{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:46:08Z","timestamp":1787697968395,"version":"build-2784847793"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2011,4,29]],"date-time":"2011-04-29T00:00:00Z","timestamp":1304035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Emphysema is largely an under-diagnosed medical condition that can exist in smokers in the absence of airway obstruction. We aimed to determine the sensitivity and specificity of pulmonary function tests (PFTs) in assessing emphysema using quantitative CT scans as the reference standard. We enrolled 224 ever-smokers (current or former) over the age of 40. CT of thorax was used to quantify the low attenuation area (% emphysema), and to measure the standardized airway wall thickness. PFTs were used individually and in combination to predict their ability to discriminate radiographic emphysema. Significant emphysema (&gt;7%) was detected in 122 (54%) subjects. Twenty six (21%) emphysema subjects had no evidence of airflow obstruction (FEV1\/FVC ratio 23% emphysema showed airflow obstruction. The sensitivity and specificity of spirometry for detecting radiographic emphysema were 79% and 75%, respectively. Standardized airway wall thickness was increased in subjects with airflow obstruction, but did not correlate with emphysema severity. In this cohort of lifetime ever-smokers, PFTs alone were inadequate for diagnosing emphysema. Airway wall thickness quantified by CT morphometry was associated with airflow limitation, but not with emphysema indicating that the heterogeneous nature of lung disease in smokers may represent distinct phenotypes.<\/jats:p>","DOI":"10.3390\/ijerph8051324","type":"journal-article","created":{"date-parts":[[2011,5,4]],"date-time":"2011-05-04T09:03:57Z","timestamp":1304499837000},"page":"1324-1340","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Cross-Sectional Analysis of the Utility of Pulmonary Function Tests in Predicting Emphysema in Ever-Smokers"],"prefix":"10.3390","volume":"8","author":[{"given":"Sean E.","family":"Hesselbacher","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ross","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3241-3216","authenticated-orcid":false,"given":"Matthew B.","family":"Schabath","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Control, The H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. O\u2019Brian","family":"Smith","sequence":"additional","affiliation":[{"name":"Children\u2019s Nutrition Research Center (CNRC), Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Perusich","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Barrow","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Smithwick","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj J.","family":"Mammen","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey","family":"Coxson","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver Campus, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Krowchuk","sequence":"additional","affiliation":[{"name":"University of British Columbia, Vancouver Campus, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Corry","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farrah","family":"Kheradmand","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"},{"name":"Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2011,4,29]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (CDC) (2009). State-specific prevalence and trends in adult cigarette smoking\u2014United States, 1998\u20132007. MMWR, 58, 221\u2013226."},{"key":"ref_2","unstructured":"Shafey, O, Eriksen, M, Ross, H, and Mackay, J (2009). The Tobacco Atlas, American Cancer Society. [3rd ed]."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1038\/nm0806-866b","article-title":"Anti-tobacco efforts going up in smoke","volume":"12","author":"Schubert","year":"2006","journal-title":"Nature Med"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/S0140-6736(06)68516-4","article-title":"COPD: The dangerous underestimate of 15%","volume":"367","author":"Rennard","year":"2006","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1513\/pats.200804-035QC","article-title":"Natural histories of chronic obstructive pulmonary disease","volume":"5","author":"Rennard","year":"2008","journal-title":"Proc. Am. Thorac. Soc"},{"key":"ref_6","first-page":"132","article-title":"Lung myeloid dendritic cells coordinately induce Th1 and Th17 responses in human emphysema","volume":"4","author":"Shan","year":"2009","journal-title":"Sci. Transl. Med"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1164\/rccm.200904-0552OC","article-title":"Lung dendritic cell expression of maturation molecules increases with worsening chronic obstructive pulmonary disease","volume":"180","author":"Freeman","year":"2009","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1513\/pats.200904-021DS","article-title":"Genetics and genomics of chronic obstructive pulmonary disease","volume":"6","author":"Silverman","year":"2009","journal-title":"Proc. Am. Thorac. Soc"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1183\/09031936.05.00008504","article-title":"Lung function, smoking and mortality in a 26-year follow-up of healthy middle-aged males","volume":"4","author":"Stavem","year":"2005","journal-title":"Eur. Resp. J"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1378\/chest.08-2858","article-title":"CT metrics of airway disease and emphysema in severe COPD","volume":"136","author":"Kim","year":"2009","journal-title":"Chest"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3109\/15412550903341513","article-title":"Clinical significance of radiologic characterizations in COPD","volume":"6","author":"Han","year":"2009","journal-title":"COPD"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s11547-008-0284-3","article-title":"How much do GOLD stages reflect CT abnormalities in COPD patients?","volume":"113","author":"Pescarolo","year":"2008","journal-title":"Radiol. Med"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1164\/rccm.2112096","article-title":"Smoking and lung function of Lung Health Study participants after 11 years","volume":"166","author":"Anthonisen","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1183\/09031936.05.00035205","article-title":"Interpretative strategies for lung function tests","volume":"26","author":"Pellegrino","year":"2005","journal-title":"Eur. Respir. J"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1183\/09031936.95.08030492","article-title":"Reference values for residual volume, functional residual capacity and total lung capacity\u2014ATS workshop on lung volume measurements. Official statement of the european respiratory society","volume":"8","author":"Stocks","year":"1995","journal-title":"Eur. Respir. J"},{"key":"ref_16","unstructured":"GOLD Executive Committee Available online: http:\/\/www.goldcopd.com\/GuidelinesResources.asp?l1=2&l2=0.2008 (accessed on 21 May 2009)."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1164\/rccm.200912-1843CC","article-title":"Chronic obstructive pulmonary disease phenotypes: The future of COPD","volume":"182","author":"Han","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1056\/NEJMsa0802902","article-title":"Mortality attributable to smoking in China","volume":"360","author":"Gu","year":"2009","journal-title":"N. Engl. J. Med"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/jnci\/djk153","article-title":"A risk model for prediction of lung cancer","volume":"99","author":"Spitz","year":"2007","journal-title":"J. Nat. Cancer Inst"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1164\/rccm.200803-435OC","article-title":"Association of radiographic emphysema and airflow obstruction with lung cancer","volume":"178","author":"Wilson","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1038\/nm1008-1023","article-title":"Common origins of lung cancer and COPD","volume":"14","author":"Houghton","year":"2008","journal-title":"Nature Med"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1093\/jnci\/djp023","article-title":"Lung cancer and chronic obstructive pulmonary disease: Needs and opportunities for integrated research","volume":"101","author":"Punturieri","year":"2009","journal-title":"J. Nat. Cancer Inst"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S0169-5002(02)00222-2","article-title":"Lung cancer screening by spiral CT. What is the optimal target population for screening trials?","volume":"38","author":"Mulshine","year":"2002","journal-title":"Lung Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1378\/chest.09-2836","article-title":"CT scan findings of emphysema predict mortality in COPD","volume":"138","author":"Haruna","year":"2010","journal-title":"Chest"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1164\/ajrccm.152.2.7633722","article-title":"Comparison of computed density and macroscopic morphometry in pulmonary emphysema","volume":"152","author":"Gevenois","year":"1995","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1164\/ajrccm.154.1.8680679","article-title":"Comparison of computed density and microscopic morphometry in pulmonary emphysema","volume":"154","author":"Gevenois","year":"1996","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1164\/rccm.200801-059OC","article-title":"Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease","volume":"178","author":"Patel","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1164\/rccm.200907-1008OC","article-title":"Quantitative computed tomography measures of emphysema and airway wall thickness are related to respiratory symptoms","volume":"181","author":"Grydeland","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1148\/radiol.2342040013","article-title":"Chronic obstructive pulmonary disease: Thin-section CT measurement of airway wall thickness and lung attenuation","volume":"234","author":"Orlandi","year":"2005","journal-title":"Radiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1016\/j.acra.2005.08.013","article-title":"Quantitative computed tomography of chronic obstructive pulmonary disease","volume":"12","author":"Coxson","year":"2005","journal-title":"Acad. Radiol"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1378\/chest.110.1.11","article-title":"Contribution of lung and chest wall mechanics following emphysema resection","volume":"110","author":"Gelb","year":"1996","journal-title":"Chest"},{"key":"ref_32","first-page":"A5952","article-title":"Physiological impairment in smokers with emphysema","volume":"181","author":"Hesselbacher","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1164\/ajrccm.159.1.9712108","article-title":"Spirometric reference values from a sample of the general U.S. population","volume":"159","author":"Hankinson","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_34","first-page":"185","article-title":"Standardized single breath normal values for carbon monoxide diffusing capacity","volume":"123","author":"Crapo","year":"1981","journal-title":"Amer. Rev. Resp. Dis"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1136\/thorax.56.11.839","article-title":"Body mass, fat percentage, and fat free mass as reference variables for lung function: Effects on terms for age and sex","volume":"56","author":"Cotes","year":"2001","journal-title":"Thorax"},{"key":"ref_36","first-page":"270","article-title":"Single breath diffusing capacity in a representative sample of the population of Michigan, a large industrial state. Predicted values, lower limits of normal, and frequencies of abnormality by smoking history","volume":"127","author":"Miller","year":"1983","journal-title":"Amer. Rev. Resp. Dis"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1136\/thx.2008.112433","article-title":"Prediction of the rate of decline in FEV(1) in smokers using quantitative computed tomography","volume":"64","author":"Yuan","year":"2009","journal-title":"Thorax"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1378\/chest.06-2325","article-title":"The effects of radiation dose and CT manufacturer on measurements of lung densitometry","volume":"132","author":"Yuan","year":"2007","journal-title":"Chest"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1164\/ajrccm\/142.3.563","article-title":"Small airway dimensions in smokers with obstruction to airflow","volume":"142","author":"Bosken","year":"1990","journal-title":"Am. Rev. Respir. Dis"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1164\/ajrccm.162.3.9907120","article-title":"Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function","volume":"162","author":"Nakano","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1164\/rccm.200407-874OC","article-title":"The prediction of small airway dimensions using computed tomography","volume":"171","author":"Nakano","year":"2004","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_42","unstructured":"Feinstein, AR (2002). Principles of Medical Statistics, Chapman & Hall\/CRC."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1164\/ajrccm.159.3.9805067","article-title":"A quantification of the lung surface area in emphysema using computed tomography","volume":"159","author":"Coxson","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1164\/rccm.200405-651OC","article-title":"Early emphysema in patients with anorexia nervosa","volume":"170","author":"Coxson","year":"2004","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1136\/thx.48.1.39","article-title":"Airspace size in lungs of lifelong non-smokers: Effect of age and sex","volume":"48","author":"Gillooly","year":"1993","journal-title":"Thorax"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1164\/ajrccm\/146.4.951","article-title":"Acute effect of cigarette smoking on the carbon monoxide diffusing capacity of the lung","volume":"146","author":"Sansores","year":"1992","journal-title":"Am. Rev. Respir. Dis"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1148\/radiology.186.1.8416548","article-title":"Morphologic effects of cigarette smoking on airways and pulmonary parenchyma in healthy adult volunteers: CT evaluation and correlation with pulmonary function tests","volume":"186","author":"Remy","year":"1993","journal-title":"Radiology"},{"key":"ref_48","first-page":"27","article-title":"Early smoking-induced lung lesions in asymptomatic subjects. Correlations between high resolution dynamic CT and pulmonary function testing","volume":"109","author":"Spaggiari","year":"2005","journal-title":"Radiol. Med"},{"key":"ref_49","first-page":"60","article-title":"Emphysema in heavy smokers with normal chest radiography. Detection and quantification by HCRT","volume":"43","author":"Sashidhar","year":"2002","journal-title":"Acta Radiol"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1164\/ajrccm.161.4.9905040","article-title":"Longitudinal follow-up study of smoking-induced lung density changes by high-resolution computed tomography","volume":"161","author":"Soejima","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Group NETTR (2003). A randomized trial comparing lung-volume\u2014reduction surgery with medical therapy for severe emphysema. N. Engl. J. Med, 348, 2059\u20132073.","DOI":"10.1056\/NEJMoa030287"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jtcvs.2006.06.051","article-title":"A multicenter trial of an intrabronchial valve for treatment of severe emphysema","volume":"133","author":"Wood","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1001\/archinternmed.2009.427","article-title":"Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer","volume":"169","author":"Lipson","year":"2009","journal-title":"Arch. Intern. Med"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/8\/5\/1324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:55:57Z","timestamp":1760219757000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/8\/5\/1324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,4,29]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2011,5]]}},"alternative-id":["ijerph8051324"],"URL":"https:\/\/doi.org\/10.3390\/ijerph8051324","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,4,29]]}}}