Effects of cigarette smoke exposure on pulmonary physiology, muscle strength and exercise capacity in a retrospective cohort with 30,000 subjects

• Published in: PloS one Vol. 16; no. 6; p. e0250957
• Main Authors: Adatia, Adil, Wahab, Mustafaa, Shahid, Izza, Moinuddin, Ali, Killian, Kieran J., Satia, Imran
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 24.06.2021; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Chronic obstructive pulmonary disease; Cigarette smoke; Cigarettes; Demographic variables; Dyspnea; Exercise; Exposure; Flow velocity; Health aspects; Health care facilities; Heart attacks; Maximum power; Medicine; Medicine and Health Sciences; Muscle strength; Patient admissions; Physical Sciences; Physiology; Smoke; Smoking; Social Sciences; Tobacco smoke; Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250957

The effects of long-term cigarette smoke exposure on pulmonary physiology and how those effects lead to reduced exercise capacity are not well established. We retrospectively analyzed the spirometry, single-breath gas transfer (DLCO), peripheral muscle strength, and maximum exercise capacity data in patients referred to McMaster University Medical Centre for cardiopulmonary exercise testing between 2000 and 2012. 29,441 subjects underwent CPET and had a recorded smoking history [58% male, mean age 51.1 years (S.D.±19.6), BMI 27.4 kg/m.sup.2 (±5.8)]. 7081 (24%) were current or former smokers and were divided into 4 categories by packs years (mean ±S.D.): 40 (53.9±12.8). Patients with greater cigarette smoke exposure had lower expiratory flow rates (FEV1, FEF50, FEF75, PEFR), DLCO, and maximum power output (MPO) during exercise. There was no association between smoke exposure and muscle strength. Modeling MPO (kpm/min) output as a function of demographic and physiologic variables showed that the data are well explained by muscle strength (kg), FEV1 (L), and DLCO (mmHg/min/mL) in similar magnitude (MPO = 42.7*Quads.sup.0.34 *FEV1.sup.0.34 * DLCO.sup.0.43 ; r = 0.84). Long-term cigarette smoke exposure is associated with small airway narrowing and impaired diffusion capacity but not with peripheral muscle weakness. The effects of smoking, age, and gender on maximum power output are mediated by reductions in FEV1, muscle strength and DLCO. Exercise capacity in smokers may benefit from therapies targeting all 3 variables.