Validation of a method to assess emphysema severity by spirometry in the COPDGene study

Respiratory Research

Vito Brusasco¹  Edwin K. Silverman²  Barry J. Make³  Elizabeth A. Regan³  James D. Crapo³  David A. Lynch⁴  Mariaelena Occhipinti⁵  Federico Lavorini⁵  Massimo Pistolesi⁵  Matteo Paoletti⁵ 

[1] Department of Experimental Medicine, University of Genoa;Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Channing Division of Network Medicine;Department of Medicine, National Jewish Health;Department of Radiology, National Jewish Health;Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence;

关键词: Spirometry;    Emphysema;    Airway obstruction;    Computed tomography;    Vital capacity;   

DOI  :  10.1186/s12931-020-01366-4

来源: DOAJ

【 摘 要 】

Abstract Background Standard spirometry cannot identify the predominant mechanism underlying airflow obstruction in COPD, namely emphysema or airway disease. We aimed at validating a previously developed methodology to detect emphysema by mathematical analysis of the maximal expiratory flow-volume (MEFV) curve in standard spirometry. Methods From the COPDGene population we selected those 5930 subjects with MEFV curve and inspiratory-expiratory CT obtained on the same day. The MEFV curve descending limb was fit real-time using forced vital capacity (FVC), peak expiratory flow, and forced expiratory flows at 25, 50 and 75% of FVC to derive an emphysema severity index (ESI), expressed as a continuous positive numeric parameter ranging from 0 to 10. According to inspiratory CT percent lung attenuation area below − 950 HU we defined three emphysema severity subgroups (%LAA-950insp < 6, 6–14, ≥14). By co-registration of inspiratory-expiratory CT we quantified persistent (%pLDA) and functional (%fLDA) low-density areas as CT metrics of emphysema and airway disease, respectively. Results ESI differentiated CT emphysema severity subgroups increasing in parallel with GOLD stages (p < .001), but with high variability within each stage. ESI had significantly higher correlations (p < .001) with emphysema than with airway disease CT metrics, explaining 67% of %pLDA variability. Conversely, standard spirometric variables (FEV1, FEV1/FVC) had significantly lower correlations than ESI with emphysema CT metrics and did not differentiate between emphysema and airways CT metrics. Conclusions ESI adds to standard spirometry the power to discriminate whether emphysema is the predominant mechanism of airway obstruction. ESI methodology has been validated in the large multiethnic population of smokers of the COPDGene study and therefore it could be applied for clinical and research purposes in the general population of smokers, using a readily available online website.

【 授权许可】

Unknown