Ratio of FEV/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function.

TitleRatio of FEV/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function.
Publication TypePublication
Year2021
AuthorsFortis S, Comellas AP, Bhatt SP, Hoffman EA, Han MK, Bhakta NR, Paine R, Ronish B, Kanner RE, Dransfield M, Hoesterey D, Buhr RG, R Barr G, Dolezal B, Ortega VE, M Drummond B, Arjomandi M, Kaner RJ, Kim V, Curtis JL, Bowler RP, Martinez F, Labaki WW, Cooper CB, O'Neal WK, Criner G, Hansel NN, Krishnan JA, Woodruff P, Couper D, Tashkin D, Barjaktarevic I
JournalChest
Volume160
Issue1
Pagination94-103
Date Published2021 07
ISSN1931-3543
KeywordsDisease Progression, Follow-Up Studies, Forced Expiratory Volume, Humans, Lung, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Smokers, Spirometry, Tomography, X-Ray Computed, Vital Capacity
Abstract

BACKGROUND: Mild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV/FVC.RESEARCH QUESTION: Does slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease?STUDY DESIGN AND METHODS: We included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV/FVC ≥ 0.7 and FEV % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV/SVC of ≥ 0.7 and 120 with postbronchodilator FEV/SVC < 0.7 at the enrollment. We performed multivariate linear and logistic regression models and negative binomial and interval-censored proportion hazards regression models adjusted for demographics and smoking exposure to examine the association of FEV/SVC < 0.7 with those characteristics and outcomes.RESULTS: Participants with FEV/SVC < 0.7 were older and had lower FEV and more emphysema than those with FEV/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV/SVC < 0.7 showed a greater percentage of emphysema by 0.45% (95% CI, 0.09%-0.82%), percentage of gas trapping by 2.52% (95% CI, 0.59%-4.44%), and percentage of functional small airways disease based on parametric response mapping by 2.78% (95% CI, 0.72%-4.83%) at baseline than those with FEV/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV/SVC < 0.7 was not associated with total exacerbations (incident rate ratio [IRR], 1.61; 95% CI, 0.97-2.64), but was associated with severe exacerbations (IRR, 2.60; 95% CI, 1.04-4.89). An FEV/SVC < 0.7 was associated with progression to COPD during a 3-year follow-up even after adjustment for demographics and smoking exposure (hazard ratio, 3.93; 95% CI, 2.71-5.72). We found similar results when we examined the association of prebronchodilator FEV/SVC < 0.7 or FEV/SVC less than the lower limit of normal with chest CT scan features and progression to COPD.INTERPRETATION: Low FEV to SVC in current and former smokers with normal spirometry results can identify individuals with CT scan features of COPD who are at risk for severe exacerbations and is associated with progression to COPD in the future.TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov.

DOI10.1016/j.chest.2021.01.067
Alternate JournalChest
PubMed ID33539837
PubMed Central IDPMC8295909
Grant ListU24 HL141762 / HL / NHLBI NIH HHS / United States
R21 EB027891 / EB / NIBIB NIH HHS / United States
P30 ES005605 / ES / NIEHS NIH HHS / United States
K23 HL133438 / HL / NHLBI NIH HHS / United States
K24 HL137013 / HL / NHLBI 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
R01 HL151421 / HL / NHLBI NIH HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
T32 HL007106 / 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
KL2 TR001882 / TR / NCATS NIH HHS / United States
TL1 TR001883 / TR / NCATS NIH HHS / United States
MS#: 
MS191
Manuscript Full Title: 
Ratio of FEV/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Iowa (University of Iowa)
ECI: 
Manuscript Status: 
Published and Public