TY - JOUR T1 - The prevalence and physiological impacts of centrilobular and paraseptal emphysema on computed tomography in smokers with preserved ratio impaired spirometry JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00063-2022 VL - 8 IS - 2 SP - 00063-2022 AU - Yusuke Shiraishi AU - Takafumi Shimada AU - Naoya Tanabe AU - Kunihiko Terada AU - Ryo Sakamoto AU - Tomoki Maetani AU - Hiroshi Shima AU - Fumi Mochizuki AU - Tsuyoshi Oguma AU - Kaoruko Shimizu AU - Susumu Sato AU - Shigeo Muro AU - Nobuyuki Hizawa AU - Motonari Fukui AU - Hiroaki Iijima AU - Izuru Masuda AU - Toyohiro Hirai Y1 - 2022/04/01 UR - http://openres.ersjournals.com/content/8/2/00063-2022.abstract N2 - 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 multicentre 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 ≥40 years who underwent computed tomography (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 (TLCCT).In 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 43.7% versus 1.2%, p<0.01; CLE 46% versus 4.7%, p<0.01) and lower than that in smokers with airflow limitation (PSE 43.7% versus 71.0%, p<0.01; CLE 46% 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.Centrilobular and paraseptal emphysema are observed in 43–46% of smokers with preserved ratio impaired spirometry. Centrilobular emphysema, but not paraseptal emphysema, is closely associated with air-trapping in these smokers. https://bit.ly/3Ky6LDy ER -