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- Title
Emphysema Predicts Hospitalisation and Incident Airflow Obstruction among Older Smokers: A Prospective Cohort Study.
- Authors
McAllister, David A.; Ahmed, Firas S.; Austin, John H. M.; Henschke, Claudia I.; Keller, Brad M.; Lemeshow, Adina; Reeves, Anthony P.; Mesia-Vela, Sonia; Pearson, G. D. N.; Shiau, Maria C.; Schwartz, Joseph E.; Yankelevitz, David F.; Barr, R. Graham
- 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.
- Subjects
LUNG cancer diagnosis; AIR flow; HOSPITAL care; COHORT analysis; HYPOTHESIS; RESPIRATORY diseases; OBSTRUCTIVE lung diseases
- Publication
PLoS ONE, 2014, Vol 9, Issue 4, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0093221