The link between smoking, emphysema, and fibrosis: A retrospective cohort study
Introduction The presence of emphysema is common in patients with interstitial lung disease (ILD), which is designated as combined pulmonary fibrosis and emphysema (CPFE). This study aimed to examine the association between smoking, emphysema, and fibrosis in ILD patients. Methods A total of 800 pa...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Publishing
2024-07-01
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| Series: | Tobacco Induced Diseases |
| Subjects: | |
| Online Access: | https://www.tobaccoinduceddiseases.org/The-link-between-smoking-emphysema-and-fibrosis-A-retrospective-cohort-study,190689,0,2.html |
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| Summary: | Introduction
The presence of emphysema is common in patients with interstitial
lung disease (ILD), which is designated as combined pulmonary fibrosis and
emphysema (CPFE). This study aimed to examine the association between
smoking, emphysema, and fibrosis in ILD patients.
Methods
A total of 800 patients hospitalized for ILD at the affiliated hospital
of Qingdao University, Shandong, Qingdao, China, from December 2012 to
December 2020 were included in our retrospective cohort study. Participants
were divided into CPFE and non-CPFE groups. The patients’ clinical presentations
and radiographic and laboratory findings were reviewed and compared. The two
groups were then divided and compared based on smoking status. Kaplan-Meier
survival analysis with log-rank testing and multivariable Cox proportional hazards
regression analysis were used to compare all-cause mortality.
Results
Emphysema was present in 188 (23.5%) ILD patients. Smoking was
associated with increased odds of CPFE (adjusted odds ratio, AOR=2.13; 95% CI:
1.33–3.41, p=0.002). The CPFE patients had a comparable risk of death to non-
CPFE patients (adjusted hazard ratio, AHR=0.89; 95% CI: 0.64–1.24, p=0.493).
Smoking was not a risk prognostic factor in the whole group (AHR=1.34; 95%
CI: 0.90–1.99, p=0.152) or the CPFE group (AHR=0.90; 95% CI: 0.43–1.86,
p=0.771). However, a significant prognostic difference between smokers and
non-smokers was found in the non-CPFE group (AHR=1.62; 95% CI: 1.02–2.58,
p=0.042). In ILD patients, smoking pack-years were weakly correlated with total
centrilobular emphysema (CLE) scores and total fibrosis scores (TFS), but not
with total emphysema scores (TES); TFS were weakly correlated with TES.
Conclusions
CPFE did not affect the prognosis of ILD. Smoking was a risk but
not a prognostic factor for CPFE. However, smoking was associated with worse
survival in non-CPFE patients. There was an intricate association among smoking,
emphysema, and fibrosis in ILD patients. |
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| ISSN: | 1617-9625 |