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Reversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS
Russell G Buhr1,2, Igor Z Barjaktarevic1, P Miguel Quibrera3
1Division of Pulmonary and Critical Care Medicine, and.
Summary
Individuals with variable airflow obstruction, defined by pre-bronchodilator but not post-bronchodilator obstruction, face a significantly higher risk of developing chronic obstructive pulmonary disease (COPD). This suggests current diagnostic criteria may need revision.
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
- Clinical Diagnostics
Background:
- Chronic obstructive pulmonary disease (COPD) is typically diagnosed using fixed post-bronchodilator spirometry criteria (FEV1/FVC < 0.70).
- The clinical significance of variable obstruction (VO), where pre-bronchodilator FEV1/FVC < 0.70 improves to ≥0.70 post-bronchodilator, remains underexplored.
- Understanding VO is crucial for accurate COPD assessment and management.
Purpose of the Study:
- To investigate physiological differences, exacerbation rates, and health status in individuals with VO compared to those without airflow obstruction.
- To evaluate the association between VO and the future development of COPD.
- To determine if current spirometric criteria for COPD diagnosis should be reconsidered.
Main Methods:
- Analysis of data from the SPIROMICS cohort, comparing 175 participants with VO to 603 reference participants without obstruction.
- Assessment of baseline radiographic emphysema and small airway disease.
- Evaluation of lung function changes, 6-minute walk distance, health status questionnaires, and exacerbation rates.
- Statistical models adjusted for participant characteristics, asthma history, and tobacco exposure.
Main Results:
- Participants with VO demonstrated a 6.2-fold increased hazard of future COPD development (95% CI, 4.6-8.3; P < 0.001), independent of other factors.
- The VO group exhibited significantly lower baseline pre- and post-bronchodilator (BD) FEV1 and greater decline in post-BD FEV1 and pre-/post-BD FVC over time.
- No significant differences in exacerbation rates were observed between the VO and reference groups.
Conclusions:
- Pre-bronchodilator airflow obstruction, even if reversible post-bronchodilator, is a significant predictor of future COPD development.
- These findings support the potential expansion of spirometric criteria for COPD diagnosis to include pre-bronchodilator obstruction.
- Identifying individuals with VO may allow for earlier intervention and risk stratification for COPD.
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