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Respiratory Research
Published in: Respiratory Research 1/2018

Open Access 01-12-2018 | Research

Heterogeneous burden of lung disease in smokers with borderline airflow obstruction

Authors: 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)

Published in: Respiratory Research | Issue 1/2018

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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.
Appendix
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Footnotes
1
Some of the results of these studies have been previously reported in the form of an abstract [41, 42].
 
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Metadata
Title
Heterogeneous burden of lung disease in smokers with borderline airflow obstruction
Authors
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)
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2018
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-018-0911-z

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