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Phillips DB, James MD, Vincent SG, Elbehairy AF, Neder JA, Kirby M, Ora J, Day AG, Tan WC, Bourbeau J, O'Donnell DE. Physiological Characterization of Preserved Ratio Impaired Spirometry in the CanCOLD Study: Implications for Exertional Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2024; 209:1314-1327. [PMID: 38170674 DOI: 10.1164/rccm.202307-1184oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
Rationale: It is increasingly recognized that adults with preserved ratio impaired spirometry (PRISm) are prone to increased morbidity. However, the underlying pathophysiological mechanisms are unknown. Objectives: Evaluate the mechanisms of increased dyspnea and reduced exercise capacity in PRISm. Methods: We completed a cross-sectional analysis of the CanCOLD (Canadian Cohort Obstructive Lung Disease) population-based study. We compared physiological responses in 59 participants meeting PRISm spirometric criteria (post-bronchodilator FEV1 < 80% predicted and FEV1/FVC ⩾ 0.7), 264 control participants, and 170 ever-smokers with chronic obstructive pulmonary disease (COPD), at rest and during cardiopulmonary exercise testing. Measurements and Main Results: Individuals with PRISm had lower total lung, vital, and inspiratory capacities than healthy controls (all P < 0.05) and minimal small airway, pulmonary gas exchange, and radiographic parenchymal lung abnormalities. Compared with healthy controls, individuals with PRISm had higher dyspnea/[Formula: see text]o2 ratio at peak exercise (4.0 ± 2.2 vs. 2.9 ± 1.9 Borg units/L/min; P < 0.001) and lower [Formula: see text]o2peak (74 ± 22% predicted vs. 96 ± 25% predicted; P < 0.001). At standardized submaximal work rates, individuals with PRISm had greater Vt/inspiratory capacity (Vt%IC; P < 0.001), reflecting inspiratory mechanical constraint. In contrast to participants with PRISm, those with COPD had characteristic small airways dysfunction, dynamic hyperinflation, and pulmonary gas exchange abnormalities. Despite these physiological differences among the three groups, the relationship between increasing dyspnea and Vt%IC during cardiopulmonary exercise testing was similar. Resting IC significantly correlated with [Formula: see text]o2peak (r = 0.65; P < 0.001) in the entire sample, even after adjusting for airflow limitation, gas trapping, and diffusing capacity. Conclusions: In individuals with PRISm, lower exercise capacity and higher exertional dyspnea than healthy controls were mainly explained by lower resting lung volumes and earlier onset of dynamic inspiratory mechanical constraints at relatively low work rates. Clinical trial registered with www.clinicaltrials.gov (NCT00920348).
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Affiliation(s)
- Devin B Phillips
- School of Kinesiology and Health Science, Faculty of Health, and
- Muscle Health Research Center, York University, Toronto, Ontario, Canada
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity, and Respiratory Medicine, The University of Manchester, and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Andrew G Day
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; and
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, and
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
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Tang X, Lei J, Li W, Peng Y, Wang C, Huang K, Yang T. The Relationship Between BMI and Lung Function in Populations with Different Characteristics: A Cross-Sectional Study Based on the Enjoying Breathing Program in China. Int J Chron Obstruct Pulmon Dis 2022; 17:2677-2692. [PMID: 36281228 PMCID: PMC9587705 DOI: 10.2147/copd.s378247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/17/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To analyze the relationship between body mass index (BMI) and lung function, which may help optimize the screening and management process for chronic obstructive pulmonary disease (COPD) in the early stages. Patients and Methods In this cross-sectional study using data from the Enjoying Breathing Program in China, participants were divided into two groups according to COPD Screening Questionnaire (COPD-SQ) scores (at risk and not at risk of COPD) and three groups based on lung function (normal lung function, preserved ratio impaired spirometry [PRISm], and obstructive lung function). Results A total of 32,033 subjects were enrolled in the current analysis. First, in people at risk of COPD, overweight and obese participants had better forced expiratory volume in one second (FEV1; overweight: 0.33 liters (l), 95% confidence interval [CI]: 0.27 to 0.38; obesity: 0.31 L, 95% CI: 0.22 to 0.39) values than the normal BMI group. Second, among people with PRISm, underweight participants had a lower FEV1 (−0.56 L, 95% CI: −0.86 to −0.26) and forced vital capacity (FVC; −0.33 L, 95% CI: −0.55 to −0.11) than participants with a normal weight, and obese participants had a higher FEV1 (0.22 L, 95% CI: 0.02 to 0.42) and FVC (0.16 L, 95% CI: 0.02 to 0.30) than participants with a normal weight. Taking normal BMI as the reference group, lower FEV1 (−0.80 L, 95% CI: −0.97 to −0.63) and FVC (−0.53 L, 95% CI: −0.64 to −0.42) were found in underweight participants with obstructive spirometry, and better FEV1 (obesity: 0.26 L, 95% CI: 0.12 to 0.40) was found in obese participants with obstructive spirometry. Conclusion Being underweight and severely obese are associated with reduced lung function. Slight obesity was shown to be a protective factor for lung function in people at risk of COPD and those with PRISm.
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Affiliation(s)
- Xingyao Tang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Capital Medical University, Beijing, 10069, People’s Republic of China
| | - Jieping Lei
- National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China,Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China
| | - Wei Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
| | - Yaodie Peng
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,Peking University Health Science Center, Beijing, 10029, People’s Republic of China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China,Correspondence: Ke Huang; Ting Yang, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China, Tel +010-8420 6275, Email ;
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
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Higbee DH, Granell R, Davey Smith G, Dodd JW. Prevalence, risk factors, and clinical implications of preserved ratio impaired spirometry: a UK Biobank cohort analysis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:149-157. [PMID: 34739861 DOI: 10.1016/s2213-2600(21)00369-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is defined as a FEV1 of less than 80% predicted and a FEV1/forced vital capacity (FVC) ratio of 0·70 or higher. Previous research has indicated that PRISm is associated with respiratory symptoms and is a precursor of chronic obstructive pulmonary disease (COPD). However, these findings are based on relatively small selective cohorts with short follow-up. We aimed to determine the prevalence, risk factors, clinical implications, and mortality of PRISm in a large adult general population. METHODS For this cohort analysis, we used data from the UKBiobank to assess PRISm prevalence, risk factors and associated symptoms, and associated comorbidities in a large adult population. Participants with spirometry deemed acceptable by an investigator (best measure FEV1 and FVC values) at baseline were included. Participants were excluded if they did not have acceptable spirometry or were missing data on body-mass index or smoking status. Control spirometry was defined as a FEV1 of 80% or more predicted and a FEV1/FVC ratio of 0·70 or higher. Airflow obstruction was defined as a FEV1/FVC ratio of less than 0·70. We used multivariable regression to determine risk factors for PRISm and associated comorbidities. Individuals who lived within close proximity to an assessment centre were invited for follow-up, with repeat spirometry. Only participants who had been included at baseline were examined in follow-up. This allowed for a longitudinal analysis of PRISm over time and risk factors for transition to airflow obstruction. We also did the survival analysis for a 12-year period. FINDINGS Participants were recruited by UK Biobank between Dec 19, 2006, and Oct 10, 2010. We included 351 874 UK Biobank participants (189 247 women and 162 627 men) in our study, with a median follow-up of 9·0 years (IQR 8·0-10·0). 38 639 (11·0%) of 351 874 participants had PRISm at baseline. After adjustment, PRISm was strongly associated with obesity (odds ratio [OR] 2·40 [2·26-2·55], p<0·0001), current smoking (1·48 [1·36-1·62], p<0·0001), and patient reported doctor-diagnosed asthma (1·76 [1·66-1·88], p<0·0001). Other risk factors identified included female sex, being overweight, trunk fat mass, and trunk fat percentage. PRISm was strongly associated with symptoms and comorbidity including increased risk of breathlessness (adjusted OR 2·0 [95% CI 1·91-2·14], p<0·0001) and cardiovascular disease (adjusted OR 1·71 [1·64-1·83], p<0·0001 for heart attack). Longitudinal analysis showed that 241 (12·2%) of 1973 participants who had PRISm at baseline had transitioned to airflow obstruction consistent with COPD. PRISm was associated with increased all-cause mortality (adjusted hazard ratio 1·61 [95% CI 1·53-1·69], p<0·0001) versus control participants. INTERPRETATION PRISm was associated with breathlessness, multimorbidity, and increased risk of death, which does not seem to be explained by smoking, obesity, or existing lung disease. Although for many patients PRISm is transient, it is important to understand which individuals are at risk of progressive lung function abnormalities. Further research into the genetic, structural and functional pathophysiology of PRISm is warranted. FUNDING UK Medical Research Council and University of Bristol.
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Affiliation(s)
- Daniel H Higbee
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Raquel Granell
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - James W Dodd
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK.
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Labaki WW, Kimmig LM, Mutlu GM, Han MK, Bhatt SP. Update in Chronic Obstructive Pulmonary Disease 2018. Am J Respir Crit Care Med 2019; 199:1462-1470. [PMID: 30958976 PMCID: PMC6835078 DOI: 10.1164/rccm.201902-0374up] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lucas M. Kimmig
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois; and
| | - Gökhan M. Mutlu
- Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois; and
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Stringer WW, Porszasz J, Bhatt SP, McCormack MC, Make BJ, Casaburi R. Physiologic Insights from the COPD Genetic Epidemiology Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:256-266. [PMID: 31342731 DOI: 10.15326/jcopdf.6.3.2019.0128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
COPD Genetic Epidemiology Study (COPDGene®) manuscripts have provided important insights into chronic obstructive pulmonary disease (COPD) pathophysiology and outcomes, including a better understanding of COPD phenotypes relating computed tomography (CT) anatomic data to spirometric and patient-reported outcomes. Spirometry significantly underdiagnoses smoking-induced lung disease, and there is a marked improvement in sensitivity and specificity with CT scanning. This review also highlights the COPDGene® exploration of specific spirometry phenotypes (e.g.,PRISm), contributors to spirometric decline, composite physiologic measures, asthma-COPD overlap (ACO) syndrome, consequences of bronchodilator responsiveness, newer methods to assess small airway dysfunction, and spirometric correlates of comorbid diseases such as obesity and diabetes.
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Affiliation(s)
- William W Stringer
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Janos Porszasz
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine and Lung Health Center, University of Alabama, Birmingham
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance
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