Pneumothorax risk factors in smokers with and without chronic obstructive pulmonary disease

Brian D. Hobbs, Marilyn G. Foreman, Russell Bowler, Francine Jacobson, Barry J. Make, Peter J. Castaldi, Raú L.San José Estépar, Edwin K. Silverman, Craig P. Hersh, Jeffrey Curtis, Ella Kazerooni, Nicola Hanania, Philip Alapat, Venkata Bandi, Kalpalatha Guntupalli, Elizabeth Guy, Antara Mallampalli, Charles Trinh, Mustafa Atik, Hasan Al-AzzawiMarc Willis, Susan Pinero, Linda Fahr, Arun Nachiappan, Collin Bray, L. Alexander Frigini, Carlos Farinas, David Katz, Jose Freytes, Anne Marie Marciel, Dawn Demeo, Craig Hersh, George Washko, Hiroto Hatabu, Peter Clarke, Ritu Gill, Andetta Hunsaker, Beatrice Trotman-Dickenson, Rachna Madan, R. Graham Barr, Byron Thomashow, John Austin, Belinda D'Souza, Neil MacIntyre, Lacey Washington, H. Page McAdams, Richard Rosiello, Timothy Bresnahan, Joseph Bradley, Sharon Kuong, Steven Meller, Suzanne Roland, Charlene Mcevoy, Joseph Tashjian, Robert Wise, Nadia Hansel, Robert Brown, Gregory Diette, Karen Horton, Richard Casaburi, Janos Porszasz, Hans Fischer, Matt Budoff, Michael E. Debakey, Amir Sharafkhaneh, Hirani Kamal, Roham Darvishi, Dennis Niewoehner, Quentin Anderson, Kathryn Rice, Audrey Caine, Marilyn Foreman, Gloria Westney, Eugene Berkowitz, David Lynch, Joyce Schroeder, Valerie Hale, John Armstrong, Debra Dyer, Jonathan Chung, Christian Cox, Gerard Criner, Victor Kim, Nathaniel Marchetti, Aditi Satti, A. James Mamary, Robert Steiner, Chandra Dass, Libby Cone, William Bailey, Mark Dransfield, Michael Wells, Surya Bhatt, Hrudaya Nath, Satinder Singh, Joe Ramsdell, Paul Friedman, Alejandro Cornellas, John Newell, Edwin J.R. Van Beek, Fernando Martinez, Mei Lan Han, Christine Wendt, Tadashi Allen, Frank Sciurba, Joel Weissfeld, Carl Fuhrman, Jessica Bon, Danielle Hooper, Antonio Anzueto, Sandra Adams, Carlos Orozco, Mario Ruiz, Amy Mumbower, Ariel Kruger, Carlos Restrepo, Michael Lane

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Rationale: The demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined.

Objectives: We evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema.

Methods: The study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report.

Measurements and Main Results: Pneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08-2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34-2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03-1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01-1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09-1.33).

Conclusions: Among smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

Original languageEnglish (US)
Pages (from-to)1387-1394
Number of pages8
JournalAnnals of the American Thoracic Society
Volume11
Issue number9
DOIs
StatePublished - Nov 1 2014

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Keywords

  • Chronic obstructive pulmonary disease
  • Emphysema
  • Pneumothorax

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Hobbs, B. D., Foreman, M. G., Bowler, R., Jacobson, F., Make, B. J., Castaldi, P. J., Estépar, R. L. S. J., Silverman, E. K., Hersh, C. P., Curtis, J., Kazerooni, E., Hanania, N., Alapat, P., Bandi, V., Guntupalli, K., Guy, E., Mallampalli, A., Trinh, C., Atik, M., ... Lane, M. (2014). Pneumothorax risk factors in smokers with and without chronic obstructive pulmonary disease. Annals of the American Thoracic Society, 11(9), 1387-1394. https://doi.org/10.1513/AnnalsATS.201405-224OC