Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study

• Published in: BMJ open respiratory research Vol. 10; no. 1; p. e001468
• Main Authors: Garcia-Rio, Francisco, Miravitlles, Marc, Soriano, Joan B, Cosío, Borja G, Soler-Cataluña, Juan José, Casanova, Ciro, de Lucas, Pilar, Alfageme, Inmaculada, Rodríguez González-Moro, José Miguel, Sánchez Herrero, María Guadalupe, Ancochea, Julio, Castillo, Elena García, Valenzuela, Claudia, Bastida, Ana Pueyo, Asegurado, Lourdes Lázaro, Pascual, Luis Rodríguez, Mora, Mª José, Clau, Luis Borderias, Mendoza, Lourdes Arizón, García, Sandra, Miranda, Juan AR, Gutiérrez, Julián Grande, Manzano, Jesús Agustín, González, Manuel, Ferrero, Miguel Barrueco, Rosales, Milagros, Villar, José AF, Represas, Cristina, Priegue, Ana, Ferreño, Isabel Portela, Roibás, Cecilia Mouronte, García, Sara Fernández, Díaz, Rocío Cordova, Pons, Nuria Toledo, Llabrés, Margalida, Trigo, José MM, Forner, Marta, Gallego, Begoña, Cubero, Pablo, Vera, Elisabet, Albero, Mª BP, García, Noelia González, Morales, Agustín Valido, Panadero, Carolina, Bernáldez, Cristina Benito, Velarde, Maria, Siminiani, Antonio Santa Cruz, Quintanilla, Carlos Castillo, Meléndez, Rocío Ibáñez, Garcerán, José JM, Vicente, Desirée Lozano, Torres, Pedro García, Valdivia, Maria del Mar, Tajes, Juan PT, Girones, Montserrat Cizur, Turrillas, Carmen Labiano, Martínez, Carlos Ruiz, Hernando, Elena, Alfaro, Elvira, García, José Manuel, Lázaro, Jorge, Bravo, David, Hidalgo, Laura, Terreros, Silvia Francisco, Zorrilla, Iñaki, Colmenero, Ainara Alonso, González, Cristina Martínez, Margon, Susana, Taveras, Rosirys Guzman, Fernández, Ramón, Álvarez, Alicia, Balbín, José RA, Calvo, Juan Agüero, Sancho, Jaume Ferrer, González, Esther Rodríguez, Loeb, Eduardo, Alonso, José LI, García, Mª AR, González, Juan Abreu, García, Candelaria Martín, Muñoz, Rebeca, García, Haydée Martín, Muñiz, Miguel AM, Antuña, Andrés AS, González, Jesús Allende, Blanco, Jose AG, Navascues, Fernando JA, Montes, Manuel AV, Pericacho, María Rodríguez, García, Concepción Rodríguez, Mavárez, Juan DA
• Format: Journal Article
• Language: English
• Published: England British Thoracic Society 01.01.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Carbon Monoxide; Chronic obstructive pulmonary disease; Cigarettes; Dyspnea; Epidemiology; Exercise; Humans; Imaging/CT MRI etc; Lung - diagnostic imaging; Lung diseases; Lung Physiology; Lungs; Medical imaging; Older people; Patients; Physical fitness; Physiology; Population; Population-based studies; Prevalence; Pulmonary arteries; Pulmonary Disease, Chronic Obstructive; Questionnaires; Respiratory Physiology; Smokers; Smoking; Spirometry; Tobacco and the lung; Tomography; Tomography, X-Ray Computed; Spain; Imaging/CT MRI etc; Exercise; Tobacco and the lung; Lung Physiology
• ISSN: 2052-4439; 2052-4439
• DOI: 10.1136/bmjresp-2022-001468

BackgroundPopulation distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe the prevalence of reduced DLCO in a population-based sample of current and former smoker subjects without airflow limitation and to describe its morphological, functional and clinical implications.MethodsA sample of 405 subjects aged 40 years or older with postbronchodilator forced expiratory volume in 1 s/forced vital capacity (FVC) >0.70 was obtained from a random population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, exhaled carbon monoxide (CO) measurement, spirometry, DLCO determination, 6 min walk test, routine blood analysis and low-dose CT scan with evaluation of lung density and airway wall thickness.ResultsIn never, former and current smokers, prevalence of reduced DLCO was 6.7%, 14.4% and 26.7%, respectively. Current and former smokers with reduced DLCO without airflow limitation were younger than the subjects with normal DLCO, and they had greater levels of dyspnoea and exhaled CO, greater pulmonary artery diameter and lower spirometric parameters, 6 min walk distance, daily physical activity and plasma albumin levels (all p<0.05), with no significant differences in other chronic respiratory symptoms or CT findings. FVC and exhaled CO were identified as independent risk factors for low DLCO.ConclusionReduced DLCO is a frequent disorder among smokers without airflow limitation, associated with decreased exercise capacity and with CT findings suggesting that it may be a marker of smoking-induced early vascular damage.Trial registration numberNCT03028207.