To investigate predictors of accelerated decline in forced expiratory volume in 1 s (FEV₁) in individuals with preexisting airflow limitation (AL). Participants in the Health2006 baseline study aged ≥ 35 with FEV₁/ forced vital capacity (FVC) < lower limit of normal (LLN) were invited for a 10-year follow-up. At both examinations, data were obtained on demographics, spirometry, fitness level, allergy, and exhaled nitric oxide. We used multiple regression modeling to predict the annual decline in FEV₁, reported as regression coefficients (R) and 95% confidence intervals (CIs). A total of 123 (43% of those invited) participated in the follow-up examination, where more had exercise-induced dyspnea but fewer had asthma symptoms. Being female (R = −29.8 ml, CI: −39.7 to −19.8), diagnosed with asthma (R = −13.7, CI: −20.4 to −7.0) or atopic dermatitis (R = −29.0, CI: −39.7 to −18.4), and having current asthma symptoms or nightly respiratory symptoms (R = −22.1, CI: −31.9 to −12.4 and R = −14.3, CI: −19.9 to −8.7, respectively) were significantly associated with a steeper decline in FEV₁. Although to a smaller extent, a steeper decline was also predicted by age, baseline FEV₁, waist/hip-ratio, and number of pack-years smoked. In individuals with preexisting AL, being female and having ever or current respiratory symptoms were associated with an accelerated annual decline in FEV₁.