Journal article
Combined Forced Expiratory Volume in 1 Second and Forced Vital Capacity Bronchodilator Response, Exacerbations, and Mortality in Chronic Obstructive Pulmonary Disease
ANNALS OF THE AMERICAN THORACIC SOCIETY, Vol.16(7), pp.826-835
07/01/2019
DOI: 10.1513/AnnalsATS.201809-601OC
PMCID: PMC6600841
PMID: 30908927
Abstract
Rationale: The American Thoracic Society (ATS)/European Respiratory Society defines a positive bronchodilator response (BDR) by a composite of BDR in either forced expiratory volume in 1 second (FEV1) and/or forced vital capacity (FVC) greater than or equal to 12% and 200 ml (ATS-BDR). We hypothesized that ATS-BDR components would be differentially associated with important chronic obstructive pulmonary disease (COPD) outcomes.
Objectives: To examine whether ATS-BDR components are differentially associated with clinical, functional, and radiographic features in COPD.
Methods: We included subjects with COPD enrolled in the COPDGene study. In the main analysis, we excluded subjects with self-reported asthma. We categorized BDR into the following: 1) No-BDR, no BDR in either FEV1 or FVC; 2) FEV1-BDR, BDR in FEV1 but no BDR in FVC; 3) FVC-BDR, BDR in FVC but no BDR in FEV1; and 4) Combined-BDR, BDR in both FEV1 and FVC. We constructed multivariable logistic, linear, zero-inflated negative binomial, and Cox hazards models to examine the association of BDR categories with symptoms, computed tomography findings, change in FEV1 over time, respiratory exacerbations, and mortality. We also created models using the ATS BDR definition (ATS-BDR) as themain independent variable.
Results: Of 3,340 COPD subjects included in the analysis, 1,083 (32.43%) had ATS-BDR, 182 (5.45%) had FEV1-BDR, 522 (15.63%) had FVC-BDR, and 379 (11.34%) had Combined-BDR. All BDR categories were associated with FEV1 decline compared with No-BDR. Compared with No-BDR, both ATS-BDR and Combined-BDR were associated with higher functional residual capacity % predicted, greater internal perimeter of 10 mm, and greater 6-minute-walk distance. In contrast to ATS-BDR, Combined-BDR was independently associated with less emphysema (adjusted beta regression coefficient, 21.67; 95% confidence interval [CI], 22.68 to 20.65; P = 0.001), more frequent respiratory exacerbations (incidence rate ratio, 1.25; 95% CI, 1.03-1.50; P = 0.02) and severe exacerbations (incidence rate ratio, 1.34; 95% CI, 1.05-1.71; P = 0.02), and lower mortality (adjusted hazards ratio, 0.76; 95% CI, 0.58-0.99; P = 0.046). Sensitivity analysis that included subjects with self-reported history of asthma showed similar findings.
Conclusions: BDR in both FEV1 and FVC indicates a COPD phenotype with asthma-like characteristics, and provides clinically more meaningful information than current definitions of BDR.
Details
- Title: Subtitle
- Combined Forced Expiratory Volume in 1 Second and Forced Vital Capacity Bronchodilator Response, Exacerbations, and Mortality in Chronic Obstructive Pulmonary Disease
- Creators
- Spyridon Fortis - University of Iowa Hospitals and ClinicsAlejandro Comellas - University of Iowa Hospitals and ClinicsBarry J. Make - National Jewish HealthCraig P. Hersh - Brigham and Women's HospitalSandeep Bodduluri - University of Alabama at BirminghamDimitris Georgopoulos - University Hospital of HeraklionVictor Kim - Temple UniversityGerard J. Criner - Temple UniversityMark T. Dransfield - University of Alabama at BirminghamSurya P. Bhatt - University of Alabama at BirminghamCOPDGene Investigators–Core Units: Administrative Center, COPDGene Investigators–Clinical Centers: Ann Arbor VA
- Resource Type
- Journal article
- Publication Details
- ANNALS OF THE AMERICAN THORACIC SOCIETY, Vol.16(7), pp.826-835
- Publisher
- Amer Thoracic Soc
- DOI
- 10.1513/AnnalsATS.201809-601OC
- PMID
- 30908927
- PMCID
- PMC6600841
- ISSN
- 1546-3222
- eISSN
- 2325-6621
- Number of pages
- 10
- Grant note
- U01 HL089897; U01 HL089856 / COPDGene study (National Heart, Lung, and Blood Institute) K23 HL133438 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA K23HL133438 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) P30DK054759 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) NCT00608764 / COPD Foundation P30ES005605 / NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Environmental Health Sciences (NIEHS)
- Language
- English
- Date published
- 07/01/2019
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
- Record Identifier
- 9984359690402771
Metrics
13 Record Views