• Spyridon Fortis, Alejandro P Comellas, Surya P Bhatt, Eric A Hoffman, MeiLan K Han, Nirav R Bhakta, Robert Paine, Bonnie Ronish, Richard E Kanner, Mark Dransfield, Daniel Hoesterey, Russell G Buhr, R Graham Barr, Brett Dolezal, Victor E Ortega, M Bradley Drummond, Mehrdad Arjomandi, Robert J Kaner, Victor Kim, Jeffrey L Curtis, Russell P Bowler, Fernando Martinez, Wassim W Labaki, Christopher B Cooper, Wanda K O'Neal, Gerald Criner, Nadia N Hansel, Jerry A Krishnan, Prescott Woodruff, David Couper, Donald Tashkin, and Igor Barjaktarevic.
• Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA. Electronic address: spyridon-fortis@uiowa.edu.
• Chest. 2021 Jul 1; 160 (1): 94-103.

BackgroundMild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV1/FVC.Research QuestionDoes slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease?Study Design And MethodsWe included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV1/FVC ≥ 0.7 and FEV1 % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV1/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV1/SVC of ≥ 0.7 and 120 with postbronchodilator FEV1/SVC < 0.7 at the enrollment. We performed multivariate linear and logistic regression models and negative binomial and interval-censored proportion hazards regression models adjusted for demographics and smoking exposure to examine the association of FEV1/SVC < 0.7 with those characteristics and outcomes.ResultsParticipants with FEV1/SVC < 0.7 were older and had lower FEV1 and more emphysema than those with FEV1/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV1/SVC < 0.7 showed a greater percentage of emphysema by 0.45% (95% CI, 0.09%-0.82%), percentage of gas trapping by 2.52% (95% CI, 0.59%-4.44%), and percentage of functional small airways disease based on parametric response mapping by 2.78% (95% CI, 0.72%-4.83%) at baseline than those with FEV1/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV1/SVC < 0.7 was not associated with total exacerbations (incident rate ratio [IRR], 1.61; 95% CI, 0.97-2.64), but was associated with severe exacerbations (IRR, 2.60; 95% CI, 1.04-4.89). An FEV1/SVC < 0.7 was associated with progression to COPD during a 3-year follow-up even after adjustment for demographics and smoking exposure (hazard ratio, 3.93; 95% CI, 2.71-5.72). We found similar results when we examined the association of prebronchodilator FEV1/SVC < 0.7 or FEV1/SVC less than the lower limit of normal with chest CT scan features and progression to COPD.InterpretationLow FEV1 to SVC in current and former smokers with normal spirometry results can identify individuals with CT scan features of COPD who are at risk for severe exacerbations and is associated with progression to COPD in the future.Trial RegistryClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov.Published by Elsevier Inc.

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