Reversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS Cohort: An Observational Cohort Study.

TitleReversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS Cohort: An Observational Cohort Study.
Publication TypePublication
Year2022
AuthorsBuhr RG, Barjaktarevic IZ, P Quibrera M, Bateman LA, Bleecker ER, Couper DJ, Curtis JL, Dolezal BA, Han MK, Hansel NN, Krishnan JA, Martinez FJ, McKleroy W, Paine R, Rennard SI, Tashkin DP, Woodruff PG, Kanner RE, Cooper CB
Corporate AuthorsSPIROMICS Investigators
JournalAm J Respir Crit Care Med
Volume206
Issue5
Pagination554-562
Date Published2022 09 01
ISSN1535-4970
Keywordsairway obstruction, asthma, Bronchodilator Agents, Cohort Studies, Forced Expiratory Volume, Humans, Pulmonary Disease, Chronic Obstructive, Spirometry, Vital Capacity
Abstract

Chronic obstructive pulmonary disease (COPD) is defined by fixed spirometric ratio, FEV/FVC < 0.70 after inhaled bronchodilators. However, the implications of variable obstruction (VO), in which the prebronchodilator FEV/FVC ratio is less than 0.70 but increases to 0.70 or more after inhaled bronchodilators, have not been determined. We explored differences in physiology, exacerbations, and health status in participants with VO compared with reference participants without obstruction. Data from the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort were obtained. Participants with VO were compared with reference participants without obstruction. We assessed differences in baseline radiographic emphysema and small airway disease at study entry, baseline, and change in lung function by spirometry, functional capacity by 6-minute walk, health status using standard questionnaires, exacerbation rates, and progression to COPD between the two groups. All models were adjusted for participant characteristics, asthma history, and tobacco exposure. We assessed 175 participants with VO and 603 reference participants without obstruction. Participants with VO had 6.2 times the hazard of future development of COPD controlling for other factors (95% confidence interval, 4.6-8.3;  < 0.001). Compared with reference participants, the VO group had significantly lower baseline pre- and post-bronchodilator (BD) FEV, and greater decline over time in post-BD FEV, and pre- and post-BD FVC. There were no significant differences in exacerbations between groups. Significant risk for future COPD development exists for those with pre- but not post-BD airflow obstruction. These findings support consideration of expanding spirometric criteria defining COPD to include pre-BD obstruction. Clinical trial registered with www.clinicaltrials.gov (NCT01969344).

DOI10.1164/rccm.202201-0094OC
Alternate JournalAm J Respir Crit Care Med
PubMed ID35549640
Grant ListU01 HL137880 / HL / NHLBI NIH HHS / United States
KL2 TR001882 / TR / NCATS NIH HHS / United States
K24 HL138188 / HL / NHLBI NIH HHS / United States
U24 HL141762 / HL / NHLBI NIH HHS / United States
L30 HL134025 / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
MS#: 
MS163
Manuscript Full Title: 
Reversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS Cohort: An Observational Cohort Study.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Los Angeles (University of California at Los Angeles)
ECI: 
Manuscript Status: 
Published and Public