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Chest. 2019 Jan 23. pii: S0012-3692(19)30030-3. doi: 10.1016/j.chest.2018.12.022. [Epub ahead of print]

Systemic markers of inflammation in smokers with symptoms despite preserved spirometry in SPIROMICS.

Author information

1
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University - Cleveland (USA); University of California, San Francisco - San Francisco (USA). Electronic address: sureshgarudadri@gmail.com.
2
University of California, San Francisco - San Francisco (USA).
3
University of Michigan - Ann Arbor (USA).
4
Columbia University - New York (USA).
5
University of Arizona - Tuscon (USA).
6
National Jewish Health - Denver (USA).
7
University of Iowa - Iowa City (USA).
8
University of California, Los Angeles - Los Angeles (USA).
9
Temple University - Philadelphia (USA).
10
University of Alabama, Birmingham - Birmingham (USA).
11
Johns Hopkins University - Baltimore (USA).
12
University of Utah - Salt Lake City (USA).
13
University of Illinois, Chicago - Chicago (USA).
14
Wake Forest University - Winston-Salem (USA).
15
Weill Cornell Medical College - New York (USA).
16
University of North Carolina - Chapel Hill (USA).

Abstract

BACKGROUND:

Chronic respiratory symptoms and exacerbation-like events are common among ever smokers without airflow limitation on spirometry. The pathobiology of respiratory disease in this subgroup remains poorly defined, but may be due to underlying inflammation that overlaps with COPD or asthma. We hypothesized that symptoms, exacerbations, and functional measures of disease severity among smokers with preserved spirometry would be associated with markers of systemic inflammation, similar to what is reported in bone fide COPD, rather than elevated type 2 inflammation which is often present in asthma.

METHODS:

We measured inflammatory markers associated with COPD (C-reactive protein [CRP], fibrinogen, soluble TNF receptors [sTNFRSF1A & 1B], and blood/sputum neutrophils) and type 2 inflammation (IgE, and blood/sputum eosinophils), in smokers with preserved spirometry (post-bronchodilator FEV1/FVC ≥0.70) from SPIROMICS. We evaluated the relationship of these markers with respiratory symptom burden (dichotomized by a COPD Assessment Test score cutoff of 10, diagnosis of chronic bronchitis), exacerbations, six-minute walk distance (6MWD), and lung function based on FEV1.

RESULTS:

CRP was associated with increased symptom burden (on the basis of CAT score and diagnosis of chronic bronchitis) and a greater number of exacerbations in the year prior to study enrollment. sTNFRSF1A was associated with symptom burden based on CAT score. CRP and sTNFRSF1A levels negatively correlated with 6MWD. IgE and eosinophils were not associated with the aforementioned outcomes.

CONCLUSIONS:

Markers of inflammation including CRP and sTNFRSF1A are enriched among symptomatic smokers with preserved spirometry, suggesting an overlap with the underlying pathophysiology of COPD.

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