Cigarette smoking is associated with subclinical parenchymal lung disease: the Multi-Ethnic Study of Atherosclerosis (MESA)-lung study.
BACKGROUND
Cigarette smoking is a risk factor for diffuse parenchymal lung disease. Risk factors for subclinical parenchymal lung disease have not been described.


OBJECTIVE
To determine if cigarette smoking is associated with subclinical parenchymal lung disease, as measured by spirometric restriction and regions of high attenuation on computed tomography (CT) imaging.


METHODS
We examined 2,563 adults without airflow obstruction or clinical cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis, a population-based cohort sampled from six communities in the United States. Cumulative and current cigarette smoking were assessed by pack-years and urine cotinine, respectively. Spirometric restriction was defined as a forced vital capacity less than the lower limit of normal. High attenuation areas on the lung fields of cardiac CT scans were defined as regions having an attenuation between -600 and -250 Hounsfield units, reflecting ground-glass and reticular abnormalities. Generalized additive models were used to adjust for age, gender, race/ethnicity, smoking status, anthropometrics, center, and CT scan parameters.


RESULTS
The prevalence of spirometric restriction was 10.0% (95% confidence interval [CI], 8.9-11.2%) and increased relatively by 8% (95% CI, 3-12%) for each 10 cigarette pack-years in multivariate analysis. The median volume of high attenuation areas was 119 cm(3) (interquartile range, 100-143 cm(3)). The volume of high attenuation areas increased by 1.6 cm(3) (95% CI, 0.9-2.4 cm(3)) for each 10 cigarette pack-years in multivariate analysis.


CONCLUSIONS
Smoking may cause subclinical parenchymal lung disease detectable by spirometry and CT imaging, even among a generally healthy cohort.
Lederer
David J
DJ
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Enright
Paul L
PL
Kawut
Steven M
SM
Hoffman
Eric A
EA
Hunninghake
Gary
G
van Beek
Edwin J R
EJ
Austin
John H M
JH
Jiang
Rui
R
Lovasi
Gina S
GS
Barr
R Graham
RG
D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003367:Cotinine / Q000652:urine; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D013147:Spirometry; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
D003367:Cotinine