Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection

Abstract

Background Cigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality. Methods Patients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis. Results In the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84–9.25]). Conclusions In a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population.

Telomere length associates with chronological age and mortality across racially diverse pulmonary fibrosis cohorts

“…In multivariable models assessing mortality, we sought to only adjust for established confounders previously linked to both the predictor and the outcome; therefore, covariate selection for inclusion in the model was based on potential confounding variables known to affect telomere length and PF mortality 55 . As smoking and BMI are inconsistently associated with mortality in interstitial lung disease [56][57][58] , and when present, seem to exert their effect on worsened PF mortality through worsening pulmonary function or accelerating the progression of fibrosis 59,60 , the analyses of all multivariable outcome models were adjusted for age, sex, measures of pulmonary function including forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DL CO ), and hospital center. The relationship between LTL and the severity of PF using the most widelyused index for assessing PF severity, the ILD-GAP score 61 .…”

Cigarette Smoking, and Blood Monocyte Count Correlate with Chronic Lung Injuries and Mortality

“…With continued cigarette smoking, diverse patterns of disease can coexist obscuring individual processes. 35 …”

“…With continued cigarette smoking, diverse patterns of disease can coexist obscuring individual processes. 35 Addressing the controversy of smoking exposure assessment in clinical studies, smoking intensity (as CPD) and duration were alternatively employed to determine associations with histologic and radiologic lung abnormalities. 58,59 While smoking intensity showed relationships with anthracosis and emphysema, the duration of smoking was associated with multiple lung injuries (cancer, RB-ILD, emphysema and HC).…”

“…An analysis of radiographic findings (emphysema subtypes, interstitial lung abnormalities (ILAs), and interstitial lung disease (ILD) patterns, traction bronchiectasis (TB), honeycombing (HC)) and histologic abnormalities (anthracosis, peribronchiolar metaplasia (PBM), respiratory bronchiolitis (RB), desquamative interstitial pneumonia (DIP), fibrosis, organizing pneumonia, emphysema, and lung cancer morphology) of the cohort have been previously reported. 35 Pulmonary hypertension status was also noted as indicated by the radiographic marker of pulmonary artery to aorta (PA/Ao) ratio >0.9.…”

“…An excessive burden of co-existing malignant and non-malignant lung injuries in the Appalachian region reflects the United States’ highest smoking rates. 35 This heavily smoking population provided an opportunity to examine the associations between CS, monocytes, and smoking-related lung diseases. Objectives of this study were to describe the associations between: 1) smoking and hematological parameters including monocyte counts, 2) CS, monocyte counts, and radiologic and histologic indices of lung injury, and, lastly, 3) CS, monocyte counts, and mortality.…”