@article{16db81316a864c9086506e1ef4642309,
title = "Reversible Airflow Obstruction Predicts Future Chronic Obstructive Pulmonary Disease Development in the SPIROMICS Cohort An Observational Cohort Study",
abstract = "Rationale: Chronic obstructive pulmonary disease (COPD) is defined by fixed spirometric ratio, FEV1/FVC, 0.70 after inhaled bronchodilators. However, the implications of variable obstruction (VO), in which the prebronchodilator FEV1/FVC ratio is less than 0.70 but increases to 0.70 or more after inhaled bronchodilators, have not been determined. Objectives: We explored differences in physiology, exacerbations, and health status in participants with VO compared with reference participants without obstruction. Methods: Data from the SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) cohort were obtained. Participants with VO were compared with reference participants without obstruction. Measurements and Main Results: We assessed differences in baseline radiographic emphysema and small airway disease at study entry, baseline, and change in lung function by spirometry, functional capacity by 6-minute walk, health status using standard questionnaires, exacerbation rates, and progression to COPD between the two groups. All models were adjusted for participant characteristics, asthma history, and tobacco exposure. We assessed 175 participants with VO and 603 reference participants without obstruction. Participants with VO had 6.2 times the hazard of future development of COPD controlling for other factors (95% confidence interval, 4.6-8.3; P, 0.001). Compared with reference participants, the VO group had significantly lower baseline pre- and postbronchodilator (BD) FEV1, and greater decline over time in post-BD FEV1, and pre- and post-BD FVC. There were no significant differences in exacerbations between groups. Conclusions: Significant risk for future COPD development exists for those with pre- but not post-BD airflow obstruction. These findings support consideration of expanding spirometric criteria defining COPD to include pre-BD obstruction. Clinical trial registered with www.clinicaltrials.gov (NCT 01969344).",
keywords = "COPD, multilevel modeling, pulmonary physiology, spirometry, survival analysis",
author = "{the SPIROMICS Investigators} and Buhr, {Russell G.} and Barjaktarevic, {Igor Z.} and Quibrera, {P. Miguel} and Bateman, {Lori A.} and Bleecker, {Eugene R.} and Couper, {David J.} and Curtis, {Jeffrey L.} and Dolezal, {Brett A.} and Han, {Mei Lan K.} and Hansel, {Nadia N.} and Krishnan, {Jerry A.} and Martinez, {Fernando J.} and William McKleroy and Robert Paine and Rennard, {Stephen I.} and Tashkin, {Donald P.} and Woodruff, {Prescott G.} and Kanner, {Richard E.} and Cooper, {Christopher B.} and Alexis, {Neil E.} and Anderson, {Wayne H.} and Mehrdad Arjomandi and Igor Barjaktarevic and Barr, {R. Graham} and Bateman, {Lori A.} and Bhatt, {Surya P.} and Bleecker, {Eugene R.} and Boucher, {Richard C.} and Bowler, {Russell P.} and Christenson, {Stephanie A.} and Comellas, {Alejandro P.} and Cooper, {Christopher B.} and Couper, {David J.} and Criner, {Gerard J.} and Crystal, {Ronald G.} and Curtis, {Jeffrey L.} and Doerschuk, {Claire M.} and Dransfield, {Mark T.} and Brad Drummond and Freeman, {Christine M.} and Craig Galban and Han, {Mei Lan K.} and Hansel, {Nadia N.} and Hastie, {Annette T.} and Hoffman, {Eric A.} and Yvonne Huang and Kaner, {Robert J.} and Kanner, {Richard E.} and Kleerup, {Eric C.} and Meyers, {Deborah A.}",
note = "Funding Information: Supported by the NIH NHLBI (contracts HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, and HHSN268200900020C and grants U01HL137880, U24HL141762, and L30HL134025 [to R.G.B.]) and supplemented by contributions made through the Foundation for the NIH and the COPD Foundation from AstraZeneca/MedImmune; Bayer; Bellerophon Therapeutics; Boehringer-Ingelheim Pharmaceuticals, Inc.; Chiesi Farmaceutici S.p.A.; Forest Research Institute, Inc.; GlaxoSmithKline; Grifols Therapeutics, Inc.; Ikaria, Inc.; Novartis Pharmaceuticals Corporation; Nycomed GmbH; ProterixBio; Regeneron Pharmaceuticals, Inc.; Sanofi; Sunovion; Takeda Pharmaceutical Company; and Theravance Biopharma and Mylan. R.G.B. additionally received support from NIH National Center for Advanced Translational Sciences grant KL2TR001882. The findings and opinions in this manuscript do not necessarily represent those of the Department of Veterans Affairs. Publisher Copyright: Copyright {\textcopyright} 2022 by the American Thoracic Society.",
year = "2022",
month = sep,
day = "1",
doi = "10.1164/rccm.202201-0094OC",
language = "English (US)",
volume = "206",
pages = "554--562",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "5",
}