Elizabeth C Oelsner1,2, Benjamin M Smith1,3, Eric A Hoffman4, Ravi Kalhan5, Kathleen M Donohue1, Joel D Kaufman6, Jennifer N Nguyen7, Ani W Manichaikul7, Jerome I Rotter8, Erin D Michos9, David R Jacobs10, Gregory L Burke11, Aaron R Folsom10, Joseph E Schwartz1, Karol Watson12, R Graham Barr1,2. 1. 1 Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. 2. 2 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. 3. 3 Respiratory Division, McGill University, Montreal, Quebec, Canada. 4. 4 Department of Radiology, University of Iowa, Iowa City, Iowa. 5. 5 Division of Pulmonary, Northwestern University, Chicago, Illinois. 6. 6 Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington. 7. 7 Division of Biostatistics and Epidemiology, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia. 8. 8 Division of Genomic Outcomes, University of California, Los Angeles, School of Medicine, Torrance, California. 9. 9 Department of Cardiology, Johns Hopkins University, Baltimore, Maryland. 10. 10 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota. 11. 11 Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; and. 12. 12 Division of Cardiology, University of California, Los Angeles, School of Medicine, Los Angeles, California.
Abstract
RATIONALE: Large airway dimensions on computed tomography (CT) have been associated with lung function, symptoms, and exacerbations in chronic obstructive pulmonary disease (COPD), as well as with symptoms in smokers with preserved spirometry. Their prognostic significance in persons without lung disease remains undefined. OBJECTIVES: To examine associations between large airway dimensions on CT and respiratory outcomes in a population-based cohort of adults without prevalent lung disease. METHODS: The Multi-Ethnic Study of Atherosclerosis recruited participants ages 45-84 years without cardiovascular disease in 2000-2002; we excluded participants with prevalent chronic lower respiratory disease (CLRD). Spirometry was measured in 2004-2006 and 2010-2012. CLRD hospitalizations and deaths were classified by validated criteria through 2014. The average wall thickness for a hypothetical airway of 10-mm lumen perimeter on CT (Pi10) was calculated using measures of airway wall thickness and lumen diameter. Models were adjusted for age, sex, principal components of ancestry, body mass index, smoking, pack-years, scanner, percent emphysema, genetic risk score, and initial forced expiratory volume in 1 second (FEV1) percent predicted. RESULTS: Greater Pi10 was associated with 9% faster FEV1 decline (95% confidence interval [CI], 2 to 15%; P = 0.012) and increased incident COPD (odds ratio, 2.22; 95% CI, 1.43-3.45; P = 0.0004) per standard deviation among 1,830 participants. Over 78,147 person-years, higher Pi10 was associated with a 57% higher risk of first CLRD hospitalization or mortality (P = 0.0496) per standard deviation. Of Pi10's component measures, both greater airway wall thickness and narrower lumen predicted incident COPD and CLRD clinical events. CONCLUSIONS: In adults without CLRD, large airway dimensions on CT were prospectively associated with accelerated lung function decline and increased risks of COPD and CLRD hospitalization and mortality.
RATIONALE: Large airway dimensions on computed tomography (CT) have been associated with lung function, symptoms, and exacerbations in chronic obstructive pulmonary disease (COPD), as well as with symptoms in smokers with preserved spirometry. Their prognostic significance in persons without lung disease remains undefined. OBJECTIVES: To examine associations between large airway dimensions on CT and respiratory outcomes in a population-based cohort of adults without prevalent lung disease. METHODS: The Multi-Ethnic Study of Atherosclerosis recruited participants ages 45-84 years without cardiovascular disease in 2000-2002; we excluded participants with prevalent chronic lower respiratory disease (CLRD). Spirometry was measured in 2004-2006 and 2010-2012. CLRD hospitalizations and deaths were classified by validated criteria through 2014. The average wall thickness for a hypothetical airway of 10-mm lumen perimeter on CT (Pi10) was calculated using measures of airway wall thickness and lumen diameter. Models were adjusted for age, sex, principal components of ancestry, body mass index, smoking, pack-years, scanner, percent emphysema, genetic risk score, and initial forced expiratory volume in 1 second (FEV1) percent predicted. RESULTS: Greater Pi10 was associated with 9% faster FEV1 decline (95% confidence interval [CI], 2 to 15%; P = 0.012) and increased incident COPD (odds ratio, 2.22; 95% CI, 1.43-3.45; P = 0.0004) per standard deviation among 1,830 participants. Over 78,147 person-years, higher Pi10 was associated with a 57% higher risk of first CLRD hospitalization or mortality (P = 0.0496) per standard deviation. Of Pi10's component measures, both greater airway wall thickness and narrower lumen predicted incident COPD and CLRD clinical events. CONCLUSIONS: In adults without CLRD, large airway dimensions on CT were prospectively associated with accelerated lung function decline and increased risks of COPD and CLRD hospitalization and mortality.
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