Radiologic Features of Airways Disease Are Associated with Interstitial Lung Abnormality Progression

Background: Interstitial lung abnormalities (ILAs) progress radiologically in many patients and may reflect early interstitial lung disease (ILD). Within idiopathic pulmonary fibrosis and other smoking-related ILDs, there is increasing evidence that aberrant airway biology plays a role in disease development and progression. In this study, we sought to investigate associations between radiologic features of airways disease and progressive ILAs that could provide valuable insights into the management of patients at risk for developing ILD. Methods: We performed a retrospective study of subjects undergoing low-dose computed tomography (LDCT) for lung cancer screening between January 2016 and August 2022. Adults aged 50–80 years with ≥2 LDCTs performed ≥24 months apart were included. Demographic data, medical history, and LDCTs were collected. LDCTs were qualitatively analyzed for ILAs and features of airways disease by a thoracic radiologist. Data were analyzed using a generalized estimating equation adjusted for age, sex, pack-years of tobacco, and a radiologic usual interstitial pneumonia pattern. Results: Of 482 subjects, 54% (259/482) were female, and 66% (316/482) were Black. Average age was 64 years. The majority of subjects were current smokers ( n = 276, 57%). Thirty-one percent ( n = 147) had COPD, and 11% had asthma ( n = 56). Median time between LDCTs was 51 (39–61) months. There were 85 subjects with ILAs, and of those, 42 (49.4%) had progressive ILAs. Bronchial wall thickening and mosaic attenuation were associated with ILA progression in adjusted models (odds ratio OR = 2.61, 95% CI: 1.08–6.23 and OR = 2.51, 95% CI: 1.02–6.17, respectively). Conclusions: Radiologic features of airways disease, including bronchial wall thickening and mosaic attenuation, were associated with ILA progression in subjects undergoing lung cancer screening.