Arjomandi Mehrdad, Zeng Siyang, Chen Jianhong, Bhatt Surya P, Abtin Fereidoun, Barjaktarevic Igor, Barr R Graham, Bleecker Eugene R, Buhr Russell G, Criner Gerard J, Comellas Alejandro P, Couper David J, Curtis Jeffrey L, Dransfield Mark T, Fortis Spyridon, Han MeiLan K, Hansel Nadia N, Hoffman Eric A, Hokanson John E, Kaner Robert J, Kanner Richard E, Krishnan Jerry A, Labaki Wassim W, Lynch David A, Ortega Victor E, Peters Stephen P, Woodruff Prescott G, Cooper Christopher B, Bowler Russell P, Paine Robert, Rennard Stephen I, Tashkin Donald P
San Francisco Veterans Affairs Healthcare System, San Francisco, California, United States.
Department of Medicine, University of California, San Francisco, California, United States.
Chronic Obstr Pulm Dis. 2023 Jul 26;10(3):270-285. doi: 10.15326/jcopdf.2022.0363.
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.
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.
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).
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.
代表气体潴留的异常肺容积可识别出肺量计检查正常但发展为肺量计定义的慢性阻塞性肺疾病（COPD）及出现不良结局的吸烟者亚组。然而，在早期COPD中，随着气流阻塞的发展，肺容积如何变化仍不清楚。
为确定肺容积如何随肺量计定义的COPD发展而变化，我们检查了美国退伍军人事务部电子健康记录中可用的肺功能数据（坐姿）中的肺容积（n = 71,356），以及慢性阻塞性肺疾病基因流行病学（COPDGene）研究（n = 7969）和慢性阻塞性肺疾病研究中的亚组和中间结局指标（SPIROMICS）（n = 2552）队列中通过计算机断层扫描测量的肺容积（仰卧位），并研究了它们在气流阻塞范围内的横断面分布和纵向变化。该分析排除了比率受损肺量计检查正常（PRISm）的患者。
所有3个队列的肺容积在气流阻塞加重时均表现出相似的分布模式和纵向变化。总肺容量（TLC）、肺活量（VC）和吸气容量（IC）的分布及其变化模式是非线性的，包括不同阶段。使用慢性阻塞性肺疾病全球倡议（GOLD）分期按气流阻塞分层时，与GOLD 0期（肺量计检查正常的吸烟者）或GOLD 2期（中度）疾病患者相比，GOLD 1期（轻度）COPD患者的肺容积（TLC、VC、IC）更大。在对进展为肺量计定义的COPD的基线GOLD 0期患者的纵向随访中，最初TLC和VC较高的患者发展为轻度阻塞（GOLD 1），而最初TLC和VC较低的患者发展为中度阻塞（GOLD 2）。
在COPD中，TLC和VC具有双相分布，随着阻塞加重呈非线性变化，并且可以区分那些有更快发展为肺量计定义疾病风险的GOLD 0期患者。
