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 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.

journal_name

Respir Res

journal_title

Respiratory research

authors

Pirozzi CS,Gu T,Quibrera PM,Carretta EE,Han MK,Murray S,Cooper CB,Tashkin DP,Kleerup EC,Barjaktarevic I,Hoffman EA,Martinez CH,Christenson SA,Hansel NN,Graham Barr R,Bleecker ER,Ortega VE,Martinez FJ,Kanner RE,Paine

doi

10.1186/s12931-018-0911-z

subject

Has Abstract

pub_date

2018-11-20 00:00:00

pages

223

issue

1

eissn

1465-9921

issn

1465-993X

pii

10.1186/s12931-018-0911-z

journal_volume

19

pub_type

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