A new breath-holding test may noninvasively reveal early lung abnormalities caused by smoking and/or obesity.
BACKGROUND
Smoking and obesity are leading global causes of death. The aim of the present study was to develop a test to detect early lung abnormalities caused by smoking and/or obesity and to elucidate the underlying mechanisms and major contributory factors.


METHODS
One hundred twenty-nine healthy adults, 20 to 40 years of age, with normal spirometry findings, were divided into the following five groups: 38 healthy subjects (15 female subjects); 46 smokers (5 female smokers); 18 overweight nonsmokers (2 female nonsmokers; normal body mass index [BMI], >or= 25 kg/m(2); range, 25.0 to 37.2 kg/m(2)); 19 overweight smokers (1 female smoker; BMI range, 25.2 to 33.5 kg/m(2)); and 8 ex-smokers (BMI range, 20.8 to 24.1 kg/m(2)). A modified pulse oximeter was employed for measuring the fall in pulse oximetric saturation caused by 20-s breath-holding (dSpo(2)) at resting end expiration in the sitting posture.


RESULTS
In healthy subjects, dSpo(2) had no significant correlation with age (r(2) = 0.009; p = 0.66). In smokers, dSpo(2) correlated with both the number of pack-years (r(2) = 0.590; p < 0.001) and closing volume (CV)/vital capacity (VC) ratio (r(2) = 0.573; p < 0.001). In overweight nonsmokers, dSpo(2) increased significantly with BMI alone (r(2) = 0.667; p < 0.001). In overweight smokers, the largest increase in the mean dSpo(2) was observed. Multiple linear regression analysis suggested that BMI and CV/VC are the two major contributing factors determining dSpo(2) during breath-holding. In young former smokers, no significant increase in the mean dSpo(2) was observed (p = 0.77) a mean (+/- SD) duration of 5.2 +/- 2.9 years after the cessation of smoking. No significant difference in dSpo(2) was observed between men and women.


CONCLUSIONS
A new test that measures oxygen saturation during breath-holding reveals early lung abnormalities in subjects who either smoke or are overweight, especially if these factors are combined. Peripheral airway abnormalities and/or lung volume reduction may play roles in the greater desaturation.
Inoue
Hiroshi
H
Divisions of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan. Electronic address: hinoue@iwate-med.ac.jp.
Yamauchi
Kohei
K
Divisions of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
Kobayashi
Hitoshi
H
Divisions of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
Shikanai
Toshiki
T
Divisions of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
Nakamura
Yutaka
Y
Divisions of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
Satoh
Jo
J
Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan.
Kohno
Nobuoki
N
Department of Molecular and Internal Medicine, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
Mishima
Michiaki
M
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Sasaki
Hidetada
H
Akita University of Nursing and Welfare, Akita, Japan.
Hildebrandt
Jack
J
Department of Physiology and Biophysics, University of Washington, Seattle, WA.
D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007320:Inspiratory Capacity; D007321:Inspiratory Reserve Volume; D016014:Linear Models; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008451:Maximal Voluntary Ventilation / Q000502:physiology*; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D010101:Oxygen Consumption / Q000502:physiology; D011336:Probability; D012016:Reference Values; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013147:Spirometry; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult