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Smokers with early airflow limitation show greater structural lung changes, including emphysema and airway thickening, on CT scans. These findings suggest lung damage precedes spirometry-defined disease in smokers.

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Area of Science:

  • Pulmonary Medicine
  • Radiology
  • Respiratory Physiology

Background:

  • Structural lung changes may precede airflow limitation in smokers.
  • Computed tomography (CT) can quantify emphysema, airway wall thickening, and gas trapping.

Purpose of the Study:

  • To investigate the prevalence of CT-quantified structural lung changes in smokers based on airflow limitation.
  • To compare emphysema, airway wall thickening, and gas trapping in smokers with and without airflow limitation.

Main Methods:

  • 1,140 male smokers underwent chest CT and spirometry.
  • Emphysema, airway wall thickening (Pi10), and gas trapping (E/I-ratio) were quantified.
  • Participants were grouped by forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio.

Main Results:

  • Smokers with FEV1/FVC < 70% but above the lower limit of normal (LLN) showed significantly lower 15th percentile for emphysema (-920.6 HU vs. -912.2 HU).
  • These subjects also had significantly higher Pi10 (2.87 mm vs. 2.57 mm) and E/I-ratio (88.6% vs. 85.6%) compared to those without airflow limitation.
  • All comparisons were statistically significant (p<0.001).

Conclusions:

  • Smokers with FEV1/FVC < 70% (but > LLN) exhibit greater structural lung changes on CT.
  • These changes include more severe emphysema, airway wall thickening, and gas trapping.
  • CT-assessed structural lung damage is more prevalent in smokers with early airflow limitation.