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Randomized Controlled Trial
. 2011 Sep;66(9):782-7.
doi: 10.1136/thx.2010.145995. Epub 2011 Apr 7.

CT-quantified emphysema in male heavy smokers: association with lung function decline

Firdaus A A Mohamed Hoesein  1 , Bartjan de Hoop, Pieter Zanen, Hester Gietema, Cas L J J Kruitwagen, Bram van Ginneken, Ivana Isgum, Christian Mol, Rob J van Klaveren, Akkelies E Dijkstra, Harry J M Groen, H Marike Boezen, Dirkje S Postma, Mathias Prokop, Jan-Willem J Lammers
Affiliations
Randomized Controlled Trial

CT-quantified emphysema in male heavy smokers: association with lung function decline

Firdaus A A Mohamed Hoesein et al. Thorax. 2011 Sep.

Abstract

Background: Emphysema and small airway disease both contribute to chronic obstructive pulmonary disease (COPD), a disease characterised by accelerated decline in lung function. The association between the extent of emphysema in male current and former smokers and lung function decline was investigated.

Methods: Current and former heavy smokers participating in a lung cancer screening trial were recruited to the study and all underwent CT. Spirometry was performed at baseline and at 3-year follow-up. The 15th percentile (Perc15) was used to assess the severity of emphysema.

Results: 2085 men of mean age 59.8 years participated in the study. Mean (SD) baseline Perc15 was -934.9 (19.5) HU. A lower Perc15 value correlated with a lower forced expiratory volume in 1 s (FEV(1)) at baseline (r=0.12, p<0.001). Linear mixed model analysis showed that a lower Perc15 was significantly related to a greater decline in FEV(1) after follow-up (p<0.001). Participants without baseline airway obstruction who developed it after follow-up had significantly lower mean (SD) Perc15 values at baseline than those who did not develop obstruction (-934.2 (17.1) HU vs -930.2 (19.7) HU, p<0.001).

Conclusion: Greater baseline severity of CT-detected emphysema is related to lower baseline lung function and greater rates of lung function decline, even in those without airway obstruction. CT-detected emphysema aids in identifying non-obstructed male smokers who will develop airflow obstruction.

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