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Thorax

Title:		Smoking duration alone provides stronger risk estimates of chronic obstructive pulmonary disease than pack-years
Author(s):		Bhatt SP; Kim YI; Harrington KF; Hokanson JE; Lutz SM; Cho MH; DeMeo DL; Wells JM; Make BJ; Rennard SI; Washko GR; Foreman MG; Tashkin DP; Wise RA; Dransfield MT; Bailey WC; Investigators CO;
Address:		"Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Department of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, USA. Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. Pulmonary and Critical Care Medicine, Harvard Medical School, Boston, Massachusetts, USA. Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA. Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA. Clinical Discovery Unit, AstraZeneca, Cambridge, UK. Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA. Division of Pulmonary and Critical Care Medicine, University of California Los Angeles, Los Angeles, California, USA. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Pulmonary and Critical Care Medicine, Birmingham VA Medical Center, Birmingham, Alabama, USA"
Journal Title:		Thorax
Year:		2018
Volume:		20180111
Issue:		5
Page Number:		414 - 421
DOI:		10.1136/thoraxjnl-2017-210722
ISSN/ISBN:		1468-3296 (Electronic) 0040-6376 (Print) 0040-6376 (Linking)
Abstract:		"BACKGROUND: Cigarette smoking is the strongest risk factor for COPD. Smoking burden is frequently measured in pack-years, but the relative contribution of cigarettes smoked per day versus duration towards the development of structural lung disease, airflow obstruction and functional outcomes is not known. METHODS: We analysed cross-sectional data from a large multicentre cohort (COPDGene) of current and former smokers. Primary outcome was airflow obstruction (FEV(1)/FVC); secondary outcomes included five additional measures of disease: FEV(1), CT emphysema, CT gas trapping, functional capacity (6 min walk distance, 6MWD) and respiratory morbidity (St George's Respiratory Questionnaire, SGRQ). Generalised linear models were estimated to compare the relative contribution of each smoking variable with the outcomes, after adjustment for age, race, sex, body mass index, CT scanner, centre, age of smoking onset and current smoking status. We also estimated adjusted means of each outcome by categories of pack-years and combined groups of categorised smoking duration and cigarettes/day, and estimated linear trends of adjusted means for each outcome by categorised cigarettes/day, smoking duration and pack-years. RESULTS: 10 187 subjects were included. For FEV(1)/FVC, standardised beta coefficient for smoking duration was greater than for cigarettes/day and pack-years (P<0.001). After categorisation, there was a linear increase in adjusted means FEV(1)/FVC with increase in pack-years (regression coefficient beta=-0.023+/-SE0.003; P=0.003) and duration over all ranges of smoking cigarettes/day (beta=-0.041+/-0.004; P<0.001) but a relatively flat slope for cigarettes/day across all ranges of smoking duration (beta=-0.009+/-0.0.009; P=0.34). Strength of association of duration was similarly greater than pack-years for emphysema, gas trapping, FEV(1), 6MWD and SGRQ. CONCLUSION: Smoking duration alone provides stronger risk estimates of COPD than the composite index of pack-years. TRIAL REGISTRATION NUMBER: Post-results; NCT00608764"
Keywords:		"Aged Cigarette Smoking/*adverse effects Cohort Studies Cross-Sectional Studies Female Forced Expiratory Volume Humans Male Middle Aged Pulmonary Disease, Chronic Obstructive/epidemiology/*etiology/physiopathology Pulmonary Emphysema/*diagnostic imaging/ep;"
Notes:		"MedlineBhatt, Surya P Kim, Young-Il Harrington, Kathy F Hokanson, John E Lutz, Sharon M Cho, Michael H DeMeo, Dawn L Wells, James M Make, Barry J Rennard, Stephen I Washko, George R Foreman, Marilyn G Tashkin, Donald P Wise, Robert A Dransfield, Mark T Bailey, William C eng R01 HL089897/HL/NHLBI NIH HHS/ S10 OD018526/OD/NIH HHS/ U01 HL089897/HL/NHLBI NIH HHS/ K23 HL133438/HL/NHLBI NIH HHS/ K24 HL140108/HL/NHLBI NIH HHS/ R01 HL089856/HL/NHLBI NIH HHS/ U01 HL089856/HL/NHLBI NIH HHS/ U54 MD008149/MD/NIMHD NIH HHS/ Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England 2018/01/13 Thorax. 2018 May; 73(5):414-421. doi: 10.1136/thoraxjnl-2017-210722. Epub 2018 Jan 11"