The diagnosis of chronic obstructive pulmonary disease (COPD) relies on demonstration of airflow obstruction. Traditional spirometric indices miss a number of subjects with respiratory symptoms or structural lung disease on imaging. We hypothesized that utilizing all data points on the expiratory spirometry curves to assess their shape will improve detection of mild airflow obstruction and structural lung disease. We analyzed spirometry data of 8307 participants enrolled in the COPDGene study, and derived metrics of airflow obstruction based on the shape on the volume-time (Parameter D), and flow-volume curves (Transition Point and Transition Distance). We tested associations of these parameters with CT measures of lung disease, respiratory morbidity, and mortality using regression analyses. There were significant correlations between FEV1/FVC with Parameter D (r = -0.83; p < 0.001), Transition Point (r = 0.69; p < 0.001), and Transition Distance (r = 0.50; p < 0.001). All metrics had significant associations with emphysema, small airway disease, dyspnea, and respiratory-quality of life (p < 0.001). The highest quartile for Parameter D was independently associated with all-cause mortality (adjusted HR 3.22,95% CI 2.42-4.27; p < 0.001) but a substantial number of participants in the highest quartile were categorized as GOLD 0 and 1 by traditional criteria (1.8% and 33.7%). Parameter D identified an additional 9.5% of participants with mild or non-recognized disease as abnormal with greater burden of structural lung disease compared with controls. The data points on the flow-volume and volume-time curves can be used to derive indices of airflow obstruction that identify additional subjects with disease who are deemed to be normal by traditional criteria.

译文

慢性阻塞性肺疾病 (COPD) 的诊断取决于气流阻塞的表现。传统的肺活量指数在影像学上遗漏了许多患有呼吸系统症状或结构性肺部疾病的受试者。我们假设利用呼气肺活量曲线上的所有数据点来评估其形状将改善轻度气流阻塞和结构性肺部疾病的检测。我们分析了参加COPDGene研究的8307名参与者的肺活量测定数据,并基于体积-时间 (参数D) 和流量-体积曲线 (过渡点和过渡距离) 的形状得出了气流阻塞的指标。我们使用回归分析测试了这些参数与肺部疾病,呼吸系统发病率和死亡率的CT测量的相关性。FEV1/FVC与参数D (r   =  -0.83; P  <  0.001) 、跃迁点 (r   =   0.69; P  <  0.001) 、跃迁距离 (r   =   0.50; P  <  0.001) 之间存在显著相关性。所有指标与肺气肿、小气道疾病、呼吸困难和呼吸-生活质量有显著关联 (p  <  0.001)。参数D的最高四分位数与全因死亡率独立相关 (调整后的HR 3.22,95% CI 2.42-4.27; P  <  0.001),但根据传统标准 (1.8% 和33.7%),最高四分位数的大量参与者被归类为0和1。参数D确定了与对照组相比,具有轻度或未识别疾病的参与者的另外9.5% 异常,并具有更大的结构性肺病负担。流量-体积和体积-时间曲线上的数据点可用于得出气流阻塞的指数,这些指数可识别其他传统标准认为正常的疾病受试者。

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