TY - JOUR
T1 - Occupational exposures and computed tomographic imaging characteristics in the SpiromICS cohort
AU - Paulin, Laura
AU - Smith, Benjamin M.
AU - Koch, Abby
AU - Han, Mei Lan
AU - Hoffman, Eric A.
AU - Martinez, Carlos
AU - Ejike, Chinedu
AU - Blanc, Paul D.
AU - Rous, Jennifer
AU - Graham Barr, R.
AU - Peters, Stephen P.
AU - Paine, Robert
AU - Pirozzi, Cheryl
AU - Cooper, Christopher B.
AU - Dransfield, Mark T.
AU - Comellas, Alejandro P.
AU - Kanner, Richard E.
AU - Brad Drummond, M.
AU - Putcha, Nirupama
AU - Hansel, Nadia N.
N1 - Funding Information:
Supported by contracts from the National Heart, Lung, and Blood Institute, National Institutes of Health (NIH) (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C) (SPIROMICS), 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.; Nycomed GmbH; Takeda Pharmaceutical Co.; Novartis Pharmaceuticals Corporation; ProterixBio; Regeneron Pharmaceuticals, Inc.; Sanofi; and Sunovion. This project was also supported by National Institute of Environmental Health Sciences, National Institutes of Health grants R01ES023500 and K23ES025781.
Publisher Copyright:
Copyright © 2018 by the American Thoracic Society.
PY - 2018/12
Y1 - 2018/12
N2 - Rationale: Quantitative computed tomographic (CT) imaging can aid in chronic obstructive pulmonary disease (COPD) phenotyping. Few studies have identified whether occupational exposures are associated with distinct CT imaging characteristics. Objectives: To examine the association between occupational exposures and CT-measured patterns of disease in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Methods: Participants underwent whole-lung multidetector helical CT at full inspiration and expiration. The association between occupational exposures (self-report of exposure to vapors, gas, dust, or fumes [VGDF] at the longest job) and CT metrics of emphysema (percentage of total voxels, 2950 Hounsfield units at total lung capacity), large airways (wall area percent [WAP] and square-root wall area of a single hypothetical airway with an internal perimeter of 10 mm [Pi10]), and small airways (percent air trapping [percent total voxels, 2856 Hounsfield units at residual volume] and parametric response mapping of functional small-airway abnormality [PRM fSAD]) were explored by multivariate linear regression, and for central airway measures by generalized estimating equations to account for multiple measurements per individual. Models were adjusted for age, sex, race, current smoking status, pack-years of smoking, body mass index, and site. Airway measurements were additionally adjusted for total lung volume. Results: A total of 2,736 participants with available occupational exposure data (n = 927 without airflow obstruction and 1,809 with COPD) were included. The mean age was 64 years, 78% were white, and 54% were male. Forty percent reported current smoking, and mean (SD) pack-years was 49.3 (26.9). Mean (SD) post-bronchodilator forced expiratory volume in 1 second (FEV1) was 73 (27) % predicted. Forty-nine percent reported VGDF exposure. VGDF exposure was associated with higher emphysema (b = 1.17; 95% confidence interval [CI], 0.44-1.89), greater large-airway disease as measured by WAP (segmental b = 0.487 [95% CI, 0.320-0.654]; subsegmental b = 0.400 [95% CI, 0.275-0.527]) and Pi10 (b = 0.008; 95% CI, 0.002-0.014), and greater small-airway disease was measured by air trapping (b = 2.60; 95% CI, 1.11-4.09) and was nominally associated with an increase in PRM fSAD (b = 1.45; 95% CI, 0.31-2.60). These findings correspond to higher odds of percent emphysema, WAP, and air trapping above the 95th percentile of measurements in nonsmoking control subjects in individuals reporting VGDF exposure. Conclusions: In an analysis of SPIROMICS participants, we found that VGDF exposure in the longest job was associated with an increase in emphysema, and in large- and small-airway disease, as measured by quantitative CT imaging.
AB - Rationale: Quantitative computed tomographic (CT) imaging can aid in chronic obstructive pulmonary disease (COPD) phenotyping. Few studies have identified whether occupational exposures are associated with distinct CT imaging characteristics. Objectives: To examine the association between occupational exposures and CT-measured patterns of disease in the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). Methods: Participants underwent whole-lung multidetector helical CT at full inspiration and expiration. The association between occupational exposures (self-report of exposure to vapors, gas, dust, or fumes [VGDF] at the longest job) and CT metrics of emphysema (percentage of total voxels, 2950 Hounsfield units at total lung capacity), large airways (wall area percent [WAP] and square-root wall area of a single hypothetical airway with an internal perimeter of 10 mm [Pi10]), and small airways (percent air trapping [percent total voxels, 2856 Hounsfield units at residual volume] and parametric response mapping of functional small-airway abnormality [PRM fSAD]) were explored by multivariate linear regression, and for central airway measures by generalized estimating equations to account for multiple measurements per individual. Models were adjusted for age, sex, race, current smoking status, pack-years of smoking, body mass index, and site. Airway measurements were additionally adjusted for total lung volume. Results: A total of 2,736 participants with available occupational exposure data (n = 927 without airflow obstruction and 1,809 with COPD) were included. The mean age was 64 years, 78% were white, and 54% were male. Forty percent reported current smoking, and mean (SD) pack-years was 49.3 (26.9). Mean (SD) post-bronchodilator forced expiratory volume in 1 second (FEV1) was 73 (27) % predicted. Forty-nine percent reported VGDF exposure. VGDF exposure was associated with higher emphysema (b = 1.17; 95% confidence interval [CI], 0.44-1.89), greater large-airway disease as measured by WAP (segmental b = 0.487 [95% CI, 0.320-0.654]; subsegmental b = 0.400 [95% CI, 0.275-0.527]) and Pi10 (b = 0.008; 95% CI, 0.002-0.014), and greater small-airway disease was measured by air trapping (b = 2.60; 95% CI, 1.11-4.09) and was nominally associated with an increase in PRM fSAD (b = 1.45; 95% CI, 0.31-2.60). These findings correspond to higher odds of percent emphysema, WAP, and air trapping above the 95th percentile of measurements in nonsmoking control subjects in individuals reporting VGDF exposure. Conclusions: In an analysis of SPIROMICS participants, we found that VGDF exposure in the longest job was associated with an increase in emphysema, and in large- and small-airway disease, as measured by quantitative CT imaging.
KW - Chronic obstructive pulmonary disease
KW - Outcome assessment
KW - Quantitative computed tomography
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U2 - 10.1513/AnnalsATS.201802-150OC
DO - 10.1513/AnnalsATS.201802-150OC
M3 - Article
C2 - 30339479
AN - SCOPUS:85057532053
SN - 2325-6621
VL - 15
SP - 1411
EP - 1419
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 12
ER -