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Limited long-term prospective data are available to characterize the effect of low-rate smoking on lung health outcomes, particularly in population-based cohorts. Prior studies have also differed in the measurement of cumulative smoking exposure, with many studies relying on imprecise measurement and long periods of retrospective reporting. Smoking exposure is traditionally indexed by pack-years, and individuals with lifetime smoking thresholds below 10 pack-years are typically excluded from clinical trials for chronic lung disease. However, recent studies have found smoking duration (i.e., years of cigarette smoking) to be superior to cigarettes per day or pack-years in predicting emphysema (1) and mortality (2). Low-rate smoking is increasingly prevalent, with 25% of smokers in the United States currently consuming fewer than 10 cigarettes per day, and a growing body of literature has identified negative health effects associated with low-rate smoking, including cardiovascular disease, cancer, and all-cause mortality (2–4). Using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, we studied how longitudinal patterns of smoking exposure, based on cigarettes per day reported annually over the course of 25 years of follow-up, are associated with loss of lung function, incident obstructive lung physiology, and computed tomography–measured emphysema.

Life-Course Smoking Trajectories and Risk for Emphysema in Middle Age: The CARDIA Lung Study