Radiographic lung volumes predict progression to COPD in smokers with preserved spirometry in SPIROMICS.

TitleRadiographic lung volumes predict progression to COPD in smokers with preserved spirometry in SPIROMICS.
Publication TypePublication
Year2019
AuthorsArjomandi M, Zeng S, Barjaktarevic I, R Barr G, Bleecker ER, Bowler RP, Buhr RG, Criner GJ, Comellas AP, Cooper CB, Couper DJ, Curtis JL, Dransfield MT, Han MK, Hansel NN, Hoffman EA, Kaner RJ, Kanner RE, Krishnan JA, Paine R, Peters SP, Rennard SI, Woodruff PG
Corporate AuthorsSPIROMICS Investigators
JournalEur Respir J
Volume54
Issue4
Date Published2019 10
ISSN1399-3003
KeywordsAged, Disease Progression, Female, Forced Expiratory Volume, Humans, Lung, Male, Middle Aged, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive, Residual Volume, smoking, Spirometry, Tomography, X-Ray Computed, Total Lung Capacity, Vital Capacity
Abstract

The characteristics that predict progression to overt chronic obstructive pulmonary disease (COPD) in smokers without spirometric airflow obstruction are not clearly defined.We conducted a analysis of 849 current and former smokers (≥20 pack-years) with preserved spirometry from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) cohort who had baseline computed tomography (CT) scans of lungs and serial spirometry. We examined whether CT-derived lung volumes representing air trapping could predict adverse respiratory outcomes and more rapid decline in spirometry to overt COPD using mixed-effect linear modelling.Among these subjects with normal forced expiratory volume in 1 s (FEV) to forced vital capacity (FVC) ratio, CT-measured residual volume (RV) to total lung capacity (TLC) ratio varied widely, from 21% to 59%. Over 2.5±0.7 years of follow-up, subjects with higher RV/TLC had a greater differential rate of decline in FEV/FVC; those in the upper RV/TLC tertile had a 0.66% (95% CI 0.06%-1.27%) faster rate of decline per year compared with those in the lower tertile (p=0.015) regardless of demographics, baseline spirometry, respiratory symptoms score, smoking status (former current) or smoking burden (pack-years). Accordingly, subjects with higher RV/TLC were more likely to develop spirometric COPD (OR 5.7 (95% CI 2.4-13.2) in upper lower RV/TLC tertile; p<0.001). Other CT indices of air trapping showed similar patterns of association with lung function decline; however, when all CT indices of air trapping, emphysema, and airway disease were included in the same model, only RV/TLC retained its significance.Increased air trapping based on radiographic lung volumes predicts accelerated spirometry decline and progression to COPD in smokers without obstruction.

DOI10.1183/13993003.02214-2018
Alternate JournalEur Respir J
PubMed ID31439683
PubMed Central IDPMC7089627
Grant ListHHSN268200900019C / HL / NHLBI NIH HHS / United States
U24 HL141762 / HL / NHLBI NIH HHS / United States
S10 OD018526 / OD / NIH HHS / United States
P30 ES005605 / ES / NIEHS NIH HHS / United States
R01 AI120526 / AI / NIAID NIH HHS / United States
K24 HL137013 / HL / NHLBI NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
I01 CX000911 / CX / CSRD VA / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
R21 AI117371 / AI / NIAID NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
MS#: 
MS144
Manuscript Full Title: 
Radiographic lung volumes predict progression to COPD in smokers with preserved spirometry in SPIROMICS.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: San Francisco (University of California at San Francisco)
ECI: 
Manuscript Status: 
Published and Public