Heterogeneous burden of lung disease in smokers with borderline airflow obstruction
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 nor...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12931-018-0911-z |
| _version_ | 1828758797041008640 |
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| author | 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 for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) |
| author_facet | 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 for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) |
| author_sort | Cheryl S. Pirozzi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T00:47:25Z |
| format | Article |
| id | doaj.art-813295b24fab4c7182e5ff9b1d3ac7b9 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-11T00:47:25Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-813295b24fab4c7182e5ff9b1d3ac7b92022-12-22T01:26:43ZengBMCRespiratory Research1465-993X2018-11-0119111010.1186/s12931-018-0911-zHeterogeneous burden of lung disease in smokers with borderline airflow obstructionCheryl S. Pirozzi0Tian Gu1Pedro M. Quibrera2Elizabeth E. Carretta3MeiLan K. Han4Susan Murray5Christopher B. Cooper6Donald P. Tashkin7Eric C. Kleerup8Igor Barjaktarevic9Eric A. Hoffman10Carlos H. Martinez11Stephanie A. Christenson12Nadia N. Hansel13R. Graham Barr14Eugene R. Bleecker15Victor E. Ortega16Fernando J. Martinez17Richard E. Kanner18Robert Paine19for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS)Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of UtahDepartment of Biostatistics, University of MichiganDepartment of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel HillDepartment of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel HillDepartment of Internal Medicine, University of MichiganDepartment of Biostatistics, University of MichiganDepartment of Medicine, UCLA David Geffen School of MedicineDepartment of Medicine, UCLA David Geffen School of MedicineDepartment of Medicine, UCLA David Geffen School of MedicineDepartment of Medicine, UCLA David Geffen School of MedicineDepartment of Radiology, University of IowaDepartment of Biostatistics, University of MichiganDepartment of Medicine, University of CaliforniaDepartment of Medicine, Johns Hopkins UniversityDepartment of Medicine, Columbia UniversityDepartment of Medicine, University of ArizonaDepartment of Medicine, Wake Forest UniversityDepartment of Medicine, Weill Cornell Medical CollegeDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of UtahDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of UtahAbstract 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.http://link.springer.com/article/10.1186/s12931-018-0911-zChronic obstructive pulmonary diseasePulmonary function testsSpirometryAirway obstructionEmphysemaForced expiratory volume |
| spellingShingle | 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 for the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Heterogeneous burden of lung disease in smokers with borderline airflow obstruction Respiratory Research Chronic obstructive pulmonary disease Pulmonary function tests Spirometry Airway obstruction Emphysema Forced expiratory volume |
| title | Heterogeneous burden of lung disease in smokers with borderline airflow obstruction |
| title_full | Heterogeneous burden of lung disease in smokers with borderline airflow obstruction |
| title_fullStr | Heterogeneous burden of lung disease in smokers with borderline airflow obstruction |
| title_full_unstemmed | Heterogeneous burden of lung disease in smokers with borderline airflow obstruction |
| title_short | Heterogeneous burden of lung disease in smokers with borderline airflow obstruction |
| title_sort | heterogeneous burden of lung disease in smokers with borderline airflow obstruction |
| topic | Chronic obstructive pulmonary disease Pulmonary function tests Spirometry Airway obstruction Emphysema Forced expiratory volume |
| url | http://link.springer.com/article/10.1186/s12931-018-0911-z |
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