{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:50:23Z","timestamp":1788825023307,"version":"build-2803163510"},"reference-count":40,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2011,10,1]],"date-time":"2011-10-01T00:00:00Z","timestamp":1317427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine"],"published-print":{"date-parts":[[2011,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Lambda-Mu-Sigma (LMS) method calculates the lower limit of normal for spirometric measures of pulmonary function as the fifth percentile of the distribution of z scores, suitably accounting for age-related changes in pulmonary function. Extending prior work, and to assess whether the LMS method is clinically valid when evaluating respiratory impairment in the elderly, our current objective was to evaluate the association of LMS-defined respiratory impairment (airflow limitation and restrictive pattern) with all-cause mortality and respiratory symptoms (chronic bronchitis, dyspnea, or wheezing) in older persons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Spirometric data and outcome data on white participants aged 65 to 80 years were obtained from the Third National Health and Nutrition Examination Survey (NHANES-III, n = 1497) and the Cardiovascular Health Study (CHS, n = 3583). Multivariable analyses determined the corresponding associations, adjusting for important covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the NHANES-III and CHS populations, respectively, LMS-defined airflow limitation had adjusted hazard ratios (95% confidence interval) of 1.64 (1.28-2.11) and 1.69 (1.48-1.92) for mortality; adjusted odds ratios for respiratory symptoms were 2.71 (1.92-3.83) and 2.63 (2.11-3.27). The LMS-defined restrictive pattern was also significantly associated with mortality (adjusted hazard ratios of 1.98 [1.54-2.53] and 1.68 [1.44-1.95]), as well as with respiratory symptoms (adjusted odds ratios of 1.55 [1.03-2.34] and 1.37 [1.07-1.75]) in NHANES-III and CHS, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The LMS-defined airflow limitation and restrictive pattern confers a significantly increased risk of death and likelihood of having respiratory symptoms. These results support the use of LMS-derived spirometric z scores as a basis for evaluating respiratory impairment in older persons.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2310\/jim.0b013e31822bb213","type":"journal-article","created":{"date-parts":[[2016,5,11]],"date-time":"2016-05-11T09:10:57Z","timestamp":1462957857000},"page":"1089-1095","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":36,"title":["Respiratory Impairment and Mortality in Older Persons: A Novel Spirometric Approach"],"prefix":"10.1177","volume":"59","author":[{"given":"Carlos A.","family":"Vaz Fragoso","sequence":"first","affiliation":[{"name":"Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT"},{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"McAvay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry Klar","family":"Yaggi","sequence":"additional","affiliation":[{"name":"Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT"},{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Van Ness","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Concato","sequence":"additional","affiliation":[{"name":"Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT"},{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,10,1]]},"reference":[{"issue":"45","key":"bibr1-JIM.0b013e31822bb213","first-page":"1221","volume":"57","author":"Thorne SL","year":"2008","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr2-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.163.2.9911116"},{"key":"bibr3-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00003609"},{"key":"bibr4-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1126\/science.274.5288.740"},{"key":"bibr5-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200703-456SO"},{"key":"bibr6-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00035205"},{"key":"bibr7-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.9712108"},{"key":"bibr8-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200708-1248OC"},{"key":"bibr9-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00143209"},{"key":"bibr10-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-1349"},{"key":"bibr11-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.04.019"},{"key":"bibr12-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2009.10.030"},{"key":"bibr13-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200909-1366OC"},{"key":"bibr14-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200508-081JS"},{"key":"bibr15-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2006.068379"},{"key":"bibr16-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.04.00088403"},{"key":"bibr17-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/147.1.125"},{"key":"bibr18-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.15.1889"},{"key":"bibr19-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.2307\/2982992"},{"key":"bibr20-JIM.0b013e31822bb213","volume-title":"National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1988-94, NHANES-III Laboratory Data File (CD-ROM), Public Use Data File Documentation Number 76200","author":"US Department of Health and Human Services","year":"1996"},{"key":"bibr21-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1016\/1047-2797(91)90005-W"},{"key":"bibr22-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"key":"bibr23-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/144.5.1202"},{"key":"bibr24-JIM.0b013e31822bb213","unstructured":"Spirometry Procedure Manual. NHANES-III. Available at: http:\/\/www.cdc.gov\/nchs\/data\/nhanes\/nhanes3\/cdrom\/nchs\/manuals\/spiro.pdf. Accessed June 9, 2011."},{"key":"bibr25-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1378\/chest.106.3.827"},{"key":"bibr26-JIM.0b013e31822bb213","volume-title":"Comparative Analysis of the NHANES-III Public-Use and Restricted-Use Linked Mortality Files","author":"Wheatcroft G","year":"2007"},{"key":"bibr27-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(95)00048-8"},{"key":"bibr28-JIM.0b013e31822bb213","volume-title":"Research","author":"Research Triangle Institute","year":"2004"},{"key":"bibr29-JIM.0b013e31822bb213","volume-title":"SAS\/STAT 9.2 User's Guide","author":"SAS Institute Inc","year":"2008"},{"key":"bibr30-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200504-036SR"},{"key":"bibr31-JIM.0b013e31822bb213","first-page":"1","volume":"322","author":"Cherry DK","year":"2001","journal-title":"Adv Data Vital Health Stat"},{"key":"bibr32-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-9-200711060-00008"},{"key":"bibr33-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.04.00014304"},{"key":"bibr34-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1378\/chest.123.6.1939"},{"key":"bibr35-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1378\/chest.115.3.869"},{"key":"bibr36-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1378\/chest.116.3.603"},{"issue":"2","key":"bibr37-JIM.0b013e31822bb213","first-page":"11","volume":"56","author":"Vestbo J","year":"2001","journal-title":"Thorax"},{"key":"bibr38-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00052805"},{"key":"bibr39-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1378\/chest.97.2.288"},{"key":"bibr40-JIM.0b013e31822bb213","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2006.04.005"}],"container-title":["Journal of Investigative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.2310\/JIM.0b013e31822bb213","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.2310\/JIM.0b013e31822bb213","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.2310\/JIM.0b013e31822bb213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:39:08Z","timestamp":1777459148000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.2310\/JIM.0b013e31822bb213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,10]]},"references-count":40,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2011,10]]}},"alternative-id":["10.2310\/JIM.0b013e31822bb213"],"URL":"https:\/\/doi.org\/10.2310\/jim.0b013e31822bb213","relation":{},"ISSN":["1081-5589","1708-8267"],"issn-type":[{"value":"1081-5589","type":"print"},{"value":"1708-8267","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,10]]}}}