PMID- 26836732 OWN - NLM STAT- MEDLINE DCOM- 20160211 LR - 20210421 IS - 1538-3598 (Electronic) IS - 0098-7484 (Print) IS - 0098-7484 (Linking) VI - 315 IP - 5 DP - 2016 Feb 2 TI - Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers. PG - 498-505 LID - 10.1001/jama.2015.19431 [doi] AB - IMPORTANCE: Central airway collapse greater than 50% of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown. OBJECTIVE: To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease. DESIGN, SETTING, AND PARTICIPANTS: Analysis of paired inspiratory-expiratory computed tomography images from a large multicenter study (COPDGene) of current and former smokers from 21 clinical centers across the United States. Participants were enrolled from January 2008 to June 2011 and followed up longitudinally until October 2014. Images were initially screened using a quantitative method to detect at least a 30% reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen-positive scans, cross-sectional area of the trachea was measured manually at 3 predetermined levels (aortic arch, carina, and bronchus intermedius) to confirm ECAC (>50% reduction in cross-sectional area). EXPOSURES: Expiratory central airway collapse. MAIN OUTCOMES AND MEASURES: The primary outcome was baseline respiratory quality of life (St George's Respiratory Questionnaire [SGRQ] scale 0 to 100; 100 represents worst health status; minimum clinically important difference [MCID], 4 units). Secondary outcomes were baseline measures of dyspnea (modified Medical Research Council [mMRC] scale 0 to 4; 4 represents worse dyspnea; MCID, 0.7 units), baseline 6-minute walk distance (MCID, 30 m), and exacerbation frequency (events per 100 person-years) on longitudinal follow-up. RESULTS: The study included 8820 participants with and without COPD (mean age, 59.7 [SD, 6.9] years; 4667 [56.7%] men; 4559 [51.7%] active smokers). The prevalence of ECAC was 5% (443 cases). Patients with ECAC compared with those without ECAC had worse SGRQ scores (30.9 vs 26.5 units; P < .001; absolute difference, 4.4 [95% CI, 2.2-6.6]) and mMRC scale scores (median, 2 [interquartile range [IQR], 0-3]) vs 1 [IQR, 0-3]; P < .001]), but no significant difference in 6-minute walk distance (399 vs 417 m; absolute difference, 18 m [95% CI, 6-30]; P = .30), after adjustment for age, sex, race, body mass index, forced expiratory volume in the first second, pack-years of smoking, and emphysema. On follow-up (median, 4.3 [IQR, 3.2-4.9] years), participants with ECAC had increased frequency of total exacerbations (58 vs 35 events per 100 person-years; incidence rate ratio [IRR], 1.49 [95% CI, 1.29-1.72]; P < .001) and severe exacerbations requiring hospitalization (17 vs 10 events per 100 person-years; IRR, 1.83 [95% CI, 1.51-2.21]; P < .001). CONCLUSIONS AND RELEVANCE: In a cross-sectional analysis of current and former smokers, the presence of ECAC was associated with worse respiratory quality of life. Further studies are needed to assess long-term associations with clinical outcomes. FAU - Bhatt, Surya P AU - Bhatt SP AD - Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham2UAB Lung Health Center, University of Alabama at Birmingham3UAB Lung Imaging Core, University of Alabama at Birmingham. FAU - Terry, Nina L J AU - Terry NL AD - UAB Lung Imaging Core, University of Alabama at Birmingham4Department of Radiology, University of Alabama at Birmingham. FAU - Nath, Hrudaya AU - Nath H AD - UAB Lung Imaging Core, University of Alabama at Birmingham4Department of Radiology, University of Alabama at Birmingham. FAU - Zach, Jordan A AU - Zach JA AD - Quantitative Imaging Laboratory, National Jewish Health, Denver, Colorado. FAU - Tschirren, Juerg AU - Tschirren J AD - VIDA Diagnostics, Coralville, Iowa. FAU - Bolding, Mark S AU - Bolding MS AD - UAB Lung Imaging Core, University of Alabama at Birmingham4Department of Radiology, University of Alabama at Birmingham. FAU - Stinson, Douglas S AU - Stinson DS AD - Department of Radiology, National Jewish Health, Denver, Colorado. FAU - Wilson, Carla G AU - Wilson CG AD - Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado. FAU - Curran-Everett, Douglas AU - Curran-Everett D AD - Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado. FAU - Lynch, David A AU - Lynch DA AD - Quantitative Imaging Laboratory, National Jewish Health, Denver, Colorado7Department of Radiology, National Jewish Health, Denver, Colorado. FAU - Putcha, Nirupama AU - Putcha N AD - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Soler, Xavi AU - Soler X AD - Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego. FAU - Wise, Robert A AU - Wise RA AD - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Washko, George R AU - Washko GR AD - Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts. FAU - Hoffman, Eric A AU - Hoffman EA AD - Department of Radiology and Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City. FAU - Foreman, Marilyn G AU - Foreman MG AD - Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia. FAU - Dransfield, Mark T AU - Dransfield MT AD - Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham2UAB Lung Health Center, University of Alabama at Birmingham3UAB Lung Imaging Core, University of Alabama at Birmingham14Veterans Affairs Medical Center, Birming. CN - Genetic Epidemiology of COPD (COPDGene) Investigators LA - eng GR - KL2 TR001419/TR/NCATS NIH HHS/United States GR - R01 HL089897/HL/NHLBI NIH HHS/United States GR - U01 HL089897/HL/NHLBI NIH HHS/United States GR - R01 HL089856/HL/NHLBI NIH HHS/United States GR - U01 HL089856/HL/NHLBI NIH HHS/United States GR - UL1 TR001417/TR/NCATS NIH HHS/United States GR - R01HL089897/HL/NHLBI NIH HHS/United States GR - R01HL089856/HL/NHLBI NIH HHS/United States GR - S10 OD018526/OD/NIH HHS/United States GR - HL122438/HL/NHLBI NIH HHS/United States GR - K23 HL123594/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA JT - JAMA JID - 7501160 SB - IM MH - Aged MH - Aged, 80 and over MH - Disease Progression MH - Dyspnea/diagnostic imaging/ethnology/physiopathology MH - Exercise Tolerance MH - Exhalation/*physiology MH - Female MH - Forced Expiratory Volume MH - Humans MH - Inhalation/physiology MH - Longitudinal Studies MH - Male MH - Middle Aged MH - Pulmonary Atelectasis/diagnostic imaging/ethnology/mortality/*physiopathology MH - Pulmonary Emphysema/diagnostic imaging/mortality/*physiopathology MH - Quality of Life MH - Respiration MH - Smoking/adverse effects/*physiopathology MH - Tomography, X-Ray Computed MH - Tracheal Diseases/diagnostic imaging/*physiopathology PMC - PMC5173387 MID - NIHMS834152 COIS- Dr. Terry, Dr. Nath and Mr. Zach have no conflicts of interest. Dr. Tschirren is an employee and shareholder at VIDA Diagnostics. Dr. Bolding, Mr. Stinson, Ms. Wilson, Dr. Everett, Dr. Putcha and Dr. Soler have no conflicts of interest. EDAT- 2016/02/03 06:00 MHDA- 2016/02/13 06:00 PMCR- 2016/12/20 CRDT- 2016/02/03 06:00 PHST- 2016/02/03 06:00 [entrez] PHST- 2016/02/03 06:00 [pubmed] PHST- 2016/02/13 06:00 [medline] PHST- 2016/12/20 00:00 [pmc-release] AID - 2484682 [pii] AID - 10.1001/jama.2015.19431 [doi] PST - ppublish SO - JAMA. 2016 Feb 2;315(5):498-505. doi: 10.1001/jama.2015.19431.