• Tae Seung Lee, Kwang Nam Jin, Hyun Woo Lee, Seo-Young Yoon, Tae Yun Park, Eun Young Heo, Deog Kyeom Kim, Hee Soon Chung, and Jung-Kyu Lee.
• Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
• Chest. 2021 Jan 1; 159 (1): 128-137.

BackgroundThe presence and progression of interstitial lung abnormalities (ILAs) is known to be associated with a decline of lung function and increased risk of mortality.Research QuestionWe aimed to elucidate the clinical course according to ILAs in patients with COPD.Study Design And MethodsA retrospective study was conducted between January 2013 and December 2018 of COPD patients who underwent chest CT imaging and longitudinal pulmonary function tests. We evaluated radiologic findings, history of acute exacerbations of COPD, and lung function changes during the longitudinal follow-up.ResultsOf 363 patients with COPD, 44 and 103 patients had equivocal and definite ILAs, respectively. Patients with ILAs were significantly older and had lower FEV1 and FVC than patients without ILAs. During the mean follow-up period of 5.2 years, ILAs were associated significantly with the annual incidence of moderate to severe acute exacerbation of COPD (β ± SD, 0.38 ± 0.12; P = .002) and with the risk of frequent exacerbation (adjusted OR, 2.03; P = .045). Patients with progressive ILAs showed a significantly higher rate of annual decline in FEV1 and FVC than those showing no change in, or improved, ILAs.InterpretationILAs were associated significantly with moderate to severe acute exacerbation in patients with COPD, and the progression of ILAs was associated with an accelerated decline in lung function.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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