Association between Functional Small Airway Disease and FEV1 Decline in Chronic Obstructive Pulmonary Disease

被引：337

作者：

Bhatt, Surya P. ^{[1
,2
]}

Soler, Xavier ^{[3
]}

Wang, Xin ^{[4
]}

Murray, Susan ^{[4
]}

Anzueto, Antonio R. ^{[10
,11
,16
]}

Beaty, Terri H. ^{[12
]}

Boriek, Aladin M. ^{[14
]}

Casaburi, Richard ^{[15
]}

Criner, Gerard J. ^{[17
]}

Diaz, Alejandro A. ^{[19
]}

Dransfield, Mark T. ^{[1
,2
]}

Curran-Everett, Douglas ^{[20
,23
]}

Galban, Craig J. ^{[5
]}

Hoffman, Eric A. ^{[25
,26
,27
]}

Hogg, James C. ^{[28
,29
]}

Kazerooni, Ella A. ^{[6
]}

Kim, Victor ^{[17
]}

Kinney, Gregory L. ^{[24
]}

Lagstein, Amir ^{[7
]}

Lynch, David A. ^{[21
]}

Make, Barry J. ^{[22
]}

Martinez, Fernando J. ^{[8
]}

Ramsdell, Joe W. ^{[3
]}

Reddy, Rishindra ^{[9
]}

Ross, Brian D. ^{[5
]}

Rossiter, Harry B. ^{[15
]}

Steiner, Robert M. ^{[18
]}

Strand, Matthew J. ^{[20
,23
]}

van Beek, Edwin J. R. ^{[30
]}

Wan, Emily S. ^{[31
]}

Washko, George R. ^{[19
]}

Wells, J. Michael ^{[1
,2
]}

Wendt, Chris H. ^{[32
]}

Wise, Robert A. ^{[13
]}

Silverman, Edwin K. ^{[31
]}

Crapo, James D. ^{[22
]}

Bowler, Russell P. ^{[22
]}

Han, MeiLan K. ^{[8
]}

机构：

[1] Univ Alabama Birmingham, Div Pulm Allergy & Crit Care Med, Birmingham, AL USA

[2] Univ Alabama Birmingham, UAB Lung Hlth Ctr, Birmingham, AL USA

[3] Univ Calif San Diego, Div Pulm Crit Care & Sleep Med, San Diego, CA 92103 USA

[4] Univ Michigan, Sch Publ Hlth, Ann Arbor, MI 48109 USA

[5] Univ Michigan, Dept Radiol, Ctr Mol Imaging, Ann Arbor, MI 48109 USA

[6] Univ Michigan, Dept Radiol, Ann Arbor, MI 48109 USA

[7] Univ Michigan, Dept Pathol, Ann Arbor, MI 48109 USA

[8] Univ Michigan, Div Pulm & Crit Care Med, Ann Arbor, MI 48109 USA

[9] Univ Michigan, Div Thorac Surg, Ann Arbor, MI 48109 USA

[10] Univ Texas Hlth Sci Ctr San Antonio, Div Pulm & Crit Care Med, San Antonio, TX 78229 USA

[11] South Texas Vet Hlth Care Syst, San Antonio, TX USA

[12] Johns Hopkins Univ, Sch Publ Hlth, Dept Epidemiol, Baltimore, MD 21205 USA

[13] Johns Hopkins Univ, Div Pulm & Crit Care Med, Baltimore, MD USA

[14] Baylor Coll Med, Pulm Crit Care & Sleep Med, Houston, TX 77030 USA

[15] Harbor UCLA Med Ctr, Div Pulm & Crit Care Physiol & Med, Torrance, CA 90509 USA

[16] Harbor UCLA Med Ctr, Rehabil Clin Trials Ctr, Los Angeles Biomed Res Inst, Torrance, CA 90509 USA

[17] Temple Univ Hosp & Med Sch, Pulm & Crit Care Med, Philadelphia, PA 19140 USA

[18] Temple Univ Hosp & Med Sch, Dept Radiol, Philadelphia, PA 19140 USA

[19] Brigham & Womens Hosp, Div Pulm & Crit Care Med, 75 Francis St, Boston, MA 02115 USA

[20] Natl Jewish Hlth, Dept Biostat & Bioinformat, Denver, CO USA

[21] Natl Jewish Hlth, Dept Radiol, Denver, CO USA

[22] Natl Jewish Hlth, Div Pulm Crit Care & Sleep Med, Denver, CO USA

[23] Univ Colorado, Dept Biostat & Informat, Colorado Sch Publ Hlth, Denver, CO 80202 USA

[24] Univ Colorado, Dept Epidemiol, Colorado Sch Publ Hlth, Denver, CO 80202 USA

[25] Univ Iowa, Dept Radiol, Iowa City, IA 52242 USA

[26] Univ Iowa, Dept Med, Iowa City, IA 52242 USA

[27] Univ Iowa, Dept Biomed Engn, Iowa City, IA 52242 USA

[28] Univ British Columbia, Dept Pathol & Lab Med, Vancouver, BC, Canada

[29] St Pauls Hosp, James Hogg Res Ctr, Vancouver, BC, Canada

[30] Univ Edinburgh, Clin Res Imaging Ctr, Edinburgh, Midlothian, Scotland

[31] Harvard Med Sch, Brigham & Womens Hosp, Channing Div Network Med, Boston, MA USA

[32] Univ Minnesota, Pulm Allergy Crit Care & Sleep Med Sect, Minneapolis VAMC, Minneapolis, MN USA

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2016年 / 194卷 / 02期

关键词：

FEV1; lung function; parametric response mapping; COPD; FLOW; EPIDEMIOLOGY; SPIROMETRY; SMOKERS; TIME; SITE;

D O I：

10.1164/rccm.201511-2219OC

中图分类号：

R4 [临床医学];

学科分类号：

100218 [急诊医学];

摘要：

Rationale: The small conducting airways are the major site of airflow obstruction in chronic obstructive pulmonary disease and may precede emphysema development. Objectives: We hypothesized a novel computed tomography (CT) biomarker of small airway disease predicts FEV1 decline. Methods: We analyzed 1,508 current and former smokers from COPDGene with linear regression to assess predictors of change in FEV1 (ml/yr) over 5 years. Separate models for subjects without and with airflow obstruction were generated using baseline clinical and physiologic predictors in addition to two novel CT metrics created by parametric response mapping (PRM), a technique pairing inspiratory and expiratory CT images to define emphysema (PRMemph) and functional small airways disease (PRMfSAD), a measure of nonemphysematous air trapping. Measurements and Main Results: Mean (SD) rate of FEV1 decline in ml/yr for GOLD (Global Initiative for Chronic Obstructive Lung Disease) 0-4 was as follows: 41.8 (47.7), 53.8 (57.1), 45.6 (61.1), 31.6 (43.6), and 5.1 (35.8), respectively (trend test for grades 1-4; P < 0.001). In multivariable linear regression, for participants without airflow obstruction, PRMfSAD but not PRMemph was associated with FEV1 decline (P < 0.001). In GOLD 1-4 participants, both PRMfSAD and PRMemph were associated with FEV1 decline (P, 0.001 and P = 0.001, respectively). Based on the model, the proportional contribution of the two CT metrics to FEV1 decline, relative to each other, was 87% versus 13% and 68% versus 32% for PRMfSAD and PRMemph in GOLD 1/2 and 3/4, respectively. Conclusions: CT-assessed functional small airway disease and emphysema are associated with FEV1 decline, but the association with functional small airway disease has greatest importance in mild-to-moderate stage chronic obstructive pulmonary disease where the rate of FEV1 decline is the greatest.

引用

页码：178 / 184

页数：7

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