Skip to main content
NCBI home page
RSNA Journals logoLink to RSNA Journals
. 2021 Apr 27;300(1):190–196. doi: 10.1148/radiol.2021203874

Association between Cardiorespiratory Fitness and Bronchiectasis at CT: A Long-term Population-based Study of Healthy Young Adults Aged 18–30 Years in the CARDIA Study

Alejandro A Diaz 1,✉, Laura A Colangelo 1, Yuka Okajima 1, Andrew Yen 1, Marc A Sala 1, Mark T Dransfield 1, Gregory Tino 1, James C Ross 1, Raúl San José Estépar 1, George R Washko 1, Ravi Kalhan 1
PMCID: PMC8248949  PMID: 33904771

Abstract

Background

Protective factors against the risk of bronchiectasis are unknown. A high level of cardiorespiratory fitness is associated with a lower risk of chronic obstructive pulmonary disease. But whether fitness relates to bronchiectasis remains, to the knowledge of the authors, unknown.

Purpose

To examine the association between cardiorespiratory fitness and bronchiectasis.

Materials and Methods

This was a secondary analysis of a prospective observational study: the Coronary Artery Risk Development in Young Adults cohort (from 1985–1986 [year 0] to 2015–2016 [year 30]). During a 30-year period, healthy participants (age at enrollment 18–30 years) underwent treadmill exercise testing at year 0 and year 20 visits. Cardiorespiratory fitness was determined according to the treadmill exercise duration. The 20-year difference in cardiorespiratory fitness was used as the fitness measurement. At year 25, chest CT was performed to assess bronchiectasis and was used as the primary outcome. Multivariable logistic models were performed to determine the association between cardiorespiratory fitness changes and bronchiectasis.

Results

Of 2177 selected participants (at year 0: mean age, 25 years ± 4 [standard deviation]; 1224 women), 209 (9.6%) had bronchiectasis at year 25. After adjusting for age, race-sex group, study site, body mass index, pack-years smoked, history of tuberculosis, pneumonia, asthma and myocardial infarction, peak lung function, and cardiorespiratory fitness at baseline, preservation of cardiorespiratory fitness was associated with lower odds of bronchiectasis at CT at year 25 (per 1-minute–longer treadmill duration from year 0 to year 20: odds ratio [OR], 0.88; 95% CI: 0.80, 0.98; P = .02). A consistent strong association was found when cough and phlegm were included in bronchiectasis (OR, 0.72; 95% CI: 0.59, 0.87; P < .001).

Conclusion

In a long-term follow-up, the preservation of cardiorespiratory fitness was associated with lower odds of bronchiectasis at CT.

© RSNA, 2021

Online supplemental material is available for this article.

See also the editorial by Stojanovska in this issue.

graphic file with name radiol.2021203874.VA.jpg

Open in a new tab

Summary

In healthy adults aged 18–30 years, the preservation of cardiorespiratory fitness over 20 years was associated with lower odds of bronchiectasis at CT at year 25 of a 30-year follow-up.

Key Results

  • ■ In a population-based cohort (Coronary Artery Risk Development in Young Adults study) of 2177 healthy adults aged 18–30 years who underwent 30 years of follow-up, preservation of cardiorespiratory fitness from baseline to year 20 was associated with lower odds of bronchiectasis at CT at year 25 (per 1-minute–longer treadmill duration from year 0 to 20 odds ratio [OR], 0.88; P = .02).

  • ■ A consistent association was found when cough and phlegm were added to the radiographic bronchiectasis (OR, 0.72; P < .001).

Introduction

Bronchiectasis, a disease defined by a pathologic enlargement of the airways, is increasingly recognized worldwide (1–4). Bronchiectasis is characterized by repeated cycles of inflammation and exacerbations, leading to airway structural damage. Although CT remains the reference standard to confirm or rule out the disease in symptomatic patients, the detection of bronchiectasis at CT has also been reported in asymptomatic and mildly symptomatic individuals (5). Although underlying factors and conditions associated with increased risk of bronchiectasis such as aging, infections (eg, pneumonia, tuberculosis), and cystic fibrosis (1,6–8) are well known, factors that can reduce the risk remain unexplored.

Studies demonstrated that higher levels of cardiorespiratory fitness were associated with a reduced risk of declining lung function and incident airway diseases, such as chronic obstructive pulmonary disease (9,10). Nevertheless, whether cardiorespiratory fitness reduces the risk of bronchiectasis is, to our knowledge, unknown. Cardiorespiratory fitness is an objective measurement of maximal oxygen uptake capacity, and it is associated with overall physical fitness (11). High levels of fitness are associated with reduced systemic inflammation, and chronic inflammation leads to recurrent infections resulting in structural damage of proximal airways, a central feature of bronchiectasis (12–14). The purpose of our study was to examine the association between cardiorespiratory fitness and bronchiectasis.

Materials and Methods

Study Sample

This was a secondary analysis of a prospective observational study, the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (ClinicalTrials.gov identifier, NCT00005130; www.cardia.dopm.uab.edu), a prospective study of the evolution of cardiovascular disease risk factors in young adults (from 1985–1986 [year 0] to 2015–2016 [year 30]) (15). The enrolled participants were free of long-term diseases or disabilities and retained the ability to walk on a treadmill. At years 0 and 5, 115 Black and White participants between ages 18 and 30 years were examined at four sites: Birmingham, Ala; Chicago, Ill; Minneapolis, Minn; and Oakland, Calif (Appendix E1 [online]). Reexamination occurred at years 2, 5, 7, 10, 15, 20, 25, and 30. Cardiorespiratory fitness was measured at year 0 (baseline) and year 20. CT scanning was included in year 25. A previous CARDIA study reported on 2735 participants with cardiorespiratory fitness measured at years 0 and 20 (9). The previous study focused on fitness and lung function. Our current study used a subset of those participants and added determination of bronchiectasis at CT in year 25 of the follow-up. No exclusion criteria were applied for imaging. Participants were subsequently eliminated for this analysis because of missing data regarding fitness, CT, or other covariates as detailed in Figure 1, leaving a study sample of 2177 participants. Bronchiectasis at CT is the main outcome of this study. The institutional review board at each site approved the study, and informed written consent was obtained from all the participants. CARDIA sites obtained Health Insurance ­Portability and Accountability Act authorization as part of the consent form.

Figure 1:

Participant selection flowchart of the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Open in a new tab

Participant selection flowchart of the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Cardiorespiratory Fitness Measurement

Fitness in the CARDIA cohort was assessed by symptom-limited graded treadmill exercise testing by using a modified Balke protocol (16). The protocol consisted of nine 2-minute stages of increasing difficulty: stage 1 was 3 mph at a 2% grade (4.1 metabolic equivalent task), with a gradual increase in both speed and grade to a maximum of 5.6 mph at 25% grade (19.0 metabolic equivalent task). The duration of the tests and maximal metabolic equivalent tasks attained were recorded. We used treadmill duration in minutes as the fitness measurement in this analysis.

Presence of Bronchiectasis

The presence of bronchiectasis at CT at year 25 was used as a primary end point. The chest CT protocol is described in Table E1 (online) (17). Briefly, the participants underwent a noncontrast electrocardiography-gated CT examination, and the images were reconstructed at 2.5–3-mm section thickness. Bronchiectasis was observed on the axial plane by using a visual assessment, as previously described (18,19) and expanded (Appendix E1 [online]). Three trained primary readers, including a chest radiologist (Y.O.) and pulmonologist (A.A.D.) with over 10 years of experience in lung imaging, independently read all the CT scans twice. All readers were blinded to participants’ clinical information. Bronchiectasis was categorized as present, absent, or equivocal. A fourth reader (A.Y., a chest radiologist) adjudicated cases in which there was disagreement among the primary readers. While defining bronchiectasis, added cough or phlegm at years 20, 25, or 30 to the radiographic criteria was used as an alternate end point. The severity of bronchiectasis on CT scans was assessed with a slightly modified score sheet (Appendix E1 [online]).

Covariate Data

Data from questionnaires, health records, and tests were used to obtain information on age; sex; race; education; height; weight; smoking habit; cough; phlegm; conditions such as asthma, pneumonia, tuberculosis, and myocardial infarction; and lung function assessment (Appendix E1 [online]) (20). Lung function was measured with standard spirometry procedures as recommended by the American Thoracic Society (21,22). We used a participant’s peak forced expiratory volume in 1 second as the maximum lung function attained at year 0, 2, 5, 10, 20, or 30 as a covariate. Prediction equations of the U.S. population were used to calculate forced expiratory volume in 1 second predicted values (23).

We also used inflammatory markers in blood, including interleukin-6 protein (IL-6) and C-reactive protein (24), measured at year 20 for a mediation analysis to explore whether systemic inflammation mediates a potential association between fitness and bronchiectasis (Appendix E1 [online]).

Statistical Analysis

Because of the differences in fitness between women and men, descriptive data are presented by sex. For descriptive purposes only, characteristics of participants are presented by groups of fitness changes (Table 1, Fig 2). Fitness changes of the participants were grouped into four groups on the basis of the sex-specific median values of treadmill duration at both year 0 and year 20 (9). The groups are as follows: (a) sustained low fitness: participants with fitness levels that were below the sex-specific median at both years 0 and 20; (b) decreased fitness: participants with fitness levels that were above the sex-specific median at year 0 but below the median at year 20; (c) increased fitness: participants with fitness levels that were below the sex-specific median at year 0 but above year 20 median; and (d) sustained high fitness: participants with fitness levels that were above the sex-specific median at both years 0 and 20. Multivariable logistic regression was used to determine the relationship between bronchiectasis on CT scans at year 25 and changes in fitness from year 0 to year 20. Note that in the multivariable logistic models, 20-year changes in fitness (ie, treadmill duration in minutes) were used as a continuous variable and not as fitness change group. We used fitness change as a continuous variable versus categorical variable because it makes the estimates easier to interpret. Covariables included race-sex group; study site; age; education; year 0 body mass index; change in body mass index from year 0 to year 20; lifetime pack-years smoked at year 20; asthma at year 0; tuberculosis at years 10, 15, or 20; pneumonia at years 10, 15, or 20; myocardial infarction by year 25; fitness at year 0; and the maximal forced expiratory volume in 1 second attained. A subgroup analysis was conducted in the participants who met the criteria for the alternate definition of bronchiectasis. To assess the effect of the participants excluded from the main analyses, we performed an additional inverse probability-weighted analysis (Appendix E1 [online]). We also conducted exploratory analyses to assess whether systemic inflammatory markers IL-6 and C-reactive protein might mediate a potential association between 20-year changes in fitness and bronchiectasis. Finally, we performed an interreader agreement analysis of bronchiectasis presence on CT scans (Appendix E1 [online]) (25). A P value less than .05 was considered to indicate statistical significance. A statistician (L.A.C.) performed theses analyses by using statistical packages (SAS 9.4, SAS Institute; and R 4.5.0, RStudio).

Table 1:

Characteristics of Participants by Group of Cardiorespiratory Fitness Change and Sex

graphic file with name radiol.2021203874.tbl1.jpg

Open in a new tab

Figure 2:

Bar graph shows the prevalence of bronchiectasis by cardiorespiratory fitness group and sex. In both women and men, the prevalence of bronchiectasis decreased from sustained low fitness (61 of 462 [13.2%] and 49 of 371 [13.2%], respectively) to decreased fitness (18 of 170 [10.6%] and nine of 105 [8.6%], respectively), to increased fitness (11 of 149 [7.4%] and 13 of 153 [8.5%], respectively), and sustained high fitness (25 of 443 [5.6%] and 23 of 324 [7.1%], respectively) (P = .008 and <.001 for women and men, respectively).

Open in a new tab

Bar graph shows the prevalence of bronchiectasis by cardiorespiratory fitness group and sex. In both women and men, the prevalence of bronchiectasis decreased from sustained low fitness (61 of 462 [13.2%] and 49 of 371 [13.2%], respectively) to decreased fitness (18 of 170 [10.6%] and nine of 105 [8.6%], respectively), to increased fitness (11 of 149 [7.4%] and 13 of 153 [8.5%], respectively), and sustained high fitness (25 of 443 [5.6%] and 23 of 324 [7.1%], respectively) (P = .008 and <.001 for women and men, respectively).

Results

Participant Characteristics

Of the 5115 participants enrolled in CARDIA, 2177 had complete data for our analysis (Fig 1). At year 0, the mean age of the study participants was 25 years ± 4 (standard deviation); 1224 study participants were women. Most of the missing participants were lost to follow-up or did not attend the year-20 fitness test. A comparison between CARDIA participants who did not complete the fitness assessment at year 20 and those who did was previously reported (9). Briefly, participants with missing fitness testing were more likely Black and had higher body mass index and smoking pack-years. These participants also had lower maximum heart rate at year-0 fitness assessment. No differences in age, sex proportion, and peak forced expiratory volume in 1 second were noted.

Table 1 shows the participant characteristics across groups of cardiorespiratory fitness changes by sex. Both women and men in the sustained high fitness group had a higher number of years of education than women and men in the sustained low fitness group. Participants of both sexes in the sustained high fitness group had lower body mass index at both year 0 and year 20 and fewer pack-years smoked than women and men in the sustained low fitness group. In men and women, there were no marked variations in the prevalence of tuberculosis and pneumonia across fitness change groups. In both sexes, the prevalence of myocardial infarction was lower in the sustained high fitness group than in the sustained low fitness group. In men and women, systemic inflammatory markers C-reactive protein and IL-6 were lower in the sustained high fitness group than in the sustained low fitness group. Finally, in both sexes, forced expiratory volume in 1 second percent predicted and peak forced expiratory volume in 1 second percent predicted were higher in the sustained high fitness group than in the sustained low fitness group.

Prevalence and Severity of Year-25 Bronchiectasis at CT

Bronchiectasis on CT scans at year 25 was identified in 209 of 2177 (9.6%) study participants selected for this analysis. The median CT severity score was 2 of a possible 28 points, ranging from 1 to 20. Bronchiectasis was more common in the lower lobes (130 of 209; 62.2%) followed by middle and lingula (105 of 209; 50.2%) and upper lobes (33 of 209; 15.8%). In women, there was a decreasing prevalence of bronchiectasis across fitness groups, as follows: sustained low fitness, 13.2% (61 of 462); decreased fitness, 10.6% (18 of 170); increased fitness, 7.4% (11 of 149); and sustained high fitness, 5.6% (25 of 443) (P = .008). Among men, the prevalence also decreased across fitness groups as follows: sustained low fitness, 13.2% (49 of 371); decreased fitness, 8.6% (nine of 105); increased fitness, 8.5% (13 of 153); and sustained high fitness, 7.1% (23 of 324) (P < .001) (Fig 2).

Association between Cardiorespiratory Fitness and Bronchiectasis at CT at Year 25

In multivariable models, preservation of cardiorespiratory fitness from year 0 to year 20 was associated with lower odds of bronchiectasis at CT at year 25 (per 1-minute–longer treadmill duration from year 0 to year 20: odds ratio [OR], 0.88; 95% CI: 0.80, 0.98; P = .02). Figure 3 shows a monotonic decrease in the probabilities of bronchiectasis at CT at year 25 as the 20-year cardiorespiratory fitness changes. We found no evidence for an effect modification of the race-sex group on the relationship between change in fitness and bronchiectasis at CT (P = .88). The probabilities of year-25 bronchiectasis at CT to 20-year cardiorespiratory fitness change by race-sex group is shown in Figure E1 (online). The multivariable model also showed that 20-year cardiorespiratory fitness change was associated with bronchiectasis severity CT score (CT score ≤ 2 vs no bronchiectasis: OR, 0.88 [95% CI: 0.79, 0.98; P = .02]; CT score > 2 vs no bronchiectasis: OR, 0.83 [95% CI: 0.70, 0.91; P = .02]).

Figure 3:

Graph shows 20-year change in cardiorespiratory fitness and probabilities of bronchiectasis on CT scans at year 25. The plot shows the fitted line and 95% CIs (dashed lines) from the multivariable analysis. Preservation of cardiorespiratory fitness between year 0 and year 20 was associated with a lower probability of bronchiectasis at CT at year 25 (odds ratio, 0.88; 95% CI: 0.80, 0.98; P = .02). For the multivariable model description, see Table 2.

Open in a new tab

Graph shows 20-year change in cardiorespiratory fitness and probabilities of bronchiectasis on CT scans at year 25. The plot shows the fitted line and 95% CIs (dashed lines) from the multivariable analysis. Preservation of cardiorespiratory fitness between year 0 and year 20 was associated with a lower probability of bronchiectasis at CT at year 25 (odds ratio, 0.88; 95% CI: 0.80, 0.98; P = .02). For the multivariable model description, see Table 2.

Additional Analysis

A consistent result was found when the same primary multi­variable model for the alternate definition of bronchiectasis (n = 57) was used, which included cough or phlegm to the radiographic finding (OR, 0.72; 95% CI: 0.59, 0.87; P < .001) (Table 2). When a more parsimonious model was used to fit the data (ie, dropping out study site, the number of years of education, pneumonia, asthma, and myocardial infarction) for the smaller sample meeting the alternate definition of bronchiectasis, the estimate was as follows: OR, 0.74 (95% CI: 0.62, 0.88; P < .001). The full model was also rerun in the subset of participants who achieved 85% of age-predicted maximum heart rate, yielding consistent results (OR, 0.83; 95% CI: 0.73, 0.94; P = .004) (Table 2). In an effort to understand whether 20-year cardiorespiratory fitness change is linked to the symptoms of bronchiectasis (cough or phlegm at year 0, 2, 10, and 20), an additional logistic analysis was performed. After adjusting for age and race-sex group, preservation of cardiorespiratory fitness was associated with cough and/or phlegm (OR, 0.88; 95% CI: 0.85, 0.91; P < .001). Finally, when the inverse probabilities (ie, propensity score weights) were used to rerun the multivariable analysis, the result was as follows: OR, 0.88 (95% CI: 0.79, 0.98; P = .02).

Table 2:

Association between 20-year Change in Cardiorespiratory Fitness and Bronchiectasis at CT at Year 25

graphic file with name radiol.2021203874.tbl2.jpg

Open in a new tab

Mediation Analysis

To assess whether year-20 inflammatory markers mediate the association between fitness change and bronchiectasis, we conducted a mediation analysis. We found that IL-6 (OR, 1.23; 95% CI: 1.01, 1.50) but not C-reactive protein (OR, 1.07; 95% CI: 0.93, 1.25) was directly related to bronchiectasis at CT in the adjusted model. The mediation analysis showed that IL-6 contributes 11% (95% CI: 0.4%, 54%; P = .04) to the 20-year fitness change effect on the odds of year-25 bronchiectasis at CT.

Discussion

We followed up 2177 healthy young adults aged 18–30 years from the Coronary Artery Risk Development in Young Adults study over a 30-year period. Our results showed that preservation of cardiorespiratory fitness from start to year 20 was associated with lower odds of bronchiectasis at CT at year 25 (per 1-minute–longer treadmill duration from year 0–20: odds ratio [OR], 0.88; P = .02). A consistent association was found when cough and phlegm were added to the radiographic bronchiectasis (OR, 0.72; P < .001). Our results suggest fitness might be a modifiable factor that can contribute positively to the preservation of airway health.

Several studies have linked high fitness and physical activity levels to a myriad of health benefits, including reduced risk of chronic diseases such as chronic obstructive pulmonary disease (10). However, physical inactivity is associated with approximately 9% of premature deaths (26). Thus, being physically active is salutary to keeping and improving health at all ages (27). We expanded previous evidence by providing data regarding the relationship between cardiorespiratory fitness and bronchiectasis. Our multivariable analyses showed an inverse exposure-response relationship between preserved cardiorespiratory fitness over 20 years and bronchiectasis at CT at year 25. The association we observed was independent of body mass index, cigarette smoking intensity, history of infections such as pneumonia and tuberculosis, forced expiratory volume in 1 second, and other covariates. Furthermore, our results suggest that cardiorespiratory fitness effects on bronchiectasis were slightly greater in participants with high-severity CT score than those with low-severity CT score. The association was present even when, on average, bronchiectasis on CT scans was in the mild side of the severity spectrum. The interpretation of these findings should be circumscribed to radiographic bronchiectasis, which is not equivalent to clinical bronchiectasis. The results suggest that preservation of cardiorespiratory fitness might be beneficial to preserve airway structure. We performed further analyses to understand whether cardiorespiratory fitness is associated with clinical characteristics of bronchiectasis in the absence of diagnostic information. We found a stronger association between changes in cardiorespiratory fitness and radiographic bronchiectasis with symptoms and that cardiorespiratory fitness was associated with typical symptoms of bronchiectasis.

There are several possible explanations for the relationship between cardiorespiratory fitness and bronchiectasis. First, bronchiectasis is characterized by high levels of systemic and airway inflammation (12) and high cardiorespiratory fitness has been linked to lower levels of systemic inflammation (28,29), which might help preserve the airway health. Our analysis supports this possibility because we found that IL-6 mediates the association between change in fitness and bronchiectasis. Second, high cardiorespiratory fitness is also associated with a lower risk of certain diseases associated with bronchiectasis, such as asthma and pneumonia (30). Finally, high fitness levels lead to an increase in the capacity and efficiency of the cardiorespiratory system (27), which may contribute to better airway perfusion and chest wall mechanics, improving the ability of the mucociliary system to clear the airways. For instance, in patients with cystic fibrosis, treadmill exercise increased mucociliary clearance, particularly in intermediate and peripheral regions of the lung (31).

Finally, we observed a high prevalence of bronchiectasis versus other epidemiologic studies showing lower overall prevalence of bronchiectasis (2–4,32). For example, a U.S. study reported a prevalence of 43 per 100 000 population (0.043%) for the age group of 45–54 years compared with our reported prevalence of 9.6% (32). A potential explanation for the difference in prevalence is that our bronchiectasis confirmation was based on the CT examination and not a physician-based diagnosis as those studies used.

Our study had several strengths. First, the confirmation of the disease was performed in a well-characterized sample with a long-term follow-up, an approach that expands the traditional search of bronchiectasis by claim codes. Second, we used CT imaging in identifying the airway abnormality, a dependable tool typically used to confirm the diagnosis of bronchiectasis in clinical settings. Finally, we performed an objective assessment of cardiorespiratory fitness at two points and conducted additional analysis, supporting the main findings. One such additional analysis demonstrated comparable results for the association between cardiorespiratory fitness and bronchiectasis at CT at year 25 among participants who achieved 85% of their predicted heart rate at baseline, indicating no limited performance by lung abnormalities.

Our study had several limitations. First, we had a high proportion of participants at year 25 who did not undergo cardiorespiratory fitness testing. This is likely not at random because participants with the lowest levels of fitness may refuse to take this test. Whereas this missing data would bias our estimates toward the null, it does not concern the directionality of the association between cardiorespiratory fitness and bronchiectasis. Second, the assessment of bronchiectasis was based on a visual imaging method that had a moderate interreader agreement. Third, the CARDIA study did not include chest CT or a question about physician-diagnosed bronchiectasis at start, preventing us from ruling out with certainty the disease at baseline, which also limits further a causality claim. Finally, although we included a reasonable list of confounders from this population-based cohort in our modeling, residual confounding may have biased the observed relationship.

In summary, by studying a population-based cohort of healthy young adults aged 18–30 years at the start of the study, we demonstrated that preservation of cardiorespiratory fitness over 20 years is associated with lower odds of bronchiectasis on CT scans at year 25. The association is stronger when bronchiectasis with respiratory symptoms is used as an alternate outcome.

A.A.D. supported by the National Heart, Lung, and Blood Institute (grants R01-HL133137, R01-HL149861) and the Brigham and Women’s Hospital Minority Faculty Career Development Award. J.C.R. supported by the National Institutes of Health. Study supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (HHSN268201800005I, HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). Additional funding was provided by National Heart, Lung, and Blood Institute (grant R01-HL122477) (CARDIA Lung Study). This manuscript has been reviewed by CARDIA for scientific content. The National Heart, Lung, and Blood Institute had input into the overall design and conduct of our study and was represented on the publications committee that approved this article.

Disclosures of Conflicts of Interest: A.A.D. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed payment for manuscript writing from Barcelona Respiratory Network Reviews. Other relationships: disclosed no relevant relationships. L.A.C. disclosed no relevant relationships. Y.O. disclosed no relevant relationships. A.Y. disclosed no relevant relationships. M.A.S. disclosed no relevant relationships. M.T.D. disclosed no relevant relationships. G.T. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed consultancy for Astra Zeneca, Cipla; grants/grants pending from Bronchiectasis and NTM Research Registry, COPD Foundation. Other relationships: disclosed no relevant relationships. J.C.R. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. R.S.J.E. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed grants/grants pending from Boehringer Ingelheim, Lung Biotechnology, Insmed; payment for lectures from Chiesi; stock/stock options from Quantitative Imaging Solutions; travel/accommodations/meeting expenses from Chiesi. Other relationships: disclosed no relevant relationships. G.R.W. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed consultancies from Pulmonx, Janssen Pharmaceuticls, Novartis, Vertex; grants/grants pending from Boehringer Ingelheim; author is the founder and co-owner for Quantitative Imaging Solutions. Other relationships: disclosed no relevant relationships. R.K. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: disclosed consultancies from GlaxoSmithKline, AstraZeneca, CVS Caremark; payment for lectures from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim. Other relationships: disclosed no relevant relationships.

Abbreviations:

CARDIA
Coronary Artery Risk Development in Young Adults
IL-6
interleukin-6 protein
OR
odds ratio

References

  • 1.Chalmers JD, Chang AB, Chotirmall SH, Dhar R, McShane PJ. Bronchiectasis. Nat Rev Dis Primers 2018;4(1):45. [DOI] [PubMed] [Google Scholar]
  • 2.Henkle E, Chan B, Curtis JR, Aksamit TR, Daley CL, Winthrop KL. Characteristics and Health-care Utilization History of Patients With Bronchiectasis in US Medicare Enrollees With Prescription Drug Plans, 2006 to 2014. Chest 2018;154(6):1311–1320. [DOI] [PubMed] [Google Scholar]
  • 3.Choi H, Yang B, Nam H, et al. Population-based prevalence of bronchiectasis and associated comorbidities in South Korea. Eur Respir J 2019;54(2):1900194. [DOI] [PubMed] [Google Scholar]
  • 4.Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016;47(1):186–193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Tan WC, Hague CJ, Leipsic J, et al. Findings on Thoracic Computed Tomography Scans and Respiratory Outcomes in Persons with and without Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study. PLoS One 2016;11(11):e0166745. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Araújo D, Shteinberg M, Aliberti S, et al. Standardised classification of the aetiology of bronchiectasis using an objective algorithm. Eur Respir J 2017;50(6):1701289. [DOI] [PubMed] [Google Scholar]
  • 7.Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162(4 Pt 1):1277–1284. [DOI] [PubMed] [Google Scholar]
  • 8.Martínez-García MA, Soler-Cataluña JJ, Donat Sanz Y, et al. Factors associated with bronchiectasis in patients with COPD. Chest 2011;140(5):1130–1137. [DOI] [PubMed] [Google Scholar]
  • 9.Benck LR, Cuttica MJ, Colangelo LA, et al. Association between Cardiorespiratory Fitness and Lung Health from Young Adulthood to Middle Age. Am J Respir Crit Care Med 2017;195(9):1236–1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Hansen GM, Marott JL, Holtermann A, Gyntelberg F, Lange P, Jensen MT. Midlife cardiorespiratory fitness and the long-term risk of chronic obstructive pulmonary disease. Thorax 2019;74(9):843–848. [DOI] [PubMed] [Google Scholar]
  • 11.Cheng YJ, Macera CA, Addy CL, Sy FS, Wieland D, Blair SN. Effects of physical activity on exercise tests and respiratory function. Br J Sports Med 2003;37(6):521–528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Chalmers JD, Moffitt KL, Suarez-Cuartin G, et al. Neutrophil Elastase Activity Is Associated with Exacerbations and Lung Function Decline in Bronchiectasis. Am J Respir Crit Care Med 2017;195(10):1384–1393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Church TS, Barlow CE, Earnest CP, Kampert JB, Priest EL, Blair SN. Associations between cardiorespiratory fitness and C-reactive protein in men. Arterioscler Thromb Vasc Biol 2002;22(11):1869–1876. [DOI] [PubMed] [Google Scholar]
  • 14.LaMonte MJ, Durstine JL, Yanowitz FG, et al. Cardiorespiratory fitness and C-reactive protein among a tri-ethnic sample of women. Circulation 2002;106(4):403–406. [DOI] [PubMed] [Google Scholar]
  • 15.Friedman GD, Cutter GR, Donahue RP, et al. CARDIA: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol 1988;41(11):1105–1116. [DOI] [PubMed] [Google Scholar]
  • 16.Sidney S, Haskell WL, Crow R, et al. Symptom-limited graded treadmill exercise testing in young adults in the CARDIA study. Med Sci Sports Exerc 1992;24(2):177–183. [PubMed] [Google Scholar]
  • 17.Moualla M, Qualls C, Arynchyn A, et al. Rapid decline in lung function is temporally associated with greater metabolically active adiposity in a longitudinal study of healthy adults. Thorax 2017;72(12):1113–1120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Diaz AA, Maselli DJ, Rahaghi F, et al. Pulmonary vascular pruning in smokers with bronchiectasis. ERJ Open Res 2018;4(4):00044–2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Diaz AA, Young TP, Maselli DJ, et al. Quantitative CT Measures of Bronchiectasis in Smokers. Chest 2017;151(6):1255–1262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Cuttica MJ, Colangelo LA, Dransfield MT, et al. Lung Function in Young Adults and Risk of Cardiovascular Events Over 29 Years: The CARDIA Study. J Am Heart Assoc 2018;7(24):e010672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.ATS statement--Snowbird workshop on standardization of spirometry. Am Rev Respir Dis 1979;119(5):831–838. [DOI] [PubMed] [Google Scholar]
  • 22.Standardization of Spirometry . 1994Update. American Thoracic Society. Am J Respir Crit Care Med 1995;152(3):1107–1136. [DOI] [PubMed] [Google Scholar]
  • 23.Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 1999;159(1):179–187. [DOI] [PubMed] [Google Scholar]
  • 24.Alshaarawy O, Sidney S, Auer R, et al. Cannabis Use and Markers of Systemic Inflammation: The Coronary Artery Risk Development in Young Adults Study. Am J Med 2019;132(11):1327–1334.e1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Lee H, Herbert RD, McAuley JH. Mediation Analysis. JAMA 2019;321(7):697–698. [DOI] [PubMed] [Google Scholar]
  • 26.Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012;380(9838):219–229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA 2018;320(19):2020–2028. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Wolff-Hughes DL, Fitzhugh EC, Bassett DR, Churilla JR. Total Activity Counts and Bouted Minutes of Moderate-to-Vigorous Physical Activity: Relationships With Cardiometabolic Biomarkers Using 2003-2006 NHANES. J Phys Act Health 2015;12(5):694–700. [DOI] [PubMed] [Google Scholar]
  • 29.Ertek S, Cicero A. Impact of physical activity on inflammation: effects on cardiovascular disease risk and other inflammatory conditions. Arch Med Sci 2012;8(5):794–804. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Kunutsor SK, Laukkanen T, Laukkanen JA. Cardiorespiratory Fitness is Associated with Reduced Risk of Respiratory Diseases in Middle-Aged Caucasian Men: A Long-Term Prospective Cohort Study. Lung 2017;195(5):607–611. [DOI] [PubMed] [Google Scholar]
  • 31.Dwyer TJ, Daviskas E, Zainuldin R, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised crossover trial. Eur Respir J 2019;53(4):1801793. [DOI] [PubMed] [Google Scholar]
  • 32.Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis bronchiectasis among US adults in 2013. Chron Respir Dis 2017;14(4):377–384. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Radiology are provided here courtesy of Radiological Society of North America

RESOURCES