Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Characteristics of "Resilient Smokers" and Correlation with Biological Markers of COPD

Session Title
TP41 - TP041 DIAGNOSIS AND RISK ASSESSMENT IN COPD
Abstract
A2316 - Characteristics of "Resilient Smokers" and Correlation with Biological Markers of COPD
Author Block: A. Oh1, I. Barjaktarevic2, R. Barr3, R. P. Bowler4, A. P. Comellas5, C. B. Cooper6, G. J. Criner7, M. K. Han8, N. N. Hansel9, E. A. Hoffman10, R. E. Kanner11, J. A. Krishnan12, R. A. Mularski13, R. Paine14, T. Parekh15, S. P. Peters16, S. Christenson17, P. Woodruff18; 1University of California, San Francisco, San Francisco, CA, United States, 2Pulmonary and Critical Care, UCLA, Los Angeles, CA, United States, 3Presbyterian Hospital, Columbia University Medical Center, New York, NY, United States, 4Natl Jewish Health, Denver, CO, United States, 5Internal Medicine/Pulmonary, University of Iowa, Iowa City, IA, United States, 6Departments of Medicine and Physiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States, 7Pulm & Crit Care Med, Temple Univ Hosp, Philadelphia, PA, United States, 8University of Michigan School of Medicine, Ann Arbor, MI, United States, 9Johns Hopkins Univ, Baltimore, MD, United States, 10Univ of Iowa Carver Coll of Med, Iowa City, IA, United States, 11Univ of Utah Sch of Med, Salt Lake City, UT, United States, 12Univ of Illinois, Chicago, IL, United States, 13The Center for Health Research, Kaiser Permanente, Portland, OR, United States, 14Univ of Utah, Salt Lake City, UT, United States, 15University of Alabama, Birmingham, AL, United States, 16Internal Medicine, Wake Forest Univ Hlth Sciences, Winston-Salem, NC, United States, 17Pulmonary & Critical Care, University of California- San Francisco, San Francisco, CA, United States, 18Medicine, University of California, San Francisco, San Francisco, CA, United States.
Introduction/RationaleOur overarching goal is to define and characterize chronic smokers who are “resilient” to the adverse pulmonary effects of smoking. We previously developed a multi-dimensional definition of a lung-related “resilient smoker” using a modified Delphi survey to be useful in research studies. This definition of a resilient smoker includes absence of cough/sputum production, dyspnea, CT radiographic measurements of lung disease, and exacerbations in addition to normal spirometry. Using this definition, we identified a resilient smoker subgroup in SPIROMICS, whom we then characterized using known biomarkers of chronic obstructive pulmonary disease (COPD).
MethodsWe applied our Delphi method-derived consensus definition of lung-related resilience to smokers with preserved spirometry in the SPIROMICS cohort to derive a subgroup of “resilient” and “non-resilient” smokers. We compared clinical and demographic characteristics of these groups using t-test and chi-squared test. We then compared resilient smokers to non-resilient smokers, Gold Stage 1 COPD and never-smoking controls with respect to known biomarkers of COPD (airway concentration of soluble mucins, plasma fibrinogen, C-reactive protein (CRP), soluble tumor-necrosis factor receptors sTNFRSF1A (TNF1a), and sTNFRSF1B (TNF1b) using t-test and linear regression.
ResultsWe applied this multidimensional definition of resilience to the 2,973 SPIROMICS participants (Figure 1). After exclusion of never smokers (n=202) and smokers with abnormal spirometry (post-bronchodilator FEV1/FVC <0.7, n=1847), we found 892 participants had preserved spirometry. Application of additional domains of resilience (symptoms, CT scan findings, exacerbations) excluded 718 participants (80.5%), resulting in 174 (19.5%) resilient smokers. We found that 516 smokers with preserved spirometry had an abnormality in at least one of the Delphi-derived domains of resilience, which created our “non-resilient” subpopulation. CRP levels in resilient smokers were similar to healthy non-smoking controls and lower in comparison to non-resilient smokers (P=0.003). When adjusting for age, gender, race, pack-years of smoking, current smoking status, and asthma, statistically significant differences in CRP between resilient smokers and non-resilient smokers remained
ConclusionApplication of a consensus-based definition of “resilient smokers” to SPIROMICS resulted in only 19.5% of smokers who would have been classified as resilient smokers based on spirometry alone. We found that resilient smokers are biologically distinct from non-resilient smokers based on CRP measurements. We conclude the development and use of the definition of our consensus-based definition of a “resilient smoker” is an essential research tool that will lead to further investigation of biological factors that convey resilience to cigarette smoke exposure.