CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Smoking related COPD and facial wrinkling: is there a common susceptibility?

B D Patel¹, W J Loo², A D Tasker³, N J Screaton³, N P Burrows², E K Silverman⁴, D A Lomas⁵

¹ Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge and Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
² Department of Dermatology Addenbrooke’s Hospital, Cambridge, UK
³ Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
⁴ Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
⁵ Department of Medicine, University of Cambridge, Cambridge Institute for Medical Research, Cambridge, UK

Correspondence to:
Dr B D Patel
Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DN, UK; Bip.Patel{at}rdehc-tr.swest.nhs.uk

Background: Cigarette smoking causes accelerated facial wrinkling and predisposes to chronic obstructive pulmonary disease (COPD). However, it has long been recognised that there is a subgroup of susceptible smokers who are at increased risk of developing airflow obstruction. We have tested the hypothesis that there is a common susceptibility for the development of COPD and facial wrinkling in cigarette smokers.

Methods: One hundred and forty nine current and ex-smokers were recruited from a family based study of COPD genetics, 68 (45.6%) of whom fulfilled the definition of COPD. 124 (83.2%) had no or minor facial wrinkling (Daniell <IV) and 25 (16.8%) were wrinkled (Daniell score IV). Generalised estimating equations were used to adjust for familial correlations between related individuals and the potential confounding effects of age and pack years smoked.

Results: Forced expiratory volume in 1 second (FEV₁) was significantly lower in those with wrinkles than in those without (mean difference in FEV₁ % predicted –13.7%, 95% CI –27.5 to 0.0, p = 0.05) and facial wrinkling was associated with a substantially increased risk of COPD (adjusted OR 5.0, 95% CI 1.3 to 18.5, p<0.02). The Daniell score correlated with the extent of emphysema on the CT scan (p<0.05) and facial wrinkling was also associated with a greater risk of more extensive emphysema (adjusted OR 3.0, 95% CI 1.0 to 9.3, p = 0.05).

Conclusion: Facial wrinkling is associated with COPD in smokers, and both disease processes may share a common susceptibility. Facial wrinkling in smokers may therefore be a biomarker of susceptibility to COPD.

Keywords: chronic obstructive pulmonary disease; facial wrinkling; smoking

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