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Related Concept Videos

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COPD is defined as a heterogeneous lung condition marked by persistent respiratory symptoms such as dyspnea, cough, and sputum production, caused by abnormalities in the airways that cause airflow obstruction.
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Chronic obstructive pulmonary disease (COPD) is a group of lung conditions that progressively worsen over time, including chronic bronchitis and emphysema. This cluster of diseases collectively leads to a gradual and irreversible decline in lung function over time.
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Related Experiment Video

Updated: Nov 19, 2025

Automated Measurement of Pulmonary Emphysema and Small Airway Remodeling in Cigarette Smoke-exposed Mice
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Normal Routine Spirometry Can Mask COPD/Emphysema in Symptomatic Smokers.

Arthur F Gelb1, Alfred Yamamoto2, Eric K Verbeken3

  • 1Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, California, United States and David Geffen School of Medicine at University of California-Los Angeles Health Sciences, Los Angeles, California, United States.

Chronic Obstructive Pulmonary Diseases (Miami, Fla.)
|January 29, 2021
PubMed
Summary
This summary is machine-generated.

Early detection of COPD in smokers with normal spirometry is challenging. Analyzing expiratory airflow at low lung volumes, specifically forced expiratory flow at 75% of FVC (FEF75), can identify small airway obstruction and emphysema.

Keywords:
COPDFEF75%emphysemasmall airways obstructionspirometry

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology

Background:

  • Chronic Obstructive Pulmonary Disease (COPD) diagnosis is often delayed in symptomatic smokers with normal spirometry.
  • Early COPD pathology begins in small peripheral airways, which are not adequately assessed by standard spirometry.
  • Standard spirometry may miss early signs of small airway disease and emphysema.

Purpose of the Study:

  • To investigate the utility of expiratory airflow measurements at low lung volumes for detecting early COPD in smokers with normal spirometry.
  • To correlate lung function tests with CT scans and lung pathology.

Main Methods:

  • Evaluated post-bronchodilator expiratory airflow at high and low lung volumes in 16 symptomatic smokers with normal spirometry.
  • Correlated airflow measurements with lung CT scans and pathological data from 6 patients.
  • Utilized data from Knudson et al, Hankinson et al NHAMES III, Quanjer et al, and the Global Lung Function Initiative.

Main Results:

  • All 16 patients showed abnormal forced expiratory flow at 75% of FVC (FEF75), indicating small airway obstruction or emphysema despite normal spirometry.
  • FEF75 was more sensitive in detecting small airway obstruction than FEF50, MEF25-75, RV, or RV/TLC ratio.
  • Lung CT and pathology confirmed the absence of emphysema in cases where it was suspected.

Conclusions:

  • Analysis of expiratory airflow at low lung volumes, particularly FEF75, is crucial for detecting small airway obstruction and emphysema in symptomatic smokers with normal spirometry.
  • Relying solely on routine spirometry can lead to delayed diagnosis and treatment of COPD in this patient group.
  • FEF75 measurements offer a valuable tool for earlier identification of early COPD.