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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Heterogeneous burden of lung disease in smokers with borderline airflow obstruction

Zeitschrift:: Respiratory Research > Ausgabe 1/2018

Autoren:: Cheryl S. Pirozzi, Tian Gu, Pedro M. Quibrera, Elizabeth E. Carretta, MeiLan K. Han, Susan Murray, Christopher B. Cooper, Donald P. Tashkin, Eric C. Kleerup, Igor Barjaktarevic, Eric A. Hoffman, Carlos H. Martinez, Stephanie A. Christenson, Nadia N. Hansel, R. Graham Barr, Eugene R. Bleecker, Victor E. Ortega, Fernando J. Martinez, Richard E. Kanner, Robert Paine III, for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS)

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Electronic supplementary material

The online version of this article (https://doi.org/10.1186/s12931-018-0911-z) contains supplementary material, which is available to authorized users.

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 FEF_25–75, 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.

Additional file 1: Table S1. Baseline characteristics for the four groups. Table S2. Comparison of physiologic and clinical variables between ever-smokers with normal FEV1 and FEV1/FVC > LLN but < 0.70 (“discordant” group, Group 1), ever-smokers with normal FEV1 and FEV1/FVC > 0.70 (Group 2), never-smokers with normal FEV1 and FEV1/FVC > 0.70 (Group 3) and ever-smokers with FEV1/FVC ≤ LLN and > 75th quartile (Group 4). Table S3. Comparison of CT variables between ever-smokers with normal FEV1 and FEV1/FVC > LLN but < 0.70 (“discordant” group, Group 1), ever-smokers with normal FEV1 and FEV1/FVC > 0.70 (Group 2), never-smokers with normal FEV1 and FEV1/FVC > 0.70 (Group 3) and ever-smokers with FEV1/FVC ≤ LLN and > 75th quartile (Group 4). (DOCX 100 kb)

Additional file 2: Figure S1. Density plot of the distribution of emphysema. (PNG 58 kb)

Additional file 3: Figure S2. Density plot of the distribution of functional small airways disease. (PNG 55 kb)

Additional file 4: Figure S3. Venn diagram illustrating patients within the discordant group (ever-smokers with normal FEV1 and FEV1/FVC > LLN but < 0.70) who have emphysema, functional small airways disease (fSAD), and both on chest CT imaging. (PDF 34 kb)

Additional file 5: Heterogeneous Burden of Lung Disease in Smokers with Borderline Airflow Obstruction. (DOCX 73 kb)

Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347–65. CrossRef

Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis. 1981;123:659–64. PubMed

Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CPM, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J. Interpretative strategies for lung function tests. Eur Respir J. 2005:948–68.

Turkeshi E, Vaes B, Andreeva E, Matheï C, Adriaensen W, Van Pottelbergh G, Degryse J-M. Airflow limitation by the global lungs initiative equations in a cohort of very old adults. Eur Respir J. 2015;46(1):123–32. CrossRef

Vollmer WM, Gíslason T, Burney P, Enright PL, Gulsvik A, Kocabas A, Buist AS. Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study. Eur Respir J. 2009;34:588–97. CrossRef

Swanney MP, Ruppel G, Enright PL, Pedersen OF, Crapo RO, Miller MR, Jensen RL, Falaschetti E, Schouten JP, Hankinson JL, Stocks J, Quanjer PH. Using the lower limit of normal for the FEV ₁/FVC ratio reduces the misclassification of airway obstruction. Thorax. 2008;63:1046–51. CrossRef

Vaz Fragoso CA, Concato J, McAvay G. Chronic obstructive pulmonary disease in older persons: a comparison of two spirometric definitions. Respiratory. 2010;104(8):1189–96. CrossRef

Hansen JE, Sun X-G, Wasserman K. Spirometric criteria for airway obstruction: use percentage of FEV ₁/FVC ratio below the fifth percentile, not. CHEST. 2007;131:349–55. CrossRef

Quanjer PH. Correctly defining criteria for diagnosing chronic obstructive pulmonary disease matters. Am J Respir Crit Care Med. 2014;189:230. PubMed

10.

Vaz Fragoso CA, McAvay G, Van Ness PH, Casaburi R, Jensen RL, MacIntyre N, Gill TM, Yaggi HK, Concato J. Phenotype of Normal spirometry in an aging population. Am J Respir Crit Care Med. 2015;192:817–25. CrossRef

11.

van Dijk W, Tan W, Li P, Guo B, Li S, Benedetti A, Bourbeau J, CanCOLD study group. Clinical relevance of fixed ratio vs lower limit of normal of FEV ₁/FVC in COPD: patient-reported outcomes from the CanCOLD cohort. Ann Fam Med. 2015;13:41–8. CrossRef

12.

Bhatt SP, Sieren JC, Dransfield MT, Washko GR, Newell JD, Stinson DS, Zamba GKD, Hoffman EA, COPDGene Investigators. Comparison of spirometric thresholds in diagnosing smoking-related airflow obstruction. Thorax. 2014;69:409–14. PubMed

13.

Mannino DM, Sonia Buist A, Vollmer WM. Chronic obstructive pulmonary disease in the older adult: what defines abnormal lung function? Thorax. 2007;62:237–41. CrossRef

14.

Mohamed Hoesein FAA, Zanen P, Lammers J-WJ. Lower limit of normal or FEV ₁/FVC. Respir Med. 2011;105:907–15. CrossRef

15.

Izquierdo Alonso JL, De Lucas Ramos P, Rodríguez Glez-Moro JM. The use of the lower limit of Normal as a criterion for COPD excludes patients with increased morbidity and high consumption of health-care resources. Archivos de Bronconeumología (English Edition). 2012;48:223–8. CrossRef

16.

Hoesein FAAM, de Jong PA, Lammers J-WJ, Mali WP, Schmidt M, de Koning HJ, van der Aalst C, Oudkerk M, Vliegenthart R, van Ginneken B, van Rikxoort EM, Zanen P. Computed tomography structural lung changes in discordant airflow limitation. PLoS One. 2013;8:e65177. CrossRef

17.

Woodruff PG, Barr RG, Bleecker E, Christenson SA, Couper D, Curtis JL, Gouskova NA, Hansel NN, Hoffman EA, Kanner RE, Kleerup E, Lazarus SC, Martinez FJ, Paine R, Rennard S, Tashkin DP, Han MK, SPIROMICS research group. Clinical significance of symptoms in smokers with preserved pulmonary function. N Engl J Med. 2016;374:1811–21. CrossRef

18.

Regan EA, Lynch DA, Curran-Everett D, Curtis JL, Austin JHM, Grenier PA, Kauczor H-U, Bailey WC, DeMeo DL, Casaburi RH, Friedman P, Van Beek EJR, Hokanson JE, Bowler RP, Beaty TH, Washko GR, Han MK, Kim V, Kim SS, Yagihashi K, Washington L, McEvoy CE, Tanner C, Mannino DM, Make BJ, Silverman EK, Crapo JD. Clinical and radiologic disease in smokers with Normal spirometry. JAMA Intern Med. 2015;175:1539. CrossRef

19.

Couper D, LaVange LM, Han M, Barr RG, Bleecker E, Hoffman EA, Kanner R, Kleerup E, Martinez FJ, Woodruff PG, Rennard S, SPIROMICS research group. Design of the Subpopulations and Intermediate Outcomes in COPD study (SPIROMICS). Thorax. 2014;69:491–4. CrossRef

20.

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CPM, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. ATS/ERS task force: standardisation of spirometry. Eur Respir J. 2005;26(2):319–38.

21.

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CPM, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. ATS/ERS task force: general considerations for lung function testing. Eur Respir J. 2005;26:153–61. CrossRef

22.

Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999;159:179–87. CrossRef

23.

Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54:581–6. CrossRef

24.

Jones PW, Harding G, Berry P, Wiklund I, Chen W-H, Kline Leidy N. Development and first validation of the COPD assessment test. Eur Respir J. 2009;34:648–54. CrossRef

25.

Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's respiratory questionnaire. Am Rev Respir Dis. 1992;145:1321–7. CrossRef

26.

Nakano Y, Wong JC, de Jong PA, Buzatu L, Nagao T, Coxson HO, Elliott WM, Hogg JC, Paré PD. The prediction of small airway dimensions using computed tomography. Am J Respir Crit Care Med. 2005;171:142–6. CrossRef

27.

Galbán CJ, Han MK, Boes JL, Chughtai KA, Meyer CR, Johnson TD, Galbán S, Rehemtulla A, Kazerooni EA, Martinez FJ, Ross BD. Computed tomography-based biomarker provides unique signature for diagnosis of COPD phenotypes and disease progression. Nat Med. 2012;18:1711–5. CrossRef

28.

Welch BL. The generalization of `student“s” problem when several different population variances are involved. Biometrika. 1947;34:28. PubMed

29.

Koenker R (2012). Package ‘quantreg’. http://cran.r-project.org/web/packages/quantreg/quantreg.pdf, accessed 15 Aug 2018.

30.

Hoffman EA, Ahmed FS, Baumhauer H, Budoff M, Carr JJ, Kronmal R, Reddy S, Barr RG. Variation in the percent of emphysema-like lung in a healthy, nonsmoking multiethnic sample. The MESA lung study. Ann Am Thorac Soc. 2014;11:898–907. CrossRef

31.

Martinez CH, Diaz AA, Meldrum C, Curtis JL, Cooper CB, Pirozzi C, Kanner RE, Paine R, Woodruff PG, Bleecker ER, Hansel NN, Barr RG, Marchetti N, Criner GJ, Kazerooni EA, Hoffman EA, Ross BD, Galbán CJ, Cigolle CT, Martinez FJ, Han MK, SPIROMICS Investigators. Age and small airway imaging abnormalities in subjects with and without airflow obstruction in SPIROMICS. Am J Respir Crit Care Med. 2017;195:464–72. CrossRef

32.

McFadden ER Jr, Linden DA. A reduction in maximum mid-expiratory flow rate. A spirographic manifestation of small airway disease. Am J Med. 1972;52(6):725–37. CrossRef

33.

Gelb AF, Zamel N. Simplified diagnosis of small-airway obstruction. N Engl J Med. 1973;288:395–8. CrossRef

34.

van den Berge M, ten NHT H, Cohen J, Douma WR, Postma DS. Small airway disease in asthma and COPD: clinical implications. CHEST. 2011;139:412–23. CrossRef

35.

Smith BM, Hoffman EA, Rabinowitz D, Bleecker E, Christenson S, Couper D, Donohue KM, Han MK, Hansel NN, Kanner RE, Kleerup E, Rennard S, Barr RG. Comparison of spatially matched airways reveals thinner airway walls in COPD. The multi-ethnic study of atherosclerosis (MESA) COPD study and the Subpopulations and intermediate outcomes in COPD study (SPIROMICS). Thorax. 2014;69:987–96. CrossRef

36.

Mets OM, de Jong PA, van Ginneken B, Kruitwagen CLJJ, Prokop M, Oudkerk M, Lammers J-WJ, Zanen P. CT air trapping is independently associated with lung function reduction over time. PLoS One. 2013;8:e61783. CrossRef

37.

Bommart S, Marin G, Bourdin A, Molinari N, Klein F, Hayot M, Vachier I, Chanez P, Mercier J, Vernhet-Kovacsik H. Relationship between CT air trapping criteria and lung function in small airway impairment quantification. BMC Pulm Med. 2014;14:29. CrossRef

38.

McDonough JE, Yuan R, Suzuki M, Seyednejad N, Elliott WM, Sanchez PG, Wright AC, Gefter WB, Litzky L, Coxson HO, Paré PD, Sin DD, Pierce RA, Woods JC, McWilliams AM, Mayo JR, Lam SC, Cooper JD, Hogg JC. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med. 2011;365:1567–75. CrossRef

39.

Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, Cherniack RM, Rogers RM, Sciurba FC, Coxson HO, Paré PD. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2645–53. CrossRef

40.

Verbanck S, Schuermans D, Meysman M, Paiva M, Vincken W. Noninvasive assessment of airway alterations in smokers. Am J Respir Crit Care Med. 2004;170:414–9. CrossRef

41.

Pirozzi CS, Paine R, Tashkin DP, Kleerup EC, Woodruff PG, Han MK, Quibrera PM, Carretta E, Kanner R: Evidence of Clinical COPD in Smokers with Airway Obstruction Diagnosed with FEV ₁/FVC Ratio of Less than 0.70 but Not Less than Predicted Lower Limit of Normal. In American Thoracic Society International Conference Abstracts. American Thoracic Society; 2015:A4473–A4473.

42.

Pirozzi CS, Gu T, Quibrera P, Carretta E, Han MK, Murray S, Cooper CB, Tashkin DP, Kleerup EC, Hoffman EA, Martinez C, Christenson S, Hansel NN, Barr RG, Bleecker ER, Ortega VE, Martinez FJ, Kanner RE, Paine R: Heterogeneous Burden of Emphysema and Functional Small Airway Abnormalities in Smokers with FEV ₁/FVC Ratio Above Lower Limit of Normal but Below 0.7. In American Thoracic Society International Conference Abstracts. Am J Respir Crit Care Med 2018;197:A6397

Titel: Heterogeneous burden of lung disease in smokers with borderline airflow obstruction
Autoren:: Cheryl S. Pirozzi
Tian Gu
Pedro M. Quibrera
Elizabeth E. Carretta
MeiLan K. Han
Susan Murray
Christopher B. Cooper
Donald P. Tashkin
Eric C. Kleerup
Igor Barjaktarevic
Eric A. Hoffman
Carlos H. Martinez
Stephanie A. Christenson
Nadia N. Hansel
R. Graham Barr
Eugene R. Bleecker
Victor E. Ortega
Fernando J. Martinez
Richard E. Kanner
Robert Paine III
for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS)
Publikationsdatum: 01.12.2018
DOI: https://doi.org/10.1186/s12931-018-0911-z
Verlag: BioMed Central
Zeitschrift: Respiratory Research
Ausgabe 1/2018
Elektronische ISSN: 1465-993X

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Heterogeneous burden of lung disease in smokers with borderline airflow obstruction

Electronic supplementary material

Abstract

Background

Methods

Results

Conclusions

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Electronic supplementary material

Abstract

Background

Methods

Results

Conclusions

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