• Am. J. Respir. Crit. Care Med. · Jan 2012

    Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease.

    • Masaharu Nishimura, Hironi Makita, Katsura Nagai, Satoshi Konno, Yasuyuki Nasuhara, Masaru Hasegawa, Kaoruko Shimizu, Tomoko Betsuyaku, Yoichi M Ito, Satoshi Fuke, Takeshi Igarashi, Yasushi Akiyama, Shigeaki Ogura, and Hokkaido COPD Cohort Study Investigators.
    • First Department of Medicine, Hokkaido University School of Medicine, and Center for Respiratory Diseases, Hokkaido Social Insurance Hospital, N-15 W-7, Kita-ku, Sapporo 060-8638, Japan. ma-nishi@med.hokudai.ac.jp
    • Am. J. Respir. Crit. Care Med.. 2012 Jan 1;185(1):44-52.

    RationaleAlthough the rate of annual decline in FEV1 is one of the most important outcome measures in chronic obstructive pulmonary disease (COPD), little is known about intersubject variability based on clinical phenotypes.ObjectivesTo examine the intersubject variability in a 5-year observational cohort study, particularly focusing on emphysema severity.MethodsA total of 279 eligible patients with COPD (stages I-IV: 26, 45, 24, and 5%) participated. We conducted a detailed assessment of pulmonary function and computed tomography (CT) at baseline, and performed spirometry every 6 months before and after inhalation of bronchodilator. Smoking status, exacerbation, and pharmacotherapy were carefully monitored. Emphysema severity was evaluated by CT and annual measurements of carbon monoxide transfer coefficient.Measurements And Main ResultsUsing mixed effects model analysis, the annual decline in post-bronchodilator FEV1 was -32±24 (SD) ml/yr (n=261). We classified the subjects of less than the 25th percentile as Rapid decliners, the 25th to 75th percentile as Slow decliners, and greater than the 75th percentile as Sustainers (-63±2, -31±1, and -2±1 [SE] ml/yr). Emphysema severity, but not %FEV1, showed significant differences among the three groups. Multiple logistic regression analysis demonstrated that the Rapid decliners were independently associated with emphysema severity assessed either by CT or carbon monoxide transfer coefficient. The Sustainers displayed less emphysema and higher levels of circulating eosinophils.ConclusionsEmphysema severity is independently associated with a rapid annual decline in FEV1 in COPD. Sustainers and Rapid decliners warrant specific attention in clinical practice.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…