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- Title
Defining Resilience to Smoking-related Lung Disease: A Modified Delphi Approach from SPIROMICS.
- Authors
Oh, Anita L.; Mularski, Richard A.; Barjaktarevic, Igor; Barr, R. Graham; Bowler, Russell P.; Comellas, Alejandro P.; Cooper, Christopher B.; Criner, Gerard J.; Han, MeiLan K.; Hansel, Nadia N.; Hoffman, Eric A.; Kanner, Richard E.; Krishnan, Jerry A.; III, Robert Paine; Parekh, Trisha M.; Peters, Stephen P.; Christenson, Stephanie A.; Woodruff, Prescott G.; Paine, Robert 3rd; SPIROMICS Investigators
- Abstract
Rationale: Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory disease who have minimal or no airflow obstruction. Objectives: To develop a multidimensional definition of a lung-related "resilient smoker" that is useful in research studies and then identify a resilient smoker subgroup in the SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) cohort using this definition. Methods: We performed a three-round modified Delphi survey among a panel of COPD experts to identify and reach a consensus on clinical and radiographic domains to be included in a lung-related resilient smoker definition. Consensus on domains of resilience was defined as ⩾80% of experts voting "agree" or "strongly agree" on a 5-point Likert scale. The Delphi-derived definition of resilience was applied to SPIROMICS to identify resilient smokers, whom we then characterized using known biomarkers of COPD. Results: Consensus was achieved on 6 of 12 diagnostic items, which include cough and sputum production, dyspnea, radiographic measures of emphysema and small airways disease, exacerbations, and decline in forced expiratory volume in 1 second. Although 892 SPIROMICS participants were classified as smokers with preserved lung function by spirometry, only 149 participants (16.7%) qualified as resilient smokers by our definition. Blood biomarker expression of CRP (C-reactive protein) and sTNFRSF1A (soluble tumor necrosis receptor factor1A) was lower in resilient than nonresilient smokers (P = 0.02 and P = 0.03). Conclusions: A Delphi-derived consensus definition of resilient smoker identified 83.3% of smokers with preserved spirometry as "nonresilient" based on the presence of adverse effects of smoking on the lung. Resilient smokers were biologically distinct from nonresilient smokers based on CRP measurements. Clinical trial registered with ClinicalTrials.gov (NCT01969344).
- Subjects
OBSTRUCTIVE lung disease diagnosis; RESEARCH; LUNGS; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; MULTIDIMENSIONAL Health Locus of Control scales; COMPARATIVE studies; FORCED expiratory volume; RESEARCH funding; SMOKING; SPIROMETRY
- Publication
Annals of the American Thoracic Society, 2021, Vol 18, Issue 11, p1822
- ISSN
2329-6933
- Publication type
journal article
- DOI
10.1513/AnnalsATS.202006-757OC