Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis.
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Barjaktarevic Igor Z, Buhr Russell G, Wang Xiaoyan, Hu Scott, Couper David, Anderson Wayne, Kanner Richard E, Paine Iii Robert, Bhatt Surya P, Bhakta Nirav R, Arjomandi Mehrdad, Kaner Robert J, Pirozzi Cheryl S, Curtis Jeffrey L, O'Neal Wanda K, Woodruff Prescott G, Han MeiLan K, Martinez Fernando J, Hansel Nadia, Wells James Michael, Ortega Victor E, Hoffman Eric A, Doerschuk Claire M, Kim Victor, Dransfield Mark T, Drummond M Bradley, Bowler Russell, Criner Gerard, Christenson Stephanie A, Ronish Bonnie, Peters Stephen P, Krishnan Jerry A, Tashkin Donald P, Cooper Christopher B, NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS)
Аннотация
METHODS: We analyzed 2974 participants from a multicenter observational study designed to identify varying COPD phenotypes (SPIROMICS). We evaluated the association of BDR with baseline clinical characteristics, rate of prospective exacerbations and mortality using negative binomial regression and Cox proportional hazards models.
RESULTS: A majority of COPD participants exhibited BDR (52.7%). BDRFEV1 occurred more often in earlier stages of COPD, while BDRFVC occurred more frequently in more advanced disease. When defined by increases in either FEV1 or FVC, BDR was associated with a self-reported history of asthma, but not with blood eosinophil counts. BDRFVC was more prevalent in subjects with greater emphysema and small airway disease on CT. In a univariate analysis, BDRFVC was associated with increased exacerbations and mortality, although no significance was found in a model adjusted for post-bronchodilator FEV1.
CONCLUSION: With advanced airflow obstruction in COPD, BDRFVC is more prevalent in comparison to BDRFEV1 and correlates with the extent of emphysema and degree of small airway disease. Since these associations appear to be related to the impairment of FEV1, BDRFVC itself does not define a distinct phenotype nor can it be more predictive of outcomes, but it can offer additional insights into the pathophysiologic mechanism in advanced COPD.
CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov: NCT01969344T4.