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Original Research: COPD |

Clinical Features of Smokers With Radiological Emphysema But Without Airway Limitation

Ana B. Alcaide, MD; Pablo Sanchez-Salcedo, MD; Gorka Bastarrika, MD; Arantza Campo, MD; Juan Berto, MD; Maria del Mar Ocon, RN; Alejandro Fernandez-Montero, MD, PhD; Bartolome R. Celli, MD; Javier J. Zulueta, MD; Juan P. de-Torres, MD
Author and Funding Information

Drs Zulueta and de-Torres contributed equally to this work.

FUNDING/SUPPORT: This work was supported in part by a grant [RD12/0036/0062] from Red Tematica de Investigacion Cooperativa en Cancer, Instituto de Salud Carlos III, the Spanish Ministry of Economy and Competitiveness and European Regional Development Fund “Una manera de hacer Europa.” It was also supported by grants PI04/2404, PI07/0792, PI10/01652, and PI11/01626 from the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Government of Spain.

aPulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain

bRadiology Department, Clínica Universidad de Navarra, Pamplona, Spain

cDepartment of Preventive Medicine, Clínica Universidad de Navarra, Pamplona, Spain

dPulmonary Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

CORRESPONDENCE TO: Juan P. de Torres, MD, Pulmonary Service, Clínica Universidad de Navarra, Av Pío XII, 36, Pamplona, Spain 31008


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(2):358-365. doi:10.1016/j.chest.2016.10.044
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Background  The clinical characteristics of patients with emphysema but without airway limitations remain unknown. The goal of this study was to compare the clinical features of current and former smokers without airflow limitation who have radiologic emphysema on chest CT scans vs a control group of current and ex-smokers without emphysema.

Methods  Subjects enrolled had anthropometric characteristics recorded, provided a medical history, and underwent low-dose chest CT scanning. The following parameters were also evaluated: pulmonary function tests including diffusion capacity for carbon monoxide (Dlco), the modified Medical Research Council dyspnea score, COPD assessment test (CAT), and 6-min walk test (6MWT). A comparison was conducted between those with and without CT-confirmed emphysema.

Results  Of the 203 subjects, 154 had emphysema, and 49 did not. Adjusted group comparisons revealed that a higher proportion of patients with emphysema according to low-dose chest CT scanning had an abnormal Dlco value (< 80%) (46% vs 19%; P = .02), a decrease in percentage of oxygen saturation > 4% during the 6MWT (8.5% vs 0; P = .04), and an altered quality of life (CAT score ≥ 10) (32% vs 14%; P = .01). A detailed analysis of the CAT questionnaire items revealed that more patients with emphysema had a score ≥ 1 in the “chest tightness” (P = .05) and “limitation when doing activities at home” (P < .01) items compared with those with no emphysema. They also experienced significantly more exacerbations in the previous year (0.19 vs 0.04; P = .02).

Conclusions  A significant proportion of smokers with emphysema according to low-dose chest CT scanning but without airway limitation had alterations in their quality of life, number of exacerbations, Dlco values, and oxygen saturation during the 6MWT test.

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