Skip to main content
Top
Published in: European Radiology 2/2010

01-02-2010 | Computed Tomography

Evolution of emphysema in relation to smoking

Authors: Massimo Bellomi, Cristiano Rampinelli, Giulia Veronesi, Sergio Harari, Federica Lanfranchi, Sara Raimondi, Patrick Maisonneuve

Published in: European Radiology | Issue 2/2010

Login to get access

Abstract

Purpose

We have little knowledge about the evolution of emphysema, and relatively little is understood about its evolution in relation to smoking habits. This study aims to assess the evolution of emphysema in asymptomatic current and former smokers over 2 years and to investigate the association with subjects’ characteristics. The study was approved by our Ethics Committee and all participants provided written informed consent.

Materials and methods

We measured emphysema by automatic low-dose computed tomography densitometry in 254 current and 282 former smokers enrolled in a lung-cancer screening. The measures were repeated after 2 years. The association between subjects’ characteristics, smoking habits and emphysema were assessed by chi-squared and Wilcoxon tests. Univariate and multivariate odds ratios (OR) with 95% confidence intervals (CI) were calculated for the risk of emphysema worsening according to subjects’ characteristics. We assessed the trend of increasing risk of emphysema progression by smoking habits using the Mantel-Haenszel chi-squared test.

Results

The median percentage increase in emphysema over a 2-year period was significantly higher in current than in former smokers (OR 1.8; 95% CI 1.3–2.6; p < 0.0001). The risk of worsening emphysema (by 30% in 2 years) in current smokers increased with smoking duration (p for trend <0.02).

Conclusion

As emphysema is a known risk factor for lung cancer, its evaluation could be used as a potential factor for identification of a high-risk population. The evaluation of emphysema progression can be added to low-dose CT screening programmes to inform and incite participants to stop smoking.
Literature
1.
go back to reference Snider GL (1992) Emphysema: the first two centuries and beyond. A historical overview, with suggestions for future research: Part 2. Am Rev Respir Dis 146:1615–1622PubMed Snider GL (1992) Emphysema: the first two centuries and beyond. A historical overview, with suggestions for future research: Part 2. Am Rev Respir Dis 146:1615–1622PubMed
2.
go back to reference O’Driscoll MC, Chan ED, Fernandez E (2000) Imaging of emphysema. In: Lynch DA, Newell JD Jr, Lee JS (eds) Imaging of diffuse lung disease. B.C. Decker, Hamilton, pp 99–233 O’Driscoll MC, Chan ED, Fernandez E (2000) Imaging of emphysema. In: Lynch DA, Newell JD Jr, Lee JS (eds) Imaging of diffuse lung disease. B.C. Decker, Hamilton, pp 99–233
3.
go back to reference Mannino DM, Buist AS (2007) Global burden of COPD: risk factors, prevalence, and future Trends. Lancet 370:765–773CrossRefPubMed Mannino DM, Buist AS (2007) Global burden of COPD: risk factors, prevalence, and future Trends. Lancet 370:765–773CrossRefPubMed
4.
go back to reference Bankier AA, Madani A, Gevenois PA (2002) CT quantification of pulmonary emphysema: assessment of lung structure and function. Crit Rev Comput Tomogr 43:399–417CrossRefPubMed Bankier AA, Madani A, Gevenois PA (2002) CT quantification of pulmonary emphysema: assessment of lung structure and function. Crit Rev Comput Tomogr 43:399–417CrossRefPubMed
5.
go back to reference Ley-Zaporozhan J, Ley S, Kauczor HU (2008) Morphological and functional imaging in COPD with CT and MRI: present and future. Eur Radiol 18:510–521CrossRefPubMed Ley-Zaporozhan J, Ley S, Kauczor HU (2008) Morphological and functional imaging in COPD with CT and MRI: present and future. Eur Radiol 18:510–521CrossRefPubMed
7.
go back to reference Litmanovich D, Boiselle PM, Bankier AA (2009) CT of pulmonary emphysema – current status, challenges, and future directions. Eur Radiol 19:537–551CrossRefPubMed Litmanovich D, Boiselle PM, Bankier AA (2009) CT of pulmonary emphysema – current status, challenges, and future directions. Eur Radiol 19:537–551CrossRefPubMed
8.
go back to reference Revel MP, Faivre JB, Jardin RJ, Deken V, Duhamel A, Marquette CH, Tacelli N, Bakai AM, Remy J (2008) Automated lobar quantification of emphysema in patients with severe COPD. Eur Radiol 18:2723–2730CrossRefPubMed Revel MP, Faivre JB, Jardin RJ, Deken V, Duhamel A, Marquette CH, Tacelli N, Bakai AM, Remy J (2008) Automated lobar quantification of emphysema in patients with severe COPD. Eur Radiol 18:2723–2730CrossRefPubMed
9.
go back to reference Yuan R, Mayo JR, Hogg JC, Paré PD, McWilliams AM, Lam S, Coxson HO (2007) The effects of radiation dose and CT manufacturer on measurements of lung densitometry. Chest 132:617–623CrossRefPubMed Yuan R, Mayo JR, Hogg JC, Paré PD, McWilliams AM, Lam S, Coxson HO (2007) The effects of radiation dose and CT manufacturer on measurements of lung densitometry. Chest 132:617–623CrossRefPubMed
10.
go back to reference Gierada DS, Pilgram TK, Whiting BR, Hong C, Bierhals AJ, Kim JH, Bae KT (2007) Comparison of standard- and low-radiation-dose CT for quantification of emphysema. AJR Am J Roentgenol 188:42–47CrossRefPubMed Gierada DS, Pilgram TK, Whiting BR, Hong C, Bierhals AJ, Kim JH, Bae KT (2007) Comparison of standard- and low-radiation-dose CT for quantification of emphysema. AJR Am J Roentgenol 188:42–47CrossRefPubMed
12.
go back to reference Camiciottoli G, Cavigli E, Grassi L, Diciotti S, Orlandi I, Zappa M, Picozzi G, Lopes Pegna A, Paci E, Falaschi F, Mascalchi M (2009) Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial. Eur Radiol 19:58–66CrossRefPubMed Camiciottoli G, Cavigli E, Grassi L, Diciotti S, Orlandi I, Zappa M, Picozzi G, Lopes Pegna A, Paci E, Falaschi F, Mascalchi M (2009) Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial. Eur Radiol 19:58–66CrossRefPubMed
13.
go back to reference Sverzellati N, Calabrò E, Randi G, La Vecchia C, Marchianò A, Kuhnigk JM, Zompatori M, Spagnolo P, Pastorino U (2009) Gender differences in emphysema phenotype in smokers without air flow obstruction. ERJ Express 33:1320–1328 Sverzellati N, Calabrò E, Randi G, La Vecchia C, Marchianò A, Kuhnigk JM, Zompatori M, Spagnolo P, Pastorino U (2009) Gender differences in emphysema phenotype in smokers without air flow obstruction. ERJ Express 33:1320–1328
14.
go back to reference Omori H, Nakashima R, Otsuka N et al (2006) Emphysema detected by lung cancer screening with low-dose spiral CT: Prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects. Respirology 11:205–210CrossRefPubMed Omori H, Nakashima R, Otsuka N et al (2006) Emphysema detected by lung cancer screening with low-dose spiral CT: Prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects. Respirology 11:205–210CrossRefPubMed
15.
go back to reference Veronesi G, Bellomi M, Mulshine JL, Pelosi G, Scanagatta P, Paganelli G, Maisonneuve P, Preda L, Leo F, Bertolotti R, Solli P, Spaggiari L (2008) Lung cancer screening with low-dose computed tomography: a non-invasive diagnostic protocol for baseline lung nodules. Lung Cancer 61:349–349CrossRef Veronesi G, Bellomi M, Mulshine JL, Pelosi G, Scanagatta P, Paganelli G, Maisonneuve P, Preda L, Leo F, Bertolotti R, Solli P, Spaggiari L (2008) Lung cancer screening with low-dose computed tomography: a non-invasive diagnostic protocol for baseline lung nodules. Lung Cancer 61:349–349CrossRef
16.
go back to reference Müller NL, Staples CA, Miller RR, Abboud RT (1988) “Density mask”. An objective method to quantitate emphysema using computed tomography. Chest 94:782–787CrossRefPubMed Müller NL, Staples CA, Miller RR, Abboud RT (1988) “Density mask”. An objective method to quantitate emphysema using computed tomography. Chest 94:782–787CrossRefPubMed
17.
go back to reference Gevenois PA, de Maertelaer V, De Vuyst P, Zanen J, Yernault JC (1996) Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154:187–192PubMed Gevenois PA, de Maertelaer V, De Vuyst P, Zanen J, Yernault JC (1996) Comparison of computed density and macroscopic morphometry in pulmonary emphysema. Am J Respir Crit Care Med 154:187–192PubMed
18.
go back to reference Madani A, Zanen J, de Maertelaer V, Gevenois PA (2006) Pulmonary emphysema: objective quantification at multi-detector row CT comparison with macroscopic and microscopic morphometry. Radiology 238:1036–1043CrossRefPubMed Madani A, Zanen J, de Maertelaer V, Gevenois PA (2006) Pulmonary emphysema: objective quantification at multi-detector row CT comparison with macroscopic and microscopic morphometry. Radiology 238:1036–1043CrossRefPubMed
19.
go back to reference Onclinx C, De Maertelaer V, Gustin P, Gevenois PA (2006) Elastase-induced pulmonary emphysema in rats: comparison of computed density and microscopic morphometry. Radiology 241:763–770CrossRefPubMed Onclinx C, De Maertelaer V, Gustin P, Gevenois PA (2006) Elastase-induced pulmonary emphysema in rats: comparison of computed density and microscopic morphometry. Radiology 241:763–770CrossRefPubMed
20.
go back to reference Madani A, De Maertelaer V, Zanen J, Gevenois PA (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification comparison with macroscopic and microscopic morphometry. Radiology 243:250–257CrossRefPubMed Madani A, De Maertelaer V, Zanen J, Gevenois PA (2007) Pulmonary emphysema: radiation dose and section thickness at multidetector CT quantification comparison with macroscopic and microscopic morphometry. Radiology 243:250–257CrossRefPubMed
21.
go back to reference Orlandi I, Moroni C, Camiciottoli G, Bartolucci M, Belli G, Villari N, Mascalchi M (2004) Spirometric-gated computed tomography quantitative evaluation of lung emphysema in chronic obstructive pulmonary disease: a comparison of 3 techniques. J Comput Assist Tomogr 28:437–442CrossRefPubMed Orlandi I, Moroni C, Camiciottoli G, Bartolucci M, Belli G, Villari N, Mascalchi M (2004) Spirometric-gated computed tomography quantitative evaluation of lung emphysema in chronic obstructive pulmonary disease: a comparison of 3 techniques. J Comput Assist Tomogr 28:437–442CrossRefPubMed
22.
go back to reference Stolk J, Dirksen A, van der Lugt AA, Hutsebaut J, Mathieu J, de Ree J, Reiber JH, Stoel BC (2001) Repeatability of lung density measurements with low-dose computed tomography in subjects with alpha-1-antitrypsin deficiency-associated emphysema. Invest Radiol 36:648–651CrossRefPubMed Stolk J, Dirksen A, van der Lugt AA, Hutsebaut J, Mathieu J, de Ree J, Reiber JH, Stoel BC (2001) Repeatability of lung density measurements with low-dose computed tomography in subjects with alpha-1-antitrypsin deficiency-associated emphysema. Invest Radiol 36:648–651CrossRefPubMed
23.
go back to reference Gietema HA, Schilham AM, van Ginneken B, van Klaveren RJ, Lammers JW, Prokop M (2007) Monitoring of smoking-induced emphysema with CT in a lung cancer screening setting: detection of real increase in extent of emphysema. Radiology 244:890–897CrossRefPubMed Gietema HA, Schilham AM, van Ginneken B, van Klaveren RJ, Lammers JW, Prokop M (2007) Monitoring of smoking-induced emphysema with CT in a lung cancer screening setting: detection of real increase in extent of emphysema. Radiology 244:890–897CrossRefPubMed
24.
go back to reference Parr DG, Stoel BC, Stolk J, Nightingale PG, Stockley RA (2004) Influence of calibration on densitometric studies of emphysema progression using computed tomography. Am J Respir Crit Care Med 170:883–890CrossRefPubMed Parr DG, Stoel BC, Stolk J, Nightingale PG, Stockley RA (2004) Influence of calibration on densitometric studies of emphysema progression using computed tomography. Am J Respir Crit Care Med 170:883–890CrossRefPubMed
25.
go back to reference de Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, Seijo LM, Pueyo JC, Villanueva A, Lozano MD, Montes U, Montuenga L, Zulueta JJ (2007) Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest 132:1932–1938CrossRefPubMed de Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, Seijo LM, Pueyo JC, Villanueva A, Lozano MD, Montes U, Montuenga L, Zulueta JJ (2007) Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest 132:1932–1938CrossRefPubMed
26.
go back to reference Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, Wilson J, Leader JK, Siegfried JM, Shapiro SD, Sciurba FC (2008) Association of radiographic emphysema and airflow obstruction with lung cancer,Journal Article. Research Support, N.I.H., Extramural. Am J Respir Crit Care Med 178:738–744CrossRefPubMed Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, Wilson J, Leader JK, Siegfried JM, Shapiro SD, Sciurba FC (2008) Association of radiographic emphysema and airflow obstruction with lung cancer,Journal Article. Research Support, N.I.H., Extramural. Am J Respir Crit Care Med 178:738–744CrossRefPubMed
Metadata
Title
Evolution of emphysema in relation to smoking
Authors
Massimo Bellomi
Cristiano Rampinelli
Giulia Veronesi
Sergio Harari
Federica Lanfranchi
Sara Raimondi
Patrick Maisonneuve
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
European Radiology / Issue 2/2010
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-009-1548-6

Other articles of this Issue 2/2010

European Radiology 2/2010 Go to the issue