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High prevalence of emphysema and its association with BMI: A study of smokers with normal spirometry
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
Linköping University, Department of Medical and Health Sciences, Pulmonary Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
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2008 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 4, 241-247 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate to what extent emphysema was evident, as identified by High Resolution Computed Tomography (HRCT), in smokers with normal lung function and to relate age, gender, smoking history, and body mass index (BMI) to the HRCT results. A secondary aim was to study to what extent emphysema was present in smokers with lower normal values of lung function defined as FEV1/FVC ratio percentage of predicted value (89-93% of predicted value for males and 90-93% for females) or FEF50 60% of predicted compared with smokers without this definition.

Methods: Fifty-nine smokers, with a mean age of 53 years and with normal lung function, were examined with HRCT.

Results: Emphysema evidenced visually by HRCT was present in 43% of the subjects. Using a 0-5 grade scale (0=normal finding; 5=emphysema in most slices), the degree of emphysema was almost exclusively 3-4. The type of emphysema was distributed as centrilobular emphysema predominant in 43.5%, paraseptal emphysema predominant in 43.5%, and as an equal mixture of these types in 13%. The presence of emphysema did not differ between the group of smokers with lower normal values of lung function and the rest of the smokers. Smokers with emphysema had significantly lower BMI than those devoid of emphysema, 24 and 27 respectively (p0.0011).

Conclusion: There was a high occurrence of visual emphysema in middle-aged smokers with normal lung function. The densitometric quantitative analysis method is inadequate for detecting mild emphysema. High prevalence of emphysema was associated with low BMI.

Place, publisher, year, edition, pages
2008. Vol. 26, no 4, 241-247 p.
Keyword [en]
Body mass index, computed tomography, family practice, pulmonary emphysema, smoking, spirometry
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16159DOI: 10.1080/02813430802452732OAI: oai:DiVA.org:liu-16159DiVA: diva2:133249
Available from: 2009-01-08 Created: 2009-01-07 Last updated: 2017-12-14
In thesis
1. Chronic Obstructive PulmonaryDisease: Early detection and prevention in primary care
Open this publication in new window or tab >>Chronic Obstructive PulmonaryDisease: Early detection and prevention in primary care
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims. Early detection of Chronic Obstructive Pulmonary Disease (COPD) and secondary prevention by means of smoking cessation are the only available methods of stopping the progression of the disease. The overall aim was to examine the possibilities of early detection and prevention of COPD in General Practice. The specific aims were to evaluate a method of detecting COPD at its early stages, to investigate the rate of emphysema in smokers with normal lung function and smokers defined as preclinical COPD, to investigate the effects of performed spirometries and brief smoking cessation advice on smoking habits and to test if concentrations of certain biomarkers in blood, saliva and exhaled breath condensate (EBC) could identify subjects with COPD or non-COPD subjects supposed to be at risk of developing COPD.

Methods. The first study evaluated an invitational method, which offered voluntary screening spirometry to a targeted population of smokers 40-55 years old. In the second follow-up study, all smokers with COPD and half of the smokers with normal lung function (NLF) were annually invited for spirometry and brief smoking cessation advice for a duration of 3 years, with half of the smokers with NLF being tested only last year. In the third study, 54 smokers with NLF were examined with High Resolution Computed Tomography (HRCT), with blood samples also being collected from each subject. In study four, 19 subjects categorised as having COPD, 30 non-COPD subjects and 15 healthy non-smoking volunteers were studied by means of spirometry, DLCO, and analysis of biomarkers in EBC, saliva and serum.

Results. A total of 512 smokers responded. The prevalence of COPD was 27.5% and was classified as mild in 85% of the sufferers, moderate in 13% and severe in 2%. At year 1, 10% of the smokers with COPD had been continuously abstinent from smoking, compared to 2% of smokers with NLF. The prolonged abstinence rate increased yearly, and at year 3 the smoking cessation rates in smokers with COPD was 25% compared to 7% in smokers with NLF. By visual analysis, HRCT showed signs of emphysema in 43% of the subjects. Emphysema was also associated with low BMI. Higher serum concentrations of lysozyme and lower DLCO were recorded in those with COPD compared to non-COPD subjects. With the exception of chlorine, none of the remaining biomarkers were detected in EBC.

Conclusions. By invitational targeted screening, COPD can be easily detected in its mild stages by using spirometry. By becoming diagnosed with COPD, smokers seem to be more motivated to stop smoking, and COPD patients should repeatedly be offered spirometry and smoking cessation advice which may prevent the progression of the disease to a severe disabling form. HRCT may detect smoke related parenchymal lung damage (i.e. emphysema) in symptom-free smokers with normal spirometry. Serum lysozyme and DLCO appeared to be the strongest discriminator between COPD and non-COPD subjects. The use of EBC as a tool to measure exhaled inflammatory biomarkers involved in COPD is as yet uncertain.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 102 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1093
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20736 (URN)978-91-7393-721-4 (ISBN)
Public defence
2009-06-01, Elsa Brändströmsalen, Hälsouniversitetet, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
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Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2009-09-18Bibliographically approved

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Stratelis, GeorgiosFransson, Sven GöranSchmekel, BirgittaJakobsson, PerMölstad, Sigvard

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Stratelis, GeorgiosFransson, Sven GöranSchmekel, BirgittaJakobsson, PerMölstad, Sigvard
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General PracticeFaculty of Health SciencesPrimary Health Care in MotalaRadiologyClinical PhysiologyDepartment of Clinical PhysiologyPulmonary MedicineDepartment of Respiratory Medicine UHL
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