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Enzer NA, Chiles J, Mason S, Shirahata T, Castro V, Regan E, Choi B, Yuan NF, Diaz AA, Washko GR, McDonald ML, Estépar RSJ, Ash SY. Proteomics and Machine Learning in the Prediction and Explanation of Low Pectoralis Muscle Area. Res Sq 2024:rs.3.rs-3957125. [PMID: 38496412 PMCID: PMC10942559 DOI: 10.21203/rs.3.rs-3957125/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Low muscle mass is associated with numerous adverse outcomes independent of other associated comorbid diseases. We aimed to predict and understand an individual's risk for developing low muscle mass using proteomics and machine learning. We identified 8 biomarkers associated with low pectoralis muscle area (PMA). We built 3 random forest classification models that used either clinical measures, feature selected biomarkers, or both to predict development of low PMA. The area under the receiver operating characteristic curve for each model was: clinical-only = 0.646, biomarker-only = 0.740, and combined = 0.744. We displayed the heterogenetic nature of an individual's risk for developing low PMA and identified 2 distinct subtypes of participants who developed low PMA. While additional validation is required, our methods for identifying and understanding individual and group risk for low muscle mass could be used to enable developments in the personalized prevention of low muscle mass.
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Ross JC, San José Estépar R, Ash S, Pistenmaa C, Han M, Bhatt SP, Bodduluri S, Sparrow D, Charbonnier JP, Washko GR, Diaz AA. Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes. EClinicalMedicine 2024; 68:102408. [PMID: 38273887 PMCID: PMC10809101 DOI: 10.1016/j.eclinm.2023.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background Abnormal lung function trajectories are associated with increased risk of chronic obstructive pulmonary disease (COPD) and premature mortality; several risk factors for following these trajectories have been identified. Airway under-sizing dysanapsis (small airway lumens relative to lung size), is associated with an increased risk for COPD. The relationship between dysanapsis and lung function trajectories at risk for adverse outcomes of COPD is largely unexplored. We test the hypothesis that dysanapsis differentially affects distinct lung function trajectories associated with adverse outcomes of COPD. Methods To identify lung function trajectories, we applied Bayesian trajectory analysis to longitudinal FEV1 and FVC Z-scores in the COPDGene Study, an ongoing longitudinal study that collected baseline data from 2007 to 2012. To ensure clinical relevance, we selected trajectories based on risk stratification for all-cause mortality and prospective exacerbations of COPD (ECOPD). Dysanapsis was measured in baseline COPDGene CT scans as the airway lumen-to-lung volume (a/l) ratio. We compared a/l ratios between trajectories and evaluated their association with trajectory assignment, controlling for previously identified risk factors. We also assigned COPDGene participants for whom only baseline data is available to their most likely trajectory and repeated our analysis to further evaluate the relationship between trajectory assignment and a/l ratio measures. Findings We identified seven trajectories: supranormal, reference, and five trajectories at increased risk for mortality and exacerbations. Three at-risk trajectories are characterized by varying degrees of concomitant FEV1 and FVC impairments and exhibit airway predominant COPD patterns as assessed by quantitative CT imaging. These trajectories have lower a/l ratio values and increased risk for mortality and ECOPD compared to the reference trajectory. Two at-risk trajectories are characterized by disparate levels of FEV1 and FVC impairment and exhibit mixed airway and emphysema COPD patterns on quantitative CT imaging. These trajectories have markedly lower a/l ratio values compared to both the reference trajectory and airway-predominant trajectories and are at greater risk for mortality and ECOPD compared to the airway-predominant trajectories. These findings were observed among the participants with baseline-only data as well. Interpretation The degree of dysanapsis appears to portend patterns of progression leading to COPD. Assignment of individuals-including those without spirometric obstruction-to distinct trajectories is possible in a clinical setting and may influence management strategies. Strategies that combine CT-assessed dysanapsis together with spirometric measures of lung function and smoke exposure assessment are likely to further improve trajectory assignment accuracy, thereby improving early detection of those most at risk for adverse outcomes. Funding United States National Institute of Health, COPD Foundation, and Brigham and Women's Hospital.
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Affiliation(s)
- James C. Ross
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raul San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sam Ash
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie Pistenmaa
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - MeiLan Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine; University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine; University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Sparrow
- VA Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | - George R. Washko
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro A. Diaz
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Diaz AA, Washko GR, San José Estépar R. Mucus Plugs and Mortality in Patients With COPD-Reply. JAMA 2023; 330:1287-1288. [PMID: 37787798 DOI: 10.1001/jama.2023.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Diaz AA, Wang W, Orejas JL, Elalami R, Dolliver WR, Nardelli P, San José Estépar R, Choi B, Pistenmaa CL, Ross JC, Maselli DJ, Yen A, Young KA, Kinney GL, Cho MH, San José Estépar R. Suspected Bronchiectasis and Mortality in Adults With a History of Smoking Who Have Normal and Impaired Lung Function : A Cohort Study. Ann Intern Med 2023; 176:1340-1348. [PMID: 37782931 PMCID: PMC10809158 DOI: 10.7326/m23-1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Bronchiectasis in adults with chronic obstructive pulmonary disease (COPD) is associated with greater mortality. However, whether suspected bronchiectasis-defined as incidental bronchiectasis on computed tomography (CT) images plus clinical manifestation-is associated with increased mortality in adults with a history of smoking with normal spirometry and preserved ratio impaired spirometry (PRISm) is unknown. OBJECTIVE To determine the association between suspected bronchiectasis and mortality in adults with normal spirometry, PRISm, and obstructive spirometry. DESIGN Prospective, observational cohort. SETTING The COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) study. PARTICIPANTS 7662 non-Hispanic Black or White adults, aged 45 to 80 years, with 10 or more pack-years of smoking history. Participants who were former and current smokers were stratified into normal spirometry (n = 3277), PRISm (n = 986), and obstructive spirometry (n = 3399). MEASUREMENTS Bronchiectasis identified by CT was ascertained using artificial intelligence-based measurements of an airway-to-artery ratio (AAR) greater than 1 (AAR >1), a measure of bronchial dilatation. The primary outcome of "suspected bronchiectasis" was defined as an AAR >1 of greater than 1% plus 2 of the following: cough, phlegm, dyspnea, and history of 2 or more exacerbations. RESULTS Among the 7662 participants (mean age, 60 years; 52% women), 1352 (17.6%) had suspected bronchiectasis. During a median follow-up of 11 years, 2095 (27.3%) died. Ten-year mortality risk was higher in participants with suspected bronchiectasis, compared with those without suspected bronchiectasis (normal spirometry: difference in mortality probability [Pr], 0.15 [95% CI, 0.09 to 0.21]; PRISm: Pr, 0.07 [CI, -0.003 to 0.15]; obstructive spirometry: Pr, 0.06 [CI, 0.03 to 0.09]). When only CT was used to identify bronchiectasis, the differences were attenuated in the normal spirometry (Pr, 0.04 [CI, -0.001 to 0.08]). LIMITATIONS Only 2 racial groups were studied. Only 1 measurement was used to define bronchiectasis on CT. Symptoms of suspected bronchiectasis were nonspecific. CONCLUSION Suspected bronchiectasis was associated with a heightened risk for mortality in adults with normal and obstructive spirometry. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts (W.W.)
| | - Jose L Orejas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Rim Elalami
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
| | - Ruben San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
| | - Bina Choi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - James C Ross
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
| | - Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, The University of Texas at San Antonio, San Antonio, Texas (D.J.M.)
| | - Andrew Yen
- Department of Radiology, University of California San Diego, San Diego, California (A.Y.)
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado (K.A.Y., G.L.K.)
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado (K.A.Y., G.L.K.)
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.H.C.)
| | - Raul San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
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Dolliver WR, Wang W, Nardelli P, Rahaghi FN, Orejas JL, Maselli DJ, Yen A, Young K, Kinney G, Estépar RSJ, Diaz AA. Pulmonary arterial pruning is associated with CT-derived bronchiectasis progression in smokers. Respir Med 2022; 202:106971. [PMID: 36116143 DOI: 10.1016/j.rmed.2022.106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
Loss of small pulmonary arteries measured as the ratio of blood vessel volume in arteries <5 mm2 in cross-section to total arterial blood vessel volume (BV5a/TBVa), with lower values indicating more pruning, was associated with 5-yr progressing CT-derived bronchiectasis in smokers (Odds Ratio (OR) [95% Confidence interval], 1.28 [1.07-1.53] per 5% lower BV5a/TBVa, P = 0.007). Corresponding results in smokers with COPD were: OR 1.45 [1.11-1.89] per 5% lower BV5a/TBVa, P = 0.007. The results support a vascular factor for structural progression of bronchiectasis.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Wei Wang
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital, Boston, USA
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Jose L Orejas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, University of Texas, San Antonio, USA
| | - Andrew Yen
- Department of Radiology, University of California, San Diego, USA
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, USA
| | - Gregory Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, USA
| | | | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA.
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6
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Gazourian L, Durgana CS, Huntley D, Rizzo GS, Thedinger WB, Regis SM, Price LL, Pagura EJ, Lamb C, Rieger-Christ K, Thomson CC, Stefanescu CF, Sanayei A, Long WP, McKee AB, Washko GR, Estépar RSJ, Wald C, Liesching TN, McKee BJ. Quantitative Pectoralis Muscle Area is Associated with the Development of Lung Cancer in a Large Lung Cancer Screening Cohort. Lung 2020; 198:847-853. [PMID: 32889594 DOI: 10.1007/s00408-020-00388-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies have demonstrated an inverse relationship between body mass index (BMI) and the risk of developing lung cancer. We conducted a retrospective cohort study evaluating baseline quantitative computed tomography (CT) measurements of body composition, specifically muscle and fat area in a large CT lung screening cohort (CTLS). We hypothesized that quantitative measurements of baseline body composition may aid in risk stratification for lung cancer. METHODS Patients who underwent baseline CTLS between January 1st, 2012 and September 30th, 2014 and who had an in-network primary care physician were included. All patients met NCCN Guidelines eligibility criteria for CTLS. Quantitative measurements of pectoralis muscle area (PMA) and subcutaneous fat area (SFA) were performed on a single axial slice of the CT above the aortic arch with the Chest Imaging Platform Workstation software. Cox multivariable proportional hazards model for cancer was adjusted for variables with a univariate p < 0.2. Data were dichotomized by sex and then combined to account for baseline differences between sexes. RESULTS One thousand six hundred and ninety six patients were included in this study. A total of 79 (4.7%) patients developed lung cancer. There was an association between the 25th percentile of PMA and the development of lung cancer [HR 1.71 (1.07, 2.75), p < 0.025] after adjusting for age, BMI, qualitative emphysema, qualitative coronary artery calcification, and baseline Lung-RADS® score. CONCLUSIONS Quantitative assessment of PMA on baseline CTLS was associated with the development of lung cancer. Quantitative PMA has the potential to be incorporated as a variable in future lung cancer risk models.
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Affiliation(s)
- Lee Gazourian
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA.
| | | | | | | | | | - Shawn M Regis
- Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, USA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, USA.,Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
| | - Elizabeth J Pagura
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Carla Lamb
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Kimberly Rieger-Christ
- Cancer Research, Sophia Gordon Cancer Center, Lahey Hospital & Medical Center, Burlington, USA
| | - Carey C Thomson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Auburn Hospital, Cambridge, USA.,Harvard Medical School, Boston, USA
| | | | - Ava Sanayei
- Tufts University School of Medicine, Boston, USA
| | | | - Andrea B McKee
- Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, USA.,Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, USA
| | - Raul San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, USA
| | - Christoph Wald
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, USA
| | - Timothy N Liesching
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
| | - Brady J McKee
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, USA
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7
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Washko GR, Colangelo LA, Estépar RSJ, Ash SY, Bhatt SP, Okajima Y, Liu K, Jacobs DR, Iribarren C, Thyagarajan B, Lewis CE, Kumar R, Han MK, Dransfield MT, Carnethon MR, Kalhan R. Adult Life-Course Trajectories of Lung Function and the Development of Emphysema: The CARDIA Lung Study. Am J Med 2020; 133:222-230.e11. [PMID: 31369720 PMCID: PMC6980254 DOI: 10.1016/j.amjmed.2019.06.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Peak lung function and rate of decline predict future airflow obstruction and nonrespiratory comorbid conditions. Associations between lung function trajectories and emphysema have not been explored. METHODS Using data from the population-based CARDIA Study, we sought to describe the prevalence of visually ascertained emphysema at multiple time points and contextualize its development based upon participant's adult life course measures of lung function. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. Trajectories for the change in percent-predicted forced expiratory volume in one second (FEV1) were determined by fitting a mixture model via maximum likelihood. Emphysema was visually identified on computed tomographic scans and its prevalence reported at mean ages of 40, 45, and 50 years. RESULTS We identified 5 trajectories describing peak and change in FEV1: "Preserved Ideal," "Preserved Good," "Preserved Impaired," "Worsening," and "Persistently Poor." Ever smokers comprised part of all 5 trajectories. The prevalence of emphysema was 1.7% (n = 46; mean age of 40 years), 2.5% (n = 67; mean age of 45 years), and 7.1% (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 18.0% were never smokers. Worsening and poor lung health trajectories were associated with increased odds of future emphysema independent of chronic tobacco smoke exposure (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44). CONCLUSIONS Lower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.
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Affiliation(s)
- George R Washko
- Division of Pulmonary and Critical Care Medicine, Boston, Mass; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Mass.
| | - Laura A Colangelo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Raul San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Mass; Department of Radiology, Brigham and Women's Hospital, Boston, Mass
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Boston, Mass; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Mass
| | - Surya P Bhatt
- Lung Health Center, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham
| | - Yuka Okajima
- Division of Pulmonary and Critical Care Medicine, Boston, Mass; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Mass
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente of Northern California, Oakland
| | - Bharat Thyagarajan
- Department of Pathology and Laboratory Medicine, University of Minnesota School of Medicine, Minneapolis
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama-, Birmingham
| | - Rajesh Kumar
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Northwestern University and The Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ravi Kalhan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
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8
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Kinney GL, Santorico SA, Young KA, Cho MH, Castaldi PJ, San José Estépar R, Ross JC, Dy JG, Make BJ, Regan EA, Lynch DA, Everett DC, Lutz SM, Silverman EK, Washko GR, Crapo JD, Hokanson JE. Identification of Chronic Obstructive Pulmonary Disease Axes That Predict All-Cause Mortality: The COPDGene Study. Am J Epidemiol 2018; 187:2109-2116. [PMID: 29771274 DOI: 10.1093/aje/kwy087] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/13/2018] [Indexed: 11/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a syndrome caused by damage to the lungs that results in decreased pulmonary function and reduced structural integrity. Pulmonary function testing (PFT) is used to diagnose and stratify COPD into severity groups, and computed tomography (CT) imaging of the chest is often used to assess structural changes in the lungs. We hypothesized that the combination of PFT and CT phenotypes would provide a more powerful tool for assessing underlying morphologic differences associated with pulmonary function in COPD than does PFT alone. We used factor analysis of 26 variables to classify 8,157 participants recruited into the COPDGene cohort between January 2008 and June 2011 from 21 clinical centers across the United States. These factors were used as predictors of all-cause mortality using Cox proportional hazards modeling. Five factors explained 80% of the covariance and represented the following domains: factor 1, increased emphysema and decreased pulmonary function; factor 2, airway disease and decreased pulmonary function; factor 3, gas trapping; factor 4, CT variability; and factor 5, hyperinflation. After more than 46,079 person-years of follow-up, factors 1 through 4 were associated with mortality and there was a significant synergistic interaction between factors 1 and 2 on death. Considering CT measures along with PFT in the assessment of COPD can identify patients at particularly high risk for death.
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Affiliation(s)
- Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie A Santorico
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, Colorado
- Human Medical Genetics and Genomics Program, University of Colorado School of Medicine, Aurora, Colorado
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raul San José Estépar
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - James C Ross
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jennifer G Dy
- Department of Electrical & Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | | | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Douglas C Everett
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Sharon M Lutz
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - George R Washko
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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9
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Boueiz A, Chang Y, Cho MH, Washko GR, San José Estépar R, Bowler RP, Crapo JD, DeMeo DL, Dy JG, Silverman EK, Castaldi PJ. Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression. Chest 2017; 153:65-76. [PMID: 28943279 DOI: 10.1016/j.chest.2017.09.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/13/2017] [Accepted: 09/06/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Emphysema has considerable variability in its regional distribution. Craniocaudal emphysema distribution is an important predictor of the response to lung volume reduction. However, there is little consensus regarding how to define upper lobe-predominant and lower lobe-predominant emphysema subtypes. Consequently, the clinical and genetic associations with these subtypes are poorly characterized. METHODS We sought to identify subgroups characterized by upper-lobe or lower-lobe emphysema predominance and comparable amounts of total emphysema by analyzing data from 9,210 smokers without alpha-1-antitrypsin deficiency in the Genetic Epidemiology of COPD (COPDGene) cohort. CT densitometric emphysema was measured in each lung lobe. Random forest clustering was applied to lobar emphysema variables after regressing out the effects of total emphysema. Clusters were tested for association with clinical and imaging outcomes at baseline and at 5-year follow-up. Their associations with genetic variants were also compared. RESULTS Three clusters were identified: minimal emphysema (n = 1,312), upper lobe-predominant emphysema (n = 905), and lower lobe-predominant emphysema (n = 796). Despite a similar amount of total emphysema, the lower-lobe group had more severe airflow obstruction at baseline and higher rates of metabolic syndrome compared with subjects with upper-lobe predominance. The group with upper-lobe predominance had greater 5-year progression of emphysema, gas trapping, and dyspnea. Differential associations with known COPD genetic risk variants were noted. CONCLUSIONS Subgroups of smokers defined by upper-lobe or lower-lobe emphysema predominance exhibit different functional and radiological disease progression rates, and the upper-lobe predominant subtype shows evidence of association with known COPD genetic risk variants. These subgroups may be useful in the development of personalized treatments for COPD.
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Affiliation(s)
- Adel Boueiz
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yale Chang
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA
| | - Michael H Cho
- Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - George R Washko
- Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raul San José Estépar
- Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Russell P Bowler
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - James D Crapo
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jennifer G Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Peter J Castaldi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Diaz AA, Rahaghi FN, Doyle TJ, Young TP, Maclean ES, Martinez CH, San José Estépar R, Guerra S, Tesfaigzi Y, Rosas IO, Washko GR, Wilson DO. Differences in Respiratory Symptoms and Lung Structure Between Hispanic and Non-Hispanic White Smokers: A Comparative Study. Chronic Obstr Pulm Dis 2017; 4:297-304. [PMID: 29354674 DOI: 10.15326/jcopdf.4.4.2017.0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Prior studies have demonstrated that U.S. Hispanic smokers have a lower risk of decline in lung function and chronic obstructive pulmonary disease (COPD) compared with non-Hispanic whites (NHW). This suggests there might be racial-ethnic differences in susceptibility in cigarette smoke-induced respiratory symptoms, lung parenchymal destruction, and airway and vascular disease, as well as in extra-pulmonary manifestations of COPD. Therefore, we aimed to explore respiratory symptoms, lung function, and pulmonary and extra-pulmonary structural changes in Hispanic and NHW smokers. Methods: We compared respiratory symptoms, lung function, and computed tomography (CT) measures of emphysema-like tissue, airway disease, the branching generation number (BGN) to reach a 2-mm-lumen-diameter airway, and vascular pruning as well as muscle and fat mass between 39 Hispanic and 39 sex-, age- and smoking exposure-matched NHW smokers. Results: Hispanic smokers had higher odds of dyspnea than NHW after adjustment for COPD and asthma statuses (odds ratio[OR] = 2.96; 95% confidence interval [CI] 1.09-8.04), but no significant differences were found in lung function and CT measurements. Conclusions: While lung function and CT measures of the lung structure were similar, dyspnea is reported more frequently by Hispanic than matched-NHW smokers. It seems to be an impossible puzzle but it's easy to solve a Rubik' Cube using a few algorithms.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas P Young
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erick S Maclean
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor
| | - Raul San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stefano Guerra
- Asthma and Airway Disease Research Center and Department of Medicine, University of Arizona, Tucson; and ISGlobal CREAL and Pompeu Fabra University, Barcelona, Spain
| | | | - Ivan O Rosas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Diaz AA, Young TP, Maselli DJ, Martinez CH, Maclean ES, Yen A, Dass C, Simpson SA, Lynch DA, Kinney GL, Hokanson JE, Washko GR, San José Estépar R. Bronchoarterial ratio in never-smokers adults: Implications for bronchial dilation definition. Respirology 2016; 22:108-113. [PMID: 27538197 DOI: 10.1111/resp.12875] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/31/2016] [Accepted: 06/17/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Bronchiectasis manifests as recurrent respiratory infections and reduced lung function. Airway dilation, which is measured as the ratio of the diameters of the bronchial lumen (B) and adjacent pulmonary artery (A), is a defining radiological feature of bronchiectasis. A challenge to equating the bronchoarterial (BA) ratio to disease severity is that the diameters of airway and vessel in health are not established. We sought to explore the variability of BA ratio in never-smokers without pulmonary disease and its associations with lung function. METHODS Objective measurements of the BA ratio on volumetric computed tomography (CT) scans and pulmonary function data were collected in 106 never-smokers. The BA ratio was measured in the right upper lobe apical bronchus (RB1) and the right lower lobe basal posterior bronchus. The association between the BA ratio and forced expiratory volume in 1 s (FEV1 ) was assessed using regression analysis. RESULTS The BA ratio was 0.79 ± 0.16 and was smaller in more peripheral RB1 bronchi (P < 0.0001). The BA ratio was >1, a typical threshold for bronchiectasis, in 10 (8.5%) subjects. Subjects with a BA ratio >1 versus ≤1 had smaller artery diameters (P < 0.0001) but not significantly larger bronchial lumens. After adjusting for age, gender, race and height, the BA ratio was directly related to FEV1 (P = 0.0007). CONCLUSION In never-smokers, the BA ratio varies by airway generation and is associated with lung function. A BA ratio >1 is driven by small arteries. Using artery diameter as reference to define bronchial dilation seems inappropriate.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas P Young
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diego J Maselli
- Division of Pulmonary Diseases & Critical Care, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Carlos H Martinez
- Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Erick S Maclean
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Yen
- Department of Radiology, University of California, San Diego, California, USA
| | - Chandra Dass
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Scott A Simpson
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado, USA
| | - Gregory L Kinney
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
| | - John E Hokanson
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raul San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kinsey CM, San José Estépar R, van der Velden J, Cole BF, Christiani DC, Washko GR. Lower Pectoralis Muscle Area Is Associated with a Worse Overall Survival in Non-Small Cell Lung Cancer. Cancer Epidemiol Biomarkers Prev 2016; 26:38-43. [PMID: 27197281 DOI: 10.1158/1055-9965.epi-15-1067] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 04/18/2016] [Accepted: 05/10/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Muscle wasting is a component of the diagnosis of cancer cachexia and has been associated with poor prognosis. However, recommended tools to measure sarcopenia are limited by poor sensitivity or the need to perform additional scans. We hypothesized that pectoralis muscle area (PMA) measured objectively on chest CT scan may be associated with overall survival (OS) in non-small cell lung cancer (NSCLC). METHODS We evaluated 252 cases from a prospectively enrolling lung cancer cohort. Eligible cases had CT scans performed prior to the initiation of surgery, radiation, or chemotherapy. PMA was measured in a semi-automated fashion while blinded to characteristics of the tumor, lung, and patient outcomes. RESULTS Men had a significantly greater PMA than women (37.59 vs. 26.19 cm2, P < 0.0001). In univariate analysis, PMA was associated with age and body mass index (BMI). A Cox proportional hazards model was constructed to account for confounders associated with survival. Lower pectoralis area (per cm2) at diagnosis was associated with an increased hazard of death of 2% (HRadj, 0.98; confidence interval, 0.96-0.99; P = 0.044) while adjusting for age, sex, smoking, chronic bronchitis, emphysema, histology, stage, chemotherapy, radiation, surgery, BMI, and ECOG performance status. CONCLUSIONS Lower PMA measured from chest CT scans obtained at the time of diagnosis of NSCLC is associated with a worse OS. IMPACT PMA may be a valuable CT biomarker for sarcopenia-associated lung cancer survival. Cancer Epidemiol Biomarkers Prev; 26(1); 38-43. ©2016 AACR SEE ALL THE ARTICLES IN THIS CEBP FOCUS SECTION, "THE OBESITY PARADOX IN CANCER EVIDENCE AND NEW DIRECTIONS".
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Affiliation(s)
- C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, Burlington, Vermont.
| | | | - Jos van der Velden
- Department of Pathology, University of Vermont Medical Center, Burlington, Vermont
| | - Bernard F Cole
- College of Engineering and Mathematics, University of Vermont, Burlington, Vermont
| | - David C Christiani
- Department of Environmental Health and Epidemiology, Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard School of Public Health, Boston, Massachusetts
| | - George R Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Diaz AA, Rahaghi FN, Ross JC, Harmouche R, Tschirren J, San José Estépar R, Washko GR. Understanding the contribution of native tracheobronchial structure to lung function: CT assessment of airway morphology in never smokers. Respir Res 2015; 16:23. [PMID: 25848985 PMCID: PMC4335784 DOI: 10.1186/s12931-015-0181-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background Computed tomographic (CT) airway lumen narrowing is associated with lower lung function. Although volumetric CT measures of airways (wall volume [WV] and lumen volume [LV]) compared to cross sectional measures can more accurately reflect bronchial morphology, data of their use in never smokers is scarce. We hypothesize that native tracheobronchial tree morphology as assessed by volumetric CT metrics play a significant role in determining lung function in normal subjects. We aimed to assess the relationships between airway size, the projected branching generation number (BGN) to reach airways of <2mm lumen diameter –the site for airflow obstruction in smokers- and measures of lung function including forced expiratory volume in 1 second (FEV1) and forced expiratory flow between 25% and 75% of vital capacity (FEF 25–75). Methods We assessed WV and LV of segmental and subsegmental airways from six bronchial paths as well as lung volume on CT scans from 106 never smokers. We calculated the lumen area ratio of the subsegmental to segmental airways and estimated the projected BGN to reach a <2mm-lumen-diameter airway assuming a dichotomized tracheobronchial tree model. Regression analysis was used to assess the relationships between airway size, BGN, FEF 25–75, and FEV1. Results We found that in models adjusted for demographics, LV and WV of segmental and subsegmental airways were directly related to FEV1 (P <0.05 for all the models). In adjusted models for age, sex, race, LV and lung volume or height, the projected BGN was directly associated with FEF 25–75 and FEV1 (P = 0.001) where subjects with lower FEV1 had fewer calculated branch generations between the subsegmental bronchus and small airways. There was no association between airway lumen area ratio and lung volume. Conclusion We conclude that in never smokers, those with smaller central airways had lower airflow and those with lower airflow had less parallel airway pathways independent of lung size. These findings suggest that variability in the structure of the tracheobronchial tree may influence the risk of developing clinically relevant smoking related airway obstruction. Electronic supplementary material The online version of this article (doi:10.1186/s12931-015-0181-y) contains supplementary material, which is available to authorized users.
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