Clinical significance of symptoms in smokers with preserved pulmonary function

Spiromics Research Group

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226 Citations (Scopus)

Abstract

BACKGROUND Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms. METHODS We conducted an observational study involving 2736 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). We examined whether current or former smokers who had preserved pulmonary function as assessed by spirometry (FEV1:FVC .0.70 and an FVC above the lower limit of the normal range after bronchodilator use) and had symptoms (CAT score, .10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score, <10) and whether those with symptoms had different findings from the asymptomatic group with respect to the 6-minute walk distance, lung function, or high-resolution computed tomographic (HRCT) scan of the chest. RESULTS Respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. The mean (-}SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27-} 0.67 vs. 0.08-}0.31 and 0.03-}0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. CONCLUSIONS Although they do not meet the current criteria for COPD, symptomatic current or former smokers with preserved pulmonary function have exacerbations, activity limitation, and evidence of airway disease. They currently use a range of respiratory medications without any evidence base. (Funded by the National Heart, Lung, and Blood Institute and the Foundation for the National Institutes of Health; SPIROMICS ClinicalTrials.gov number, NCT01969344.).

Original languageEnglish (US)
Pages (from-to)1811-1821
Number of pages11
JournalNew England Journal of Medicine
Volume374
Issue number19
DOIs
StatePublished - May 12 2016

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Vital Capacity
Bronchodilator Agents
Forced Expiratory Volume
Lung
Chronic Obstructive Pulmonary Disease
Spirometry
Inspiratory Capacity
National Heart, Lung, and Blood Institute (U.S.)
Emphysema
National Institutes of Health (U.S.)
Respiratory Rate
Glucocorticoids
Observational Studies
Reference Values
Thorax
Asthma

ASJC Scopus subject areas

  • Medicine(all)

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Clinical significance of symptoms in smokers with preserved pulmonary function. / Spiromics Research Group.

In: New England Journal of Medicine, Vol. 374, No. 19, 12.05.2016, p. 1811-1821.

Research output: Contribution to journalArticle

Spiromics Research Group. / Clinical significance of symptoms in smokers with preserved pulmonary function. In: New England Journal of Medicine. 2016 ; Vol. 374, No. 19. pp. 1811-1821.
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title = "Clinical significance of symptoms in smokers with preserved pulmonary function",
abstract = "BACKGROUND Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms. METHODS We conducted an observational study involving 2736 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). We examined whether current or former smokers who had preserved pulmonary function as assessed by spirometry (FEV1:FVC .0.70 and an FVC above the lower limit of the normal range after bronchodilator use) and had symptoms (CAT score, .10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score, <10) and whether those with symptoms had different findings from the asymptomatic group with respect to the 6-minute walk distance, lung function, or high-resolution computed tomographic (HRCT) scan of the chest. RESULTS Respiratory symptoms were present in 50{\%} of current or former smokers with preserved pulmonary function. The mean (-}SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27-} 0.67 vs. 0.08-}0.31 and 0.03-}0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42{\%} used bronchodilators and 23{\%} used inhaled glucocorticoids. CONCLUSIONS Although they do not meet the current criteria for COPD, symptomatic current or former smokers with preserved pulmonary function have exacerbations, activity limitation, and evidence of airway disease. They currently use a range of respiratory medications without any evidence base. (Funded by the National Heart, Lung, and Blood Institute and the Foundation for the National Institutes of Health; SPIROMICS ClinicalTrials.gov number, NCT01969344.).",
author = "{Spiromics Research Group} and Woodruff, {Prescott G.} and Barr, {R. Graham} and Eugene Bleecker and Christenson, {Stephanie A.} and David Couper and Curtis, {Jeffrey L.} and Gouskova, {Natalia A.} and Hansel, {Nadia N.} and Hoffman, {Eric A.} and Kanner, {Richard E.} and Eric Kleerup and Lazarus, {Stephen C.} and Martinez, {Fernando J.} and Robert Paine and Stephen Rennard and Tashkin, {Donald P.} and Han, {Meilan K.}",
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T1 - Clinical significance of symptoms in smokers with preserved pulmonary function

AU - Spiromics Research Group

AU - Woodruff, Prescott G.

AU - Barr, R. Graham

AU - Bleecker, Eugene

AU - Christenson, Stephanie A.

AU - Couper, David

AU - Curtis, Jeffrey L.

AU - Gouskova, Natalia A.

AU - Hansel, Nadia N.

AU - Hoffman, Eric A.

AU - Kanner, Richard E.

AU - Kleerup, Eric

AU - Lazarus, Stephen C.

AU - Martinez, Fernando J.

AU - Paine, Robert

AU - Rennard, Stephen

AU - Tashkin, Donald P.

AU - Han, Meilan K.

PY - 2016/5/12

Y1 - 2016/5/12

N2 - BACKGROUND Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms. METHODS We conducted an observational study involving 2736 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). We examined whether current or former smokers who had preserved pulmonary function as assessed by spirometry (FEV1:FVC .0.70 and an FVC above the lower limit of the normal range after bronchodilator use) and had symptoms (CAT score, .10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score, <10) and whether those with symptoms had different findings from the asymptomatic group with respect to the 6-minute walk distance, lung function, or high-resolution computed tomographic (HRCT) scan of the chest. RESULTS Respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. The mean (-}SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27-} 0.67 vs. 0.08-}0.31 and 0.03-}0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. CONCLUSIONS Although they do not meet the current criteria for COPD, symptomatic current or former smokers with preserved pulmonary function have exacerbations, activity limitation, and evidence of airway disease. They currently use a range of respiratory medications without any evidence base. (Funded by the National Heart, Lung, and Blood Institute and the Foundation for the National Institutes of Health; SPIROMICS ClinicalTrials.gov number, NCT01969344.).

AB - BACKGROUND Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms. METHODS We conducted an observational study involving 2736 current or former smokers and controls who had never smoked and measured their respiratory symptoms using the COPD Assessment Test (CAT; scores range from 0 to 40, with higher scores indicating greater severity of symptoms). We examined whether current or former smokers who had preserved pulmonary function as assessed by spirometry (FEV1:FVC .0.70 and an FVC above the lower limit of the normal range after bronchodilator use) and had symptoms (CAT score, .10) had a higher risk of respiratory exacerbations than current or former smokers with preserved pulmonary function who were asymptomatic (CAT score, <10) and whether those with symptoms had different findings from the asymptomatic group with respect to the 6-minute walk distance, lung function, or high-resolution computed tomographic (HRCT) scan of the chest. RESULTS Respiratory symptoms were present in 50% of current or former smokers with preserved pulmonary function. The mean (-}SD) rate of respiratory exacerbations among symptomatic current or former smokers was significantly higher than the rates among asymptomatic current or former smokers and among controls who never smoked (0.27-} 0.67 vs. 0.08-}0.31 and 0.03-}0.21 events, respectively, per year; P<0.001 for both comparisons). Symptomatic current or former smokers, regardless of history of asthma, also had greater limitation of activity, slightly lower FEV1, FVC, and inspiratory capacity, and greater airway-wall thickening without emphysema according to HRCT than did asymptomatic current or former smokers. Among symptomatic current or former smokers, 42% used bronchodilators and 23% used inhaled glucocorticoids. CONCLUSIONS Although they do not meet the current criteria for COPD, symptomatic current or former smokers with preserved pulmonary function have exacerbations, activity limitation, and evidence of airway disease. They currently use a range of respiratory medications without any evidence base. (Funded by the National Heart, Lung, and Blood Institute and the Foundation for the National Institutes of Health; SPIROMICS ClinicalTrials.gov number, NCT01969344.).

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DO - 10.1056/NEJMoa1505971

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JO - New England Journal of Medicine

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