Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis.

TitleClinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis.
Publication TypePublication
Year2019
AuthorsBarjaktarevic IZ, Buhr RG, Wang X, Hu S, Couper D, Anderson W, Kanner RE, Iii RPaine, Bhatt SP, Bhakta NR, Arjomandi M, Kaner RJ, Pirozzi CS, Curtis JL, O'Neal WK, Woodruff PG, Han MK, Martinez FJ, Hansel N, Wells JMichael, Ortega VE, Hoffman EA, Doerschuk CM, Kim V, Dransfield MT, M Drummond B, Bowler R, Criner G, Christenson SA, Ronish B, Peters SP, Krishnan JA, Tashkin DP, Cooper CB
Corporate AuthorsNHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study(SPIROMICS)
JournalInt J Chron Obstruct Pulmon Dis
Volume14
Pagination2927-2938
Date Published2019
ISSN1178-2005
KeywordsAdult, airway obstruction, asthma, Biological Variation, Population, Bronchodilator Agents, Disease Progression, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Prevalence, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Treatment Outcome, United States, Vital Capacity
Abstract

OBJECTIVE: Bronchodilator responsiveness (BDR) is prevalent in COPD, but its clinical implications remain unclear. We explored the significance of BDR, defined by post-bronchodilator change in FEV (BDR) as a measure reflecting the change in flow and in FVC (BDR) reflecting the change in volume.METHODS: We analyzed 2974 participants from a multicenter observational study designed to identify varying COPD phenotypes (SPIROMICS). We evaluated the association of BDR with baseline clinical characteristics, rate of prospective exacerbations and mortality using negative binomial regression and Cox proportional hazards models.RESULTS: A majority of COPD participants exhibited BDR (52.7%). BDR occurred more often in earlier stages of COPD, while BDR occurred more frequently in more advanced disease. When defined by increases in either FEV or FVC, BDR was associated with a self-reported history of asthma, but not with blood eosinophil counts. BDR was more prevalent in subjects with greater emphysema and small airway disease on CT. In a univariate analysis, BDR was associated with increased exacerbations and mortality, although no significance was found in a model adjusted for post-bronchodilator FEV.CONCLUSION: With advanced airflow obstruction in COPD, BDR is more prevalent in comparison to BDR and correlates with the extent of emphysema and degree of small airway disease. Since these associations appear to be related to the impairment of FEV, BDR itself does not define a distinct phenotype nor can it be more predictive of outcomes, but it can offer additional insights into the pathophysiologic mechanism in advanced COPD.CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov: NCT01969344T4.

DOI10.2147/COPD.S220164
Alternate JournalInt J Chron Obstruct Pulmon Dis
PubMed ID31908441
PubMed Central IDPMC6930016
Grant ListHHSN268200900019C / HL / NHLBI NIH HHS / United States
U24 HL141762 / HL / NHLBI NIH HHS / United States
S10 OD018526 / OD / NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
I01 CX000911 / CX / CSRD VA / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
R01 HL122438 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
R01 HL125432 / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
K24 HL138188 / HL / NHLBI NIH HHS / United States
K23 HL123778 / HL / NHLBI NIH HHS / United States
K24 HL137013 / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
T32 HL007106 / HL / NHLBI NIH HHS / United States
K08 HL123940 / HL / NHLBI NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
TL1 TR001883 / TR / NCATS NIH HHS / United States
MS#: 
MS006
Manuscript Full Title: 
Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Los Angeles (University of California at Los Angeles)
ECI: 
Manuscript Status: 
Published