Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers

Genetic Epidemiology of COPD (COPDGene) Investigators

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Central airway collapse greater than 50% of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown.

OBJECTIVE: To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease.

DESIGN, SETTING, AND PARTICIPANTS: Analysis of paired inspiratory-expiratory computed tomography images from a large multicenter study (COPDGene) of current and former smokers from 21 clinical centers across the United States. Participants were enrolled from January 2008 to June 2011 and followed up longitudinally until October 2014. Images were initially screened using a quantitative method to detect at least a 30% reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen-positive scans, cross-sectional area of the trachea was measured manually at 3 predetermined levels (aortic arch, carina, and bronchus intermedius) to confirm ECAC (>50% reduction in cross-sectional area).

EXPOSURES: Expiratory central airway collapse.

MAIN OUTCOMES AND MEASURES: The primary outcome was baseline respiratory quality of life (St George's Respiratory Questionnaire [SGRQ] scale 0 to 100; 100 represents worst health status; minimum clinically important difference [MCID], 4 units). Secondary outcomes were baseline measures of dyspnea (modified Medical Research Council [mMRC] scale 0 to 4; 4 represents worse dyspnea; MCID, 0.7 units), baseline 6-minute walk distance (MCID, 30 m), and exacerbation frequency (events per 100 person-years) on longitudinal follow-up.

RESULTS: The study included 8820 participants with and without COPD (mean age, 59.7 [SD, 6.9] years; 4667 [56.7%] men; 4559 [51.7%] active smokers). The prevalence of ECAC was 5% (443 cases). Patients with ECAC compared with those without ECAC had worse SGRQ scores (30.9 vs 26.5 units; P 

CONCLUSIONS AND RELEVANCE: In a cross-sectional analysis of current and former smokers, the presence of ECAC was associated with worse respiratory quality of life. Further studies are needed to assess long-term associations with clinical outcomes.

Original languageEnglish (US)
Pages (from-to)498-505
Number of pages8
JournalJournal of the American Medical Association
Volume315
Issue number5
DOIs
StatePublished - Feb 2 2016

Fingerprint

Dyspnea
Chronic Obstructive Pulmonary Disease
Quality of Life
Exhalation
Bronchi
Trachea
Thoracic Aorta
Lung Diseases
Health Status
Multicenter Studies
Biomedical Research
Cross-Sectional Studies
Smoking
Tomography
Morbidity
Surveys and Questionnaires

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers. / Genetic Epidemiology of COPD (COPDGene) Investigators.

In: Journal of the American Medical Association, Vol. 315, No. 5, 02.02.2016, p. 498-505.

Research output: Contribution to journalArticle

Genetic Epidemiology of COPD (COPDGene) Investigators. / Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers. In: Journal of the American Medical Association. 2016 ; Vol. 315, No. 5. pp. 498-505.
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abstract = "IMPORTANCE: Central airway collapse greater than 50{\%} of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown.OBJECTIVE: To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease.DESIGN, SETTING, AND PARTICIPANTS: Analysis of paired inspiratory-expiratory computed tomography images from a large multicenter study (COPDGene) of current and former smokers from 21 clinical centers across the United States. Participants were enrolled from January 2008 to June 2011 and followed up longitudinally until October 2014. Images were initially screened using a quantitative method to detect at least a 30{\%} reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen-positive scans, cross-sectional area of the trachea was measured manually at 3 predetermined levels (aortic arch, carina, and bronchus intermedius) to confirm ECAC (>50{\%} reduction in cross-sectional area).EXPOSURES: Expiratory central airway collapse.MAIN OUTCOMES AND MEASURES: The primary outcome was baseline respiratory quality of life (St George's Respiratory Questionnaire [SGRQ] scale 0 to 100; 100 represents worst health status; minimum clinically important difference [MCID], 4 units). Secondary outcomes were baseline measures of dyspnea (modified Medical Research Council [mMRC] scale 0 to 4; 4 represents worse dyspnea; MCID, 0.7 units), baseline 6-minute walk distance (MCID, 30 m), and exacerbation frequency (events per 100 person-years) on longitudinal follow-up.RESULTS: The study included 8820 participants with and without COPD (mean age, 59.7 [SD, 6.9] years; 4667 [56.7{\%}] men; 4559 [51.7{\%}] active smokers). The prevalence of ECAC was 5{\%} (443 cases). Patients with ECAC compared with those without ECAC had worse SGRQ scores (30.9 vs 26.5 units; P CONCLUSIONS AND RELEVANCE: In a cross-sectional analysis of current and former smokers, the presence of ECAC was associated with worse respiratory quality of life. Further studies are needed to assess long-term associations with clinical outcomes.",
author = "{Genetic Epidemiology of COPD (COPDGene) Investigators} and Bhatt, {Surya P.} and Terry, {Nina L J} and Hrudaya Nath and Zach, {Jordan A.} and Juerg Tschirren and Bolding, {Mark S.} and Stinson, {Douglas S.} and Wilson, {Carla G.} and Douglas Curran-Everett and Lynch, {David A.} and Nirupama Putcha and Xavi Soler and Wise, {Robert A} and Washko, {George R.} and Hoffman, {Eric A.} and Foreman, {Marilyn G.} and Dransfield, {Mark T.}",
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AU - Genetic Epidemiology of COPD (COPDGene) Investigators

AU - Bhatt, Surya P.

AU - Terry, Nina L J

AU - Nath, Hrudaya

AU - Zach, Jordan A.

AU - Tschirren, Juerg

AU - Bolding, Mark S.

AU - Stinson, Douglas S.

AU - Wilson, Carla G.

AU - Curran-Everett, Douglas

AU - Lynch, David A.

AU - Putcha, Nirupama

AU - Soler, Xavi

AU - Wise, Robert A

AU - Washko, George R.

AU - Hoffman, Eric A.

AU - Foreman, Marilyn G.

AU - Dransfield, Mark T.

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N2 - IMPORTANCE: Central airway collapse greater than 50% of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown.OBJECTIVE: To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease.DESIGN, SETTING, AND PARTICIPANTS: Analysis of paired inspiratory-expiratory computed tomography images from a large multicenter study (COPDGene) of current and former smokers from 21 clinical centers across the United States. Participants were enrolled from January 2008 to June 2011 and followed up longitudinally until October 2014. Images were initially screened using a quantitative method to detect at least a 30% reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen-positive scans, cross-sectional area of the trachea was measured manually at 3 predetermined levels (aortic arch, carina, and bronchus intermedius) to confirm ECAC (>50% reduction in cross-sectional area).EXPOSURES: Expiratory central airway collapse.MAIN OUTCOMES AND MEASURES: The primary outcome was baseline respiratory quality of life (St George's Respiratory Questionnaire [SGRQ] scale 0 to 100; 100 represents worst health status; minimum clinically important difference [MCID], 4 units). Secondary outcomes were baseline measures of dyspnea (modified Medical Research Council [mMRC] scale 0 to 4; 4 represents worse dyspnea; MCID, 0.7 units), baseline 6-minute walk distance (MCID, 30 m), and exacerbation frequency (events per 100 person-years) on longitudinal follow-up.RESULTS: The study included 8820 participants with and without COPD (mean age, 59.7 [SD, 6.9] years; 4667 [56.7%] men; 4559 [51.7%] active smokers). The prevalence of ECAC was 5% (443 cases). Patients with ECAC compared with those without ECAC had worse SGRQ scores (30.9 vs 26.5 units; P CONCLUSIONS AND RELEVANCE: In a cross-sectional analysis of current and former smokers, the presence of ECAC was associated with worse respiratory quality of life. Further studies are needed to assess long-term associations with clinical outcomes.

AB - IMPORTANCE: Central airway collapse greater than 50% of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown.OBJECTIVE: To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease.DESIGN, SETTING, AND PARTICIPANTS: Analysis of paired inspiratory-expiratory computed tomography images from a large multicenter study (COPDGene) of current and former smokers from 21 clinical centers across the United States. Participants were enrolled from January 2008 to June 2011 and followed up longitudinally until October 2014. Images were initially screened using a quantitative method to detect at least a 30% reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen-positive scans, cross-sectional area of the trachea was measured manually at 3 predetermined levels (aortic arch, carina, and bronchus intermedius) to confirm ECAC (>50% reduction in cross-sectional area).EXPOSURES: Expiratory central airway collapse.MAIN OUTCOMES AND MEASURES: The primary outcome was baseline respiratory quality of life (St George's Respiratory Questionnaire [SGRQ] scale 0 to 100; 100 represents worst health status; minimum clinically important difference [MCID], 4 units). Secondary outcomes were baseline measures of dyspnea (modified Medical Research Council [mMRC] scale 0 to 4; 4 represents worse dyspnea; MCID, 0.7 units), baseline 6-minute walk distance (MCID, 30 m), and exacerbation frequency (events per 100 person-years) on longitudinal follow-up.RESULTS: The study included 8820 participants with and without COPD (mean age, 59.7 [SD, 6.9] years; 4667 [56.7%] men; 4559 [51.7%] active smokers). The prevalence of ECAC was 5% (443 cases). Patients with ECAC compared with those without ECAC had worse SGRQ scores (30.9 vs 26.5 units; P CONCLUSIONS AND RELEVANCE: In a cross-sectional analysis of current and former smokers, the presence of ECAC was associated with worse respiratory quality of life. Further studies are needed to assess long-term associations with clinical outcomes.

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