Respiratory Exacerbations and Lung Function Decline in People with Smoking History and Normal Spirometry

<b>Rationale:</b> The impact of respiratory exacerbation on chronic obstructive pulmonary disease (COPD) is well established. The effects of respiratory exacerbations in people with cigarette smoking but normal spirometry are unknown. <b>Objectives:</b> To assess the association of respiratory exacerbations with lung function decline and mortality in people with normal spirometry and current or former cigarette smoking history. <b>Methods:</b> We analyzed data from COPDGene study participants with ⩾10 pack-years of cigarette smoking and normal spirometry at enrollment (Visit 1) defined as post-bronchodilator FEV<sub>1</sub>/FVC greater than or equal to the lower limit of normal and FEV<sub>1</sub> greater than or equal to the lower limit of normal. We examined whether respiratory exacerbations occurring between Visit 1 and the 5-year follow-up visit (Visit 2) were associated with FEV<sub>1</sub> decline and all-cause mortality. <b>Measurements and Main Results:</b> Among 2,939 participants with cigarette smoking history and normal lung function at Visit 1, each additional exacerbation between Visits 1 and 2 was associated with a 2.96 ml/yr FEV<sub>1</sub> decline (95% confidence interval [CI], 1.81 to 4.12; <i>P</i> < 0.001) at Visit 2. Experiencing one or more severe exacerbations between Visits 1 and 2 was associated with 14.6 ml/yr FEV<sub>1</sub> decline relative to those with no severe exacerbations (95% CI, 8.56 to 20.6; <i>P</i> < 0.001). Individuals with one or more severe exacerbations between Visits 1 and 2 had increased mortality compared with those with no severe exacerbations (17.1% vs. 9.8%; adjusted hazard ratio, 1.97; 95% CI, 1.40 to 2.77; <i>P</i> < 0.001). <b>Conclusions:</b> Respiratory exacerbations in people with cigarette smoking but normal spirometry were associated with lung function decline. Experiencing a severe respiratory exacerbation was associated with increased mortality.

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Publication Details

Journal
American Journal of Respiratory and Critical Care Medicine
Published
2025-02-13
DOI
https://doi.org/10.1164/rccm.202401-0023oc
Citations
9
Primary Topic
Chronic Obstructive Pulmonary Disease (COPD) Research
Type
article
Field-Weighted Citation Impact
13.67
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article

Respiratory Exacerbations and Lung Function Decline in People with Smoking History and Normal Spirometry

Trisha M. Parekh, Gregory L. Kinney, Mark Dransfield, Elizabeth A. Regan et al.
9 citations
American Journal of Respiratory and Critical Care Medicine
Chronic Obstructive Pulmonary Disease (COPD) Research
13.67
article

Respiratory Exacerbations and Lung Function Decline in People with Smoking History and Normal Spirometry

Trisha M. Parekh, Gregory L. Kinney, Mark Dransfield, Elizabeth A. Regan, Chris H. Wendt, Russell Paul Bowler, Edwin K. Silverman, Spyridon Fortis, Linder Wendt, Surya Prakash Bhatt, Emily S. Wan, James D. Crapo, Jeffrey L. Curtis, John E. Hokanson, Matthew Strand, Patrick Ten Eyck, Alejandro P. Comellas, Ken M. Kunisaki, MeiLan K. Han
article en
9 citations

Abstract

<b>Rationale:</b> The impact of respiratory exacerbation on chronic obstructive pulmonary disease (COPD) is well established. The effects of respiratory exacerbations in people with cigarette smoking but normal spirometry are unknown. <b>Objectives:</b> To assess the association of respiratory exacerbations with lung function decline and mortality in people with normal spirometry and current or former cigarette smoking history. <b>Methods:</b> We analyzed data from COPDGene study participants with ⩾10 pack-years of cigarette smoking and normal spirometry at enrollment (Visit 1) defined as post-bronchodilator FEV<sub>1</sub>/FVC greater than or equal to the lower limit of normal and FEV<sub>1</sub> greater than or equal to the lower limit of normal. We examined whether respiratory exacerbations occurring between Visit 1 and the 5-year follow-up visit (Visit 2) were associated with FEV<sub>1</sub> decline and all-cause mortality. <b>Measurements and Main Results:</b> Among 2,939 participants with cigarette smoking history and normal lung function at Visit 1, each additional exacerbation between Visits 1 and 2 was associated with a 2.96 ml/yr FEV<sub>1</sub> decline (95% confidence interval [CI], 1.81 to 4.12; <i>P</i> < 0.001) at Visit 2. Experiencing one or more severe exacerbations between Visits 1 and 2 was associated with 14.6 ml/yr FEV<sub>1</sub> decline relative to those with no severe exacerbations (95% CI, 8.56 to 20.6; <i>P</i> < 0.001). Individuals with one or more severe exacerbations between Visits 1 and 2 had increased mortality compared with those with no severe exacerbations (17.1% vs. 9.8%; adjusted hazard ratio, 1.97; 95% CI, 1.40 to 2.77; <i>P</i> < 0.001). <b>Conclusions:</b> Respiratory exacerbations in people with cigarette smoking but normal spirometry were associated with lung function decline. Experiencing a severe respiratory exacerbation was associated with increased mortality.

American Journal of Respiratory and Critical Care MedicineVol. 211(6)
University of Iowa (US), Brigham and Women's Hospital (US), University of Minnesota (US), United States Department of Veterans Affairs (US), Colorado School of Public Health (US), University of Michigan (US), Seton Medical Center (US), VA Boston Healthcare System (US), University of Iowa Hospitals and Clinics (US), National Jewish Health (US), University of Alabama at Birmingham (US), Cancer Research And Biostatistics (US), VA Ann Arbor Healthcare System (US), Michigan United (US), Michigan Medicine (US), Birmingham VA Medical Center (US), Minneapolis VA Health Care System (US), Iowa City VA Health Care System (US), SleepMed (US), Seton Medical Center Austin (US), Pulmonary and Critical Care Associates (US), University of Colorado Anschutz Medical Campus (US), The University of Texas at Austin (US), University of Colorado Denver (US)
Good health and well-being
Openalex Percentile: Top 1%
Chronic Obstructive Pulmonary Disease (COPD) Research
13.67
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