TY - JOUR
T1 - Defining resilience to smoking-related lung disease a modified delphi approach from Spiromics
AU - Oh, Anita L.
AU - Mularski, Richard A.
AU - Barjaktarevic, Igor
AU - Barr, R. Graham
AU - Bowler, Russell P.
AU - Comellas, Alejandro P.
AU - Cooper, Christopher B.
AU - Criner, Gerard J.
AU - Han, Mei Lan K.
AU - Hansel, Nadia N.
AU - Hoffman, Eric A.
AU - Kanner, Richard E.
AU - Krishnan, Jerry A.
AU - Paine, Robert
AU - Parekh, Trisha M.
AU - Peters, Stephen P.
AU - Christenson, Stephanie A.
AU - Woodruff, Prescott G.
N1 - Funding Information:
Supported by U.S. National Institutes of Health (NIH) grants F32HL149329 and K24 HL137013. SPIROMICS was supported by contracts from the NIH/U.S. National Heart, Lung, and Blood Institute (NHLBI) (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, and HHSN268200900020C) and grants from the NIH/NHLBI (U01 HL137880 and U24 HL141762) and supplemented by contributions made through the Foundation for the NIH and the COPD Foundation from AstraZeneca/MedImmune; Bayer; Bellerophon Therapeutics; Boehringer-Ingelheim Pharmaceuticals, Inc.; Chiesi Farmaceutici S.p.A.; Forest Research Institute, Inc.; GlaxoSmithKline; Grifols Therapeutics, Inc.; Ikaria, Inc.; Novartis Pharmaceuticals Corporation; Nycomed GmbH; ProterixBio; Regeneron Pharmaceuticals, Inc.; Sanofi; Sunovion; Takeda Pharmaceutical Co.; and Theravance Biopharma and Mylan.
Publisher Copyright:
© 2021 by the American Thoracic Society
PY - 2021/11
Y1 - 2021/11
N2 - Rationale: Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory disease who have minimal or no airflow obstruction. Objectives: To develop a multidimensional definition of a lung-related “resilient smoker” that is useful in research studies and then identify a resilient smoker subgroup in the SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) cohort using this definition. Methods: We performed a three-round modified Delphi survey among a panel of COPD experts to identify and reach a consensus on clinical and radiographic domains to be included in a lung-related resilient smoker definition. Consensus on domains of resilience was defined as >80% of experts voting “agree” or “strongly agree” on a 5-point Likert scale. The Delphi-derived definition of resilience was applied to SPIROMICS to identify resilient smokers, whom we then characterized using known biomarkers of COPD. Results: Consensus was achieved on 6 of 12 diagnostic items, which include cough and sputum production, dyspnea, radiographic measures of emphysema and small airways disease, exacerbations, and decline in forced expiratory volume in 1 second. Although 892 SPIROMICS participants were classified as smokers with preserved lung function by spirometry, only 149 participants (16.7%) qualified as resilient smokers by our definition. Blood biomarker expression of CRP (C-reactive protein) and sTNFRSF1A (soluble tumor necrosis receptor factor1A) was lower in resilient than nonresilient smokers (P = 0.02 and P = 0.03). Conclusions: A Delphi-derived consensus definition of resilient smoker identified 83.3% of smokers with preserved spirometry as “nonresilient” based on the presence of adverse effects of smoking on the lung. Resilient smokers were biologically distinct from nonresilient smokers based on CRP measurements.
AB - Rationale: Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory disease who have minimal or no airflow obstruction. Objectives: To develop a multidimensional definition of a lung-related “resilient smoker” that is useful in research studies and then identify a resilient smoker subgroup in the SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) cohort using this definition. Methods: We performed a three-round modified Delphi survey among a panel of COPD experts to identify and reach a consensus on clinical and radiographic domains to be included in a lung-related resilient smoker definition. Consensus on domains of resilience was defined as >80% of experts voting “agree” or “strongly agree” on a 5-point Likert scale. The Delphi-derived definition of resilience was applied to SPIROMICS to identify resilient smokers, whom we then characterized using known biomarkers of COPD. Results: Consensus was achieved on 6 of 12 diagnostic items, which include cough and sputum production, dyspnea, radiographic measures of emphysema and small airways disease, exacerbations, and decline in forced expiratory volume in 1 second. Although 892 SPIROMICS participants were classified as smokers with preserved lung function by spirometry, only 149 participants (16.7%) qualified as resilient smokers by our definition. Blood biomarker expression of CRP (C-reactive protein) and sTNFRSF1A (soluble tumor necrosis receptor factor1A) was lower in resilient than nonresilient smokers (P = 0.02 and P = 0.03). Conclusions: A Delphi-derived consensus definition of resilient smoker identified 83.3% of smokers with preserved spirometry as “nonresilient” based on the presence of adverse effects of smoking on the lung. Resilient smokers were biologically distinct from nonresilient smokers based on CRP measurements.
KW - Biomarkers
KW - Chronic obstructive pulmonary disease
KW - Consensus development
KW - Smoking
KW - Spirometry
UR - http://www.scopus.com/inward/record.url?scp=85118368346&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85118368346&partnerID=8YFLogxK
U2 - 10.1513/AnnalsATS.202006-757OC
DO - 10.1513/AnnalsATS.202006-757OC
M3 - Article
C2 - 33631079
AN - SCOPUS:85118368346
SN - 2329-6933
VL - 18
SP - 1822
EP - 1831
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 11
ER -