RT Journal Article
SR Electronic
T1 Are systemic manifestations ascribable to COPD in smokers? A structural equation modeling approach
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4196
VO 44
IS Suppl 58
A1 Etienne Audureau
A1 Laurent Boyer
A1 Christos Chouaid
A1 Bruno Housset
A1 Genevieve Derumeaux
A1 Jorge Boczkowski
A1 Bernard Maitre
A1 Sylvie Bastuji-Garin
A1 Serge Adnot
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P4196.abstract
AB Introduction: Whether the systemic manifestations observed in Chronic Obstructive Pulmonary Disease (COPD) are ascribable to lung dysfunction or direct effects of smoking is in debate. Structural Equations Modeling (SEM) technique could help unraveling the pathways involved, by enabling estimation of direct and indirect associations between groups of variables.Aim: Investigate the relative impact of smoking and COPD on systemic manifestations, inflammation and telomere length.Methods: In 301 individuals (105 women; 100 smokers with COPD, 100 smokers without COPD, 101 non-smokers), we used SEM to explore the pathways between smoking (pack-years), lung disease (FEV1, KCO), and the following parameters: arterial stiffness (aortic pulse wave velocity, PWV), bone mineral density (BMD), appendicular skeletal muscle mass (ASMM), grip strength, insulin resistance (HOMA-IR), creatinine clearance (CCr), blood leukocyte telomere length and inflammatory markers (Luminex assay). All models were adjusted on age and stratified by gender.Results: latent constructs were built for systemic inflammation (inflammatory markers) and musculoskeletal aging (ASMM, grip strength, BMD). Models had excellent fit. SEM showed that most effects of smoking were indirectly mediated by lung dysfunction: e.g. via FEV1 on musculoskeletal aging, CCr, PWV (men) and HOMA-IR (both genders), and via KCO on HOMA-IR, PWV (men), CCr (women) and musculoskeletal aging (both genders). Direct effects of smoking were limited to inflammatory markers and telomere length.Conclusion: SEM identified smoking effects as mostly mediated by lung function, highlighting the major role of COPD in the occurrence of systemic manifestations.