Abstract
Pulmonary emphysema is a phenotypic component of chronic obstructive pulmonary disease (COPD) which carries substantial morbidity and mortality. We explored the association between emphysema and body height in 726 patients with COPD using computed tomography as the reference diagnostic standard for emphysema. We applied univariate analysis to look for differences between patients with emphysema and those without, and multivariate logistic regression to identify significant predictors of the risk of emphysema. As covariates we included age, sex, body height, body mass index, pack-years of smoking, and forced expiratory volume in one second (FEV1) as percent predicted. The overall prevalence of emphysema was 52%. Emphysemic patients were significantly taller and thinner than non-emphysemic ones, and featured significantly higher pack-years of smoking and lower FEV1 (P < 0.001). The prevalence of emphysema rose linearly by 10-cm increase in body height (r2 = 0.96). In multivariate analysis, the odds of emphysema increased by 5% (95% confidence interval, 3 to 7%) along with one-centimeter increase in body height, and remained unchanged after adjusting for all the potential confounders considered (P < 0.001). The odds of emphysema were not statistically different between males and females. In conclusion, body height is a strong, independent risk factor for emphysema in COPD.
Highlights
Pulmonary emphysema is a phenotypic component of chronic obstructive pulmonary disease (COPD) which carries substantial morbidity and mortality
We explored the association between emphysema and body height in 726 patients with COPD using computed tomography as the reference diagnostic standard for emphysema
We examined the association between pulmonary emphysema and body height in a sample of 726 patients with spirometry-based diagnosis of COPD
Summary
Pulmonary emphysema is a phenotypic component of chronic obstructive pulmonary disease (COPD) which carries substantial morbidity and mortality. Body height is a strong, independent risk factor for emphysema in COPD. Emphysema is a phenotypic component of chronic obstructive pulmonary disease (COPD), bearing substantial lung function impairment and poor prognosis[3]. Protease/antiprotease imbalance, triggered by chronic lung inflammation, is advocated as a pathogenetic mechanism of emphysema in smokers[10]. The risk of COPD is two to three times higher in smokers having a first-degree relative affected by the disease[11]. This suggests that genetic factors contribute to the development of COPD and related phenotypes[11]. Deficiency of the serine protease inhibitor alpha-1-antitrypsin is the best known genetic factor linked to early-onset emphysema, but it occurs in 1 to 3% of the patients with COPD12
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