Journal article
Heterogeneous burden of lung disease in smokers with borderline airflow obstruction
Respiratory research, Vol.19(1), 223
01/01/2018
DOI: 10.1186/s12931-018-0911-z
PMCID: PMC6245799
PMID: 30454050
Abstract
Background: The identification of smoking-related lung disease in current and former smokers with normal FEV1 is complex, leading to debate regarding using a ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) of less than 0.70 versus the predicted lower limit of normal (LLN) for diagnosis of airflow obstruction. We hypothesized that the discordant group of ever-smokers with FEV1/FVC between the LLN and 0.70 is heterogeneous, and aimed to characterize the burden of smoking-related lung disease in this group. Methods: We compared spirometry, chest CT characteristics, and symptoms between 161 ever-smokers in the discordant group and 940 ever-smokers and 190 never-smokers with normal FEV1 and FEV1/FVC > 0.70 in the SPIROMICS cohort. We also estimated sensitivity and specificity for diagnosing objective radiographic evidence of chronic obstructive pulmonary disease (COPD) using different FEV1/FVC criteria thresholds. Results: The discordant group had more CT defined emphysema and non-emphysematous gas trapping, lower post-bronchodilator FEV1 and FEF25-75, and higher respiratory medication use compared with the other two groups. Within the discordant group, 44% had radiographic CT evidence of either emphysema or non-emphysematous gas trapping; an FEV1/FVC threshold of 0.70 has greater sensitivity but lower specificity compared with LLN for identifying individuals with CT abnormality. Conclusions: Ever-smokers with normal FEV1 and FEV1/FVC < 0.70 but > LLN are a heterogeneous group that includes significant numbers of individuals with and without radiographic evidence of smoking-related lung disease. These findings emphasize the limitations of diagnosing COPD based on spirometric criteria alone.
Methods
We compared spirometry, chest CT characteristics, and symptoms between 161 ever-smokers in the discordant group and 940 ever-smokers and 190 never-smokers with normal FEV1 and FEV1/FVC > 0.70 in the SPIROMICS cohort. We also estimated sensitivity and specificity for diagnosing objective radiographic evidence of chronic obstructive pulmonary disease (COPD) using different FEV1/FVC criteria thresholds.
Results
The discordant group had more CT defined emphysema and non-emphysematous gas trapping, lower post-bronchodilator FEV1 and FEF25–75, and higher respiratory medication use compared with the other two groups. Within the discordant group, 44% had radiographic CT evidence of either emphysema or non-emphysematous gas trapping; an FEV1/FVC threshold of 0.70 has greater sensitivity but lower specificity compared with LLN for identifying individuals with CT abnormality.
Conclusions
Ever-smokers with normal FEV1 and FEV1/FVC < 0.70 but > LLN are a heterogeneous group that includes significant numbers of individuals with and without radiographic evidence of smoking-related lung disease. These findings emphasize the limitations of diagnosing COPD based on spirometric criteria alone.
Details
- Title: Subtitle
- Heterogeneous burden of lung disease in smokers with borderline airflow obstruction
- Creators
- Cheryl S. Pirozzi - University of UtahTian Gu - University of Michigan–Ann ArborPedro M. Quibrera - University of North Carolina at Chapel HillElizabeth E. Carretta - University of North Carolina at Chapel HillMeiLan K. Han - University of MichiganSusan Murray - University of MichiganChristopher B. Cooper - University of California, Los AngelesDonald P. Tashkin - University of California, Los AngelesEric C. Kleerup - University of California, Los AngelesIgor Barjaktarevic - University of California, Los AngelesEric A. Hoffman - University of IowaCarlos H. Martinez - University of Michigan–Ann ArborStephanie A. Christenson - University of California, San FranciscoNadia N. Hansel - Johns Hopkins UniversityR Graham Barr - New York, NY USAEugene R. Bleecker - University of ArizonaVictor E. Ortega - Wake Forest UniversityFernando J. Martinez - Cornell CollegeRichard E. Kanner - University of UtahNHLBI SubPopulations InteRmediateRobert Paine - University of Utah
- Resource Type
- Journal article
- Publication Details
- Respiratory research, Vol.19(1), 223
- DOI
- 10.1186/s12931-018-0911-z
- PMID
- 30454050
- PMCID
- PMC6245799
- NLM abbreviation
- Respir Res
- ISSN
- 1465-9921
- eISSN
- 1465-993X
- Publisher
- BioMed Central
- Grant note
- ; HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C HHSN268200900019C, HHSN268200900020C / ; R01 HL122438; K24 HL138188 / ;
- Language
- English
- Date published
- 01/01/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
- Record Identifier
- 9984318819402771
Metrics
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