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Original Research: COPD |

A Novel Spirometric Measure Identifies Mild COPD Unidentified by Standard Criteria

Asli Gorek Dilektasli, MD; Janos Porszasz, MD, PhD; Richard Casaburi, PhD, MD; William W. Stringer, MD; Surya P. Bhatt, MD; Youngju Pak, PhD; Harry B. Rossiter, PhD; George Washko, MD; Peter J. Castaldi, MD; Raul San Jose Estepar, PhD; James E. Hansen, MD
Author and Funding Information

FUNDING/SUPPORT: COPDGene is funded by the National Heart, Lung, and Blood Institute [Grants R01 HL 08 9856 and R01 HL 08 9897]. S. P. B. is supported by the National Institutes of Health [KL2 Scholarship 1KL2TR001419].

aRehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA

bUCLA Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA

cDepartment of Pulmonary Medicine, Faculty of Medicine, Uludağ University, Bursa, Turkey

dDivision of Pulmonary, Allergy and Critical Care Medicine, UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL

eFaculty of Biological Sciences, University of Leeds, Leeds, England

fBrigham and Women’s Hospital Clinics, Brigham and Women’s Hospital, Boston, MA

gChanning Division of Network Medicine and Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA

CORRESPONDENCE TO: Richard Casaburi, PhD, MD, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 W Carson St, Building CDCRC, Torrance, CA 90502


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(5):1080-1090. doi:10.1016/j.chest.2016.06.047
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Background  In chronic obstructive pulmonary disease, both smaller and larger airways are affected. FEV1 mainly reflects large airways obstruction, while the later fraction of forced exhalation reflects reduction in terminal expiratory flow. In this study, the objective was to evaluate the relationship between spirometric ratios, including the ratio of forced expiratory volume in 3 and 6 seconds (FEV3/FEV6), and small airways measures and gas trapping at quantitative chest CT scanning, and clinical outcomes in the Genetic Epidemiology of COPD (COPDGene) cohort.

Methods  Seven thousand eight hundred fifty-three current and ex-smokers were evaluated for airflow obstruction by using recently defined linear iteratively derived equations of Hansen et al to determine lower limit of normal (LLN) equations for prebronchodilator FEV1/FVC, FEV1/FEV6, FEV3/FEV6, and FEV3/FVC. General linear and ordinal regression models were applied to the relationship between prebronchodilator spirometric and radiologic and clinical data.

Results  Of the 10,311 participants included in the COPDGene phase I study, participants with incomplete quantitative CT scanning or relevant spirometric data were excluded, resulting in 7,853 participants in the present study. Of 4,386 participants with FEV1/FVC greater than or equal to the LLN, 15.4% had abnormal FEV3/FEV6. Compared with normal FEV3/FEV6 and FEV1/FVC, abnormal FEV3/FEV6 was associated with significantly greater gas trapping; St. George’s Respiratory Questionnaire score; modified Medical Research Council dyspnea score; and BMI, airflow obstruction, dyspnea, and exercise index and with shorter 6-min walking distance (all P < .0001) but not with CT scanning evidence of emphysema.

Conclusions  Current and ex-smokers with prebronchodilator FEV3/FEV6 less than the LLN as the sole abnormality identifies a distinct population with evidence of small airways disease in quantitative CT scanning, impaired indexes of physical function and quality of life otherwise deemed normal by using the current spirometric definition.

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