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Lung volume indices predict morbidity in smokers with preserved spirometry
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  • Published on:
    Lung volumes measurement for risk stratification in smokers without COPD
    • Mehrdad Arjomandi, Associate Professor of Medicine University of California San Francisco; San Francisco Veterans Affairs Medical Center

    We appreciate the points raised by the commentator about our study (Zeng et al.)[1] published in June 2018 issue of Thorax that (1) the prevalence of abnormal residual volume to total lung capacity ratio (RV:TLC) in our study of ever-smokers with preserved spirometry is substantially higher than that observed in the commentator’s past studies,[2-4] and (2) an assumption by the commentator that stringent exclusion of those with abnormally low TLC and those with diagnosis codes of interstitial lung diseases (ILD) in their electronic health records (EHR) may have resulted in overestimation of the prevalence of abnormally high RV:TLC among smokers with preserved spirometry.

    We would like to draw the attention of commentator and readers to the following points:

    1- The studies referenced by the commentator used pulmonary function tests (PFT) data collected from 708 patients in 2013 across 5 clinical sites associated with University of Minnesota Medical Center with inclusion criteria of patients 18 years of age or older with or without history of smoking.[2] They included about 50% women and 3 African Americans. Our study was performed on PFT data obtained from 1985 through 2017 through the United States Veterans Affairs (VA) nationwide EHR from 7,479 patients across 37 VA medical centers in the United States with inclusion criteria of patients 40 years of age or older with an EHR diagnosis code of smoking, which likely suggests heavy smoking for VA patients. Our st...

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    Conflict of Interest:
    None declared.
  • Published on:
    Should lung volumes measurement accompany every spirometry?
    • Spyridon Fortis, Pulmonary and Critica Care physician 1Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics

    Should lung volumes measurement accompany every spirometry?
    Spyridon Fortis MD1
    1Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA

    Corresponding Author:
    Spyridon Fortis, MD
    UIHC – Internal Medicine
    200 Hawkins Drive – C33 GH
    Iowa City, IA 52242
    Word Count:
    Author Disclosures: Authors declare that there is no conflict of interest regarding the publication of this paper.
    Running Head: Lung volumes with every spirometry
    Key Words: COPD, diagnosis, lung volumes, RV/TLC, preserved lung function.

    In their study published in the June 2018 issue of Thorax, Zeng et al showed that RV/TLC ratio in smokers with preserved lung function is associated with clinical diagnosis of COPD, higher rates of respiratory medications prescriptions, emergency room visits, hospitalizations, and all cause-mortality[1]. The findings strongly support that patients with respiratory symptoms and normal spirometry who have air trapping in lung volume measurements have worse outcomes than those with no air trapping. Those patients at risk for COPD may suffer early obstructive lung disease which has not yet met the spirometric criteria for COPD diagnosis.
    I congratulate the authors for their study as they address a very clinically relevant topic. Further studies are neede...

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    Conflict of Interest:
    None declared.