Dodos Konstantinos, Kalamara Tsampika-Vasileia, Mavroudi Antigoni, Kapoukranidou Dorothea, Trakas Nikolaos, Spandidos Demetrios A, Corlateanu Alexandru, Georgakopoulou Vasiliki Epameinondas
Laboratory of Physiology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Third Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
Exp Ther Med. 2025 Jun 11;30(2):156. doi: 10.3892/etm.2025.12906. eCollection 2025 Aug.
Diurnal variation in pulmonary function is a key physiological phenomenon, with potential clinical significance in chronic obstructive pulmonary disease (COPD). The reduced diurnal fluctuation of forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV) in patients with COPD may be attributed to airway inflammation, autonomic dysregulation and impaired lung compliance, with potential influence from altered cortisol rhythms. These fluctuations are clinically significant as they highlight the importance of optimizing bronchodilator timing and interpreting spirometry results within a diurnal context. The present systematic review and meta-analysis examined the diurnal fluctuations in FVC and FEV) among healthy individuals and patients with COPD. A total of 8 studies, including 595 for FVC (or 725 for FEV) healthy individuals and 172 patients with COPD, were analyzed. In healthy adults, the mean diurnal FVC difference was 1.92 (P<0.01), with morning values significantly higher than nighttime values. Patients with COPD also exhibited a morning increase in FVC values, but with a smaller, non-significant difference of 1.04 (P=0.06). The mean difference in diurnal FVC variation between the two groups was 1.46 (P<0.01), indicating a significantly greater variation in healthy individuals. For FEV, healthy individuals exhibited a mean diurnal difference of 4.94 (P<0.01), whereas patients with COPD showed a smaller but significant difference of 0.82 (P<0.01). However, the between-group difference in diurnal FEV variation was 3.07 (P=0.17), which was not statistically significant. Heterogeneity was moderate to high (I²=57-59%), suggesting variability across the included studies. The reduced diurnal fluctuation of FVC and FEV in patients with COPD may be attributed to airway inflammation, autonomic dysregulation and impaired lung compliance, with potential influence from altered cortisol rhythms. These findings underscore the importance of personalized treatment approaches, optimizing bronchodilator timing and considering diurnal patterns in spirometry interpretation for improved COPD management. Future research should explore longitudinal home spirometry to refine therapeutic strategies.
肺功能的昼夜变化是一种关键的生理现象，在慢性阻塞性肺疾病（COPD）中具有潜在的临床意义。COPD患者用力肺活量（FVC）和第1秒用力呼气容积（FEV）的昼夜波动减小，可能归因于气道炎症、自主神经调节异常和肺顺应性受损，同时可能受到皮质醇节律改变的影响。这些波动具有临床意义，因为它们凸显了优化支气管扩张剂给药时间以及在昼夜背景下解读肺量计结果的重要性。本系统评价和荟萃分析研究了健康个体和COPD患者中FVC和FEV的昼夜波动情况。共分析了8项研究，其中包括595名FVC（或725名FEV）健康个体和172名COPD患者。在健康成年人中，FVC的平均昼夜差异为1.92（P<0.01），早晨值显著高于夜间值。COPD患者的FVC值也在早晨有所增加，但差异较小，为1.04，无统计学意义（P=0.06）。两组间FVC昼夜变化的平均差异为1.46（P<0.01），表明健康个体的变化显著更大。对于FEV，健康个体的平均昼夜差异为4.94（P<0.01），而COPD患者的差异较小，但为0.82，有统计学意义（P<0.01）。然而，两组间FEV昼夜变化的差异为3.07（P=0.17），无统计学意义。异质性为中度至高度（I²=57-59%），表明纳入研究存在变异性。COPD患者FVC和FEV昼夜波动减小可能归因于气道炎症、自主神经调节异常和肺顺应性受损，同时可能受到皮质醇节律改变的影响。这些发现强调了个性化治疗方法、优化支气管扩张剂给药时间以及在肺量计解读中考虑昼夜模式以改善COPD管理的重要性。未来的研究应探索纵向家庭肺量计检查以完善治疗策略。
