Defining Resilience to Smoking-related Lung Disease: A Modified Delphi Approach from SPIROMICS.

TitleDefining Resilience to Smoking-related Lung Disease: A Modified Delphi Approach from SPIROMICS.
Publication TypePublication
Year2021
AuthorsOh AL, Mularski RA, Barjaktarevic I, R Barr G, Bowler RP, Comellas AP, Cooper CB, Criner GJ, Han MK, Hansel NN, Hoffman EA, Kanner RE, Krishnan JA, Paine R, Parekh TM, Peters SP, Christenson SA, Woodruff PG
Corporate AuthorsSPIROMICS Smoking Resilience Group
JournalAnn Am Thorac Soc
Volume18
Issue11
Pagination1822-1831
Date Published2021 Nov
ISSN2325-6621
KeywordsForced Expiratory Volume, Humans, Lung, Pulmonary Disease, Chronic Obstructive, smoking, Spirometry
Abstract

Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory disease who have minimal or no airflow obstruction. To develop a multidimensional definition of a lung-related "resilient smoker" that is useful in research studies and then identify a resilient smoker subgroup in the SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) cohort using this definition. We performed a three-round modified Delphi survey among a panel of COPD experts to identify and reach a consensus on clinical and radiographic domains to be included in a lung-related resilient smoker definition. Consensus on domains of resilience was defined as ⩾80% of experts voting "agree" or "strongly agree" on a 5-point Likert scale. The Delphi-derived definition of resilience was applied to SPIROMICS to identify resilient smokers, whom we then characterized using known biomarkers of COPD. Consensus was achieved on 6 of 12 diagnostic items, which include cough and sputum production, dyspnea, radiographic measures of emphysema and small airways disease, exacerbations, and decline in forced expiratory volume in 1 second. Although 892 SPIROMICS participants were classified as smokers with preserved lung function by spirometry, only 149 participants (16.7%) qualified as resilient smokers by our definition. Blood biomarker expression of CRP (C-reactive protein) and sTNFRSF1A (soluble tumor necrosis receptor factor1A) was lower in resilient than nonresilient smokers ( = 0.02 and = 0.03). A Delphi-derived consensus definition of resilient smoker identified 83.3% of smokers with preserved spirometry as "nonresilient" based on the presence of adverse effects of smoking on the lung. Resilient smokers were biologically distinct from nonresilient smokers based on CRP measurements. Clinical trial registered with ClinicalTrials.gov (NCT01969344).

DOI10.1513/AnnalsATS.202006-757OC
Alternate JournalAnn Am Thorac Soc
PubMed ID33631079
PubMed Central IDPMC8641833
Grant ListU24 HL141762 / HL / NHLBI NIH HHS / United States
P30 ES005605 / ES / NIEHS NIH HHS / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
K23 HL153672 / HL / NHLBI NIH HHS / United States
L30 HL154180 / HL / NHLBI NIH HHS / United States
F32 HL149329 / HL / NHLBI NIH HHS / United States
K23 HL123778 / HL / NHLBI NIH HHS / United States
K24 HL137013 / HL / NHLBI NIH HHS / United States
MS#: 
MS190
Manuscript Full Title: 
Defining Resilience to Smoking-related Lung Disease: A Modified Delphi Approach from SPIROMICS.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: San Francisco (University of California at San Francisco)
ECI: 
Manuscript Status: 
Published and Public