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CT-quantified emphysema in male heavy smokers: association with lung function decline
  1. Firdaus A A Mohamed Hoesein1,
  2. Bartjan de Hoop2,
  3. Pieter Zanen1,
  4. Hester Gietema2,
  5. Cas L J J Kruitwagen3,
  6. Bram van Ginneken4,5,
  7. Ivana Isgum4,
  8. Christian Mol4,5,
  9. Rob J van Klaveren6,
  10. Akkelies E Dijkstra7,
  11. Harry J M Groen7,
  12. H Marike Boezen8,
  13. Dirkje S Postma7,
  14. Mathias Prokop2,5,
  15. Jan-Willem J Lammers1
  1. 1Division of Heart and Lungs, Department of Respiratory Medicine, University Medical Centre, Utrecht, The Netherlands
  2. 2Department of Radiology, University Medical Centre, Utrecht, The Netherlands
  3. 3Centre for Biostatistics, Julius Centre, University Utrecht, Utrecht, The Netherlands
  4. 4Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands
  5. 5Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  6. 6Department of Pulmonology, Erasmus Medical Centre, Rotterdam, The Netherlands
  7. 7Department of Pulmonology, University Medical Centre, University of Groningen, The Netherlands
  8. 8Department of Epidemiology, University Medical Centre, University of Groningen, The Netherlands
  1. Correspondence to Firdaus Mohamed Hoesein, University Medical Centre Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands; f.a.a.mohamedhoesein{at}


Background Emphysema and small airway disease both contribute to chronic obstructive pulmonary disease (COPD), a disease characterised by accelerated decline in lung function. The association between the extent of emphysema in male current and former smokers and lung function decline was investigated.

Methods Current and former heavy smokers participating in a lung cancer screening trial were recruited to the study and all underwent CT. Spirometry was performed at baseline and at 3-year follow-up. The 15th percentile (Perc15) was used to assess the severity of emphysema.

Results 2085 men of mean age 59.8 years participated in the study. Mean (SD) baseline Perc15 was −934.9 (19.5) HU. A lower Perc15 value correlated with a lower forced expiratory volume in 1 s (FEV1) at baseline (r=0.12, p<0.001). Linear mixed model analysis showed that a lower Perc15 was significantly related to a greater decline in FEV1 after follow-up (p<0.001). Participants without baseline airway obstruction who developed it after follow-up had significantly lower mean (SD) Perc15 values at baseline than those who did not develop obstruction (−934.2 (17.1) HU vs −930.2 (19.7) HU, p<0.001).

Conclusion Greater baseline severity of CT-detected emphysema is related to lower baseline lung function and greater rates of lung function decline, even in those without airway obstruction. CT-detected emphysema aids in identifying non-obstructed male smokers who will develop airflow obstruction.

  • CT
  • chronic obstructive pulmonary disease
  • emphysema
  • lung function
  • spirometry
  • COPD epidemiology
  • imaging/CT MRI etc

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  • See Editorial, p 741

  • FAAMH and BdH contributed equally to this study.

  • Linked articles 161430.

  • Competing interests HJMG received funds for research from Eli Lilly and Roche. DSP received funding for research from AstraZeneca, GSK, Nycomed. Travel to ERS or ATS has been partially funded by AstraZeneca, GSK, Chiesi, Nycomed. DSP has been consultant to AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Nycomed and TEVA.

  • Ethics approval This study was conducted with the approval of the Dutch Ministry of Health and by the ethics committee of the two participating hospitals (University Medical Center Utrecht and University Medical Center Groningen).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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