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Original Research |

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; Bartolome R. Celli, MD; Javier J. Zulueta, MD; Juan P. de-Torres, MD
Author and Funding Information

Conflicts of interest: Javier Zulueta, MD, is CMO of Visiongate, Inc. USA. Juan P. de Torres has received consultancy fees for participating in Advisory Boards for Takeda Pharmaceuticals International GmbH, Menarini, and Novartis AG; he also received fees for speaking activities from GlaxoSmithKline plc, AstraZeneca, Chiesi, Menarini, Novartis AG, Merck, Sharp & Dohme Corporation, and Takeda Pharmaceuticals International GmbH, as well as consultancy fees for participating in the Advisory Boards for Takeda Pharmaceuticals International GmbH and Novartis AG. The rest of authors declared no conflict of interest.

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, Spanish Ministry of Economy and Competitiveness and European Regional Development Fund (ERDF) “Una manera de hacer Europa”; and by grants PI04/2404, PI07/0792, PI10/01652, PI11/01626, Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Government of Spain.

1Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain

2Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain

3Pulmonary Department, Brigham and Women’s Hospital. Harvard Medical School Boston, MA

Corresponding author: Juan P. de Torres MD Pulmonary Service Clínica Universidad de Navarra Pamplona – SPAIN 31008.


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


Chest. 2016. doi:10.1016/j.chest.2016.10.044
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Abstract

Rationale  The clinical characteristics of patients with emphysema but without airway limitation remain unknown.

Objective  To compare the clinical features of current and former smokers without airflow limitation who have radiological emphysema on chest CT with a control group of current and ex-smokers without emphysema.

Methods  Subjects enrolled had anthropometrics, medical history and a low dose chest computed tomography (LDCT). The following parameters were also evaluated: pulmonary function tests (PFT) including diffusion capacity for carbon monoxide (DLCO), modified MRC dyspnea score, COPD assessment test (CAT) and 6-min walk distance (6MWD). A comparison was conducted between those with and those without CT emphysema.

Results  Of the 203 subjects, 154 had emphysema (78%) while 49 did not. Adjusted group comparisons revealed that a higher proportion of patients with emphysema on LDCT had an abnormal DLCO (<80%) (46% vs 19%, p=0.02), a fall of SpO2% >4% during the 6MWD (8,5% vs 0%, p= 0,04) and an altered quality of life (CAT score ≥ 10) (32% vs 14%, p=0.01). A detailed analysis of the CAT questionnaire items revealed that more patients with emphysema had a score≥1 in the “chest tightness” (p=0.05), and “limitation when doing activities at home” items (p<0.01) compared with no emphysema. They also had significantly more exacerbations in the previous year (0.19 vs 0.04, p=0.02).

Conclusions  A significant proportion of smokers with emphysema on LDCT but without airway limitation have alterations in their quality of life, number of exacerbations, diffusion capacity and oxygen saturation during the 6MWD test.


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