PMID- 30030304
OWN - NLM
STAT- MEDLINE
DCOM- 20190506
LR  - 20190506
IS  - 1468-3296 (Electronic)
IS  - 0040-6376 (Linking)
VI  - 74
IP  - 2
DP  - 2019 Feb
TI  - Lung volume indices predict morbidity in smokers with preserved spirometry.
PG  - 114-124
LID - 10.1136/thoraxjnl-2018-211881 [doi]
AB  - BACKGROUND: Abnormal lung volumes that reflect air trapping are common in COPD.
      However, their significance in smokers with preserved spirometry (normal FEV1 to 
      FVC ratio) is unclear. METHODS: Using the Veterans Administration Informatics and
      Computing Infrastructure database, we identified 7479 patients at risk for COPD
      (ever smokers >40 years of age without restrictive lung disease) who had
      preserved spirometry and concomitant lung volume measurements, and examined their
      subsequent health records for clinical diagnoses of COPD, healthcare utilisation,
      follow-up spirometry and mortality. RESULTS: Air trapping was prevalent, with 31%
      of patients having residual volume to total lung capacity ratio (RV:TLC) greater 
      than the upper limit of normal (ULN). RV:TLC varied widely from 14% to 77% (51%
      to 204% of predicted) across the normal ranges of FEV1:FVC and FEV1. Patients
      with RV:TLC greater than the ULN were more likely to receive subsequent clinical 
      diagnoses of COPD (HR (95% CI)=1.55 (1.42 to 1.70), p<0.001) and had higher
      all-cause mortality (HR (95% CI)=1.41 (1.29 to 1.54), p<0.001). They had higher
      rates of respiratory medication prescriptions and hospital and intensive care
      unit admissions. Other air trapping and static hyperinflation indices showed
      similar associations with health outcomes. Additionally, high-normal RV:TLC was
      associated with intermediate adverse health outcomes compared with low-normal and
      abnormal RV:TLC. Abnormal RV:TLC predicted higher likelihood of progression to
      spirometric COPD (OR (95% CI)=1.30 (1.03 to 1.65), p=0.027). CONCLUSION: In this 
      study of the Veterans Affairs electronic health records, air trapping was common 
      in smokers with preserved spirometry and predicted adverse respiratory outcomes
      and progression to overt COPD.
CI  - (c) Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and
      permissions. Published by BMJ.
FAU - Zeng, Siyang
AU  - Zeng S
AD  - Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco,
      California, USA.
AD  - Department of Medicine, University of California, San Francisco, California, USA.
FAU - Tham, Andrea
AU  - Tham A
AD  - Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco,
      California, USA.
AD  - School of Medicine, University of Southern California, Los Angeles, USA.
FAU - Bos, Bruce
AU  - Bos B
AD  - Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco,
      California, USA.
AD  - School of Medicine, Radboud University Medical Center, Nijmegen, Gelderland, The 
      Netherlands.
FAU - Jin, Joan
AU  - Jin J
AD  - Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco,
      California, USA.
AD  - School of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA.
FAU - Giang, Brian
AU  - Giang B
AD  - Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco,
      California, USA.
AD  - Department of Medicine, University of California, San Francisco, California, USA.
FAU - Arjomandi, Mehrdad
AU  - Arjomandi M
AUID- ORCID: 0000-0002-0116-9217
AD  - Medical Section, San Francisco Veterans Affairs Medical Center, San Francisco,
      California, USA.
AD  - Department of Medicine, University of California, San Francisco, California, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180720
PL  - England
TA  - Thorax
JT  - Thorax
JID - 0417353
SB  - IM
MH  - Adult
MH  - Aged
MH  - Databases, Factual
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Lung/*physiopathology
MH  - Male
MH  - Middle Aged
MH  - Patient Acceptance of Health Care/statistics & numerical data
MH  - Pulmonary Disease, Chronic Obstructive/mortality/*physiopathology
MH  - Retrospective Studies
MH  - Smokers/*statistics & numerical data
MH  - Spirometry/*methods
MH  - Survival Rate
MH  - Veterans
OTO - NOTNLM
OT  - *copd epidemiology
OT  - *copd AU mechanisms
OT  - *lung physiology
OT  - *respiratory measurement
COIS- Competing interests: None declared.
EDAT- 2018/07/22 06:00
MHDA- 2019/05/07 06:00
CRDT- 2018/07/22 06:00
PHST- 2018/03/30 00:00 [received]
PHST- 2018/06/19 00:00 [revised]
PHST- 2018/06/25 00:00 [accepted]
PHST- 2018/07/22 06:00 [pubmed]
PHST- 2019/05/07 06:00 [medline]
PHST- 2018/07/22 06:00 [entrez]
AID - thoraxjnl-2018-211881 [pii]
AID - 10.1136/thoraxjnl-2018-211881 [doi]
PST - ppublish
SO  - Thorax. 2019 Feb;74(2):114-124. doi: 10.1136/thoraxjnl-2018-211881. Epub 2018 Jul
      20.