Importance of Studying Tobacco-Exposed Individuals with Preserved Spirometry and Respiratory Symptoms

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Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating condition, often linked to tobacco smoking.

However, some individuals with a history of tobacco exposure may experience respiratory symptoms without spirometric airflow obstruction, a condition known as tobacco exposure and preserved spirometry (TEPS).

This population is typically excluded from COPD trials, leaving them without evidence-based therapies. The objective of this study was to define the natural history of TEPS individuals with symptoms (symptomatic TEPS) and without symptoms (asymptomatic TEPS). Participants from the SPIROMICS I and II multicenter study were followed up over a span of 5.8 years to assess lung function decline, incidence of COPD, and respiratory exacerbations.

Introduction

Chronic obstructive pulmonary disease (COPD) is a major global health concern, predominantly linked to tobacco smoking. However, some individuals with a history of tobacco exposure may exhibit respiratory symptoms despite having normal spirometry, a condition known as tobacco exposure and preserved spirometry (TEPS).

Unfortunately, these individuals are commonly excluded from COPD trials, leaving them without evidence-based therapies. Understanding the natural history of TEPS and symptomatic TEPS is crucial to better manage and treat this subset of patients.

Methods

The study utilized data from SPIROMICS I and II, a multicenter investigation involving individuals aged 40 to 80 years with a history of cigarette smoking (>20 pack-years) with or without COPD, as well as control subjects without tobacco exposure or airflow obstruction.

The participants underwent spirometry, 6-minute walk distance testing, assessment of respiratory symptoms, and chest computed tomography (CT) at yearly visits for 3 to 4 years in SPIROMICS I.

SPIROMICS II involved an additional in-person visit 5 to 7 years after enrollment in SPIROMICS I.

Respiratory symptoms were assessed using the COPD Assessment Test (CAT), and participants were categorized into two groups: symptomatic TEPS (CAT scores ≥ 10) and asymptomatic TEPS (CAT scores < 10).

Results

Out of 1397 study participants, 226 had symptomatic TEPS (mean age 60.1 [SD 9.8] years; 134 were women [59%]) and 269 had asymptomatic TEPS (mean age 63.1 [SD 9.1] years; 134 were women [50%]). Over a median follow-up period of 5.8 years, participants with symptomatic TEPS experienced a decline in forced expiratory volume in the first second (FEV1) of -31.3 mL/year, while those with asymptomatic TEPS had a decline of -38.8 mL/year.

However, there was no significant difference in the decline in FEV1 between the two groups (between-group difference, -7.5 mL/year [95% CI, -16.6 to 1.6 mL/year]). The cumulative incidence of COPD was 33.0% among participants with symptomatic TEPS compared to 31.6% among those with asymptomatic TEPS (hazard ratio, 1.05 [95% CI, 0.76 to 1.46]), indicating no significant difference in COPD development between the two groups.

However, participants with symptomatic TEPS experienced significantly more respiratory exacerbations than those with asymptomatic TEPS (0.23 vs. 0.08 exacerbations per person-year, respectively; rate ratio, 2.38 [95% CI, 1.71 to 3.31], P < .001).

Discussion

The study’s findings highlight the importance of investigating individuals with TEPS and respiratory symptoms. While the rate of FEV1 decline and COPD development did not significantly differ between symptomatic and asymptomatic TEPS individuals, those with symptomatic TEPS experienced a higher burden of respiratory exacerbations. This observation suggests that symptomatic TEPS individuals may require targeted interventions and therapies to manage their respiratory symptoms and reduce exacerbations effectively.

Conclusion

Individuals with symptomatic TEPS did not exhibit accelerated rates of decline in FEV1 or an increased incidence of COPD compared to those with asymptomatic TEPS. However, symptomatic TEPS individuals experienced significantly more respiratory exacerbations over the median follow-up period of 5.8 years.

These findings emphasize the importance of studying and managing this specific population, providing evidence for better approaches to treat and improve the quality of life for individuals with respiratory symptoms and preserved spirometry but a history of tobacco exposure. Further research is warranted to explore effective therapeutic interventions tailored to the needs of this subgroup of patients.


Tobacco exposure and preserved spirometry (TEPS) is a condition in which a person has a history of smoking but their lung function tests, known as spirometry, are normal. This means that the person’s lungs are able to take in and exhale air normally, even though they have been exposed to tobacco smoke.

TEPS is a relatively common condition, affecting an estimated 10-20% of smokers. It is more common in people who have smoked for a shorter period of time or who smoke less heavily. However, even people who have smoked for many years and who smoke heavily can have TEPS.

The exact cause of TEPS is not fully understood, but it is thought to be due to a combination of factors, including the person’s genetics, the type of tobacco they smoke, and how they smoke.

People with TEPS are at an increased risk of developing chronic obstructive pulmonary disease (COPD), even though their lung function tests are normal. COPD is a progressive lung disease that is characterized by shortness of breath, chronic cough, and sputum production.

There is no cure for TEPS, but there are things that people can do to reduce their risk of developing COPD. These include quitting smoking, getting regular exercise, and eating a healthy diet.

If you are a smoker with TEPS, it is important to talk to your doctor about your risk of developing COPD. Your doctor can help you develop a plan to quit smoking and to manage your risk of developing COPD.

Here are some additional information about TEPS:

  • Symptoms: People with TEPS may not have any symptoms, or they may have mild symptoms such as shortness of breath with exertion or a chronic cough.
  • Diagnosis: TEPS is diagnosed based on a person’s medical history, a physical examination, and spirometry. Spirometry is a test that measures how much air a person can take in and exhale.
  • Treatment: There is no specific treatment for TEPS. However, people with TEPS should quit smoking to reduce their risk of developing COPD. Other treatments for COPD, such as bronchodilators and steroids, may also be helpful for people with TEPS.
  • Prognosis: The prognosis for people with TEPS is generally good. However, people with TEPS are at an increased risk of developing COPD, so it is important to quit smoking and to get regular medical checkups.

If you are concerned that you may have TEPS, talk to your doctor. They can help you determine if you have TEPS and discuss your treatment options.


reference link : https://jamanetwork.com/journals/jama/article-abstract/2807747

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