Dataset Information

Predicting COPD Progression in Current and Former Smokers Using a Joint Model for Forced Expiratory Volume in 1 Second and Forced Expiratory Volume in 1 Second to Forced Vital Capacity Ratio.

ABSTRACT: Understanding baseline characteristics that can predict the progression of lung disease such as chronic obstructive pulmonary disease (COPD) for current or former smokers may allow for therapeutic intervention, particularly for individuals at high risk of rapid disease progression or transition from non-COPD to COPD. Classic diagnostic criteria for COPD and disease severity such as the Global Initiative for Chronic Obstructive Lung Disease document are based on forced expiratory volume in 1 second (FEV₁) and FEV₁ to forced vital capacity (FVC) ratio. Modeling changes in these outcomes jointly is beneficial given that they are correlated, and they are both required for specific disease classifications. Here, linear mixed models were used to model changes in FEV₁ and FEV₁/FVC jointly for 5- and 10-year intervals, using important baseline predictors to better understand the factors that affect disease progression. Participants with predicted loss of FEV₁ and/or FEV₁/FVC of at least 5% tended to have more emphysema, higher functional residual capacity, higher airway wall thickness as measured by Pi10, lower FVC to total lung capacity ratio and a lower body mass index at baseline, all relative to overall cohort averages. The model developed can be used to predict progression for any potential COPD individual, based on demographic, symptom, computed tomography, and comorbidity variables.

SUBMITTER: Strand M

PROVIDER: S-EPMC9448007 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Predicting COPD Progression in Current and Former Smokers Using a Joint Model for Forced Expiratory Volume in 1 Second and Forced Expiratory Volume in 1 Second to Forced Vital Capacity Ratio.

Strand Matthew M Khatiwada Aastha A Baraghoshi David D Lynch David D Silverman Edwin K EK Bhatt Surya P SP Austin Erin E Regan Elizabeth A EA Boriek Aladin M AM Crapo James D JD

Chronic obstructive pulmonary diseases (Miami, Fla.) 20220701 3

Understanding baseline characteristics that can predict the progression of lung disease such as chronic obstructive pulmonary disease (COPD) for current or former smokers may allow for therapeutic intervention, particularly for individuals at high risk of rapid disease progression or transition from non-COPD to COPD. Classic diagnostic criteria for COPD and disease severity such as the Global Initiative for Chronic Obstructive Lung Disease document are based on forced expiratory volume in 1 seco ...[more]

PMID: 35905755

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Project description:BackgroundThe clinical implication of bronchodilator response (BDR) is not fully understood. However, BDR is frequently present in patients with chronic obstructive pulmonary disease (COPD). We identified the differences in clinical features regarding BDR. In addition, we divided BDR into BDR for forced expiratory volume in 1 s (FEV1) and BDR for forced vital capacity (FVC; i.e., BDR-FEV1 and BDR-FVC, respectively) and analyzed clinical significance.MethodsWe used data from the Korea COPD Subgroup Study, a multicenter cohort study of COPD patients recruited from 54 centers in South Korea since April 2012. We analyzed differences in baseline characteristics, 1-year exacerbation rate, and 3-year FEV1 decline between BDR negative and positive patients. Moreover, we analyzed the differences in clinical features between BDR-FEV1 positive and negative patients and between BDR-FVC positive and negative patients.ResultsOf the 2,181 patients enrolled in this study, 366 (16.8%) were BDR positive. BDR positive patients were more likely to be ever-smokers and to have a lower body mass index and higher symptom scores compared to BDR negative patients. Baseline FEV1 and FEV1/FVC were lower in the BDR positive compared to the BDR negative group (1.7 ± 0.6 and 1.6 ± 0.5, respectively, p < 0.01; 50.9 ± 12.1 and 46.5 ± 14.8, respectively, p < 0.01). BDR positive patients were more likely to have been diagnosed with asthma-COPD overlap and to receive inhaled corticosteroids (ICS) than BDR negative patients. BDR-FVC patients were more likely to be smokers, suffer from worse symptoms and have lower lung function than those with no BDR-FVC. BDR had no significant effect on 1-year moderate to severe or severe exacerbation rates or 3-year annual FEV1 decline. Interactive effects of ICS and BDR on the exacerbation rate were not significant in any group.ConclusionsIn this study, BDR positive patients were more likely to be ever-smokers and to have worse symptoms and lung function than BDR negative patients. BDR-FVC was associated with worse symptom control and lung function compared to BDR-FEV1. However, there were no significant differences in exacerbation rate or decline in lung function in any BDR group. In addition, the effects of ICS on exacerbations were not significant in any group.

Project description: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 the main 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, -1.67; 95% confidence interval [CI], -2.68 to -0.65; 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.

Project description:BackgroundCough variant asthma (CVA) is characterized by cough as a sole symptom and normal pulmonary function. However, it is unclear whether CVA really common among asthmatic patients with normal forced expiratory volume in 1 second (FEV1). The aim of this study was to evaluate the incidence of cough alone symptom among the subjects with normal FEV1 and to evaluate their differences from ordinary asthmatic subjects.MethodsWe defined normal FEV1 as ≥90% predicted based on the article of Kotti GH. Of the patients with normal FEV1, we chose subjects without wheeze, and the duration of cough was not to ask, since the symptoms often occurred with acute exacerbation and timing of visiting a doctor depended on each patient's perception. Test for airway hyperresponsiveness was not performed in this study. Visual analogue scale (VAS) scores for cough and dyspnea, FEV1, and fractional exhaled nitric oxide (FeNO) responsiveness to inhaled corticosteroid (ICS)/long-acting beta2 agonist (LABA) treatment were compared in patients with normal FEV1 and with low FEV1 <90%. Correlations of changes in symptoms with changes of FEV1, FeNO, peripheral eosinophil count, and serum immunoglobulin E (IgE) at single time point were also examined in each group and in overall patients.ResultsThe participants were 329 physician-diagnosed treatment-naive patients with asthma who were divided into 187 in normal FEV1 and 142 in low FEV1 groups. Cough without dyspnea was present in 16 patients (8.6%) in the normal FEV1 group, suggesting candidates for CVA in this analysis were quite few. Improvement in symptoms after treatment was similar between both groups. But VAS scores of dyspnea were still higher in the low FEV1 group. The degree of improvement in FEV1 after ICS/LABA treatment was less in the normal FEV1 group than in the low FEV1 group, but was still evident. Peripheral eosinophil count, serum IgE, and FeNO values before treatment were lower in the normal FEV1 group. In overall patients, improvements of symptoms after treatment were significantly correlated with FEV1 changes. Improvement of dyspnea was also significantly related to peripheral eosinophil count and change of FeNO, whereas improvement of cough was not related to these T helper 2 (Th2) response markers.ConclusionsCandidates for CVA among the patients with asthma with predicted FEV1 ≥90% were few. Participants with normal FEV1 respond well to ICS/LABA treatment for improvement of symptom. The change of FEV1 after treatment, and the pre-treatment blood eosinophil count, serum IgE, and FeNO were lower in normal FEV1 cases than in low FEV1 cases. These observations suggest asthmatic patients with normal FEV1, including candidates for CVA having just common mild asthma. In overall participants, symptoms of cough and dyspnea were similar, but were not identical in relation to the Th2 background.

Dataset Information

Predicting COPD Progression in Current and Former Smokers Using a Joint Model for Forced Expiratory Volume in 1 Second and Forced Expiratory Volume in 1 Second to Forced Vital Capacity Ratio.

Publications

Predicting COPD Progression in Current and Former Smokers Using a Joint Model for Forced Expiratory Volume in 1 Second and Forced Expiratory Volume in 1 Second to Forced Vital Capacity Ratio.

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