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Annual Change in Pulmonary Function and Clinical Phenotype in Chronic Obstructive Pulmonary Disease.

著者 Nishimura M , Makita H , Nagai K , Konno S , Nasuhara Y , Hasegawa M , Shimizu K , Betsuyaku T , Ito YM , Fuke S , Igarashi T , Akiyama Y , Ogura S ,
Am J Respir Crit Care Med.2011 Oct 20 ; ():.
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First Department of Medicine, Hokkaido University School of Medicine, North 15, West 7, Kita-ku, 060-8638, Sapporo, 060-8638, Japan.

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RATIONALE: Although the rate of annual decline in forced expiratory volume in one second (FEV1) is one of the most important outcome measures in chronic obstructive pulmonary disease (COPD), little is known about inter-subject variability based on clinical phenotypes. OBJECTIVES: To examine the inter-subject variability in a 5-year observational cohort study, particularly focusing on emphysema severity. METHODS: A total of 279 eligible patients with COPD (Stage I to IV: 26, 45, 24, and 5%) participated. We conducted a detailed assessment of pulmonary function and computed tomography (CT) at baseline, and performed spirometry every 6 months before and after inhalation of bronchodilator. Smoking status, exacerbation and pharmacotherapy were carefully monitored. Emphysema severity was evaluated by CT and annual measurements of carbon monoxide transfer coefficient (Kco). MEASUREMENTS AND MAIN RESULTS: Using mixed effects model analysis, the annual decline in post-bronchodilator FEV1 was -32 ± 24 (SD) ml/y (n=261). We classified the subjects of < the 25th percentile as Rapid decliners, the 25th -75th percentile as Slow decliners, and > the 75th percentile as Sustainers (-63±2, -31±1, and -2±1 (SE) ml/y). Emphysema severity, but not %FEV1, showed significant differences among the three groups. Multiple logistic regression analysis demonstrated that the Rapid decliners were independently associated with emphysema severity assessed either by CT or Kco. The Sustainers displayed less emphysema and higher levels of circulating eosinophils. CONCLUSIONS: Emphysema severity is independently associated with a rapid annual decline in FEV1 in COPD. Sustainers as well as Rapid decliners warrant specific attention in clinical practice.
PMID: 22016444 [PubMed - as supplied by publisher]
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