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The Use of Statins and Lung Function in Current and Former Smokers^*

^* From Pulmonary and Critical Care Medicine, the Oklahoma City VA Medical Center and the University of Oklahoma Medical Center, Oklahoma City, OK.

Correspondence to: Jean I. Keddissi, MD, FCCP, Associate Professor of Medicine, 920 Stanton Young Blvd, WP 1310, Oklahoma City, OK 73104; e-mail: Jean-keddissi{at}ouhsc.edu

Abstract

Background: Smokers are affected by a variety of inflammatory diseases, including COPD. Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme-A reductase inhibitors, are used for their lipid-lowering characteristics but also appear to have antiinflammatory and immunomodulatory activities. We assessed their ability to preserve lung function in current and former smokers.

Methods: All smokers and ex-smokers seen at the Oklahoma City VA hospital in 2005 with abnormal baseline spirometry findings and two or more pulmonary function tests done 6 months apart were classified into obstructive and restrictive groups based on the initial PFT result. Statin use, annual decline in FEV₁ and FVC, and need for respiratory-related urgent care (emergency department or inpatient) were compared.

Results: Approximately one half, 215 of 418 patients, were receiving a statin. Compared to the control group, statin users had a lower decline in FEV₁ (– 0.005 ± 0.20 L/yr vs 0.085 ± 0.17 L/yr, p < 0.0001) and FVC (– 0.046 ± 0.45 L/yr vs 0.135 ± 0.32 L/yr, p < 0.0001) [mean ± SD]. This difference remained significant irrespective of whether the patient had obstructive (n = 319), or restrictive (n = 99) disease, and regardless of whether the patient continued or stopped smoking. In patients with an obstructive spirometry finding, we found a lower incidence of respiratory-related urgent care in favor of the statin group (0.12 ± 0.29 patient-years vs 0.19 ± 0.32/patient-years; p = 0.02).

Conclusion: In smokers and former smokers, statins are associated with a slower decline in pulmonary function, independent of the underlying lung disease.

Clinical implication: Prospective, randomized trials are needed to study the effect of statins on lung function.

Key Words: COPD • ex-smokers • pulmonary function tests • smokers • statins