{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T09:55:49Z","timestamp":1775469349265,"version":"3.50.1"},"reference-count":45,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:00:00Z","timestamp":1612828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respir Care"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The objective of our study was to identify variables associated with inhaled medication use in smokers with normal spirometry (GOLD-0) and to examine the association of inhaled medication use with development of exacerbations and obstructive spirometry in the future.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We performed a retrospective multivariable analysis of GOLD-0 subjects identified in data from the COPDGene study to examine factors associated with medication use. Five categories were identified: (1) no medications, (2) short-acting bronchodilator, (3) long-acting bronchodilator; long-acting muscarinic antagonists and\/or long-acting \u03b2 agonist, (4) inhaled corticosteroids (ICS) with or without long-acting bronchodilator, and (5) dual bronchodilator with ICS. Sensitivity analysis was performed excluding subjects with history of asthma. We also evaluated whether long-acting inhaled medication use was associated with exacerbations and obstructive spirometry at the follow-up visit 5 y after enrollment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 4,303 GOLD-0 subjects within the analysis, 541 of them (12.6%) received inhaled medications. Of these, 259 (6%) were using long-acting inhaled medications and 282 (6.6%) were taking short-acting bronchodilator. Female sex (odds ratio [OR] 1.47,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003), numerous medical comorbidities, radiographic emphysema (OR 2.22,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02), chronic bronchitis (OR 1.77,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), dyspnea (OR 2.24,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), asthma history (OR 15.56,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), prior exacerbation (OR 8.45,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and 6-min walk distance (OR 0.9,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) were associated with medication use. Minimal changes were noted in a sensitivity analysis. Additionally, inhaled medications were associated with increased total (incidence rate ratio 2.83,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and severe respiratory exacerbations (incidence rate ratio 3.64,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and presence of obstructive spirometry (OR 2.83,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .002) at follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Respiratory symptoms, history of asthma, and radiographic emphysema were associated with inhaled medication use in smokers with normal spirometry. These individuals were more likely to develop obstructive spirometry, which suggests that health care providers may be able to identify obstructive lung disease prior to meeting the current criteria for COPD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4187\/respcare.08016","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T16:29:20Z","timestamp":1612888160000},"page":"652-660","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Inhaled Medication Use in Smokers With Normal Spirometry"],"prefix":"10.1177","volume":"66","author":[{"given":"Nicholas","family":"R Arnold","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of General Internal Medicine, University of Iowa Roy J. and Lucille A. 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Carver College of Medicine, Iowa City, Iowa."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Kinney","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kendra","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Hokanson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A","family":"Regan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado."},{"name":"Department of Medicine, Division of Rheumatology, National Jewish Health, Denver, Colorado."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"P Comellas","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spyridon","family":"Fortis","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa."},{"name":"Center for Access &amp; Delivery Research &amp; Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,2,9]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00164-2019"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-2759"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.01.015"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-0672"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2007.085456"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-13-68"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04647"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.2735"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3109\/15412550903499522"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.05.00034805"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.12.10102"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201501-0157OC"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2015141579"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-15-52"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-2948"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12160-015-9760-x"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-018-1204-3"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201809-601OC"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1505971"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmn006"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2007.01394.x"},{"key":"e_1_3_2_23_2","unstructured":"Percentage of people with asthma who smoke. 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