Forced Expiratory Flow at 25%-75% Links COPD Physiology to Emphysema and Disease Severity in the SPIROMICS Cohort.

TitleForced Expiratory Flow at 25%-75% Links COPD Physiology to Emphysema and Disease Severity in the SPIROMICS Cohort.
Publication TypePublication
Year2022
AuthorsRonish BE, Couper DJ, Barjaktarevic IZ, Cooper CB, Kanner RE, Pirozzi CS, Kim V, Wells JM, Han MK, Woodruff PG, Ortega VE, Peters SP, Hoffman EA, Buhr RG, Dolezal BA, Tashkin DP, Liou TG, Bateman LA, Schroeder JD, Martinez FJ, R Barr G, Hansel NN, Comellas AP, Rennard SI, Arjomandi M, Iii RPaine
JournalChronic Obstr Pulm Dis
Volume9
Issue2
Pagination111-121
Date Published2022 Apr 29
ISSN2372-952X
Abstract

BACKGROUND: Forced expiratory volume in 1 second (FEV) is central to the diagnosis of chronic obstructive pulmonary disease (COPD) but is imprecise in classifying disease burden. We examined the potential of the maximal mid-expiratory flow rate (forced expiratory flow rate between 25% and 75% [FEF]) as an additional tool for characterizing pathophysiology in COPD.OBJECTIVE: To determine whether FEF helps predict clinical and radiographic abnormalities in COPD.STUDY DESIGN AND METHODS: The SubPopulations and InteRediate Outcome Measures In COPD Study (SPIROMICS) enrolled a prospective cohort of 2978 nonsmokers and ever-smokers, with and without COPD, to identify phenotypes and intermediate markers of disease progression. We used baseline data from 2771 ever-smokers from the SPIROMICS cohort to identify associations between percent predicted FEF (%predFEF) and both clinical markers and computed tomography (CT) findings of smoking-related lung disease.RESULTS: Lower %predFEF was associated with more severe disease, manifested radiographically by increased functional small airways disease, emphysema (most notably with homogeneous distribution), CT-measured residual volume, total lung capacity (TLC), and airway wall thickness, and clinically by increased symptoms, decreased 6-minute walk distance, and increased bronchodilator responsiveness (BDR). A lower %predFEF remained significantly associated with increased emphysema, functional small airways disease, TLC, and BDR after adjustment for FEV or forced vital capacity (FVC).INTERPRETATION: The %predFEF provides additional information about disease manifestation beyond FEV. These associations may reflect loss of elastic recoil and air trapping from emphysema and intrinsic small airways disease. Thus, %predFEF helps link the anatomic pathology and deranged physiology of COPD.

DOI10.15326/jcopdf.2021.0241
Alternate JournalChronic Obstr Pulm Dis
PubMed ID35114743
Grant ListHHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
HHSN268200900019C / HL / NHLBI NIH HHS / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
/ / COPD Foundation / United States
KL2 TR001882 / TR / NCATS NIH HHS / United States
U24 HL141762 / HL / NHLBI NIH HHS / United States
HSN268200900018C / / NIH/NHLBI / United States
L30 HL134025 / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
MS#: 
MS183
Manuscript Full Title: 
Forced Expiratory Flow at 25%-75% Links COPD Physiology to Emphysema and Disease Severity in the SPIROMICS Cohort.
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Utah (University of Utah)
ECI: 
Manuscript Status: 
Published and Public