Dataset Information

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study.

ABSTRACT:

Background

Little is known about the factors associated with CT-quantified emphysema progression in heavy smokers. The objective of this study was to investigate the effect of length of smoking cessation and clinical / demographical factors on the rate of emphysema progression and FEV1-decline in male heavy smokers.

Methods

3,670 male smokers with mean (SD) 40.8 (17.9) packyears underwent chest CT scans and pulmonary function tests at baseline and after 1 and 3 years follow-up. Smoking status (quitted ?5, ?1-<5, <1 years or current smoker) was noted. Rate of progression of emphysema and FEV1-decline after follow-up were assessed by analysis of variance adjusting for age, height, baseline pulmonary function and emphysema severity, packyears, years in study and respiratory symptoms. The quitted ?5 group was used as reference.

Results

Median (Q1-Q3) emphysema severity,<-950 HU, was 8.8 (5.1 - 14.1) and mean (SD) FEV1 was 3.4 (0.73) L or 98.5 (18.5) % of predicted. The group quitted '>5 years' showed significantly lower rates of progression of emphysema compared to current smokers, 1.07% and 1.12% per year, respectively (p<0.001). Current smokers had a yearly FEV1-decline of 69 ml, while subjects quit smoking >5 years had a yearly decline of 57.5 ml (p<0.001).

Conclusion

Quit smoking >5 years significantly slows the rate of emphysema progression and lung function decline.

Trial registration

Registered at http://www.trialregister.nl with trial number ISRCTN63545820.

SUBMITTER: Mohamed Hoesein FA

PROVIDER: S-EPMC3669040 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study.

Mohamed Hoesein Firdaus A A FA Zanen Pieter P de Jong Pim A PA van Ginneken Bram B Boezen H Marike HM Groen Harry J M HJ Oudkerk Mathijs M de Koning Harry J HJ Postma Dirkje S DS Lammers Jan-Willem J JW

Respiratory research 20130520

<h4>Background</h4>Little is known about the factors associated with CT-quantified emphysema progression in heavy smokers. The objective of this study was to investigate the effect of length of smoking cessation and clinical / demographical factors on the rate of emphysema progression and FEV1-decline in male heavy smokers.<h4>Methods</h4>3,670 male smokers with mean (SD) 40.8 (17.9) packyears underwent chest CT scans and pulmonary function tests at baseline and after 1 and 3 years follow-up. Sm ...[more]

PMID: 23688060

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Project description:Background The correlation between visual emphysema patterns and subsequent progression of disease may provide a way to enrich a study population for treatment trials of emphysema. Purpose To evaluate the potential relationship between emphysema visual subtypes and progression of emphysema and gas trapping. Materials and Methods Current and former smokers with and without chronic obstructive pulmonary disease (COPD) enrolled in the prospective Genetic Epidemiology of COPD (COPDGene) study (ClinicalTrials.gov identifier: NCT02445183) between 2008 and 2011 had their Fleischner Society visual CT scores assessed at baseline, quantitative inspiratory, and expiratory CT and at 5 years. They also underwent pulmonary function testing at baseline CT and at 5 years. The dependent variables were inspiratory lung density at 15th percentile (adjusted for lung volume) as a measure of emphysema and percentage of lung volume with attenuation less than -856 HU at expiratory CT as a measure of air trapping. Statistical analysis used a linear mixed model, adjusted for age, height, sex, race, smoking status, and scanner make. Results A total of 4166 participants (mean age, 60 years ± 9 [standard deviation]; 2091 [50%] men) were evaluated. In participants with COPD (1655 participants, 40%), those with visual presence of mild, moderate, and confluent emphysema at baseline CT showed a mean decline in lung density of 4.6 g/L ± 1.1 (P < .001), 6.7 g/L ± 1.1 (P < .001), and 6.4 g/L ± 1.2 (P < .001), respectively, compared with 2.4 g/L ± 1.3 (P < .001) for those with trace emphysema. For participants without COPD, those with visual presence of mild and moderate emphysema at baseline CT showed a mean decline in lung density of 3.6 g/L ± 1.0 (P < .001) and 3.1 g/L ± 1.6 (P < .001), respectively, compared with 1.8 g/L ± 1.0 (P < .001) for those with trace emphysema. Conclusion The pattern of parenchymal emphysema at baseline CT was an independent predictor of subsequent progression of emphysema in participants who are current or former cigarette smokers with and without chronic obstructive pulmonary disease. © RSNA, 2020 Online supplemental material is available for this article.

Project description:PurposeNormalized emphysema score is a protocol-robust CT biomarker of mortality. We aimed to improve mortality prediction by including the emphysema score progression rate-its change over time-into the models.Method and materialsCT scans from 6000 National Lung Screening Trial CT arm participants were included. Of these, 1810 died (445 lung cancer-specific). The remaining 4190 survivors were sampled with replacement up to 24432 to approximate the full cohort. Three overlapping subcohorts were formed which required participants to have images from specific screening rounds. Emphysema scores were obtained after resampling, normalization, and bullae cluster analysis of the original images. Base models contained solely the latest emphysema score. Progression models included emphysema score progression rate. Models were adjusted by including baseline age, sex, BMI, smoking status, smoking intensity, smoking duration, and previous COPD diagnosis. Cox proportional hazard models predicting all-cause and lung cancer mortality were compared by calculating the area under the curve per year follow-up.ResultsIn the subcohort of participants with baseline and first annual follow-up scans, the analysis was performed on 4940 participants (23227 after resampling). Area under the curve for all-cause mortality predictions of the base and progression models 6 years after baseline were 0.564 (0.564 to 0.565) and 0.569 (0.568 to 0.569) when unadjusted, and 0.704 (0.703 to 0.704) to 0.705 (0.704 to 0.705) when adjusted. The respective performances predicting lung cancer mortality were 0.638 (0.637 to 0.639) and 0.643 (0.642 to 0.644) when unadjusted, and 0.724 (0.723 to 0.725) and 0.725 (0.725 to 0.726) when adjusted.ConclusionIncluding emphysema score progression rate into risk models shows no clinically relevant improvement in mortality risk prediction. This is because scan normalization does not adjust for an overall change in lung density. Adjusting for changes in smoking behavior is likely required to make this a clinically useful measure of emphysema progression.

Project description:BackgroundTobacco smoking may cause pulmonary perfusion abnormality. Assessment of the lung perfusion characteristics is very significant to timely treatment and prevent disease progression in smokers. The purpose was to investigate the value of iodine maps from spectral dual-layer detector computed tomography (DLCT) in assessing lung perfusion changes in smokers.MethodsNineteen smokers and 29 non-smokers who underwent dual-phase contrast enhanced scans on a spectral DLCT were retrospectively collected. Emphysema on non-contrast images and perfusion defect (PD) on iodine maps were scored visually at bilateral lung fields of three anatomic levels (on the slice of the aortic arch, the carina, and the aperture of the inferior pulmonary veins). The scores were calculated based on the ratio of the abnormality occupied in the pulmonary field of each slice as described below: point 0, no abnormality; point 1, 0%< abnormality scope ≤25%; points 2, 25%< abnormality scope ≤50%; points 3, 50%< abnormality scope ≤75%; points 4, abnormality scope >75%. The sum of scores for each patient was calculated. The iodine density (ID) of PD and thoracic aorta were measured respectively (IDdefect, IDthoracic aorta), then calculating the ratio as the normalized ID (nID). Emphysema index (EI) was defined as the volume percentage of the lung attenuation below -950 Hounsfield units. The percentage of forced expiratory volume in 1 second (FEV1) to the predicted value (FEV1%) and the ratio of FEV1 to forced vital capacity (FVC) were recorded. The differences of the emphysema and PD visual scores, IDdefect, nID, EI were analyzed by analysis of variance between smokers and non-smokers. Correlations between emphysema, PD and FEV1%, FEV1/FVC were evaluated by Spearman correlation analysis.ResultsThe PD visual scores on ID images were significantly higher in smokers compared with that in non-smokers (P=0.014), while no significantly difference was found for emphysema visual scores (P=0.402). Both IDdefect and nID were significantly lower in smokers compared with non-smokers (P=0.003; P=0.029), while no significantly difference was found for EI (P=0.061). Besides, PD visual scores were negatively correlated with FEV1% (r=-0.61, P=0.025) and FEV1/FVC (r=-0.62, P=0.024) for smokers.ConclusionsCompared with emphysema, the iodine map derived from spectral DLCT showed higher sensitivity for the evaluation of the pulmonary abnormalities of smokers.

Dataset Information

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study.

Background

Methods

Results

Conclusion

Trial registration

Publications

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study.

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