To evaluate, among older persons, the association between respiratory impairment and hospitalization for chronic obstructive pulmonary disease (COPD), based on spirometric Z-scores (Lambda-Mu-Sigma [LMS]) and a competing risk approach.

Using data on 3,563 white participants aged 65-80 years (Cardiovascular Health Study), we evaluated the association of LMS-defined respiratory impairment with incident COPD hospitalization and the competing outcome of death without COPD hospitalization, over a 5-year period. Respiratory impairment included airflow limitation (mild, moderate, and severe) and restrictive-pattern.Over a 5-year period, 276 (7.7%) participants had incident COPD hospitalization, whereas 296 (8.3%) died without COPD hospitalization.

The risk of COPD hospitalization was elevated more than 2-fold in LMS-defined mild and moderate airflow limitation and restrictive-pattern (adjusted hazard ratio [HR]: 2.25 [1.25, 4.05], 2.54 [1.53, 4.22], and 2.65 [1.82, 3.86], respectively), and more than 8-fold in LMS-defined severe airflow limitation (adjusted HR: 8.33 [6.24, 11.12]). Conversely, only LMS-defined restrictive-pattern was associated with the competing outcome of death without COPD hospitalization (adjusted HR: 1.68 [1.22, 2.32]).In white older persons, LMS-defined respiratory impairment is strongly associated with an increased risk of COPD hospitalization.

These results support the LMS method as a basis for defining respiratory impairment in older persons.