Severity grading of chronic obstructive pulmonary disease: the confounding effect of phenotype and thoracic gas compression
- PMID: 25414244
- DOI: 10.1152/japplphysiol.00801.2014
Severity grading of chronic obstructive pulmonary disease: the confounding effect of phenotype and thoracic gas compression
Abstract
Current guidelines recommend severity of chronic obstructive pulmonary disease be graded by using forced expiratory volume in 1 s (FEV1). But this measurement is biased by thoracic gas compression depending on lung volume and airflow resistance. The aim of this study was to test the hypothesis that the effect of thoracic gas compression on FEV1 is greater in emphysema than chronic bronchitis because of larger lung volumes, and this influences severity classification and prognosis. FEV1 was simultaneously measured by spirometry and body plethysmography (FEV1-pl) in 47 subjects with dominant emphysema and 51 with dominant chronic bronchitis. Subjects with dominant emphysema had larger lung volumes, lower diffusion capacity, and lower FEV1 than those with dominant chronic bronchitis. However, FEV1-pl, patient-centered variables (dyspnea, quality of life, exercise tolerance, exacerbation frequency), arterial blood gases, and respiratory impedance were not significantly different between groups. Using FEV1-pl instead of FEV1 shifted severity distribution toward less severe classes in dominant emphysema more than chronic bronchitis. The body mass, obstruction, dyspnea, and exercise (BODE) index was significantly higher in dominant emphysema than chronic bronchitis, but this difference significantly decreased when FEV1-pl was substituted for FEV1. In conclusion, the FEV1 is biased by thoracic gas compression more in subjects with dominant emphysema than in those with chronic bronchitis. This variably and significantly affects the severity grading systems currently recommended.
Keywords: chronic bronchitis; emphysema; forced expiratory volume in 1 s; plethysmography.
Copyright © 2015 the American Physiological Society.
Comment in
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Is FEV1 determined in a plethysmograph a better indication of obstructive lung disease than FEV1 determined by a spirometer?J Appl Physiol (1985). 2015 Apr 1;118(7):795. doi: 10.1152/japplphysiol.01124.2014. Epub 2014 Dec 30. J Appl Physiol (1985). 2015. PMID: 25549766 No abstract available.
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