Journal article
Defining Resilience to Smoking-related Lung Disease: A Modified Delphi Approach from SPIROMICS
Annals of the American Thoracic Society, Vol.18(11), pp.1822-1831
11/2021
DOI: 10.1513/AnnalsATS.202006-757OC
PMCID: PMC8641833
PMID: 33631079
Abstract
Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory disease who have minimal or no airflow obstruction.
To develop a multidimensional definition of a lung-related "resilient smoker" that is useful in research studies and then identify a resilient smoker subgroup in the SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) cohort using this definition.
We performed a three-round modified Delphi survey among a panel of COPD experts to identify and reach a consensus on clinical and radiographic domains to be included in a lung-related resilient smoker definition. Consensus on domains of resilience was defined as ⩾80% of experts voting "agree" or "strongly agree" on a 5-point Likert scale. The Delphi-derived definition of resilience was applied to SPIROMICS to identify resilient smokers, whom we then characterized using known biomarkers of COPD.
Consensus was achieved on 6 of 12 diagnostic items, which include cough and sputum production, dyspnea, radiographic measures of emphysema and small airways disease, exacerbations, and decline in forced expiratory volume in 1 second. Although 892 SPIROMICS participants were classified as smokers with preserved lung function by spirometry, only 149 participants (16.7%) qualified as resilient smokers by our definition. Blood biomarker expression of CRP (C-reactive protein) and sTNFRSF1A (soluble tumor necrosis receptor factor1A) was lower in resilient than nonresilient smokers (
= 0.02 and
= 0.03).
A Delphi-derived consensus definition of resilient smoker identified 83.3% of smokers with preserved spirometry as "nonresilient" based on the presence of adverse effects of smoking on the lung. Resilient smokers were biologically distinct from nonresilient smokers based on CRP measurements. Clinical trial registered with ClinicalTrials.gov (NCT01969344).
Details
- Title: Subtitle
- Defining Resilience to Smoking-related Lung Disease: A Modified Delphi Approach from SPIROMICS
- Creators
- Anita L Oh - University of California, San FranciscoRichard A Mularski - Kaiser Permanente Center for Health ResearchIgor Barjaktarevic - University of California SystemR Graham Barr - Columbia University Irving Medical CenterRussell P Bowler - National Jewish HealthAlejandro P Comellas - Roy J. and Lucille A. Carver College of MedicineChristopher B Cooper - University of California, Los AngelesGerard J Criner - Temple University HospitalMeiLan K Han - University of MichiganNadia N Hansel - Johns Hopkins UniversityEric A Hoffman - University of IowaRichard E Kanner - University of UtahJerry A Krishnan - University of Illinois ChicagoRobert Paine III - University of UtahTrisha M Parekh - University of Alabama at BirminghamStephen P Peters - Wake Forest UniversityStephanie A Christenson - University of California, San FranciscoPrescott G Woodruff - University of California, San FranciscoSubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Investigators
- Resource Type
- Journal article
- Publication Details
- Annals of the American Thoracic Society, Vol.18(11), pp.1822-1831
- DOI
- 10.1513/AnnalsATS.202006-757OC
- PMID
- 33631079
- PMCID
- PMC8641833
- NLM abbreviation
- Ann Am Thorac Soc
- ISSN
- 2329-6933
- eISSN
- 2325-6621
- Grant note
- U24 HL141762 / NHLBI NIH HHS U01 HL137880 / NHLBI NIH HHS K23 HL123778 / NHLBI NIH HHS K23 HL153672 / NHLBI NIH HHS F32 HL149329 / NHLBI NIH HHS K24 HL137013 / NHLBI NIH HHS L30 HL154180 / NHLBI NIH HHS
- Language
- English
- Date published
- 11/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
- Record Identifier
- 9984318707402771
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