{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:25:39Z","timestamp":1791210339091,"version":"4.1.0"},"reference-count":32,"publisher":"European Respiratory Society (ERS)","issue":"6","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["HL084936"],"award-info":[{"award-number":["HL084936"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1-RR024996"],"award-info":[{"award-number":["UL1-RR024996"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2015,7,30]]},"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:p>Smokers are assessed for chronic obstructive pulmonary disease (COPD) using spirometry, with COPD defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as airflow limitation that is not fully reversible with bronchodilators. There is a subset of smokers with normal spirometry (by GOLD criteria), who have a low diffusing capacity of the lung for carbon monoxide (<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>), a parameter linked to emphysema and small airway disease. The natural history of these \u201cnormal spirometry\/low<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>\u201d smokers is unknown.<\/jats:p><jats:p>From a cohort of 1570 smokers in the New York City metropolitian area, all of whom had normal spirometry, two groups were randomly selected for lung function follow-up: smokers with normal spirometry\/normal<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>(n=59) and smokers with normal spirometry\/low<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>(n=46). All had normal history, physical examination, complete blood count, urinalysis, HIV status, \u03b1<jats:sub>1<\/jats:sub>-antitrypsin level, chest radiography, forced expiratory volume in 1\u2005s (FEV<jats:sub>1<\/jats:sub>), forced vital capacity (FVC), FEV<jats:sub>1<\/jats:sub>\/FVC ratio and total lung capacity. Throughout the study, all continued to be active smokers.<\/jats:p><jats:p>In the normal spirometry\/normal<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>group assessed over 45\u00b120\u2005months, 3% developed GOLD-defined COPD. In contrast, in the normal spirometry\/low<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>group, followed over 41\u00b131\u2005months, 22% developed GOLD-defined COPD.<\/jats:p><jats:p>Despite appearing \u201cnormal\u201d according to GOLD, smokers with normal spirometry but low<jats:italic>D<\/jats:italic><jats:sub>LCO<\/jats:sub>are at significant risk of developing COPD with obstruction to airflow.<\/jats:p>","DOI":"10.1183\/13993003.02377-2014","type":"journal-article","created":{"date-parts":[[2015,11,6]],"date-time":"2015-11-06T18:58:32Z","timestamp":1446836312000},"page":"1589-1597","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":109,"title":["Risk of COPD with obstruction in active smokers with normal spirometry and reduced diffusion capacity"],"prefix":"10.1183","volume":"46","author":[{"given":"Ben-Gary","family":"Harvey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Strulovici-Barel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Kaner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Sanders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Vincent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G.","family":"Mezey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald G.","family":"Crystal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2015,11,5]]},"reference":[{"key":"2024102023470944000_46.6.1589.1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200703-456SO"},{"key":"2024102023470944000_46.6.1589.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61380-4"},{"key":"2024102023470944000_46.6.1589.3","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. 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