg C.J., Knudson R.J. and Burrows B. (1987): Longitudinal study of pulmonary function development in childhood, adolescence and early adulthood. - Am. Rev. Respir. Dis., 136: 69–75.
Lippmann M., Lioy P.J., Leikauf G., Green W.B. et al. (1982): Effects of ozone on the pulmonary function of children. - Adv. in Mod. Environ. Tox., Vol. 5, pp. 423–446.
McCarty D.S., Craig D.B. and Cherniack R.M. (1976): Effect of modification of the smoking habit on lung function. - Am. Rev. Respir. Dis., 114: 103.
Martinez F., Antognom G., Macri F., Lebowitz M.D. and Ronchetti R. (1985): Distribution of bronchial responsiveness to a constrictive drug in a random pediatric population sample. - Am. Rev. Respir. Dis., 131: A142.
Matsukura S., Taminato T., Kitano N. et al, (1984.): Effects of environmental tobacco smoke on urinary continine excretion in nonsmokers. - New Eng. J. Med., pp. 828–832.
Morris J.F., Koski A. and Johnson S.C. (1971): Spirometric standards for healthy non-smoking adults. - Am. Rev. Respir. Dis. 103: 57.
Nickerson B.G., Lemen R.J., Gerdes C.B. et al. (1980): Within subject variability and percent change for significance of of spirometry in normal subjects and cystic fibrosis patients. - Am. Rev. Respir. Dis., 122: 859–866.
NRC/NAS (1977): Carbon Monoxide. Washington DC: National Academy Press.
Pennock B.E. and Rogers R.M. (1978): An evaluation of tests used to measure bronchodilator drug response. - Chest, 73 (Suppl): 988.
Pennock B.E., Rogers R.M. and McCaffree D.R. (1981): Changes in measured Spirometric indices. What is significant? -Chest, 80 (1): 97–99.
Pride N. Physiology. In: Clark T.J.H. and Godfrey S. (eds.) (1983): Asthma. (2nd Ed) London: Chapman and Hall, pp. 27–53.
Rarnsdale E.H., Morris M.M., Roberts R.S., Hargreave F.E. (1985): Asymptomatic bronchial hyper-responsiveness in rhinitis. - J. Allergy Clin. Immunol., 75(5): 573–577.
Reinberg A., Gervais P., Holberg F. and Holberg F. (1971): Trisentinel monitoring of air pollution by autorhythmometry of peak expiratory flow. Proc. 2nd Int. Clean Air Cong., New York: Academic Press, pp. 217–220.
Schievelbein H. and Richter F. (1984): The influence of passive smoking on the cardiovascular system. - Preventive Med. 13 (6): 626–644.
Shy C.M., Goldsmith J.C., Hackney J.D., Lebowitz M.D., Menzel D.B. (1978): Health effects of air pollution. Official Statement of the American Thoracic Society. American Lung Assoc., ATS New 4: 22–62.
Silverman F., Corey P., Mintz S., Olver P., Hosein R. (1982): A study of effects of ambient urban air pollution using personal samplers: a preliminary report. - Environ. Internat. 8: 311–316.
Sly P.D. And Landau L.I. (1986): Diurnal variation in bronchial responsiveness in asthmatic children. -Ped. Pulmonol., 2 (6): 344–352.
Snider G.L., Kory R.C. and Lyons H.A. (1967): Grading of pulmonary function impairment by means of pulmonary function tests. - Dis. Chest., 52: 270–271.
Spicer W.S. and Kerr D.H. (1966): Variation in respiratory function. - Arch. Environ. Health, 12: 217.
Tager I.B., Weiss S.T., Munoz A. et al. (1983): Longitudinal study of maternal smoking and pulmonary function in children. - N. Eng. J. Med., 309: 699–703.
Thomas III H.M. and Garrett R.C. (1984): Interpretation of spirometry. A graphic and computational approach. - Chest, 86 (1): 129–131.
Van der Lende R., Kob T.J., Peset R.R., Quanjer P.H. et al. (1981): Decreases in VC and FEV1 with time: indicators for effects of smoking and air pollution. - Bull. Europ. Physiopath. Resp., 17: 775–792.
Ware J.H., Thibodeau L.A., Speizer F.E., Colome S., Ferris Jr. B.G. (1981): Assessment of the health effects of atmospheric sulfur oxides and particulate matter: evidence from observational studies. - Environ. Health Perspect, 41: 255–276.
World Health Organization (WHO) (1982): Indoor air pollutants: exposure and health effects. WHO/EURO Reports and Studies #78, Copenhagen.
World Health Organization (WHO) (1983): Guidelines for studies in environmental epidemiology (ECH 27). Geneva: WHO.
Yocum J.E. (1982): Indoor-outdoor air quality relationships: a critical review. - JAPCA, 32: 500.
Zagraniski R.T., Leaderer B.P. and Stolwijk J.A.J. (1979): Ambient sulfates, photochemical oxidants, and acute health effect: an epidemiological study. -Environ. Res., 19: 306–320.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lebowitz, M.D., Quackenboss, J., Camilli, A.E. et al. The epidemiological importance of intraindividual changes in objective pulmonary responses. Eur J Epidemiol 3, 390–398 (1987). https://doi.org/10.1007/BF00145651
Issue Date:
DOI: https://doi.org/10.1007/BF00145651