• Resp Res · Nov 2018

    Multicenter Study

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

    • 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, Graham Barr R R Department of Medicine, Columbia University, New York, NY, USA., Eugene R Bleecker, Victor E Ortega, Fernando J Martinez, Richard E Kanner, Robert Paine, and NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS).
    • Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, 26 N 1900 E, Salt Lake City, UT, 84132, USA. Cheryl.pirozzi@hsc.utah.edu.
    • Resp Res. 2018 Nov 20; 19 (1): 223.

    BackgroundThe 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.MethodsWe 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.ResultsThe 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.ConclusionsEver-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.

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