Structural predictors of lung function decline in young smokers with normal spirometry

Andrew I Ritchie; Gavin C Donaldson; Eric A Hoffman; James P Allinson; Chloe I Bloom; Charlotte E Bolton; Gourab Choudhury; Sarah E Gerard; Junfeng Guo; Luana Alves-Moreira; Lorcan McGarvey; Elizabeth Sapey; Robert A Stockley; K P Yip; Dave Singh; Tom Wilkinson; Malin Fageras; Kristoffer Ostridge; Olaf Jöns; Enrica Bucchioni; Chris H Compton; Paul Jones; Karen Mezzi; Jørgen Vestbo; Peter M A Calverley; Jadwiga A Wedzicha

doi:10.1164/rccm.202307-1203OC

Structural predictors of lung function decline in young smokers with normal spirometry

Andrew I Ritchie, Gavin C Donaldson, Eric A Hoffman, James P Allinson, Chloe I Bloom, Charlotte E Bolton, Gourab Choudhury, Sarah E Gerard, Junfeng Guo, Luana Alves-Moreira, Lorcan McGarvey, Elizabeth Sapey, Robert A Stockley, K P Yip, Dave Singh, Tom Wilkinson, Malin Fageras, Kristoffer Ostridge, Olaf Jöns, Enrica BucchioniChris H Compton, Paul Jones, Karen Mezzi, Jørgen Vestbo, Peter M A Calverley, Jadwiga A Wedzicha

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

RATIONALE: Chronic obstructive pulmonary disease (COPD) due to tobacco smoking commonly presents when extensive lung damage has occurred.

OBJECTIVES: We hypothesised that structural change would be detected early in the natural history of COPD and would relate to loss of lung function with time.

METHODS: We recruited 431 current smokers (median age 39 years, 16 pack-years smoked) and recorded symptoms by the COPD Assessment Test (CAT), spirometry and quantitative thoracic CT (QCT) scans at study entry. These scans results were compared to 67 never smoking controls. 368 participants were followed every six months with measurement of post-bronchodilator spirometry for a median of 32 months. The rate of FEV 1 decline, adjusted for current smoking status, age and sex was related to the initial QCT appearances and symptoms, measured with the CAT.

MEASUREMENTS AND MAIN RESULTS: There were no material differences in demography or subjective CT appearances between the young smokers and controls, but 55.7% of the former had a CAT score above 10 and 24.2% reported chronic bronchitis. QCT assessments of Disease Probability-defined functional small airways disease, ground glass opacification, bronchovascular prominence and small blood vessel to total pulmonary vessel volume ratio were increased compared to controls and were all associated with a faster FEV 1 decline as was a higher CAT score.

CONCLUSIONS: Radiologic abnormalities on CT are already established in young smokers with normal lung function and is associated with FEV 1 loss independently of the impact of symptoms. Structural abnormalities are present early in the natural history of COPD and are markers of disease progression.

Original language	English
Pages (from-to)	1208-1218
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	209
Issue number	10
Early online date	04 Jan 2024
DOIs	https://doi.org/10.1164/rccm.202307-1203OC
Publication status	Published - 15 May 2024

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10.1164/rccm.202307-1203OCLicence: CC BY

Structural predictors of lung function decline in young smokers with normal spirometry
Copyright 2024 American Thoracic Society. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 1.73 MBLicence: CC BY

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Ritchie, A. I., Donaldson, G. C., Hoffman, E. A., Allinson, J. P., Bloom, C. I., Bolton, C. E., Choudhury, G., Gerard, S. E., Guo, J., Alves-Moreira, L., McGarvey, L., Sapey, E., Stockley, R. A., Yip, K. P., Singh, D., Wilkinson, T., Fageras, M., Ostridge, K., Jöns, O., ... Wedzicha, J. A. (2024). Structural predictors of lung function decline in young smokers with normal spirometry. American Journal of Respiratory and Critical Care Medicine, 209(10), 1208-1218. https://doi.org/10.1164/rccm.202307-1203OC

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title = "Structural predictors of lung function decline in young smokers with normal spirometry",

abstract = "RATIONALE: Chronic obstructive pulmonary disease (COPD) due to tobacco smoking commonly presents when extensive lung damage has occurred.OBJECTIVES: We hypothesised that structural change would be detected early in the natural history of COPD and would relate to loss of lung function with time.METHODS: We recruited 431 current smokers (median age 39 years, 16 pack-years smoked) and recorded symptoms by the COPD Assessment Test (CAT), spirometry and quantitative thoracic CT (QCT) scans at study entry. These scans results were compared to 67 never smoking controls. 368 participants were followed every six months with measurement of post-bronchodilator spirometry for a median of 32 months. The rate of FEV 1 decline, adjusted for current smoking status, age and sex was related to the initial QCT appearances and symptoms, measured with the CAT. MEASUREMENTS AND MAIN RESULTS: There were no material differences in demography or subjective CT appearances between the young smokers and controls, but 55.7% of the former had a CAT score above 10 and 24.2% reported chronic bronchitis. QCT assessments of Disease Probability-defined functional small airways disease, ground glass opacification, bronchovascular prominence and small blood vessel to total pulmonary vessel volume ratio were increased compared to controls and were all associated with a faster FEV 1 decline as was a higher CAT score. CONCLUSIONS: Radiologic abnormalities on CT are already established in young smokers with normal lung function and is associated with FEV 1 loss independently of the impact of symptoms. Structural abnormalities are present early in the natural history of COPD and are markers of disease progression. ",

author = "Ritchie, {Andrew I} and Donaldson, {Gavin C} and Hoffman, {Eric A} and Allinson, {James P} and Bloom, {Chloe I} and Bolton, {Charlotte E} and Gourab Choudhury and Gerard, {Sarah E} and Junfeng Guo and Luana Alves-Moreira and Lorcan McGarvey and Elizabeth Sapey and Stockley, {Robert A} and Yip, {K P} and Dave Singh and Tom Wilkinson and Malin Fageras and Kristoffer Ostridge and Olaf J{\"o}ns and Enrica Bucchioni and Compton, {Chris H} and Paul Jones and Karen Mezzi and J{\o}rgen Vestbo and Calverley, {Peter M A} and Wedzicha, {Jadwiga A}",

year = "2024",

month = may,

day = "15",

doi = "10.1164/rccm.202307-1203OC",

language = "English",

volume = "209",

pages = "1208--1218",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

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Ritchie, AI, Donaldson, GC, Hoffman, EA, Allinson, JP, Bloom, CI, Bolton, CE, Choudhury, G, Gerard, SE, Guo, J, Alves-Moreira, L, McGarvey, L, Sapey, E, Stockley, RA, Yip, KP, Singh, D, Wilkinson, T, Fageras, M, Ostridge, K, Jöns, O, Bucchioni, E, Compton, CH, Jones, P, Mezzi, K, Vestbo, J, Calverley, PMA & Wedzicha, JA 2024, 'Structural predictors of lung function decline in young smokers with normal spirometry', American Journal of Respiratory and Critical Care Medicine, vol. 209, no. 10, pp. 1208-1218. https://doi.org/10.1164/rccm.202307-1203OC

TY - JOUR

T1 - Structural predictors of lung function decline in young smokers with normal spirometry

AU - Ritchie, Andrew I

AU - Donaldson, Gavin C

AU - Hoffman, Eric A

AU - Allinson, James P

AU - Bloom, Chloe I

AU - Bolton, Charlotte E

AU - Choudhury, Gourab

AU - Gerard, Sarah E

AU - Guo, Junfeng

AU - Alves-Moreira, Luana

AU - McGarvey, Lorcan

AU - Sapey, Elizabeth

AU - Stockley, Robert A

AU - Yip, K P

AU - Singh, Dave

AU - Wilkinson, Tom

AU - Fageras, Malin

AU - Ostridge, Kristoffer

AU - Jöns, Olaf

AU - Bucchioni, Enrica

AU - Compton, Chris H

AU - Jones, Paul

AU - Mezzi, Karen

AU - Vestbo, Jørgen

AU - Calverley, Peter M A

AU - Wedzicha, Jadwiga A

PY - 2024/5/15

Y1 - 2024/5/15

N2 - RATIONALE: Chronic obstructive pulmonary disease (COPD) due to tobacco smoking commonly presents when extensive lung damage has occurred.OBJECTIVES: We hypothesised that structural change would be detected early in the natural history of COPD and would relate to loss of lung function with time.METHODS: We recruited 431 current smokers (median age 39 years, 16 pack-years smoked) and recorded symptoms by the COPD Assessment Test (CAT), spirometry and quantitative thoracic CT (QCT) scans at study entry. These scans results were compared to 67 never smoking controls. 368 participants were followed every six months with measurement of post-bronchodilator spirometry for a median of 32 months. The rate of FEV 1 decline, adjusted for current smoking status, age and sex was related to the initial QCT appearances and symptoms, measured with the CAT. MEASUREMENTS AND MAIN RESULTS: There were no material differences in demography or subjective CT appearances between the young smokers and controls, but 55.7% of the former had a CAT score above 10 and 24.2% reported chronic bronchitis. QCT assessments of Disease Probability-defined functional small airways disease, ground glass opacification, bronchovascular prominence and small blood vessel to total pulmonary vessel volume ratio were increased compared to controls and were all associated with a faster FEV 1 decline as was a higher CAT score. CONCLUSIONS: Radiologic abnormalities on CT are already established in young smokers with normal lung function and is associated with FEV 1 loss independently of the impact of symptoms. Structural abnormalities are present early in the natural history of COPD and are markers of disease progression.

AB - RATIONALE: Chronic obstructive pulmonary disease (COPD) due to tobacco smoking commonly presents when extensive lung damage has occurred.OBJECTIVES: We hypothesised that structural change would be detected early in the natural history of COPD and would relate to loss of lung function with time.METHODS: We recruited 431 current smokers (median age 39 years, 16 pack-years smoked) and recorded symptoms by the COPD Assessment Test (CAT), spirometry and quantitative thoracic CT (QCT) scans at study entry. These scans results were compared to 67 never smoking controls. 368 participants were followed every six months with measurement of post-bronchodilator spirometry for a median of 32 months. The rate of FEV 1 decline, adjusted for current smoking status, age and sex was related to the initial QCT appearances and symptoms, measured with the CAT. MEASUREMENTS AND MAIN RESULTS: There were no material differences in demography or subjective CT appearances between the young smokers and controls, but 55.7% of the former had a CAT score above 10 and 24.2% reported chronic bronchitis. QCT assessments of Disease Probability-defined functional small airways disease, ground glass opacification, bronchovascular prominence and small blood vessel to total pulmonary vessel volume ratio were increased compared to controls and were all associated with a faster FEV 1 decline as was a higher CAT score. CONCLUSIONS: Radiologic abnormalities on CT are already established in young smokers with normal lung function and is associated with FEV 1 loss independently of the impact of symptoms. Structural abnormalities are present early in the natural history of COPD and are markers of disease progression.

U2 - 10.1164/rccm.202307-1203OC

DO - 10.1164/rccm.202307-1203OC

M3 - Article

C2 - 38175920

SN - 1073-449X

VL - 209

SP - 1208

EP - 1218

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 10

ER -

Structural predictors of lung function decline in young smokers with normal spirometry

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