Signs of gas trapping in normal lung density regions in smokers

Academic Article


  • Rationale: A substantial proportion of subjects without overt airflow obstruction have significant respiratory morbidity and structural abnormalities as visualized by computed tomography. Whether regions of the lung that appear normal using traditional computed tomography criteria have mild disease is not known. Objectives: To identify subthreshold structural disease in normal-appearing lung regions in smokers. Methods: We analyzed 8,034 subjects with complete inspiratory and expiratory computed tomographic data participating in the COPDGene Study, including 103 lifetime nonsmokers. The ratio of the mean lung density at end expiration (E) to end inspiration (I) was calculated in lung regions with normal density (ND) by traditional thresholds for mild emphysema (2910 Hounsfield units) and gas trapping (2856 Hounsfield units) to derive the ND-E/I ratio. Multivariable regression analysis was used to measure the associations between ND-E/I, lung function, and respiratory morbidity. Measurements and Main Results: The ND-E/I ratio was greater in smokers than in nonsmokers, and it progressively increased from mild to severe chronic obstructive pulmonary disease severity. A proportion of 26.3% of smokers without airflow obstruction had ND-E/I greater than the 90th percentile of normal. ND-E/I was independently associated with FEV1 (adjusted b = 20.020; 95% confidence interval [CI], 20.032 to 20.007; P = 0.001), St. George‚Äôs Respiratory Questionnaire scores (adjusted b = 0.952; 95% CI, 0.529 to 1.374; P, 0.001), 6-minute-walk distance (adjusted b = 210.412; 95% CI, 212.267 to 28.556; P, 0.001), and body mass index, airflow obstruction, dyspnea, and exercise capacity index (adjusted b = 0.169; 95% CI, 0.148 to 0.190; P, 0.001), and also with FEV1 change at follow-up (adjusted b = 23.013; 95% CI, 24.478 to 21.548; P = 0.001). Conclusions: Subthreshold gas trapping representing mild small airway disease is prevalent in normal-appearing lung regions in smokers without airflow obstruction, and it is associated with respiratory morbidity.
  • Digital Object Identifier (doi)

    Author List

  • Bodduluri S; Reinhardt JM; Hoffman EA; Newell JD; Nath H; Dransfield MT; Bhatt SP
  • Start Page

  • 1404
  • End Page

  • 1410
  • Volume

  • 196
  • Issue

  • 11