Laura H Thomsen1, Saher B Shaker1, Asger Dirksen1, Jesper H Pedersen2, Ruth Tal-Singer3, Per Bakke4, Jørgen Vestbo1,5. 1. Department of Respiratory Medicine, Gentofte Hospital, University of Copenhagen, Denmark. 2. Department of Cardiothoracic Surgery, University of Copenhagen, Denmark. 3. GlaxoSmithKline, King of Prussia, Pennsylvania. 4. Department of Clinical Science, University of Bergen, and Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway. 5. Respiratory and Allergy Research Group, Manchester Academic Health Science Centre, University Hospital South Manchester; NHS Foundation Trust, Manchester, United Kingdom.
Abstract
Background: Emphysema is an important component of COPD; however, in previous studies of the correlation between airflow limitation (AFL) and computed tomography (CT) lung density as a surrogate for emphysema has varied. We hypothesised a good correlation between lung function (forced expiratory volume in first second [FEV1]) and emphysema (15th percentile density [PD15]) and that this correlation also exists between loss of lung tissue and decline in lung function even within the time frame of longitudinal studies of relatively short duration. Methods: We combined 2 large longitudinal studies (the Danish Lung Cancer Screening Trial [DLCST] and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints [ECLIPSE]) of smokers or former smokers, with a wide range of AFL and CT lung density, and analysed data from 2148 participants who did not change smoking habits and who had at least 2 CT scans and 2 FEV1 measurements at least 3 years apart. Results: Baseline correlation between FEV1 and PD15 was high (r=0.716, 95% confidence interval [CI]: 0.694-0.736, p<0.001) indicating that at least half of the variation in FEV1 can be explained by variation in CT lung density. Correlation between the decline in FEV1 and progression of PD15 was considerably weaker (r= 0.081, 95% CI: 0.038-0.122, p<0.001). Conclusions: Correlation is very high between lung density and lung function in a broad spectrum of smokers and ex-smokers. In contrast, the temporal associations (slopes) are weakly correlated, probably due to uncertainty in the estimation of slopes within a time frame of 3-4 years.
Background: Emphysema is an important component of COPD; however, in previous studies of the correlation between airflow limitation (AFL) and computed tomography (CT) lung density as a surrogate for emphysema has varied. We hypothesised a good correlation between lung function (forced expiratory volume in first second [FEV1]) and emphysema (15th percentile density [PD15]) and that this correlation also exists between loss of lung tissue and decline in lung function even within the time frame of longitudinal studies of relatively short duration. Methods: We combined 2 large longitudinal studies (the Danish Lung Cancer Screening Trial [DLCST] and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints [ECLIPSE]) of smokers or former smokers, with a wide range of AFL and CT lung density, and analysed data from 2148 participants who did not change smoking habits and who had at least 2 CT scans and 2 FEV1 measurements at least 3 years apart. Results: Baseline correlation between FEV1 and PD15 was high (r=0.716, 95% confidence interval [CI]: 0.694-0.736, p<0.001) indicating that at least half of the variation in FEV1 can be explained by variation in CT lung density. Correlation between the decline in FEV1 and progression of PD15 was considerably weaker (r= 0.081, 95% CI: 0.038-0.122, p<0.001). Conclusions: Correlation is very high between lung density and lung function in a broad spectrum of smokers and ex-smokers. In contrast, the temporal associations (slopes) are weakly correlated, probably due to uncertainty in the estimation of slopes within a time frame of 3-4 years.
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