Cross-Sectional Analysis of the Utility of Pulmonary Function Tests in Predicting Emphysema in Ever-Smokers

International Journal of Environmental Research and Public Health

Sean E. Hesselbacher⁴  Robert Ross⁴  Matthew B. Schabath¹  E. O𠆛rian Smith³  Sarah Perusich⁴  Nadia Barrow⁴  Pamela Smithwick⁴  Manoj J. Mammen⁴  Harvey Coxson²  Natasha Krowchuk²  David B. Corry⁴ 

[1] Division of Cancer Prevention and Control, The H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA; E-Mail:;University of British Columbia, Vancouver Campus, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada; E-Mails:;Children’s Nutrition Research Center (CNRC), Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA; E-Mail:;Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; E-Mails:

关键词: airflow limitation;    chronic obstructive pulmonary disease;    CT morphometry;    emphysema;    airway wall thickness;    pulmonary function test;   

DOI  :  10.3390/ijerph8051324

来源: mdpi

【 摘 要 】

Emphysema is largely an under-diagnosed medical condition that can exist in smokers in the absence of airway obstruction. We aimed to determine the sensitivity and specificity of pulmonary function tests (PFTs) in assessing emphysema using quantitative CT scans as the reference standard. We enrolled 224 ever-smokers (current or former) over the age of 40. CT of thorax was used to quantify the low attenuation area (% emphysema), and to measure the standardized airway wall thickness. PFTs were used individually and in combination to predict their ability to discriminate radiographic emphysema. Significant emphysema (>7%) was detected in 122 (54%) subjects. Twenty six (21%) emphysema subjects had no evidence of airflow obstruction (FEV₁/FVC ratio <70%), while all subjects with >23% emphysema showed airflow obstruction. The sensitivity and specificity of spirometry for detecting radiographic emphysema were 79% and 75%, respectively. Standardized airway wall thickness was increased in subjects with airflow obstruction, but did not correlate with emphysema severity. In this cohort of lifetime ever-smokers, PFTs alone were inadequate for diagnosing emphysema. Airway wall thickness quantified by CT morphometry was associated with airflow limitation, but not with emphysema indicating that the heterogeneous nature of lung disease in smokers may represent distinct phenotypes.

【 授权许可】

CC BY   
© 2011 by the authors; licensee MDPI, Basel, Switzerland.