NCHS Data Brief ■ No. 180 ■ January 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Lung Obstruction Among Adults Aged 40–79:

United States, 2007–2012 

Timothy Tilert, B.S.; Ryne Paulose-Ram, Ph.D., M.A.; and Debra J. Brody, M.P.H.

Key findings

Data from the National 

Health and Nutrition 

Examination Survey, 

2007–2012

● During 2007–2012, almost 

15% (14.7%) of adults aged 

40–79 had any lung obstruction; 

9.4% had mild and 5.3% 

had moderate or worse lung 

obstruction.

● A similar percentage of men 

and women had lung obstruction, 

overall and at each level of 

severity. 

● A greater percentage of adults 

aged 60–79 (17.0%) than adults 

aged 40–59 (13.6%) had lung 

obstruction.

● Rates of lung obstruction, 

overall and at the moderate or 

worse severity level, were lower 

for adults with at least some 

college education than for those 

with less education. 

● More than one-half of adults 

aged 40–79 with lung obstruction 

(55.7%) reported one or more 

respiratory symptoms. Among 

adults with moderate or worse 

lung obstruction, more than 

80% had at least one respiratory 

symptom. 

Lung obstruction is characterized by a decrease in airflow and shortness 

of breath. Common types of obstructive lung diseases include asthma and 

chronic obstructive pulmonary disease (COPD), which includes emphysema 

and chronic bronchitis. During 2007–2010, about 15% of adults aged 40–79 

had lung obstruction, with about one-third of those having moderate or worse 

obstruction (1). This report uses 2011–2012 data from the National Health and 

Nutrition Examination Survey (NHANES) to update these percentages, overall 

and by severity level. For this report, lung obstruction is defined based on 

lung function tests or self-reported oxygen use with diagnosed emphysema or 

current chronic bronchitis.

Keywords: obstructive lung disease • lung impairment • spirometry • COPD

What were the percentages of adults aged 40–79 with lung 

obstruction, overall and by sex?

About 15% of U.S. adults aged 40–79 had any lung obstruction, with 9.4% 

having mild lung obstruction and 5.3% having moderate or worse lung 

Figure 1. Percentage of adults aged 40–79 with lung obstruction, overall, by sex and severity of

obstruction: United States, 2007–2012

NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db180_table.pdf#1. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012. Percent

Total Men Women

14.7

9.4

5.3

16.1

10.3

5.8

13.4

8.6

4.8

0

5

10

15

20

Any Mild Moderate or worse

Lung obstruction
NCHS Data Brief ■ No. 180 ■ January 2015

■  2  ■

obstruction (Figure 1). A similar percentage of men and women aged 40–79 had lung obstruction 

overall and at each level of severity.

Did the percentage of adults aged 40–79 with lung obstruction differ by 

age? 

A lower percentage of adults aged 40–59 had any lung obstruction (13.6%) compared with 

adults aged 60–79 (17.0%) (Figure 2). There was a similar difference by age among adults with 

moderate or worse lung obstruction (3.9% and 8.1%, respectively). Among adults with mild lung 

obstruction, there were no differences in the percentages of adults aged 40–59 and 60–79 with 

lung obstruction. Percent

Figure 2. Percentage of adults aged 40–79 with lung obstruction, by age group and severity of obstruction: United States, 

2007–2012

1

Significantly different from adults aged 60–79. 

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db180_table.pdf#2. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

1

13.6

9.7

1

3.9

17.0

8.9

8.1

0

5

10

15

20

Any Mild Moderate or worse

Lung obstruction

40–59 60–79
NCHS Data Brief ■ No. 180 ■ January 2015

■  3  ■

Did the percentage of adults aged 40–79 with lung obstruction differ by 

race and Hispanic origin? 

The percentage of adults aged 40–79 with lung obstruction varied by race and Hispanic origin. 

Non-Hispanic white adults had a higher percentage of any lung obstruction (16.3%) than

non-Hispanic black adults (13.5%) who, in turn, had a higher percentage than Hispanic adults 

(7.7%) (Figure 3). This pattern was similar for mild lung obstruction. For moderate or worse lung 

obstruction, both non-Hispanic white (5.9%) and non-Hispanic black (5.6%) adults had higher 

rates than Hispanic adults (1.9%). Percent

Figure 3. Age-adjusted percentage of adults aged 40–79 with lung obstruction, by race and Hispanic origin and severity of 

obstruction: United States, 2007–2012

1

Significantly different from non-Hispanic black adults.

2

Significantly different from Hispanic adults.

NOTES: Data are age-adjusted to year 2000 U.S. Census Bureau estimates using age groups 40–59 and 60–79.

Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db180_table.pdf#3.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

1,2

16.3

1,2

10.4

2

5.9

2

13.5

2

7.9

2

5.6

7.7

5.7

1.9

0

5

10

15

20

Any Mild Moderate or worse

Lung obstruction

Non-Hispanic white Non-Hispanic black Hispanic
NCHS Data Brief ■ No. 180 ■ January 2015

■  4  ■

Did the percentage of adults aged 40–79 with lung obstruction differ by 

education? 

The percentage of adults aged 40–79 with any lung obstruction was lower for those with at 

least some college education (13.3%) compared with adults with a high school diploma or less 

education (16.7% and 17.0%, respectively) (Figure 4). This relationship persisted for those with 

moderate or worse lung obstruction. However, among adults with mild lung obstruction, the rates 

of lung obstruction were similar across education levels. Percent

Figure 4. Percentage of adults aged 40–79 with lung obstruction, by education and severity of obstruction: United States, 

2007–2012

1

Significantly different from those with some college or more.

NOTE: Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db180_table.pdf#4. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

1

17.0

8.4 1

8.7

1

16.7

10.0

1

6.8

13.3

9.5

3.7

0

5

10

15

20

Any Mild Moderate or worse

Lung obstruction

Less than high school High school graduate Some college or more
NCHS Data Brief ■ No. 180 ■ January 2015

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Did the percentage of adults aged 40–79 with respiratory symptoms differ 

by severity of lung obstruction? 

More than one-half (55.7%) of adults aged 40–79 with any lung obstruction reported one or more 

of the following respiratory symptoms: shortness of breath, wheezing, chronic cough, and chronic 

phlegm (Figure 5). Shortness of breath was the most commonly reported symptom (43.6%). 

More than 40% of adults with mild lung obstruction and more than 80% of adults with moderate 

or worse lung obstruction reported one or more respiratory symptoms. Each respiratory symptom 

was reported at a higher rate among adults with moderate or worse lung obstruction compared 

with adults with mild obstruction. Percent

Figure 5. Percentage of adults aged 40–79 with selected respiratory symptoms, by severity of lung obstruction:

United States, 2007–2012

1

Significantly different from moderate or worse lung obstruction.

NOTE: Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db180_table.pdf#5. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2007–2012.

Any Mild Moderate or worse

Lung obstruction

55.7

1

41.3

81.6

43.6

1

29.7

68.4

28.2

1

17.8

46.8

17.4

1

12.3

26.5

15.4

1

10.6

24.0

0

20

40

60

80

100 One or more

symptoms

Shortness

of breath

Wheezing Chronic

cough

Chronic

phlegm
NCHS Data Brief ■ No. 180 ■ January 2015

■  6  ■

Summary

During 2007–2012, 14.7% of U.S. adults aged 40–79 had lung obstruction, with almost twothirds having mild lung obstruction (9.4%) and one-third having moderate or worse obstruction 

(5.3%). A similar percentage of men and women had any lung obstruction, a pattern that persisted 

at each level of severity. 

There were notable differences in lung obstruction by race and Hispanic origin. Overall and at 

both levels of severity, rates of lung obstruction were higher for non-Hispanic white and nonHispanic black adults compared with Hispanic adults. Overall and at the mild lung obstruction 

level, the percentage of non-Hispanic white adults with lung obstruction was significantly higher 

than that of non-Hispanic black adults. 

Lung obstruction also varied by education level. Adults who had attended college had a 

significantly lower percentage of moderate or worse lung obstruction compared with adults with 

less education. Among adults with mild lung obstruction, percentages were similar by education 

level. 

More than one-half of adults aged 40–79 with lung obstruction reported having at least one 

respiratory symptom. Reporting rates for each symptom and for one or more symptoms were 

all higher for those adults with moderate or worse lung obstruction than for those with mild 

obstruction. Among adults with moderate or worse lung obstruction, more than 80% reported 

having at least one respiratory symptom.

Definitions

Lung obstruction: Based on lung function values obtained from a pre-bronchodilator spirometry 

examination, lung obstruction was defined as a forced expiratory volume in the first second 

(FEV1) to forced vital capacity (FVC) ratio less than the lower limit of normal (2). Persons 

were also defined as having lung obstruction based on a positive response to use of daytime 

supplemental oxygen and ever having been diagnosed with emphysema or still having chronic 

bronchitis. 

Severity of lung obstruction: Mild lung obstruction was defined as an FEV1 greater than 70% 

predicted among those with lung obstruction. Moderate or worse lung obstruction was defined as 

an FEV1 less than or equal to 70% predicted among those with lung obstruction (2). Persons who 

were identified as having lung obstruction based on supplemental oxygen use were defined as 

having moderate or worse lung obstruction. 

Respiratory symptoms: Shortness of breath was defined as having shortness of breath on stairs 

or inclines. Wheezing was defined as having wheezing or whistling in the chest in the past year. 

Chronic cough was defined as coughing most days over a 3-month period for at least 2 years. 

Chronic phlegm was defined as bringing up phlegm most days over a 3-month period for at least 

2 years. 

Data source and methods

Data from NHANES 2007–2012 were used for these analyses. NHANES is a cross-sectional 

survey designed to monitor the health and nutritional status of the civilian noninstitutionalized 
NCHS Data Brief ■ No. 180 ■ January 2015

■  7  ■

resident population of the United States (3). It is conducted by the Centers for Disease Control 

and Prevention’s (CDC) National Center for Health Statistics. The survey consists of interviews 

conducted in participants’ homes and standardized physical examinations conducted in mobile 

examination centers (MECs), where blood and urine specimens are collected. The NHANES 

sample is selected through a complex, multistage probability design. Data collection is based 

on a representative sample covering all ages of the target population. During 2007–2010, nonHispanic black and Hispanic persons were oversampled to obtain more reliable estimates of the 

health of these population subgroups. During 2011–2012, non-Hispanic Asian persons were also 

oversampled. Public-use data files are released in 2-year cycles (available from http://www.cdc.

gov/nchs/nhanes.htm).

During NHANES 2007–2012, spirometry data were collected in the MEC from survey 

participants aged 6–79 years. Details of the NHANES spirometry examination procedures and 

data collection are available elsewhere (4). Lung obstruction may be defined using multiple 

criteria. This report uses the American Thoracic Society/European Respiratory Society (ATS/

ERS) diagnostic criteria (2) and follows the data and analytic methodology conducted by Tilert 

et al. (1). Examination sample weights were used to account for differential probabilities of 

selection, nonresponse, and noncoverage, and they were incorporated into the estimation process. 

Standard errors of the percentages were estimated using Taylor series linearization, a method 

that incorporates the sample weights and accounts for the complex survey design. Estimates 

for race and Hispanic origin were age-adjusted by the direct method to the year 2000 projected 

U.S. standard population using two age groups: 40–59 and 60–79. Differences between groups 

were tested using Student’s t statistic at the p < 0.05 significance level. Statistical analyses were 

conducted using STATA version 12.1 (StataCorp, College Station, Tex.). 

About the authors

Timothy Tilert, Ryne Paulose-Ram, and Debra J. Brody are with CDC’s National Center for 

Health Statistics, Division of Health and Nutrition Examination Surveys. 

References

1. Tilert T, Dillon C, Paulose-Ram R, Hnizdo E, Doney B. Estimating the U.S. prevalence 

of chronic obstructive pulmonary disease using pre- and post-bronchodilator spirometry: 

The National Health and Nutrition Examination Survey (NHANES) 2007–2010. Respir Res 

14(1):103. 2013.

2. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative 

strategies for lung function tests. Eur Respir J 26(5):948–68. 2005.

3. Zipf G, Chiappa M, Porter KS, et al. The National Health and Nutrition Examination Survey: 

Plan and operations, 1999–2010. National Center for Health Statistics. Vital Health Stat 1(56). 

2013.

4. NCHS. National Health and Nutrition Examination Survey (NHANES): Respiratory health 

spirometry procedures manual. 2011. Available from: http://www.cdc.gov/nchs/data/nhanes/

nhanes_11_12/Spirometry_Procedures_Manual.pdf.
NCHS Data Brief ■ No. 180 ■ January 2015

Suggested citation

Tilert T, Paulose-Ram R, Brody DJ. Lung 

obstruction among adults aged 40–79: 

United States, 2007–2012. NCHS data brief, 

no 180. Hyattsville, MD: National Center 

for Health Statistics. 2015.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

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