Chronic Airflow Limitation, Emphysema, and Impaired Diffusing Capacity in Relation to Smoking Habits in a Swedish Middle-aged Population

<b>Rationale:</b> Chronic obstructive pulmonary disease (COPD) includes respiratory symptoms and chronic airflow limitation (CAL). In some cases, emphysema and impaired diffusing capacity of the lung for carbon monoxide (Dl<sub>CO</sub>) are present, but characteristics and symptoms vary with smoking exposure. <b>Objective:</b> To study the prevalence of CAL, emphysema, and impaired Dl<sub>CO</sub> in relation to smoking and respiratory symptoms in a middle-aged population. <b>Methods:</b> We investigated 28,746 randomly invited individuals (52% women) aged 50-64 years across six Swedish sites. We performed spirometry, Dl<sub>CO</sub> testing, and high-resolution computed tomography and asked for smoking habits and respiratory symptoms. CAL was defined as post-bronchodilator forced expiratory volume in 1 second divided by forced vital capacity (FEV<sub>1</sub>/FVC) < 0.7. <b>Results:</b> The overall prevalence was 8.8% for CAL, 5.7% for impaired Dl<sub>CO</sub> (Dl<sub>CO</sub> < LLN), and 8.8% for emphysema, with a higher prevalence in current smokers than in ex-smokers and never-smokers. The proportion of never-smokers among those with CAL, emphysema, and impaired Dl<sub>CO</sub> was 32%, 19%, and 31%, respectively. Regardless of smoking habits, the prevalence of respiratory symptoms was higher among people with CAL and impaired Dl<sub>CO</sub> than those with normal lung function. Asthma prevalence in never-smokers with CAL was 14%. In this group, asthma was associated with lower FEV<sub>1</sub> and more respiratory symptoms. <b>Conclusions:</b> In this large population-based study of middle-aged people, CAL and impaired Dl<sub>CO</sub> were associated with common respiratory symptoms. Self-reported asthma was not associated with CAL in never-smokers. Our findings suggest that CAL in never-smokers signifies a separate clinical phenotype that may be monitored and, possibly, treated differently from smoking-related COPD.

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Publication Details

Journal
Annals of the American Thoracic Society
Published
2024-08-12
DOI
https://doi.org/10.1513/annalsats.202402-122oc
Citations
6
Primary Topic
Chronic Obstructive Pulmonary Disease (COPD) Research
Type
article
Field-Weighted Citation Impact
2.51

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article

Chronic Airflow Limitation, Emphysema, and Impaired Diffusing Capacity in Relation to Smoking Habits in a Swedish Middle-aged Population

Anders Persson, Anders Blomberg, Anders Andersson, Anna‐Carin Olin et al.
6 citations
Annals of the American Thoracic Society
Chronic Obstructive Pulmonary Disease (COPD) Research
2.51
article

Chronic Airflow Limitation, Emphysema, and Impaired Diffusing Capacity in Relation to Smoking Habits in a Swedish Middle-aged Population

Anders Persson, Anders Blomberg, Anders Andersson, Anna‐Carin Olin, David Kylhammar, Göran M.L. Bergström, Lars Lind, Eva Swahn, Emil Hagström, Annelie Behndig, Magnus Per Ekström, Andreï Malinovschi, Anne Lindberg, Jenny Vikgren, Tomas Jernberg, Per Liv, Stefan Söderberg, Christer Janson, Kjell Torén, Annika Rosengren, Hans Lennart Persson, Carl Johan Östgren, Per Wollmer, Jan Engvall, Gabriel Granåsen, Eva Lindberg, Johan Sundström, Kerstin Cederlund, Kenneth Caidahl, Lars Nilsson, John Brandberg, Maria J. Eriksson, Maria Mannila, Arne Egesten, C. Magnus Sköld, Claes-Göran Löfdahl
article en
6 citations

Abstract

<b>Rationale:</b> Chronic obstructive pulmonary disease (COPD) includes respiratory symptoms and chronic airflow limitation (CAL). In some cases, emphysema and impaired diffusing capacity of the lung for carbon monoxide (Dl<sub>CO</sub>) are present, but characteristics and symptoms vary with smoking exposure. <b>Objective:</b> To study the prevalence of CAL, emphysema, and impaired Dl<sub>CO</sub> in relation to smoking and respiratory symptoms in a middle-aged population. <b>Methods:</b> We investigated 28,746 randomly invited individuals (52% women) aged 50-64 years across six Swedish sites. We performed spirometry, Dl<sub>CO</sub> testing, and high-resolution computed tomography and asked for smoking habits and respiratory symptoms. CAL was defined as post-bronchodilator forced expiratory volume in 1 second divided by forced vital capacity (FEV<sub>1</sub>/FVC) < 0.7. <b>Results:</b> The overall prevalence was 8.8% for CAL, 5.7% for impaired Dl<sub>CO</sub> (Dl<sub>CO</sub> < LLN), and 8.8% for emphysema, with a higher prevalence in current smokers than in ex-smokers and never-smokers. The proportion of never-smokers among those with CAL, emphysema, and impaired Dl<sub>CO</sub> was 32%, 19%, and 31%, respectively. Regardless of smoking habits, the prevalence of respiratory symptoms was higher among people with CAL and impaired Dl<sub>CO</sub> than those with normal lung function. Asthma prevalence in never-smokers with CAL was 14%. In this group, asthma was associated with lower FEV<sub>1</sub> and more respiratory symptoms. <b>Conclusions:</b> In this large population-based study of middle-aged people, CAL and impaired Dl<sub>CO</sub> were associated with common respiratory symptoms. Self-reported asthma was not associated with CAL in never-smokers. Our findings suggest that CAL in never-smokers signifies a separate clinical phenotype that may be monitored and, possibly, treated differently from smoking-related COPD.

Annals of the American Thoracic SocietyVol. 21(12)
Linköping University (SE), Uppsala University (SE), Karolinska University Hospital (SE), Lund University (SE), Sahlgrenska University Hospital (SE), Karolinska Institutet (SE), UNSW Sydney (AU), Region Västra Götaland (SE), Glanrhyd Hospital (GB), ENT and Allergy (US), The George Institute for Global Health (AU), Faculty of Public Health (GB), COPD Foundation (US), Institute of Cardiology (PL), Pediatrics and Genetics (US), Czech Academy of Sciences, Institute of Physiology (CZ), University of Gothenburg (SE), Umeå University (SE)
Hjärt-Lungfonden, Akademiska Sjukhuset
Good health and well-being
Openalex Percentile: Top 10%
Chronic Obstructive Pulmonary Disease (COPD) Research
2.51
DOIOpen Access PDFOpenAlex
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