TY - JOUR
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.
N1 - Funding Information:
Supported by grants (HHSN2682009000019C, HHSN268200900013C, HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, and HHSN268200900020C) from the National Heart, Lung, and Blood Institute of the National Institutes of Health and by the Foundation for the National Institutes of Health through contributions made to an external advisory board that includes members from AstraZeneca, Bellerophon Therapeutics, Boehringer-Ingelheim Pharmaceuticals, Chiesi Farmaceutici, Forest Research Institute, GlaxoSmithKline, Grifols Therapeutics, Ikaria, Nycomed, Takeda Pharmaceutical, Novartis Pharmaceuticals, Regeneron Pharmaceuticals, and Sanofi.
Publisher Copyright:
© 2016 Massachusetts Medical Society.
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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U2 - 10.1056/NEJMoa1505971
DO - 10.1056/NEJMoa1505971
M3 - Article
C2 - 27168432
AN - SCOPUS:84966650988
SN - 0028-4793
VL - 374
SP - 1811
EP - 1821
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 19
ER -