The interactions between cigarette smoking and reduced lung function on systemic inflammation

James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Room No. 368A, 1081 Burrard St, Vancouver, BC, V6Z 1Y6 Canada.
Chest (Impact Factor: 7.48). 02/2005; 127(2):558-64. DOI: 10.1378/chest.127.2.558
Source: PubMed


Low-grade systemic inflammation is commonly observed in conditions associated with reduced FEV(1). Active cigarette smoking, which is a leading risk factor for decreased FEV(1), can also independently induce systemic inflammation.
To determine the independent contributions of active cigarette smoking and reduced FEV(1) (as well as their potential interactions) on systemic inflammation.
Cross-sectional survey.
The US general population.
A total of 7,685 adult participants, >/= 40 years of age, in the Third National Health and Nutrition Examination Survey, who had acceptable data on spirometry and laboratory measurements such as serum C-reactive protein (CRP).
The participants were stratified into four equal groups (quartiles) based on the percent predicted FEV(1) values. Each group was further categorized as active smokers or nonsmokers according to serum cotinine level (ie, >/= 10 or < 10 ng/mL). Serum levels of CRP, plasma fibrinogen, blood leukocytes, and platelets were compared across the predicted FEV(1) quartile groups and across smoking status using multiple logistic regression models.
We found that active smoking by itself increased the odds of having elevated CRP levels by 63% (adjusted odds ratio [OR], 1.63; 95% confidence interval, 1.28 to 2.09). The adjusted OR for reduced FEV(1) was 2.27 (95% confidence interval, 1.92 to 2.70). Having both risk factors increased the OR to 3.31 (95% confidence interval, 2.73 to 4.02). Similar findings were observed for blood leukocytes and plasma fibrinogen.
These findings suggest an additive effect of active smoking and reduced FEV(1) on markers of systemic inflammation and suggest their potential interactions in the pathogenesis of systemic complications observed in patients with poor lung function.

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Available from: Wen Qi Gan, Dec 13, 2013
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    • "Data collected in the Third National Health and Nutrition Examination Survey (NHANES III) also found associations between increased CRP level and reduced pulmonary function [Cirillo et al., 2002; Mannino et al., 2003; Gan et al., 2005]. Moreover, when Gan et al. [2005] focused on smoking status, the authors observed an additive effect of current smoking on the inverse relationship of CRP, FEV 1 observed previously in this cohort. "
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    ABSTRACT: To assess the association between markers of systemic inflammation and pulmonary function in a population of structural firefighters. We studied male career members of a large Midwestern fire department with questionnaires, spirometry, and high-sensitivity C-reactive protein (hsCRP) as a biomarker of systemic inflammation. We examined percent predicted forced expiratory volume in 1 s (FEV1 %-predicted) and forced vital capacity (FVC%-predicted). Complete data were available for 401 firefighters. Higher hsCRP levels were associated with lower lung function values, after adjusting for confounding variables. Specifically, for every twofold increase in log10-hsCRP, FEV1 %-predicted decreased by a mean 1.5% (95% CI: 0.4, 2.6%) and FVC%-predicted decreased by a mean 1.4% (95% CI: 0.4, 2.3%). hsCRP as a biomarker of systemic inflammation may indicate reduced lung function in structural firefighters. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 01/2014; 57(1). DOI:10.1002/ajim.22260 · 1.74 Impact Factor
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    • "We also found that CRP levels correlated independently with other important prognostic clinical variables: namely BMI and GOLD stage(spirometric classification). Some studies have demonstrated elevated levels of CRP and fibrinogen in patients with COPD [9,10] and a meta-analysis by Gan et al. confirmed a significant increase in CRP levels in COPD patients compared with controls indicating a persistent systemic inflammation in subjects with COPD [4]. Yende et al. reported a higher level of serum CRP in cases with an obstructive pattern in their spirometry (3.5 mg/l) in comparison to normal population (2.5 mg/l) (p < 0.0001) [8]. "
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    ABSTRACT: The purpose of the study was to determine the relationship between high sensitivity C-reactive protein (hs-CRP) levels and prognostic factors in chronic obstructive pulmonary disease.Materials and methodsWe studied 50 stable COPD patients with: spirometry, 6 minute walk distance, body mass index, GOLD stage (spirometric classification) and smoking status. In these patients hs-CRP values were measured and compared with those of 50 healthy controls. Then the serum hs-CRP was subjected to evaluation for any correlation with the predictors of outcomes in COPD subjects. Hs-CRP levels were higher in COPD patients than in controls (4.82 vs. 0.88 mg/L p < 0.01). Correlation was found between hs-CRP and the following variables: FEV1 (r= -0.813; p < 0.01), 6MWD (r= -0.876; p < 0.01), body mass index (r= -0.710; p < 0.01), GOLD stage (r= 0.797, p < 0.01) and smoking status (r= 0.796; p < 0.01). Using multivariate analysis, FEV1 and 6MWD showed the strongest negative association with hs-CRP levels. The circulating levels of the inflammatory marker hs-CRP are significantly elevated in patients with COPD, supporting the view that COPD is in part an inflammatory disorder. Hs-CRP levels in stable COPD patients are best correlated with FEV1 and 6-minute walk distance (6MWD). This information should be considered when hs-CRP levels are measured in stable COPD patients.
    Multidisciplinary respiratory medicine 09/2013; 8(1):63. DOI:10.1186/2049-6958-8-63 · 0.15 Impact Factor
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    • "CRP is an acute-phase reactant that increases in a very sensitive but non-specific way in most forms of tissue damage, inflammation and infection, all are very dynamic processes in patients with COPD [2]. As regards serum CRP correlations, our results in consistence with Gan et al. [45] who reported that elevated CRP is associated with decline in lung function and worsening of chronic COPD. Also, Rasmussen et al. [46] concluded that there is an association between inflammation in COPD and FEV 1 and FVC decline. "
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    ABSTRACT: COPD is no longer considered to affect only the lungs and airways but also the rest of the body. The systemic manifestations of COPD include a number of endocrine disorders such as those involving the pituitary, thyroid, gonads, adrenals and pancreas.The aim of this work is to detect the endocrinal and inflammatory changes in COPD patients during stability of the disease and the effect of acute exacerbation on these changes.Subjects and methodsTwenty acute exacerbated COPD (AECOPD) male patients with acute respiratory failure (ARF) were included in this study as a patient group and a control group which included 10 healthy age-matched males with normal pulmonary functions and without any of the exclusion criteria. For patients enrolled in this study, measurement of serum levels of sex hormones [total testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH)], insulin like growth factor-1 (IGF-1) and C-reactive protein (CRP) were done on admission and 1 month after hospital discharge. For healthy group, the previous measurements were done once only.ResultsThere were statistically significant decrease in serum testosterone and IGF-1 levels in patients after stabilization than those in the control group with more decrease of their levels during exacerbation and the difference between their levels in patients during exacerbation and after stabilization was statistically highly significant. As regards serum LH and FSH, there were statistically highly significant increase in their levels in COPD patients during exacerbation than those in the control group but there were non-significant differences in these hormones levels between the patients after stabilization and the control group. As regards serum CRP, there was highly significant increase in its serum level in patients in both exacerbation and after stabilization than that in the control group. The level of CRP in patients during exacerbation was higher than that after stabilization and the difference was statistically highly significant. As regards disease severity, there were statistically highly significant decrease in testosterone level in severe to very severe COPD patient group than that in mild to moderate one. There was also statistically significant decrease in serum IGF-1 level in severe to very severe COPD patient group than that in mild to moderate one. There was statistically highly significant increase in serum CRP level in severe to very severe COPD patient group than that in mild to moderate one. On the other hand, there was statistically non-significant increase in serum LH and FSH levels in severe to very severe CPOD patient group than those in mild to moderate one. There were statistically highly significant positive correlations between serum testosterone levels and both FEV1% predicted and PaO2. There were also statistically highly significant positive correlations between serum IGF-1 levels and both FEV1% predicted and PaO2 and also between serum CRP levels and PaCO2 in patients during exacerbation. Also during exacerbation, there was statistically highly significant negative correlation between serum CRP levels and FEV1% predicted.ConclusionCOPD leads to alterations in serum levels of sex hormones (testosterone, LH and FSH), IGF-1 and CRP. There was decrease in testosterone hormone levels of male stable COPD patients and this decrease was more evident, with compensatory increase in LH and FSH hormones levels, during exacerbation period when hypoxemia is more significant. CRP level is increased even in stable COPD and this rise is magnified with increased disease severity. IGF-1 decreased in stable COPD patients with more decrease in its level during acute exacerbation.
    07/2012; 61(3):81–88. DOI:10.1016/j.ejcdt.2012.10.011
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