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The prevalence and physiological impacts of centrilobular and paraseptal emphysema on CT in smokers with Preserved Ratio Impaired Spirometry

Yusuke Shiraishi, Takafumi Shimada, Naoya Tanabe, Kunihiko Terada, Ryo Sakamoto, Tomoki Maetani, Hiroshi Shima, Fumi Mochizuki, Tsuyoshi Oguma, Kaoruko Shimizu, Susumu Sato, Shigeo Muro, Nobuyuki Hizawa, Motonari Fukui, Hiroaki Iijima, Izuru Masuda, Toyohiro Hirai
ERJ Open Research 2022; DOI: 10.1183/23120541.00063-2022
Yusuke Shiraishi
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
2Respiratory Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Kita-ku, Osaka, Japan
10YS and TS contributed equally to this work
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Takafumi Shimada
3Department of Respiratory Medicine, Tsukuba Medical Center, Tsukuba, Ibaraki, Japan
10YS and TS contributed equally to this work
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Naoya Tanabe
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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  • For correspondence: ntana@kuhp.kyoto-u.ac.jp
Kunihiko Terada
4Terada Clinic, Respiratory Medicine and General Practice, Himeji, Hyogo, Japan
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Ryo Sakamoto
5Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Tomoki Maetani
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Hiroshi Shima
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Fumi Mochizuki
3Department of Respiratory Medicine, Tsukuba Medical Center, Tsukuba, Ibaraki, Japan
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Tsuyoshi Oguma
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Kaoruko Shimizu
6Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Susumu Sato
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Shigeo Muro
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
7Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan
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Nobuyuki Hizawa
8Department of Pulmonary Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Motonari Fukui
2Respiratory Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Kita-ku, Osaka, Japan
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Hiroaki Iijima
3Department of Respiratory Medicine, Tsukuba Medical Center, Tsukuba, Ibaraki, Japan
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Izuru Masuda
9Medical examination center, Takeda Hospital, Kyoto, Japan
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Toyohiro Hirai
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Abstract

Centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are observed in smokers with Preserved Ratio Impaired Spirometry (PRISm, defined as the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC)≥0.7 and FEV1<80%), but their prevalence and physiological impacts remain unestablished. This multicenter study aimed to investigate its prevalence and to test whether emphysema subtypes are differently associated with physiological impairments in smokers with PRISm.

Both never and ever smokers aged at ≥40 years who underwent CT for lung cancer screening and spirometry were retrospectively and consecutively enrolled at three hospitals and a clinic. Emphysema subtypes were visually classified according to the Fleischner system. Air-trapping was assessed as the ratio of FVC to total lung capacity on CT (FVC/TLCCT).

Of 1046 never-smokers and 772 smokers with >10 pack-years, the prevalence of PRISm was 8.2% and 11.3%, respectively. The prevalence of PSE and CLE in smokers with PRISm was comparable to that in smokers with normal spirometry (PSE 43.7% versus 36.2%, p=1.00, CLE 46.0% versus 31.8%, p=0.21), but higher than that in never-smokers with PRISm (PSE, versus 1.2%, p<0.01, CLE, versus 4.7%, p<0.01) and lower than that in smokers with airflow limitation (PSE, versus 71.0%, p<0.01, CLE, versus 79.3%, p<0.01). The presence of CLE but not PSE was independently associated with reduced FVC/TLCCT in smokers with PRISm.

Both PSE and CLE were common, but only CLE was associated with air-trapping in smokers with PRISm, suggesting different physiological roles of these emphysema subtypes.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflicts of interest: N.T, S.S, T.O. and T.H. were supported by a grant from FUJIFILM Co., Ltd.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received February 2, 2022.
  • Accepted April 26, 2022.
  • Copyright ©The authors 2022
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org

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The prevalence and physiological impacts of centrilobular and paraseptal emphysema on CT in smokers with Preserved Ratio Impaired Spirometry
Yusuke Shiraishi, Takafumi Shimada, Naoya Tanabe, Kunihiko Terada, Ryo Sakamoto, Tomoki Maetani, Hiroshi Shima, Fumi Mochizuki, Tsuyoshi Oguma, Kaoruko Shimizu, Susumu Sato, Shigeo Muro, Nobuyuki Hizawa, Motonari Fukui, Hiroaki Iijima, Izuru Masuda, Toyohiro Hirai
ERJ Open Research Jan 2022, 00063-2022; DOI: 10.1183/23120541.00063-2022

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The prevalence and physiological impacts of centrilobular and paraseptal emphysema on CT in smokers with Preserved Ratio Impaired Spirometry
Yusuke Shiraishi, Takafumi Shimada, Naoya Tanabe, Kunihiko Terada, Ryo Sakamoto, Tomoki Maetani, Hiroshi Shima, Fumi Mochizuki, Tsuyoshi Oguma, Kaoruko Shimizu, Susumu Sato, Shigeo Muro, Nobuyuki Hizawa, Motonari Fukui, Hiroaki Iijima, Izuru Masuda, Toyohiro Hirai
ERJ Open Research Jan 2022, 00063-2022; DOI: 10.1183/23120541.00063-2022
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