Journal article
Ratio of FEV1/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function
Chest, Vol.160(1), pp.94-103
07/2021
DOI: 10.1016/j.chest.2021.01.067
PMCID: PMC8295909
PMID: 33539837
Abstract
Mild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV1/FVC.
Does slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease?
We included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV1/FVC ≥ 0.7 and FEV1 % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV1/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV1/SVC of ≥ 0.7 and 120 with postbronchodilator FEV1/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 FEV1/SVC < 0.7 with those characteristics and outcomes.
Participants with FEV1/SVC < 0.7 were older and had lower FEV1 and more emphysema than those with FEV1/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV1/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 FEV1/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV1/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 FEV1/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 FEV1/SVC < 0.7 or FEV1/SVC less than the lower limit of normal with chest CT scan features and progression to COPD.
Low FEV1 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.
ClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov
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Details
- Title: Subtitle
- Ratio of FEV1/Slow Vital Capacity of < 0.7 Is Associated With Clinical, Functional, and Radiologic Features of Obstructive Lung Disease in Smokers With Preserved Lung Function
- Creators
- Spyridon Fortis - Iowa City VA Health Care SystemAlejandro P. Comellas - University of IowaSurya P. Bhatt - University of Alabama at BirminghamEric A. Hoffman - University of IowaMeiLan K. Han - University of Michigan–Ann ArborNirav R. Bhakta - University of California, San FranciscoRobert Paine - University of UtahBonnie Ronish - University of UtahRichard E. Kanner - University of UtahMark Dransfield - University of Alabama at BirminghamDaniel Hoesterey - University of California, Los AngelesRussell G. Buhr - VA Greater Los Angeles Healthcare SystemR. Graham Barr - Columbia UniversityBrett Dolezal - University of California, Los AngelesVictor E. Ortega - Wake Forest UniversityM. Bradley Drummond - Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NCMehrdad Arjomandi - University of California, San FranciscoRobert J. Kaner - Weill Cornell MedicineVictor Kim - Temple UniversityJeffrey L. Curtis - University of Michigan–Ann ArborRussell P. Bowler - National Jewish HealthFernando Martinez - Weill Cornell MedicineWassim W. Labaki - University of Michigan–Ann ArborChristopher B. Cooper - University of California, Los AngelesWanda K. O’Neal - Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NCGerald Criner - Temple UniversityNadia N. Hansel - University of California, Los AngelesJerry A. Krishnan - University of Illinois at ChicagoPrescott Woodruff - University of California, San FranciscoDavid Couper - University of North Carolina at Chapel HillDonald Tashkin - University of California, Los AngelesIgor Barjaktarevic - University of California, Los Angeles
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.160(1), pp.94-103
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.chest.2021.01.067
- PMID
- 33539837
- PMCID
- PMC8295909
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Grant note
- National Heart, Lung, and Blood Institute (https://doi.org/10.13039/100000050) HHSN268200900013C; HHSN268200900014C; HHSN268200900015C; HHSN268200900016C; HHSN268200900017C; HHSN268200900018C; HHSN268200900019C; HHSN268200900020C; U01 HL137880; U24 HL141762 / National Institutes of Health (https://doi.org/10.13039/100000002) Bayer (https://doi.org/10.13039/100004326) GlaxoSmithKline (https://doi.org/10.13039/100004330) Sanofi (https://doi.org/10.13039/100004339) Novartis (https://doi.org/10.13039/100004336) HL122438; HL138188 / National Institutes of Health (https://doi.org/10.13039/100000002) R01HL125432-01A1; T32HL007106-41; TL1TR001883-01; R01HL151421; R21EB027891; K23HL133438 / National Institutes of Health (https://doi.org/10.13039/100000002) AstraZeneca (https://doi.org/10.13039/100004325)
- Language
- English
- Date published
- 07/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
- Record Identifier
- 9984318721902771
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