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Cigarette Smoking Is Associated with Subclinical Parenchymal Lung Disease

The Multi-Ethnic Study of Atherosclerosis (MESA)–Lung Study

¹ Department of Medicine, and ⁷ Department of Radiology, College of Physicians and Surgeons, ⁸ Department of Epidemiology, Mailman School of Public Health, and ⁹ Institute of Social and Economic Research and Policy, Columbia University, New York, New York; ² Department of Medicine, University of Arizona, Tucson, Arizona; ³ Center for Clinical Epidemiology and Biostatistics, and ⁴ Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and ⁵ Department of Radiology, and ⁶ Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, lowa

Correspondence and requests for reprints should be addressed to R. Graham Barr, M.D., Dr.P.H., Columbia University Medical Center, 630 West 168th Street, PH 9 East - Room 105, New York, NY 10032. E-mail: rgb9{at}columbia.edu

Rationale: Cigarette smoking is a risk factor for diffuse parenchymal lung disease. Risk factors for subclinical parenchymal lung disease have not been described.

Objectives: To determine if cigarette smoking is associated with subclinical parenchymal lung disease, as measured by spirometric restriction and regions of high attenuation on computed tomography (CT) imaging.

Methods: We examined 2,563 adults without airflow obstruction or clinical cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis, a population-based cohort sampled from six communities in the United States. Cumulative and current cigarette smoking were assessed by pack-years and urine cotinine, respectively. Spirometric restriction was defined as a forced vital capacity less than the lower limit of normal. High attenuation areas on the lung fields of cardiac CT scans were defined as regions having an attenuation between –600 and –250 Hounsfield units, reflecting ground-glass and reticular abnormalities. Generalized additive models were used to adjust for age, gender, race/ethnicity, smoking status, anthropometrics, center, and CT scan parameters.

Measurements and Main Results: The prevalence of spirometric restriction was 10.0% (95% confidence interval [CI], 8.9–11.2%) and increased relatively by 8% (95% CI, 3–12%) for each 10 cigarette pack-years in multivariate analysis. The median volume of high attenuation areas was 119 cm³ (interquartile range, 100–143 cm³). The volume of high attenuation areas increased by 1.6 cm³ (95% CI, 0.9–2.4 cm³) for each 10 cigarette pack-years in multivariate analysis.

Conclusions: Smoking may cause subclinical parenchymal lung disease detectable by spirometry and CT imaging, even among a generally healthy cohort.

Key Words: cigarette smoking • computed tomography • interstitial lung disease • restrictive lung disease • spirometry

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Cigarette smoking is a risk factor for some idiopathic interstitial pneumonias, and current smokers have a higher prevalence of spirometric restriction. There are no population-based cohort studies examining the association between cigarette smoking and increased lung density on computed tomography (CT). What This Study Adds to the Field Smoking may cause subclinical parenchymal lung disease detectable by spirometry and CT imaging.