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Title: Heterogeneous burden of lung disease in smokers with borderline airflow obstruction.

Authors: Pirozzi, Cheryl S; Gu, Tian; Quibrera, Pedro M; Carretta, Elizabeth E; Han, MeiLan K; Murray, Susan; Cooper, Christopher B; Tashkin, Donald P; Kleerup, Eric C; Barjaktarevic, Igor; Hoffman, Eric A; Martinez, Carlos H; Christenson, Stephanie A; Hansel, Nadia N; Graham Barr, R; Bleecker, Eugene R; Ortega, Victor E; Martinez, Fernando J; Kanner, Richard E; Paine 3rd, Robert; NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS)

Published In Respir Res, (2018 Nov 20)

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.

PubMed ID: 30454050 Exiting the NIEHS site

MeSH Terms: Aged; Cohort Studies; Cost of Illness*; Female; Forced Expiratory Volume/physiology*; Humans; Lung Diseases/diagnostic imaging*; Lung Diseases/physiopathology*; Male; Middle Aged; Prospective Studies; Pulmonary Disease, Chronic Obstructive/diagnostic imaging; Pulmonary Disease, Chronic Obstructive/physiopathology; Pulmonary Emphysema/diagnostic imaging; Pulmonary Emphysema/physiopathology; Smokers*; Spirometry/methods; Vital Capacity/physiology

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