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Original Research: LUNG FUNCTION TESTING |

A New Breath-Holding Test May Noninvasively Reveal Early Lung Abnormalities Caused by Smoking and/or Obesity

Hiroshi Inoue, MD, PhD, FCCP; Kohei Yamauchi, MD, PhD; Hitoshi Kobayashi, MD, PhD; Toshiki Shikanai, MD, PhD, FCCP; Yutaka Nakamura, MD, PhD; Jo Satoh, MD, PhD; Nobuoki Kohno, MD, PhD, FCCP; Michiaki Mishima, MD, PhD; Hidetada Sasaki, MD, PhD; Jack Hildebrandt, PhD
Author and Funding Information

From the Divisions of Pulmonary Medicine, Allergy, and Rheumatology (Drs. Inoue, Yamauchi, Kobayashi, Shikanai, and Nakamura), and Diabetes and Metabolism (Dr. Satoh), Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan; the Department of Molecular and Internal Medicine (Dr. Kohno), Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan; the Department of Respiratory Medicine (Dr. Mishima), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Akita University of Nursing and Welfare (Dr. Sasaki), Akita, Japan; and the Department of Physiology and Biophysics (Dr. Hildebrandt), University of Washington, Seattle, WA.

Hiroshi Inoue, MD, PhD, FCCP, Department of Internal Medicine, Division of Pulmonary Medicine, Allergy, and Rheumatology, Iwate Medical University School of Medicine, 19–1, Uchimaru, Morioka, Japan 020–8505; e-mail: hinoue@iwate-med.ac.jp


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):545-553. doi:10.1378/chest.08-1378
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Background:  Smoking and obesity are leading global causes of death. The aim of the present study was to develop a test to detect early lung abnormalities caused by smoking and/or obesity and to elucidate the underlying mechanisms and major contributory factors.

Methods:  One hundred twenty-nine healthy adults, 20 to 40 years of age, with normal spirometry findings, were divided into the following five groups: 38 healthy subjects (15 female subjects); 46 smokers (5 female smokers); 18 overweight nonsmokers (2 female nonsmokers; normal body mass index [BMI], ≥ 25 kg/m2; range, 25.0 to 37.2 kg/m2); 19 overweight smokers (1 female smoker; BMI range, 25.2 to 33.5 kg/m2); and 8 ex-smokers (BMI range, 20.8 to 24.1 kg/m2). A modified pulse oximeter was employed for measuring the fall in pulse oximetric saturation caused by 20-s breath-holding (dSpo2) at resting end expiration in the sitting posture.

Results:  In healthy subjects, dSpo2 had no significant correlation with age (r2 = 0.009; p = 0.66). In smokers, dSpo2 correlated with both the number of pack-years (r2 = 0.590; p < 0.001) and closing volume (CV)/vital capacity (VC) ratio (r2 = 0.573; p < 0.001). In overweight nonsmokers, dSpo2 increased significantly with BMI alone (r2 = 0.667; p < 0.001). In overweight smokers, the largest increase in the mean dSpo2 was observed. Multiple linear regression analysis suggested that BMI and CV/VC are the two major contributing factors determining dSpo2 during breath-holding. In young former smokers, no significant increase in the mean dSpo2 was observed (p = 0.77) a mean (± SD) duration of 5.2 ± 2.9 years after the cessation of smoking. No significant difference in dSpo2 was observed between men and women.

Conclusions:  A new test that measures oxygen saturation during breath-holding reveals early lung abnormalities in subjects who either smoke or are overweight, especially if these factors are combined. Peripheral airway abnormalities and/or lung volume reduction may play roles in the greater desaturation.

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