Does your ‘lung age’ tell you anything useful? New ways of thinking about disease risk

In this blog for people interested in changing to a healthy lifestyle Robert Walton, a general practitioner, looks at new ways of showing your risk of developing common illnesses.

About the only thing I can say in Chinese is “How old are you?”.  Now you could be forgiven for thinking that the answer would be fairly precise and easy to understand – although my linguistic skills have not stretched that far yet!

Well it’s work in progress….

But cutting-edge thinking is that both this question and the answer can be much more complex than they may at first sight appear.  There is now a plethora of calculators which allow you to estimate the age separately of all the individual organs in your body!  For example Public Health England launched a website which will give you your ‘heart age’ by comparing your profile to those of other people with similar blood pressure, cholesterol and other risk factors.  The calculator will then give you your ‘effective heart age’ which is that of a healthy person with the same profile as your own (Spiegelhalter 2016).  So if your ‘real’ heart age is 60 and your effective heart age is 49 then you might be very happy, but if it is 73 you might have some cause for concern!

The same argument applies to other organs and systems of the body such as your lungs or your metabolism.  Whilst there is considerable variation in the scientific backing for some of these calculations and their value in mainstream healthcare has been called into question (McCartney 2018) these estimates of effective age could  a clearer way of conveying your overall risk of developing than ones that have been used so far.  Thus an important question might be ‘If your effective age is higher than your actual age would you be motivated to change your lifestyle to improve your health?’.

Essentially your effective age is a compilation of your risk factors for a particular illness.

Quitting smoking and risk assessment

So a recent Cochrane review (Clair et al 2019) examined whether giving people an assessment of their risk disease might act as a motivator to help people to stop smoking.  The results show a lack of high quality evidence on whether feeding back risk information can help people to quit tobacco.  Overall there were 20 trials with nearly 10,000 participants examining feeding back the results of various biomedical tests to people who were smoking and looking at rates of quitting.  Disappointingly the review concluded that there was no evidence that feedback of risk generally had any effect on subsequent smoking behaviour. This finding applied to studies of several different types including those that gave feedback on smoking exposure, smoking related risk and harm from smoking tobacco.

Only two studies included in the review looked at feeding back the risk factors in the form of  lung age and then measured subsequent smoking cessation.  In one trial in general practice in the UK, participants had their lung function measured and then a computer software system estimated their lung age which was fed back to the participants if it was higher than their chronological age (Parkes et al 2008). This trial showed an increase in the smoking cessation rate at 12 months from 6.4% to 13.6%. The other trial in people having problems with substance use was much smaller – only 50 people – and the estimate of the effect was therefore less precise and the results showed no evidence of any benefit (Drummond et al 2014).

So while feeding back a ‘risk assessment’ may not be of any great help to you in changing your lifestyle, feedback in terms of the effective age of your lungs might be effective in motivating you to stop.

Oh and in case you are still wondering 你几岁!

Join in the conversation on Twitter with @rtwalton123 @CochraneUK @CochraneTAG or leave a comment on the blog.

References may be found here.

Dr. Walton reports grants from NIHR Health Technology Asessment, grants from NIHR Programme Grants for Applied Research, other from TTS Pharma,  outside the submitted work;  In addition, Dr. Walton has a patent WALTON R, MCKINNEY E, MARSHALL S, MURPHY M, WELSH K, others. GENETIC INDICATORS OF TOBACCO CONSUMPTION. Patent number: 2001038567. Filed date: 24 Nov 2000. Publication date: 01 Jun 2001  with royalties paid to gNostics.

 


Robert Walton

About Robert Walton

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Robert Walton is a Cochrane UK Senior Fellow in General Practice. Robert qualified in medicine in London in 1983, having taken an intercalated degree in human pharmacology and immunology. He trained at St Georges Hospital, London and became a member of the Royal College of Physicians in 1986. His work applying computerised decision support to prescribing drugs in the Department of Public Health and Primary care in Oxford led to a doctoral thesis in 1998. Robert was elected a Fellow of the Royal College of General Practitioners in 1999 and the RoyalCollege of Physicians in 2001. He became a Senior Investigator in the National Institute for Health Research (NIHR) in 2016. Robert is Clinical Professor of Primary Medical Care at Queen Mary and joint lead of the NIHR Research Design Service east London team, his research interests are in primary care, genetics, clinical trials and personalised medicine. Robert leads a five-year NIHR funded programme developing a novel training intervention to promote smoking cessation in pharmacies in east London which involves a substantive systematic review and meta analysis on behaviour change interventions in community pharmacies and will lead to a large scale cluster-randomised clinical trial. His research team is also developing a smartphone game to promote smoking cessation and researching a personalised/stratified medicine approach to tobacco dependence using computerised decision support. He sits on the NIHR Programme Grants for Applied Research sub panel A and works as an evaluator for the European Union Horizon 2020 programme (Global Alliance for Chronic Diseases, New Therapies for Rare Diseases). He contributes to UK national guidance, serving on the National Institute for Health and Care Excellence (NICE) Outcome Indicator and Technology Appraisals Committees. He has worked as a general practitioner in Oxford since 1988.

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