Prognostic significance of large airway measures on computed tomography (CT) in the general population: The MESA-lung study

Background: Airway wall thickening and lumen narrowing have been associated with COPD and asthma, but the prognostic significance of large airway structure is unclear. Aim: To test if airway measures on CT were associated longitudinally with physiologic, anatomic, and clinical outcomes in the general population. Methods: MESA recruited participants ages 45-84 years without cardiovascular disease in 2000-02. Airway wall thickness (AWT), lumen diameter, 10mm luminal perimeter (Pi10), and wall area percent (WA%) were measured in two dimensions on cardiac CTs at baseline. Spirometry was performed in 2004-06 and 2010-12. Percent emphysema was defined on cardiac (2000-07) and full-lung (2010-12) CT. Respiratory mortality was classified by death certificate. Random-intercept mixed and proportional-hazards models were adjusted for age, sex, race/ethnicity, site, height, weight, scanner, smoking, and pack-years. Results: Repeated measures of lung function and percent emphysema were available for 3561 and 4108 participants; 6324 had 15-year mortality follow-up. Greater AWT and Pi10 were associated with more rapid FEV1 decline (P Conclusions: Airway wall thickening predicted lung function decline and smaller lumen diameter predicted emphysema progression and respiratory mortality over 15 years, including in never-smokers.