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      Risk for COPD with Obstruction of Active Smokers with Normal Spirometry and Reduced Diffusion Capacity

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          Abstract

          Background

          Smokers are assessed for COPD using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusion capacity (DLCO), a parameter linked to emphysema and small airway disease. The natural history of these “normal spirometry/low DLCO” smokers is unknown.

          Methods

          From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry/normal DLCO (n=59) and smokers with normal spirometry/low DLCO (n=46). All had normal history, physical examination, CBC, urinalysis, HIV status, α1-antitrypsin level, chest X-ray, FEV1, FVC, FEV1/FVC ratio and total lung capacity (TLC). Throughout the study, all continued to be active smokers.

          Findings

          In the normal spirometry/normal DLCO group assessed over 45 ± 20 months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry/low DLCO group, followed over 41 ± 31 months, 22% developed GOLD-defined COPD.

          Interpretation

          Despite appearing “normal” by GOLD, smokers with normal spirometry but low DLCO are at significant risk for developing COPD with obstruction to airflow.

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          Author and article information

          Journal
          8803460
          3682
          Eur Respir J
          Eur. Respir. J.
          The European respiratory journal
          0903-1936
          1399-3003
          4 February 2016
          05 November 2015
          December 2015
          01 December 2016
          : 46
          : 6
          : 1589-1597
          Affiliations
          [1 ]Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
          [2 ]Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
          [3 ]Department of Biological Statistics and Computational Biology, Cornell University, Ithaca, New York
          Author notes
          Correspondence: Department of Genetic Medicine, Weill Cornell Medical College, 1300 York Avenue, Box 164, New York, New York 10065, Phone: (646) 962-4363, Fax: (646) 962-0220, geneticmedicine@ 123456med.cornell.edu
          Article
          PMC4752006 PMC4752006 4752006 nihpa755618
          10.1183/13993003.02377-2014
          4752006
          26541521
          321ebb68-d75b-4dd4-a995-6076745ce4cc
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