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Spirometry-Defined Restriction Modifies the Association between Forced Vital Capacity and Bronchiectasis
Jang Ho Lee1, Hyun Lee2, Seonok Kim3
1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Tuberculosis and Respiratory Diseases
|November 6, 2025
Summary
Restrictive ventilatory defects (RVD) and mixed ventilatory defects (MVD) in bronchiectasis patients increase acute exacerbation (AE) risk. These spirometry findings modify the impact of forced vital capacity (FVC) on AE risk.
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
Background:
- Obstructive ventilatory defect (OVD) is common in bronchiectasis, linked to acute exacerbations (AE).
- The impact of restrictive ventilatory defects (RVD) or mixed ventilatory defects (MVD) on AE risk in bronchiectasis is largely unreported.
- This study investigates the association between spirometry-defined restrictive components and AE risk.
Purpose of the Study:
- To evaluate the association between spirometry-defined restrictive components (RVD, MVD) and the risk of acute exacerbations (AE) in patients with bronchiectasis.
- To compare AE risk across normal, OVD, RVD, and MVD groups.
- To determine how restrictive components modify the effect of FVC and FEV1 on AE risk.
Main Methods:
- Prospective cohort study involving 51 hospitals in South Korea.
- Patients were categorized into normal, OVD, RVD, and MVD groups based on spirometry (FEV1/FVC and FVC) criteria.
- Incidence rate ratios (IRRs) of AE were compared using the normal group as a reference.
Main Results:
- The MVD group showed the highest annual severe AE IRR (3.557), followed by RVD (2.678) and OVD (1.926) compared to the normal group (p for trend=0.051).
- Lower FVC and FEV1 were significantly associated with increased risk of any AE and severe AE in RVD and MVD groups.
- Spirometry-defined restrictive components significantly affected the relationship between FVC and AE risk (p for interaction <0.05), but not FEV1.
Conclusions:
- The presence of spirometry-defined restrictive components (RVD/MVD) is associated with higher annual rates of any AE and severe AE in bronchiectasis patients.
- Restrictive components modify the effect of FVC, but not FEV1, on the risk of acute exacerbations.
- These findings highlight the importance of identifying restrictive patterns in bronchiectasis management to predict AE risk.
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