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Int. J. Environ. Res. Public Health 2011, 8(5), 1324-1340; doi:10.3390/ijerph8051324

Cross-Sectional Analysis of the Utility of Pulmonary Function Tests in Predicting Emphysema in Ever-Smokers

1
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
2
Division of Cancer Prevention and Control, The H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
3
Children’s Nutrition Research Center (CNRC), Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA
4
University of British Columbia, Vancouver Campus, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
5
Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA
*
Author to whom correspondence should be addressed.
Received: 15 January 2011 / Revised: 20 April 2011 / Accepted: 22 April 2011 / Published: 29 April 2011
(This article belongs to the Special Issue Tobacco Smoking and Public Health)
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Abstract

Emphysema is largely an under-diagnosed medical condition that can exist in smokers in the absence of airway obstruction. We aimed to determine the sensitivity and specificity of pulmonary function tests (PFTs) in assessing emphysema using quantitative CT scans as the reference standard. We enrolled 224 ever-smokers (current or former) over the age of 40. CT of thorax was used to quantify the low attenuation area (% emphysema), and to measure the standardized airway wall thickness. PFTs were used individually and in combination to predict their ability to discriminate radiographic emphysema. Significant emphysema (>7%) was detected in 122 (54%) subjects. Twenty six (21%) emphysema subjects had no evidence of airflow obstruction (FEV1/FVC ratio 23% emphysema showed airflow obstruction. The sensitivity and specificity of spirometry for detecting radiographic emphysema were 79% and 75%, respectively. Standardized airway wall thickness was increased in subjects with airflow obstruction, but did not correlate with emphysema severity. In this cohort of lifetime ever-smokers, PFTs alone were inadequate for diagnosing emphysema. Airway wall thickness quantified by CT morphometry was associated with airflow limitation, but not with emphysema indicating that the heterogeneous nature of lung disease in smokers may represent distinct phenotypes. View Full-Text
Keywords: airflow limitation; chronic obstructive pulmonary disease; CT morphometry; emphysema; airway wall thickness; pulmonary function test airflow limitation; chronic obstructive pulmonary disease; CT morphometry; emphysema; airway wall thickness; pulmonary function test
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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MDPI and ACS Style

Hesselbacher, S.E.; Ross, R.; Schabath, M.B.; Smith, E.O.; Perusich, S.; Barrow, N.; Smithwick, P.; Mammen, M.J.; Coxson, H.; Krowchuk, N.; Corry, D.B.; Kheradmand, F. Cross-Sectional Analysis of the Utility of Pulmonary Function Tests in Predicting Emphysema in Ever-Smokers. Int. J. Environ. Res. Public Health 2011, 8, 1324-1340.

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