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. 2014 Apr 3;9(4):e93221.
doi: 10.1371/journal.pone.0093221. eCollection 2014.

Emphysema predicts hospitalisation and incident airflow obstruction among older smokers: a prospective cohort study

David A McAllister  1 , Firas S Ahmed  2 , John H M Austin  3 , Claudia I Henschke  4 , Brad M Keller  5 , Adina Lemeshow  2 , Anthony P Reeves  6 , Sonia Mesia-Vela  2 , G D N Pearson  3 , Maria C Shiau  7 , Joseph E Schwartz  2 , David F Yankelevitz  4 , R Graham Barr  8
Affiliations

Emphysema predicts hospitalisation and incident airflow obstruction among older smokers: a prospective cohort study

David A McAllister et al. PLoS One. .

Abstract

Background: Emphysema on CT is common in older smokers. We hypothesised that emphysema on CT predicts acute episodes of care for chronic lower respiratory disease among older smokers.

Materials and methods: Participants in a lung cancer screening study age ≥ 60 years were recruited into a prospective cohort study in 2001-02. Two radiologists independently visually assessed the severity of emphysema as absent, mild, moderate or severe. Percent emphysema was defined as the proportion of voxels ≤ -910 Hounsfield Units. Participants completed a median of 5 visits over a median of 6 years of follow-up. The primary outcome was hospitalization, emergency room or urgent office visit for chronic lower respiratory disease. Spirometry was performed following ATS/ERS guidelines. Airflow obstruction was defined as FEV1/FVC ratio <0.70 and FEV1<80% predicted.

Results: Of 521 participants, 4% had moderate or severe emphysema, which was associated with acute episodes of care (rate ratio 1.89; 95% CI: 1.01-3.52) adjusting for age, sex and race/ethnicity, as was percent emphysema, with similar associations for hospitalisation. Emphysema on visual assessment also predicted incident airflow obstruction (HR 5.14; 95% CI 2.19-21.1).

Conclusion: Visually assessed emphysema and percent emphysema on CT predicted acute episodes of care for chronic lower respiratory disease, with the former predicting incident airflow obstruction among older smokers.

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Conflict of interest statement

Competing Interests: The authors have the following interests: DY, AR, and CH are named inventors on the following patents and patent applications relating to the evaluation of diseases of the chest including measurement of nodules: 7274810 (System and method for three-dimensional image rendering and analysis), 7499578 (System, method and apparatus for small pulmonary nodule computer aided diagnosis from computed tomography scans), 7693729 (System and method for conducting a clinical trial study),7751607 (System, method and apparatus for small pulmonary nodule computer aided diagnosis from computed tomography scans), 8045770 (System and method for three-dimensional image rendering and analysis), 8050481 (Method and apparatus for small pulmonary nodule computer aided diagnosis from computed tomography scans), 8165385 (System and method for three-dimensional image rendering and analysis), 8577129 (System and method for three-dimensional image rendering and analysis). Some of these, which are owned by Cornell Research Foundation (CRF) are nonexclusively licensed to General Electric. As an inventor of these patents, DY, AR, and CH are entitled to a share of any compensation which CRF may receive from its commercialization of these patents. As of April 2009, CH has signed away any financial benefit including royalties and any other proceeds related to the patents or patent applications. SV is currently employed by GSK but exclusively performed the work while an employee of Columbia University. This study was partly funded by Empire Blue Cross and Blue Shield. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Cumulative incidence plot of time to first episode by percent emphysema.
See this image and copyright information in PMC

References

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