Peripheral airway dysfunction and relationship with symptoms in smokers with preserved spirometry

ABSTRACT Background and objective Smokers develop respiratory symptoms and peripheral airway dysfunction even when spirometry is preserved. Multiple breath nitrogen washout (MBNW) and impulse oscillometry system (IOS) are potentially useful measures of peripheral airway function but they have not been compared in such subjects. We hypothesized that MBNW and IOS are jointly abnormal in smokers with normal spirometry and that these abnormalities relate to respiratory symptoms. Methods Eighty smokers with normal spirometry completed a symptom questionnaire, had ventilation heterogeneity in diffusion (Sacin) and convection‐dependent (Scond) airways and trapped gas volume at functional residual capacity as a percentage of vital capacity (%VtrFRC/VC) measured by MBNW. Respiratory resistance and reactance at 5 and 20 Hz were measured using IOS. Results Respiratory symptoms were reported in 55 (68%) subjects. Forty (50%) subjects had at least one abnormal MBNW parameter, predominantly in Sacin. Forty‐one (51%) subjects had at least one abnormal IOS parameter, predominantly in resistance. Sixty‐one (76%) subjects had an abnormality in either MBNW or IOS. Chronic bronchitis symptoms were associated with an increased Scond, while wheeze was associated with lower spirometry and an increased resistance. Abnormalities in MBNW and IOS parameters were unrelated to each other. Conclusions Respiratory symptoms and peripheral airway dysfunction are common in smokers with normal spirometry. Symptoms of chronic bronchitis related to conductive airway abnormalities, while wheeze was related to spirometry and IOS. The clinical significance of abnormalities in peripheral airway function in smokers remains undetermined. See related Editorial Multiple breath nitrogen washout (MBNW) or impulse oscillometry system (IOS) abnormalities were highly prevalent in smokers without COPD but highly discordant between individuals. Cough was related to peripheral conductive airway function, while wheeze was related to IOS and spirometry. In smokers with normal spirometry, MBNW and IOS abnormalities may have different underlying structural bases and prognostic significance.