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Associations between emphysema-like lung on CT and incident airflow limitation: a general population-based cohort study
  1. Elizabeth C Oelsner1,2,
  2. Benjamin M Smith1,3,
  3. Eric A Hoffman4,
  4. Aaron R Folsom5,
  5. Steven M Kawut6,
  6. Joel D Kaufman7,
  7. Ani Manichaikul8,
  8. David J Lederer1,
  9. Joseph E Schwartz1,
  10. Karol E Watson9,
  11. Paul L Enright10,
  12. John H M Austin1,
  13. Joao A C Lima11,
  14. Steven J Shea1,2,
  15. Robert G Barr1,2
  1. 1 Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, New York, USA
  2. 2 Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
  3. 3 Respiratory Division, McGill University, Montreal, Quebec, Canada
  4. 4 Department of Radiology, University of Iowa, Iowa City, Iowa, USA
  5. 5 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
  6. 6 School of Medicine, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  7. 7 Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
  8. 8 Department of Public Health Sciences, Division of Biostatistics and Epidemiology, University of Virginia, Charlottesville, Virginia, USA
  9. 9 Division of Cardiology, UCLA School of Medicine, Los Angeles, California, USA
  10. 10 Department of Medicine, University of Arizona, Tucson, Arizona, USA
  11. 11 Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Elizabeth C Oelsner, Department of Medicine, Columbia University Medical Center, Presbyterian Hospital, New York, NY 10032, USA; eco7{at}


Emphysema on CT is associated with accelerated lung function decline in heavy smokers and patients with COPD; however, in the general population, it is not known whether greater emphysema-like lung on CT is associated with incident COPD. We used data from 2045 adult participants without initial prebronchodilator airflow limitation, classified by FEV1/FVC<0.70, in the Multi-Ethnic Study of Atherosclerosis. Emphysema-like lung on baseline cardiac CT, defined as per cent low attenuation areas<—950HU>upper limit of normal, was associated with increased odds of incident airflow limitation at 5-year follow-up on both prebronchodilator (adjusted OR 2.62, 95% CI 1.47 to 4.67) and postbronchodilator (adjusted OR 4.38, 95% CI 1.63 to 11.74) spirometry, independent of smoking history. These results support investigation into whether emphysema-like lung could be informative for COPD risk stratification.

  • COPD epidemiology
  • emphysema
  • imaging/CT MRI

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  • Contributors All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship, having all made substantial contributions to: study conception, design, and/or data collection; interpretation of data; drafting and/or critical revision of the manuscript; and final manuscript review. All coauthors agree to be accountable for all aspects of the work and will ensure any questions regarding the accuracy or integrity of any part of the work are appropriately investigated and resolved. Specific contributions of each author are enumerated as follows: ECO: literature search, funding, study design, data analysis, data interpretation, drafting of manuscript, preparation of tables and figures. BMS, SMK, AM, DJL, JES, PLE: study design, data interpretation, manuscript review. EAH, ARF, SJS, JDK, KEW, JACL: study design, data collection, data interpretation, manuscript review. JHMA: emphysema measurement, data interpretation, manuscript review. RGB: study design, funding, data collection, data interpretation, drafting and review of manuscript.

  • Funding The MESA Lung Study is funded by R01-HL077612, R01-HL093081 and RC1-HL100543. Additional funding is provided by K23-HL-130627, R21-HL129924 and R01-HL130506. MESA was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and UL1-RR-025005 from NCRR. This publication was also developed under a STAR research assistance agreement, No. RD831697 (MESA Air), awarded by the US Environmental Protection Agency. It has not been formally reviewed by the EPA. The views expressed in this document are solely those of the authors and the EPA does not endorse any products or commercial services mentioned in this publication.

  • Competing interests The authors do not report any competing interests, besides funding from the NIH, with the following exceptions: BMS reports training/salary awards from the Quebec Health Research Fund, and grants from McGill University; EAH is a founder and shareholder of VIDA Diagnostics, a company commercialising lung image analysis software developed, in part, at the University of Iowa; SMK has received non-financial support from the ATS, personal fees from the European Respiratory Journal for serving on an editorial board, and the University of Pennsylvania has received grants from Actelion, grants from United Therapeutics, grants from Gilead, grants from Lung Biotech, and grants from Bayer for CME courses; RGB reports grants from the Alpha-1 Foundation, COPD Foundation, and Foundation for the NIH, personal fees from UpToDate, and travel reimbursement from the COPD Foundation.

  • Ethics approval The study was approved by the NHLBI as well as the institutional review boards of all collaborating institutions.

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

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