Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function

Prescott G Woodruff; R Graham Barr; Eugene Bleecker; Stephanie A Christenson; David Couper; Jeffrey L Curtis; Natalia A Gouskova; Nadia N Hansel; Eric A Hoffman; Richard E Kanner; Eric Kleerup; Stephen C Lazarus; Fernando J Martinez; Robert Paine III; Stephen Rennard; Donald P Tashkin; MeiLan K Han; SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Research Group

doi:10.1056/NEJMoa1505971

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Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function

Journal article

Open access

Peer reviewed

Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function

Prescott G Woodruff, R Graham Barr, Eugene Bleecker, Stephanie A Christenson, David Couper, Jeffrey L Curtis, Natalia A Gouskova, Nadia N Hansel, Eric A Hoffman, Richard E Kanner, …

The New England journal of medicine, Vol.374(19), pp.1811-1821

05/12/2016

DOI: 10.1056/NEJMoa1505971

PMCID: PMC4968204

PMID: 27168432

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Abstract

Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms. We conducted an observational study involving 2736 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). We examined whether current or former smokers who had preserved pulmonary function as assessed by spirometry (FEV1:FVC ≥0.70 and an FVC above the lower limit of the normal range after bronchodilator use) and had symptoms (CAT score, ≥10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score, <10) and whether those with symptoms had different findings from the asymptomatic group with respect to the 6-minute walk distance, lung function, or high-resolution computed tomographic (HRCT) scan of the chest. Respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. The mean (±SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27±0.67 vs. 0.08±0.31 and 0.03±0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. Although they do not meet the current criteria for COPD, symptomatic current or former smokers with preserved pulmonary function have exacerbations, activity limitation, and evidence of airway disease. They currently use a range of respiratory medications without any evidence base. (Funded by the National Heart, Lung, and Blood Institute and the Foundation for the National Institutes of Health; SPIROMICS ClinicalTrials.gov number, NCT01969344.).

Adult

Aged

Aged, 80 and over

Asthma - complications

Bronchodilator Agents - therapeutic use

Confounding Factors, Epidemiologic

Female

Forced Expiratory Volume

Humans

Lung - diagnostic imaging

Lung - physiology

Male

Middle Aged

Pulmonary Disease, Chronic Obstructive - complications

Pulmonary Disease, Chronic Obstructive - diagnosis

Pulmonary Disease, Chronic Obstructive - physiopathology

Smoking - physiopathology

Symptom Assessment

Tomography, X-Ray Computed

Vital Capacity

Details

Title: Subtitle: Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function
Creators: Prescott G Woodruff - University of California, San Francisco
R Graham Barr - Columbia University
Eugene Bleecker - Wake Forest University
Stephanie A Christenson - University of California, San Francisco
David Couper - University of North Carolina
Jeffrey L Curtis - University of Michigan–Ann Arbor
Natalia A Gouskova - University of North Carolina
Nadia N Hansel - Johns Hopkins University
Eric A Hoffman - University of Iowa
Richard E Kanner - PULMONARY
Eric Kleerup - University of California at Los Angeles
Stephen C Lazarus - University of California, San Francisco
Fernando J Martinez - Cornell University
Robert Paine III
Stephen Rennard - AstraZeneca (United States)
Donald P Tashkin - University of California at Los Angeles
MeiLan K Han - University of Michigan
SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Research Group
Resource Type: Journal article
Publication Details: The New England journal of medicine, Vol.374(19), pp.1811-1821
DOI: 10.1056/NEJMoa1505971
PMID: 27168432
PMCID: PMC4968204
NLM abbreviation: N Engl J Med
ISSN: 0028-4793
eISSN: 1533-4406
Grant note: HHSN268200900017C / NHLBI NIH HHS P30 ES005605 / NIEHS NIH HHS HHSN268200900019C / NHLBI NIH HHS HHSN268200900020C / NHLBI NIH HHS HHSN268200900015C / NHLBI NIH HHS I01 CX000911 / CSRD VA HHSN268200900013C / NHLBI NIH HHS HHSN2682009000019C / PHS HHS R01 HL095372 / NHLBI NIH HHS R01 HL110906 / NHLBI NIH HHS HHSN268200900016C / NHLBI NIH HHS HHSN268200900018C / NHLBI NIH HHS HHSN268200900014C / NHLBI NIH HHS S10 OD018526 / NIH HHS HHSN268200900009C / WHI NIH HHS K12 HL119997 / NHLBI NIH HHS
Language: English
Date published: 05/12/2016
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984318795402771

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