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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)

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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

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