Cross-sectional analysis of the utility of pulmonary function tests in predicting emphysema in ever-smokers

Sean E. Hesselbacher, Robert Ross, Matthew B. Schabath, E. O.brian Smith, Sarah Perusich, Nadia Barrow, Pamela Smithwick, Manoj J. Mammen, Harvey Coxson, Natasha Krowchuk, David Corry, Farrah Kheradmand

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


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 (>7%) was detected in 122 (54%) subjects. Twenty six (21%) emphysema subjects had no evidence of airflow obstruction (FEV1/FVC ratio <70%), while all subjects with >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.

Original languageEnglish (US)
Pages (from-to)1324-1340
Number of pages17
JournalInternational journal of environmental research and public health
Issue number5
StatePublished - May 2011


  • Air flow limitation
  • Airway wall thickness
  • Chronic obstructive pulmonary disease
  • CT morphometry
  • Emphysema
  • Pulmonary function test

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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