Published ahead of print on June 19, 2009, doi:10.1164/rccm.200812-1966OC Am. J. Respir. Crit. Care Med., Volume 180, Number 5, September 2009, 407-414 A more recent version of this article appeared on September 1, 2009
Submitted on December 31, 2008 Cigarette Smoking is Associated with Subclinical Parenchymal Lung Disease: The MESA-Lung StudyDavid J Lederer1,1 Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States, 2 Department of Medicine, University of Arizona, Tucson, Arizona, United States, 3 Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States, 4 Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States, 5 Department of Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States, 6 Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, New York, United States, 7 Institute of Social and Economic Research and Policy, Columbia University, New York, New York, United States * To whom correspondence should be addressed. E-mail: rgb9{at}columbia.edu.
Rationale: Cigarette smoking is a risk factor for diffuse parenchymal lung disease. Risks factors for subclinical parenchymal lung disease have not been described. Objective: To determine if cigarette smoking is associated with subclinical parenchymal lung disease, as measured by spirometric restriction and regions of high attenuation on 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 packyears 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. Results: The prevalence of spirometric restriction was 10.0% (95% confidence interval 8.9 to 11.2%) and increased relatively by 8% (95% confidence interval 3 to 12%) for each 10 cigarette packyears in multivariate analysis. The median volume of high attenuation areas was 119 cm3 (interquartile range 100 to 143 cm3). The volume of high attenuation areas increased by 1.6 cm3 (95% confidence interval 0.9 to 2.4 cm3) for each 10 cigarette packyears 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 tomgraphy • interstitital lung disease • restrictive lung disease • spirometry
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