Spirometry Doesn’t Fully Reveal Tobacco-Induced Lung Damage, Study Finds

The adverse effects of tobacco use on health are widely recognized. Yet, a study recently featured in JAMA offers a deeper dive into the enduring respiratory challenges faced by individuals with significant tobacco exposure, even when standard lung function tests show no apparent issues. This research furnishes crucial data, potentially refining our perception of tobacco’s influence on respiratory well-being.

Read Also: Guide to Lung Function Tests: Types, Procedures, and Indications for Diagnosis, Monitoring, and Assessment of Respiratory Conditions

Patient Doing Spirometry

Patient Doing Spirometry. Credit: Jmarchn

Study Design and Participants

The investigation, named “Longitudinal Analysis of Individuals with Tobacco Exposure and Preserved Spirometry”, built upon the SPIROMICS I study. It targeted adults aged 40 to 80 who had a smoking history of over 20 pack-years. Remarkably, despite their substantial tobacco use, these participants did not display any airflow restriction in spirometry tests, a primary metric for assessing lung performance.

Enrollment spanned from November 10, 2010, to July 31, 2015, with tracking continuing until July 31, 2021. Based on respiratory symptoms and spirometry findings, participants were classified into two segments: those with tobacco exposure and preserved spirometry with symptoms (symptomatic TEPS) and those without symptoms (asymptomatic TEPS).

Key Methodologies

  • Yearly spirometry assessments, a 6-minute walk test, respiratory symptom evaluations, and chest CT scans were performed for a period of 3 to 4 years.
  • The COPD Assessment Test, scoring between 0 and 40, was employed to gauge respiratory symptoms. A higher score signified increased symptom severity.
  • Participants identified as symptomatic TEPS presented standard spirometry outcomes but scored 10 or above on the COPD Assessment Test. Those classified as asymptomatic TEPS exhibited normal spirometry and garnered scores below 10 on the assessment.
  • Every quarter, participants provided updates on their respiratory symptoms and exacerbations over phone consultations.

Primary Observations

  • Over an average monitoring duration of 5.76 years, FEV1’s decline (a lung function metric) was measured at -31.3 mL/y for the symptomatic TEPS group and -38.8 mL/y for the asymptomatic TEPS group.
  • The overall incidence of COPD was 33.0% for the symptomatic TEPS cohort and 31.6% for the asymptomatic TEPS cohort.
  • Importantly, the symptomatic TEPS group reported considerably more respiratory exacerbations in comparison to the asymptomatic TEPS group, with rates standing at 0.23 against 0.08 exacerbations per person-year.

Read Also: New Hope for COPD Patients: Early Trials Show Promise in Lung Cell Transplants

Discussion on Implications

The divergence in respiratory exacerbations between symptomatic and asymptomatic TEPS groups despite similar spirometric outcomes offers a critical observation. It suggests that other underlying pathophysiological changes might be at play, not readily evident in routine spirometry. Could there be other tissue or cellular alterations that traditional assessments overlook? Exploring these avenues might pave the way for novel diagnostic or therapeutic strategies tailored for such unique subsets of smokers.

Conclusions and Wider Relevance

This study prompts a reevaluation of our traditional stance on the respiratory implications of tobacco exposure. Even if spirometry results are within normal parameters, evident respiratory symptoms and a heightened frequency of exacerbations among the symptomatic TEPS participants suggest latent respiratory conditions. It accentuates the value of an all-encompassing evaluation of respiratory health in smokers, moving beyond just spirometry.

Read Also: Proven Strategies for Successful Smoking Cessation: A Science-Backed Guide

Fundamentally, the data accentuates the imperative for thorough health examinations and strategies for individuals with notable tobacco exposure histories, regardless of their spirometry readings. The consistent symptoms and elevated respiratory exacerbations in the symptomatic TEPS cohort underline the prolonged repercussions of tobacco consumption.


McKleroy WShing TAnderson WH, et al. Longitudinal Follow-Up of Participants With Tobacco Exposure and Preserved Spirometry. JAMA. 2023;330(5):442–453. https://doi.org/10.1001/jama.2023.11676


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