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Table of Content - Volume 15 Issue 1 - July 2020
An assessment of pulmonary functions and chest X-ray imaging in smoker and nonsmoker adults
Yogesh Singh1, Manish Lamoria2*, Ketaki Poorey3, Keerti Mathur4, Usha Jaipal5
1,3Assistant Professor, 2Associate Professor, Department of Physiology, Jaipur National University Institute for Medical Sciences & Research Centre, Jaipur, INDIA. {4Senior Professor (Retired), Department of Physiology} {5Senior Professor, Department of Radiodiagnosis} S.M.S. Medical College & Attached Hospitals, Jaipur, Rajasthan, INDIA. Email: mhlamoria@gmail.com
Abstract Background: Despite the increasing evidence regarding the hazards of tobacco, its consumption continues to rise. Premature deaths and disabling illnesses, especially related to the pulmonary and cardiovascular system, caused by cigarette smoking, had now reached epidemic proportions and presented the most challenging problem to medical scientists. Tobacco smoke contains a number of substances which may exert an adverse effect on the whole body especially on the respiratory system. Spirometry is the most effective way of determining the severity of damage in lungs. Pulmonary Functions (Spirometry) and Chest X-ray imaging (Conventional and Computer Aided Diagnosis (CAD)) were assessed on smoker (n=240) and nonsmoker (n=240) adult population in the Department of Physiology and Radiodiagnosis, S.M.S. Medical College and Attached Hospitals, Jaipur (Rajasthan). Significant (p<0.05) declines of pulmonary indices such as FVC (L), FEV1 (L) and FEV1/FVC (%) were observed in smoker as compared with nonsmoker. Significant improved quality and radiological findings (Emphysema, Hyperinflation, Calcification and Other Suspected Abnormalities) were observed in chest X-ray by CAD tool as compared to conventional method. Statistically significant lower values of pulmonary indices found suggesting that functioning of the lung is affected in the group of cigarette smoker than in nonsmoker group. A significant increase in the appearance of radiological findings and quality of chest X-ray in smokers by CAD tool ropes the contribution of image processing in the medical field. Key Words: Smoking, Chest X-ray, Computer Aided Diagnosis, Pulmonary Function Test
INTRODUCTION In today’s scenario, the presence of smoke whether industrial, household, or is actively or passively, taken by an individual in the environment is a serious problem. Smoke in any form is hazardous to individuals of every age group. Tobacco smoking is an act in which burnt tobacco is inhaled or smoked. In both developed and developing countries, smoking is one of the main cause of morbidity and mortality.1 It is also one of the leading threats to existing and upcoming world health. Smoking affects almost every system in the human body. Smokers have increased risk of lung diseases: Chronic Bronchitis, Emphysema, Chronic Obstructive Pulmonary Disease (COPD) and Carcinoma.2,3 Pulmonary function testing is indicated for all persons in whom there are symptoms and a positive response to a suitable respiratory questionnaire. It should be especially indicated for persons with complaint of shortness of breath. In any person, particularly cigarette smokers or asthmatics, spirometry will provide a baseline performance value for comparison with results of future tests.4 Spirometry is the most effective way of determining the severity of lung damage. A major advantage of spirometry is that it enables us to detect chronic obstructive pulmonary disease (COPD) before symptoms become apparent. It can confirm the presence of COPD even in mild or moderate stage.5 Patient having tuberculosis, pneumonia, cancer and chronic obstructive pulmonary disease (COPD), chest radiography is still the first diagnostic step. Assessment of chest X-ray with applications of image processing Computer Aided Diagnosis (CAD) gives meaningful information in a quick way. CAD techniques bring new means for peering into the human body, helping to reduce the need for more invasive diagnostic and treatment procedures. The aim of the present study was to assess and compare the pulmonary functions as well as radiological findings and quality of Chest X-ray imaging (Conventional and Computer Aided Diagnosis tool) in smoker and nonsmoker adult population.
METHODS After taking a prior clearance from Institutional Ethics Committee and informed written consent from the subjects, they underwent medical history assessment and routine clinical examinations before recording of chest X-ray and pulmonary functions to exclude any kind of disorder. Height, Weight, Body Mass Index was also recorded using standard instrument and procedures. The assessment of pulmonary function and chest X-ray was carried out in the Department of Physiology and Radiodiagnosis, S.M.S. Medical College and Attached Hospitals, Jaipur (Rajasthan). The subjects were selected randomly from general population, staff members, doctors and patient’s attendants of a medical college, who meet up the inclusion criteria. The pulmonary function test, quality comparison and radiological findings of chest X-ray imaging by Conventional method and Computer Aided Diagnosis (CAD) tool assessments were done on smoker (n=240) and nonsmoker (n=240) adults:
Quality comparison and radiological findings of chest X-ray (CXR) imaging by conventional method and computer aided diagnosis (CAD) tool was observed in the present study in both groups (smoker and nonsmoker) as follows: Chest X-ray Imaging:
Statistical Analysis: Data were entered in excel sheet. Continuous data were summarized in form of mean and standard deviation. Difference in means of pulmonary function parameters of two groups were analyzed using student’s unpaired ‘t’ test and comparison of radiological findings and quality were analyzed by Chi-square test. The p value <0.05 was considered as statistically significant (S) and p value >0.05 is non-significant (NS).
RESULTS Table 1: Demographic and Anthropometrical Data of Nonsmoker and Smoker Group
Data were presented as Mean + SD; n = number of subjects; LS = Level of Significance at 5%; *p = student’s ‘t’-test (unpaired)
Table 2: Selected Respiratory Indices in Nonsmoker and Smoker Group
Data were presented as Mean + SD; n = number of subjects; LS = Level of Significance at 5%; *p = student’s ‘t’-test (unpaired)
Table 3: Radiograph Quality Comparison of Chest X-ray imaging by Conventional Method and Computer Aided Diagnosis (CAD) Tool with regards to Bronchovascular Marking
n= number of subjects, % = Percentage in parenthesis (%); LS = Level of Significance at 5%, *p= Chi Square Test
Table 4: Comparisons of Radiological Findings of Chest X-ray Imaging by Conventional Method and Computer Aided Diagnosis (CAD) Tool
n = number of subjects, % = Percentage in parenthesis (%); Sc-nP = Radiological findings present in number of subject in Smoker group with Conventional Method; SCAD-nP = Radiological findings present in number of subject in Smoker group with CAD Method LS = Level of Significance at 5%, *p = Chi Square Test
A non-significant difference was found in comparison of demographic variables such as Age (years), Weight (Kg), Height (cm) and Body Mass Index (Kg/m2) (Table-1). FVC (L), FEV1 (L) and FEV1/FVC ratio (%) were significantly decreased in smoker as compared to nonsmoker group (Table-2). Appearance of Bronchovascular Marking in the chest X-ray was significantly improved with computer aided diagnosis tool as compared to conventional method (Table-3). On analysis by Chi-square test a significant improved changes (p <0.05) were observed in the number of radiological findings present in chest X-rays with CAD tool as compared to conventional method, especially in hyperinflation and other suspected abnormalities (Table-4).
DISCUSSION The statistical analysis by unpaired t-test showed a significant decrease (p < 0.05) in pulmonary indices such as FVC (L), FEV1 (L) and FEV1/FVC ratio (%) in smoker as compared to nonsmoker group. The present study showed lower PFT values in smokers, which may be due to toxic effects of tobacco smoking on respiratory system acting as the major cause of damage to the respiratory system. The above observed difference in pulmonary function of smoker and nonsmoker adult populations illustrates that effects of smoking can lead to tribulations with the normal functioning of respiratory system. The claim of the present study further substantiates the results of earlier research done by Najeeb et al. (2010),8 Nawafleh et al. (2012)9 and Helal (2014).10The findings of present study are comparable with the results of Salih et al. (2015)11 in terms of considerable decrease in pulmonary functions in smokers relative to the nonsmoker group and they reported that lower pulmonary function signifies greater risk for cardiac, pulmonary disease and lung cancer. The study of Vyas et al. (2014)12 compared the lung functions among smoker and non smoker and their findings are contrasting to the result of the present study. The difference in FEV1/ FVC ratio and FVC were not significant but partly comparable with a statistically significant difference only in the FEV1 value (p<0.05) between smoker and nonsmoker groups. A significant (p<0.05) increased number of radiological findings was observed in the chest X-ray assessed with CAD tool as compared to chest X-ray with conventional method (Table-4). The finding of the present study was analogous with Mazzone et al. (2013).13 Sashidhar et al. (2002)14 observed the findings of emphysema in clinically undiagnosed and asymptomatic smokers and reported that chest scans and pulmonary function test may be useful in an early diagnosis of damage in smokers as well as in group of asymptomatic smokers. Eisner et al. (2011)15 reported the beneficial role of advance techniques for early detection of disease especially in chest abnormalities and indicated their advantages and disadvantages in reference to the radiation dose. Patient having tuberculosis, pneumonia, cancer and chronic obstructive pulmonary disease (COPD), chest radiography is still the first diagnostic step. Gupta et al. (2011)16, Prakash and Khare (2014)17 reported that pre and post processing of digital image analysis helps to reduce perceptual and cognitive errors by highlighting abnormalities and characterizing lung patterns. The present study recommended that further evaluation is necessary to determine the role of chest radiography with CAD tool as a screening of lung abnormalities which can minimize the financial burden and hazards of computed tomography (CT) based screening.
CONCLUSION Statistically significant decrease values of pulmonary indices in the group of cigarette smoker than in nonsmoker group suggesting lower lung functioning in smokers. A significant increase in the radiological findings and quality of chest X-ray in smokers by computer aided diagnosis (CAD) tool ropes the contribution of image processing in the medical field. A proper approach regarding the implementation and interpretation of basic investigation modality and subsequently the use of advance diagnostic methods allowing the earliest intervention and management, which can improves outcome of the disease. The prediction for the patients with life threatening disease in later phase is correlated with the duration of the disease at the time of diagnosis. CAD techniques may facilitate this prediction as compared to the conventional procedure.
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