Academic Journal
Emphysema and airway disease synergistically impair exercise tolerance in smokers: A CT-based study.
| Τίτλος: | Emphysema and airway disease synergistically impair exercise tolerance in smokers: A CT-based study. |
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| Συγγραφείς: | Maetani T; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Takatsuki, Osaka, Japan., Sugitani T; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Tanabe N; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan. Electronic address: ntana@kuhp.kyoto-u.ac.jp., Shiraishi Y; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Hayashi Y; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Oguma T; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Medicine, Kyoto City Hospital, Kyoto, Japan., Sakamoto R; Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Ikeda K; Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan., Oshima Y; Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan., Yoshioka Y; Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan., Hamada R; Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan., Sato A; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Sato S; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Ikeguchi R; Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan., Hirai T; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. |
| Πηγή: | Respiratory physiology & neurobiology [Respir Physiol Neurobiol] 2026 Aug-Sep; Vol. 344, pp. 104612. Date of Electronic Publication: 2026 Jun 23. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 101140022 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-1519 (Electronic) Linking ISSN: 15699048 NLM ISO Abbreviation: Respir Physiol Neurobiol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Amsterdam ; New York : Elsevier Science, c2002- |
| Ιατρικοί όροι (MeSH): | Exercise Tolerance*/physiology , Pulmonary Disease, Chronic Obstructive*/physiopathology , Pulmonary Disease, Chronic Obstructive*/diagnostic imaging , Pulmonary Disease, Chronic Obstructive*/complications , Pulmonary Emphysema*/physiopathology , Pulmonary Emphysema*/diagnostic imaging , Smoking*/physiopathology, Humans ; Tomography, X-Ray Computed ; Female ; Male ; Cross-Sectional Studies ; Middle Aged ; Aged ; Prospective Studies ; Spirometry ; Walk Test ; Phenotype |
| Περίληψη: | Introduction: Emphysema and airway disease are major pathological features in smokers, including those with chronic obstructive pulmonary disease (COPD); however, how these two distinct pathologies interact to impair exercise capacity remains poorly understood. This study aimed to comprehensively compare physical performance, body composition, and physical activity across four computed tomography (CT)-based phenotypes: emphysema-dominant (ED), airway disease-dominant (AD), both-dominant (Mixed), and neither-dominant (Mild). Methods: This cross-sectional analysis used baseline data from a single-center prospective cohort of smokers enriched for COPD. Alongside spirometry and 6-minute walk distance (6MWD), chest CT was performed to quantify the low attenuation volume percentage (LAV%) and airway wall area (Pi10), which enabled classification into Mild, AD, ED, and Mixed phenotypes. Results: A total of 181 smokers (77.9% with COPD) were categorized into Mild, AD, ED, and Mixed groups (n = 62/33/55/31, respectively). The Mixed group exhibited a significantly shorter 6MWD compared with the Mild group. Furthermore, the ED and Mixed phenotypes showed greater dyspnea and oxygen desaturation during exercise. In multivariable analysis, both LAV% and Pi10 were independently associated with 6MWD after adjusting for relevant clinical covariates and muscle strength. A significant interaction between LAV% and Pi10 was observed, demonstrating their synergistic detrimental effect on 6MWD. Conclusion: Emphysema and airway disease independently and synergistically contribute to impaired exercise tolerance in smokers. CT-based phenotyping, particularly identification of the Mixed phenotype, may be useful to stratify functional risk and guide targeted interventions for preserving physical function in this population. (Copyright © 2026 Elsevier B.V. All rights reserved.) |
| Competing Interests: | Declaration of Competing Interest N.T. and T.H. were supported by grants from FUJIFILM Co., Ltd. and Daiichi Sankyo Company, Ltd., outside the submitted work. N.T. received a lecture fee from AstraZeneca outside of the submitted work. S.S. received grants from FUJIFILM Co., Ltd., Nippon Boehringer Ingelheim, Philips- Respironics, Fukuda Denshi, Fukuda Lifetec Keiji, and ResMed outside of the submitted work. None of these companies played a role in the design or analysis of the study, or in the writing of the manuscript. The other authors have no conflicts of interest to declare. |
| Contributed Indexing: | Keywords: 6-minute walk distance; COPD; airway disease; emphysema; exercise tolerance |
| Entry Date(s): | Date Created: 20260623 Date Completed: 20260725 Latest Revision: 20260725 |
| Update Code: | 20260726 |
| DOI: | 10.1016/j.resp.2026.104612 |
| PMID: | 42336306 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1878-1519 |
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| DOI: | 10.1016/j.resp.2026.104612 |