Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study

Respiratory Research

Jan-Willem J Lammers⁷  Dirkje S Postma¹  Harry J de Koning⁶  Mathijs Oudkerk³  Harry JM Groen¹  H Marike Boezen²  Bram van Ginneken⁵  Pim A de Jong⁴  Pieter Zanen⁷  Firdaus AA Mohamed Hoesein⁷ 

[1] Department of Pulmonology, University Medical Center Groningen, University of Groningen, PO box 30001, Groningen 9700 RB, the Netherlands;Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO box 30001, Groningen 9700 RB, the Netherlands;Department of Radiology, University Medical Center Groningen, University of Groningen, PO box 30001, Groningen 9700 RB, the Netherlands;Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO box 85500, Utrecht 3508 GA, the Netherlands;Department of Radiology, Radboud University Nijmegen Medical Center, PO box 9101, Nijmegen 6500 HB, the Netherlands;Department of Public Health, Erasmus MC, PO box 2040, Rotterdam 3000 CA, the Netherlands;Department of Respiratory Medicine, Division of Heart & Lungs, University Medical Center Utrecht, PO box 85500, Utrecht 3508 GA, the Netherlands

关键词: Pulmonary function testing;    Smoking;    Emphysema;    Chronic obstructive pulmonary disease (COPD);   

Others  :  794629
DOI  :  10.1186/1465-9921-14-55

 received in 2013-02-20, accepted in 2013-05-02,  发布年份 2013

【 摘 要 】

Background

Little is known about the factors associated with CT-quantified emphysema progression in heavy smokers. The objective of this study was to investigate the effect of length of smoking cessation and clinical / demographical factors on the rate of emphysema progression and FEV₁-decline in male heavy smokers.

Methods

3,670 male smokers with mean (SD) 40.8 (17.9) packyears underwent chest CT scans and pulmonary function tests at baseline and after 1 and 3 years follow-up. Smoking status (quitted ≥5, ≥1-<5, <1 years or current smoker) was noted. Rate of progression of emphysema and FEV₁-decline after follow-up were assessed by analysis of variance adjusting for age, height, baseline pulmonary function and emphysema severity, packyears, years in study and respiratory symptoms. The quitted ≥5 group was used as reference.

Results

Median (Q1-Q3) emphysema severity,<-950 HU, was 8.8 (5.1 – 14.1) and mean (SD) FEV₁ was 3.4 (0.73) L or 98.5 (18.5) % of predicted. The group quitted ‘>5 years’ showed significantly lower rates of progression of emphysema compared to current smokers, 1.07% and 1.12% per year, respectively (p<0.001). Current smokers had a yearly FEV₁-decline of 69 ml, while subjects quit smoking >5 years had a yearly decline of 57.5 ml (p<0.001).

Conclusion

Quit smoking >5 years significantly slows the rate of emphysema progression and lung function decline.

Trial registration

Registered at http://www.trialregister.nl webcite with trial number ISRCTN63545820.

【 授权许可】

   
2013 Mohamed Hoesein et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM: Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006 Sep, 28(3):523-532.
• [2]Murray CJ, Lopez AD: Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997 May 24, 349(9064):1498-1504.
• [3]Fletcher C, Peto R: The natural history of chronic airflow obstruction. Br. Med J 1977, 1:1645-1648.
• [4]Godtfredsen NS, Lam TH, Hansel TT, Leon ME, Gray N, Dresler C: COPD-related morbidity and mortality after smoking cessation: status of the evidence. Eur Respir J 2008 Oct, 32(4):844-853.
• [5]Willemse BW, Postma DS, Timens W, ten Hacken NH: The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J 2004 Mar, 23(3):464-476.
• [6]Bellomi M, Rampinelli C, Veronesi G, Harari S, Lanfranchi F, Raimondi S: Evolution of emphysema in relation to smoking. Eur Radiol 2010 Feb, 20(2):286-292.
• [7]Suki B, Jesudason R, Sato S: Mechanical failure, stress redistribution, elastase activity and binding site availability on elastin during the progression of emphysema. Pulm Pharmacol Ther 2011, 25(4):268-275.
• [8]Pellegrino R, Antonelli A: Unfolding the mechanisms of progression of pulmonary emphysema in COPD. Eur Respir J 2012 Oct, 40(4):801-803.
• [9]Grydeland TB, Dirksen A, Coxson HO: Quantitative computed tomography measures of emphysema and airway wall thickness are related to respiratory symptoms. Am J Respir Crit Care Med 2010 Feb 15, 181(4):353-359.
• [10]Grydeland TB, Dirksen A, Coxson HO: Quantitative computed tomography: emphysema and airway wall thickness by sex, age and smoking. Eur Respir J 2009 Oct, 34(4):858-865.
• [11]Rutten EP, Grydeland TB, Pillai SG: Quantitative CT: Associations between Emphysema. Airway Wall Thickness and Body Composition in COPD. Pulm Med 2011, 2011:419328.
• [12]van Iersel CA, de Koning HJ, Draisma G, Mali WP, Scholten ET, Nackaerts K: Risk-based selection from the general population in a screening trial: selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer multi-slice CT screening trial (NELSON). Int J Cancer 2007 Feb 15, 120(4):868-874.
• [13]Mohamed Hoesein FA, de Hoop B, Zanen P: CT-quantified emphysema in male heavy smokers: association with lung function decline. Thorax 2011 Sep, 66(9):782-787.
• [14]Mohamed Hoesein FA, Zanen P, van Ginneken B, van Klaveren RJ, Lammers JW: Association of the transfer coefficient of the lung for carbon monoxide with emphysema progression in male smokers. Eur Respir J 2011 Nov, 38(5):1012-1018.
• [15]Mohamed Hoesein FA, Van Rikxoort E, Van Ginneken B: CT-quantified emphysema distribution is associated with lung function decline. Eur Respir J 2012, 844-850.
• [16]van Rikxoort EM, de Hoop B, Viergever MA, Prokop M, van Ginneken B: Automatic lung segmentation from thoracic computed tomography scans using a hybrid approach with error detection. Med Phys 2009 Jul, 36(7):2934-2947.
• [17]Parr DG, Stoel BC, Stolk J, Stockley RA: Validation of computed tomographic lung densitometry for monitoring emphysema in {alpha}1-antitrypsin deficiency. Thorax 2006 Jun 1, 61(6):485-490.
• [18]Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R: General considerations for lung function testing. Eur Respir J 2005 Jul, 26(1):153-161.
• [19]Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P: Global strategy for the diagnosis, management, and prevention of chronic obstructivepulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007 Sep 15, 176(6):532-555.
• [20]Ashraf H, Lo P, Shaker SB: Short-term effect of changes in smoking behaviour on emphysema quantification by CT. Thorax 2011 Jan, 66(1):55-60.
• [21]Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC: Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1993 Mar, 16:5-40.
• [22]Doll R, Peto R, Boreham J, Sutherland I: Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004 Jun 26, 328(7455):1519.
• [23]Skold CM, Blaschke E, Eklund A: Transient increases in albumin and hyaluronan in bronchoalveolar lavage fluid after quitting smoking: possible signs of reparative mechanisms. Respir Med 1996 Oct, 90(9):523-529.
• [24]Andersson O, Cassel TN, Skold CM, Eklund A, Lund J, Nord M: Clara cell secretory protein. Levels in BAL fluid after smoking cessation. Chest 2000 Jul, 118(1):180-182.
• [25]Soejima K, Yamaguchi K, Kohda E: Longitudinal follow-up study of smoking-induced lung density changes by high-resolution computed tomography. Am J Respir Crit Care Med 2000 Apr, 161(4 Pt 1):1264-1273.
• [26]Coxson HO, Dirksen A, Edwards LD: The presence and progression of emphysema in COPD as determined by CT scanning and biomarker expression: a prospective analysis from the ECLIPSE study. The Lancet Respiratory Medicine. Early Online Publication1 February 2013
• [27]Anthonisen NR, Connett JE, Murray RP: Smoking and lung function of Lung Health Study participants after 11 years. Am J Respir Crit Care Med 2002 Sep 1, 166(5):675-679.
• [28]Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS: Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med 2000 Feb, 161(2 Pt 1):381-390.
• [29]Sverzellati N, Calabro E, Randi G, La VC, Marchiano A, Kuhnigk JM: Sex differences in emphysema phenotype in smokers without airflow obstruction. Eur Respir J 2009 Jun, 33(6):1320-1328.
• [30]Shaker SB, Dirksen A, Lo P, Skovgaard LT, de Bruijne M: Pedersen JH Factors influencing the decline in lung density in a Danish lung cancer screening cohort. Eur Respir J 2012 Nov, 40(5):1142-1148.