Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity

Ben Gary Harvey, Yael Strulovici-Barel, Robert J. Kaner, Abraham Sanders, Thomas L. Vincent, Jason G. Mezey, Ronald Crystal

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these "normal spirometry/low DLCO" smokers is unknown. From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers. In the normal spirometry/normal DLCO group assessed over 45±20 months, 3% developed GOLDdefined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22% developed GOLD-defined COPD. Despite appearing "normal" according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

Original languageEnglish
Pages (from-to)1589-1597
Number of pages9
JournalEuropean Respiratory Journal
Volume46
Issue number6
DOIs
Publication statusPublished - 1 Dec 2015
Externally publishedYes

Fingerprint

Spirometry
Chronic Obstructive Pulmonary Disease
Vital Capacity
Forced Expiratory Volume
Lung Volume Measurements
Total Lung Capacity
Urinalysis
Blood Cell Count
Bronchodilator Agents
Emphysema
Carbon Monoxide
Natural History
Radiography
Physical Examination
HIV-1
Thorax
History
Lung

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity. / Harvey, Ben Gary; Strulovici-Barel, Yael; Kaner, Robert J.; Sanders, Abraham; Vincent, Thomas L.; Mezey, Jason G.; Crystal, Ronald.

In: European Respiratory Journal, Vol. 46, No. 6, 01.12.2015, p. 1589-1597.

Research output: Contribution to journalArticle

Harvey, Ben Gary ; Strulovici-Barel, Yael ; Kaner, Robert J. ; Sanders, Abraham ; Vincent, Thomas L. ; Mezey, Jason G. ; Crystal, Ronald. / Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity. In: European Respiratory Journal. 2015 ; Vol. 46, No. 6. pp. 1589-1597.
@article{f49bc50dea4e44049067e771d7965269,
title = "Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity",
abstract = "Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these {"}normal spirometry/low DLCO{"} smokers is unknown. From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers. In the normal spirometry/normal DLCO group assessed over 45±20 months, 3{\%} developed GOLDdefined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22{\%} developed GOLD-defined COPD. Despite appearing {"}normal{"} according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.",
author = "Harvey, {Ben Gary} and Yael Strulovici-Barel and Kaner, {Robert J.} and Abraham Sanders and Vincent, {Thomas L.} and Mezey, {Jason G.} and Ronald Crystal",
year = "2015",
month = "12",
day = "1",
doi = "10.1183/13993003.02377-2014",
language = "English",
volume = "46",
pages = "1589--1597",
journal = "Acta tuberculosea Scandinavica",
issn = "0903-1936",
publisher = "European Respiratory Society",
number = "6",

}

TY - JOUR

T1 - Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity

AU - Harvey, Ben Gary

AU - Strulovici-Barel, Yael

AU - Kaner, Robert J.

AU - Sanders, Abraham

AU - Vincent, Thomas L.

AU - Mezey, Jason G.

AU - Crystal, Ronald

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these "normal spirometry/low DLCO" smokers is unknown. From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers. In the normal spirometry/normal DLCO group assessed over 45±20 months, 3% developed GOLDdefined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22% developed GOLD-defined COPD. Despite appearing "normal" according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

AB - Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these "normal spirometry/low DLCO" smokers is unknown. From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, α1-antitrypsin level, chest radiography, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers. In the normal spirometry/normal DLCO group assessed over 45±20 months, 3% developed GOLDdefined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41±31 months, 22% developed GOLD-defined COPD. Despite appearing "normal" according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

UR - http://www.scopus.com/inward/record.url?scp=84948984627&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84948984627&partnerID=8YFLogxK

U2 - 10.1183/13993003.02377-2014

DO - 10.1183/13993003.02377-2014

M3 - Article

VL - 46

SP - 1589

EP - 1597

JO - Acta tuberculosea Scandinavica

JF - Acta tuberculosea Scandinavica

SN - 0903-1936

IS - 6

ER -