Facial Wrinkling in Smokers Underlines Increased COPD Risk

DEVON, England, June 14 - Middle-age smokers with heavily wrinkled faces are five times likelier to develop chronic obstructive pulmonary disease (COPD) than smooth-faced smokers, according to researchers here.

It is well known that smoking ages the skin and that most cases of COPD are caused by smoking. But not all smokers develop the airway disease, said Bipen Patel, M.D., of the Royal Devon & Exeter NHS Foundation Trust here, and colleagues, in a report published online by Thorax.

To determine whether facial wrinkling might serve as a marker for susceptibility to cigarette smoke, the researchers recruited 149 middle-age current and ex-smokers (77.9% male) from a family-based study of COPD genetics. Of these, 68 (45.6%) had COPD, 124 (83.2%) had no or only minor facial wrinkling (Daniell score < IV), and 25 (16.8%) were wrinkled (Daniell ≥IV).

Generalized estimating equations were used to adjust for familial correlations between related individuals and the potential confounding effects of age and pack-years smoked, the investigators said. Wrinkling scores were determined from photographs of the left and right temporal regions of the face.

Forced expiratory volume in 1 second (FEV1) was significantly lower in those with wrinkles than in the unwrinkled group (mean difference in FEV1 % predicted was -13.7% (95% CI -27.5 to 0.0, P= 0.05).

Facial wrinkling compared with no wrinkles was associated with a fivefold increased risk of COPD after adjustment for age and pack-years smoked (adjusted OR 5.0, CI 1.3 to 18.5, P < 0.02), the researchers said.

The Daniell wrinkling score correlated with the extent of emphysema determined by high-resolution CT scan (P =0.05), while facial wrinkling was also associated with a threefold greater risk of extensive emphysema affecting more than 10% of the lung (adjusted OR 3.0, CI 0.1 to 9.3, P= 0.05).

Individuals with wrinkling were significantly older and had smoked more pack-years than the unwrinkled smokers.

None of the outdoor sun exposure variables was significant as covariates, and inclusion did not affect the association between facial wrinkling and COPD (adjusted OR 5.6 CI 1.2 to 27.3, P = 0.03) or more severe airflow obstruction (OR 4.5, CI 1.3 to 15.6, P<0.02), according to the study. Because sun exposure is not known to be linked to COPD, it is not surprising that it did not play a role, the researchers said.

More than 80% of the smokers with facial wrinkling fulfilled the criteria for COPD. Facial wrinkling was also associated with tissue destruction (emphysema) on high-resolution CT scans. Because facial wrinkling is associated with COPD in smokers, both processes may share a common susceptibility, Dr. Patel said.

These results suggest that facial wrinkling in this susceptible group is strongly predictive of airflow obstruction and emphysema and is independent of cumulative tobacco exposure, Dr. Patel said.

It seems likely, he noted, that changes in collagen and elastin are important in the pathogenesis of both lung and skin pathology. Wrinkling may be a consequence of metalloproteinases that are activated as a consequence of smoking or a defect in repair mechanisms that affects both skin and lungs.

Severe facial wrinkling, Dr. Patel concluded, may therefore be a marker for COPD susceptibility and should alert the clinician to assess such individuals for the presence of airway disease.