• Ciro Casanova, Enrique Gonzalez-Dávila, Cristina Martínez-Gonzalez, Borja G Cosio, Antonia Fuster, Nuria Feu, Ingrid Solanes, Carlos Cabrera, José M Marin, Eva Balcells, Germán Peces-Barba, Juan P de Torres, Marta Marín-Oto, Myriam Calle, Rafael Golpe, Elena Ojeda, Miguel Divo, Victor Pinto-Plata, Carlos Amado, José Luis López-Campos, and Bartolome R Celli.
• Pulmonary Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain; Pulmonary Department, Universidad de La Laguna, Tenerife, Spain. Electronic address: casanovaciro@gmail.com.
• Chest. 2021 Aug 1; 160 (2): 481-490.

BackgroundThe value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression.Research QuestionWhat is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression?Study Design And MethodsWe phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time.ResultsThe mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV1 % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039).InterpretationPatients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function.Trial RegistryClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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