Changes in Lung Volumes with Spirometric Disease Progression in COPD

Mehrdad Arjomandi; Siyang Zeng; Jianhong Chen; Surya P Bhatt; Fereidoun Abtin; Igor Barjaktarevic; R Graham Barr; Eugene R Bleecker; Russell G Buhr; Gerard J Criner; Alejandro P Comellas; David J Couper; Jeffrey L Curtis; Mark T Dransfield; Spyridon Fortis; MeiLan K Han; Nadia N Hansel; Eric A Hoffman; John E Hokanson; Robert J Kaner; Richard E Kanner; Jerry A Krishnan; Wassim W Labaki; David A Lynch; Victor E Ortega; Stephen P Peters; Prescott G Woodruff; Christopher B Cooper; Russell P Bowler; Robert Paine 3rd; Stephen I Rennard; Donald P Tashkin; and the COPDGene and SPIROMICS Investigators

doi:10.15326/jcopdf.2022.0363

Changes in Lung Volumes with Spirometric Disease Progression in COPD

Chronic Obstr Pulm Dis. 2023 Jul 26;10(3):270-285. doi: 10.15326/jcopdf.2022.0363.

Authors

Mehrdad Arjomandi^{1

2}, Siyang Zeng^{1

3}, Jianhong Chen^{1

2}, Surya P Bhatt⁴, Fereidoun Abtin⁵, Igor Barjaktarevic⁵, R Graham Barr⁶, Eugene R Bleecker⁷, Russell G Buhr⁵, Gerard J Criner⁸, Alejandro P Comellas⁹, David J Couper¹⁰, Jeffrey L Curtis^{11

12}, Mark T Dransfield⁴, Spyridon Fortis⁹, MeiLan K Han¹¹, Nadia N Hansel¹³, Eric A Hoffman⁹, John E Hokanson¹⁴, Robert J Kaner¹⁵, Richard E Kanner¹⁶, Jerry A Krishnan¹⁷, Wassim W Labaki¹¹, David A Lynch¹⁸, Victor E Ortega¹⁹, Stephen P Peters²⁰, Prescott G Woodruff², Christopher B Cooper⁵, Russell P Bowler²¹, Robert Paine 3rd¹⁶, Stephen I Rennard²², Donald P Tashkin⁶; and the COPDGene and SPIROMICS Investigators

Affiliations

¹ San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States.
² Department of Medicine, University of California, San Francisco, California, United States.
³ Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, United States.
⁴ University of Alabama at Birmingham, Birmingham, Alabama, United States.
⁵ Department of Medicine, University of California, Los Angeles, California, United States.
⁶ Columbia-Presbyterian Medical Center, New York, New York, United States.
⁷ University of Arizona, College of Medicine, Tucson, Arizona, United States.
⁸ Temple University, Philadelphia, Pennsylvania, United States.
⁹ University of Iowa, Iowa City, Iowa, United States.
¹⁰ University of North Carolina, Chapel Hill, North Carolina, United States.
¹¹ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States.
¹² Medical Services, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.
¹³ Johns Hopkins Medical Institute, Baltimore, United States.
¹⁴ Department of Epidemiology, School of Public Health, University of Colorado, United States.
¹⁵ Weill Cornell Medical Center, New York, New York, United States.
¹⁶ University of Utah, Salt Lake City, Utah, United States.
¹⁷ University of Illinois at Chicago, Chicago, Illinois, United States.
¹⁸ Department of Radiology, National Jewish Health Systems, Denver, Colorado, United States.
¹⁹ Mayo Clinic, Scottsdale, Arizona, United States.
²⁰ Wake Forest School of Medicine, Winston-Salem, North Carolina, United States.
²¹ Department of Medicine, National Jewish Health Systems, Denver, Colorado, United States.
²² University of Nebraska Medical Center, Omaha, Nebraska, United States.

Abstract

Background: Abnormal lung volumes representing air trapping identify the subset of smokers with preserved spirometry who develop spirometric chronic obstructive pulmonary disease (COPD) and adverse outcomes. However, how lung volumes evolve in early COPD as airflow obstruction develops remains unclear.

Methods: To establish how lung volumes change with the development of spirometric COPD, we examined lung volumes from the pulmonary function data (seated posture) available in the U.S. Department of Veterans Affairs electronic health records (n=71,356) and lung volumes measured by computed tomography (supine posture) available from the COPD Genetic Epidemiology (COPDGene^®) study (n=7969) and the SubPopulations and InterMediate Outcome Measures In COPD Study (SPIROMICS) (n=2552) cohorts, and studied their cross-sectional distributions and longitudinal changes across the airflow obstruction spectrum. Patients with preserved ratio-impaired spirometry (PRISm) were excluded from this analysis.

Results: Lung volumes from all 3 cohorts showed similar patterns of distributions and longitudinal changes with worsening airflow obstruction. The distributions for total lung capacity (TLC), vital capacity (VC), and inspiratory capacity (IC) and their patterns of change were nonlinear and included different phases. When stratified by airflow obstruction using Global initiative for chronic Obstructive Lung Disease (GOLD) stages, patients with GOLD 1 (mild) COPD had larger lung volumes (TLC, VC, IC) compared to patients with GOLD 0 (smokers with preserved spirometry) or GOLD 2 (moderate) disease. In longitudinal follow-up of baseline GOLD 0 patients who progressed to spirometric COPD, those with an initially higher TLC and VC developed mild obstruction (GOLD 1) while those with an initially lower TLC and VC developed moderate obstruction (GOLD 2).

Conclusions: In COPD, TLC, and VC have biphasic distributions, change in nonlinear fashions as obstruction worsens, and could differentiate those GOLD 0 patients at risk for more rapid spirometric disease progression.

Keywords: COPD; air trapping; computed tomography; early disease; lung volumes.

Abstract

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