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

McAllister, D. A. et al. (2014) Emphysema predicts hospitalisation and incident airflow obstruction among older smokers: a prospective cohort study. PLoS ONE, 9(4), e93221. (doi: 10.1371/journal.pone.0093221) (PMID:24699215) (PMCID:PMC3974731)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McAllister, Professor David
• Authors: McAllister, D. A., Ahmed, F. S., Austin, J. H.M., Henschke, C. I., Keller, B. M., Lemeshow, A., Reeves, A. P., Mesia-Vela, S., Pearson, G.D.N., Shiau, M. C., Schwartz, J. E., Yankelevitz, D. F., and Barr, R. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: PLoS ONE
• Publisher: Public Library of Science
• ISSN: 1932-6203
• ISSN (Online): 1932-6203
• Copyright Holders: Copyright © 2014 McAllister et al.
• First Published: First published in PLoS ONE 9(4):e93221
• Publisher Policy: Reproduced under a Creative Commons License