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

Nishimura, Masaharu; Makita, Hironi; Nagai, Katsura; Konno, Satoshi; Nasuhara, Yasuyuki; Hasegawa, Masaru; Shimizu, Kaoruko; Betsuyaku, Tomoko; Ito, Yoichi M.; Fuke, Satoshi; Igarashi, Takeshi; Akiyama, Yasushi; Ogura, Shinji

doi:10.1164/rccm.201106-0992oc

Cited by 299 publications

(276 citation statements)

References 39 publications

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“…A range of susceptible smokers develop airflow obstruction. This range is fairly consistent considering the differences in subject selection: 42-46% of the clinical COPD patients in the study by SANCHEZ-SALCEDO et al [3], excluding any with bronchial responsiveness; 33% of males (24% of females) in the Framingham cohort [5]; 25% of the Nishimura group, most of whom had mild-to-moderate COPD [7]; and 18% in the BODE cohort [4] of ''well-characterised'' COPD patients (mean forced expiratory volume in 1 s (FEV1) 46% predicted). In the study by FLETCHER and PETO [2], 387 moderate (f15 cigarettes?day -1 ) continuing smokers lost FEV1 at a rate of 63 mL?yr -1 and 12% developed airflow obstruction.…”

Section: @Erspublicationssupporting

confidence: 60%

“…Many smokers with dyspnoea and cough also wheeze and/or have positive bronchodilator responses, and were included as having a COPD diagnosis. In their study of 300 patients with respiratory physician-diagnosed COPD, NISHIMURA et al [7] excluded only those with ''clinically diagnosed asthma'' and specifically included those with a positive bronchodilator response. This renders the cohort of NISHIMURA et al [7] less ''real world'' as a COPD population and marginalises the effect of medication on lung function.…”

Section: @Erspublicationsmentioning

confidence: 99%

“…In their study of 300 patients with respiratory physician-diagnosed COPD, NISHIMURA et al [7] excluded only those with ''clinically diagnosed asthma'' and specifically included those with a positive bronchodilator response. This renders the cohort of NISHIMURA et al [7] less ''real world'' as a COPD population and marginalises the effect of medication on lung function. NISHIMURA et al [7] noted an overall decline in FEV1 of 32 mL?yr -1 and reported that 25% were rapid decliners (63 mL?yr -1 ), 50% were slow decliners (31 mL?yr -1 ) and 25% were non-decliners (2 mL?yr -1 ).…”

Section: @Erspublicationsmentioning

confidence: 99%

“…This renders the cohort of NISHIMURA et al [7] less ''real world'' as a COPD population and marginalises the effect of medication on lung function. NISHIMURA et al [7] noted an overall decline in FEV1 of 32 mL?yr -1 and reported that 25% were rapid decliners (63 mL?yr -1 ), 50% were slow decliners (31 mL?yr -1 ) and 25% were non-decliners (2 mL?yr -1 ). There were no differences in spirometry, bronchodilator response, quality of life, smoking, exacerbation rate or medication in the cohort of NISHIMURA et al [7].…”

Section: @Erspublicationsmentioning

confidence: 99%

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The natural history of COPD: confirming and going beyond Fletcher and Peto

Miller

Raskin

2014

Eur Respir J

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@ERSpublicationsFindings of Fletcher and Peto confirmed, and importance of early COPD stages in FEV1 decline and treatment emphasised http://ow.ly/xnKns ''The natural history of chronic airflow obstruction'', initially published in the BMJ in 1977 by FLETCHER and PETO [1], and preceded by a fuller monograph [2], has long been a part of the landscape of pulmonary medicine. Their insights have helped form our collective thinking as we interpret pulmonary function in relation to ageing and lung disease.In this issue of the European Respiratory Journal (ERJ), contribute to our knowledge of chronic obstructive pulmonary disease (COPD) clinical status and progression in a study of 103 younger and 463 older patients followed for o2 years. All patients attended specialised pulmonary clinics, had smoked for o20 pack-years and were (presumably) symptomatic from their physiciandiagnosed COPD. The majority (59%) of the younger patients were ''active smokers'' compared with only 20% of the older group. The rapid decliners in this study may be considered similar to the susceptible smokers who demonstrated rapid decline in the study by FLETCHER and PETO [1]. The Fletcher-Peto cohort was a random sample of 792 employed middle-aged Caucasian males who were followed for 8 years. Presciently, 37 years ago, this cohort demonstrated that not all smokers are susceptible to losing lung function and that in the susceptible smokers, continued smoking accelerates loss. As in the Fletcher-Peto cohort, which followed only males, and in the BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) cohort study by CASANOVA et al. [4], in which 92% were male, the study by is heavily weighted to males, with 85% of the younger and 92% of the older patients being male. Data on females were provided by the Framingham Offspring Cohort [5] (4391 community residents followed for 23 years, of whom 51% were females) and by the Lung Health Study [6] (5885 COPD patients followed for o14.5 years, of whom 37% were females). The absence of data on females renders the study by less applicable to population analysis for rates of change in forced expiratory volume in 1 s (FEV1). The Framingham cohort showed a lower decline in females who continued to smoke compared with males (23.9 versus 38.2 mL?yr -1 ), and fewer female smokers who developed airflow obstruction (24.2%) than male smokers (33.0%) [5].Many of the core findings of FLETCHER and PETO [1] have been confirmed in studies of smokers and/or COPD patients published since their report. A range of susceptible smokers develop airflow obstruction. This range is fairly consistent considering the differences in subject selection: 42-46% of the clinical COPD patients in the study by , excluding any with bronchial responsiveness; 33% of males (24% of females) in the Framingham cohort [5]; 25% of the Nishimura group, most of whom had mild-to-moderate COPD [7]; and 18% in the BODE cohort [4] of ''well-characterised'' COPD patients (mean forced expiratory volume in 1 s (FEV1) 46% predicted). In...

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Section: @Erspublicationssupporting

confidence: 60%

Section: @Erspublicationsmentioning

confidence: 99%

Section: @Erspublicationsmentioning

confidence: 99%

Section: @Erspublicationsmentioning

confidence: 99%

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The natural history of COPD: confirming and going beyond Fletcher and Peto

Miller

Raskin

2014

Eur Respir J

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“…In them, FEV 1 remains stable or even increased (4,5). However, these results were obtained from follow-ups of only 3 to 5 years, too short a time.…”

Section: To the Editormentioning

confidence: 82%

Reply: Prognostic Value of Functional Decline in Middle-Aged Smokers

Drummond¹,

Wise²

2013

Am J Respir Crit Care Med

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Drummond and colleagues (1) report that smokers with mild to moderate chronic obstructive pulmonary disease (COPD) and worse initial FEV 1 /FVC have a more rapid decrease of FEV 1 and higher rate of death. Only subjects with lower than 70% FEV 1 /FVC ratio are at risk for excessive lung function decline. The main limitation of their study is the only 5 years of followup, so their conclusion that spirometry predicts long-term outcome is not warranted. The authors refer to the previous study by Burrows and colleagues (2) of 13 smokers, with initial FEV 1 /FVC less than 70%, followed for 10 years, but omit another study of 56 middle-aged smokers, followed for 13 years (3), including besides spirometry, airway resistance, maximal expiratory flow rates, and small-airway disease tests such as closing volume and N 2 slope. Both studies showed that subjects with a low FEV 1 /FVC or a low FEV 1 /VC at the entry had a subsequent accelerated loss of FEV 1 . In the article by Burrows and colleagues (2) on 141 male smokers, with an FEV 1 greater than 60% of predicted, followed by spirometry for at least 6 years, initial normal FEV 1 /FVC explained only about 16% of the subsequent decrease of FEV 1 . Similarly, in our study, 79% of smokers with a normal FEV 1 /VC still had normal values (more than 70%) 13 years later (3). Conversely, a decreased FEV 1 /VC has no necessarily serious implication in itself. Indeed, only a minority of our subjects, with lower than 60% FEV 1 /VC, showed an accelerated loss of FEV 1 , reaching end FEV 1 /VC values lower than 45%. An associated high N 2 slope adds the necessary information to predict a low FEV 1 /VC. In agreement with our data, the analysis of Drummond and colleagues (1) showed that excessive lung function decline occurred only below FEV 1 /FVC of 0.65. Both figures of Drummond and colleagues (1) and ours (3) are lower than current thresholds used to define COPD. Our data suggest that a subgroup of smokers in their 50s with a low FEV 1 /VC and a high N 2 slope are probably the susceptible smokers at high risk to develop COPD.Recently it was reported that in some subjects, the progressive decrease with age of FEV 1 is not the rule. In them, FEV 1 remains stable or even increased (4, 5). However, these results were obtained from follow-ups of only 3 to 5 years, too short a time. In 7 out of 56 subjects, over 13 years, FEV 1 either did not change or even increased (3). We thank Dr. Stanescu for his interest in our article describing the association between baseline lung function measurements and longitudinal lung function decline and mortality in over 5,800 smokers from the Lung Health Study (1). Dr. Stanescu and colleagues' prior publication of 13-year follow-up of 56 smokers and ex-smokers (2) was an important foundation for our analysis. We agree that there is substantial heterogeneity in lung function decline, and a single baseline measure does not necessarily predict excessive decline in all persons. Although the individual risk for excessive lung function decline may not be compl...

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Large‐scale plasma proteomics can reveal distinct endotypes in chronic obstructive pulmonary disease and severe asthma

Suzuki

Cole

Konno

et al. 2021

Clinical & Translational All

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Background Chronic airway diseases including chronic obstructive pulmonary disease (COPD) and asthma are heterogenous in nature and endotypes within are underpinned by complex biology. This study aimed to investigate the utility of proteomic profiling of plasma combined with bioinformatic mining, and to define molecular endotypes and expand our knowledge of the underlying biology in chronic respiratory diseases. Methods The plasma proteome was evaluated using an aptamer‐based affinity proteomics platform (SOMAscan®), representing 1238 proteins in 34 subjects with stable COPD and 51 subjects with stable but severe asthma. For each disease, we evaluated a range of clinical/demographic characteristics including bronchodilator reversibility, blood eosinophilia levels, and smoking history. We applied modified bioinformatic approaches used in the evaluation of RNA transcriptomics. Results Subjects with COPD and severe asthma were distinguished from each other by 365 different protein abundancies, with differential pathway networks and upstream modulators. Furthermore, molecular endotypes within each disease could be defined. The protein groups that defined these endotypes had both known and novel biology including groups significantly enriched in exosomal markers derived from immune/inflammatory cells. Finally, we observed associations to clinical characteristics that previously have been under‐explored. Conclusion This investigational study evaluating the plasma proteome in clinically‐phenotyped subjects with chronic airway diseases provides support that such a method can be used to define molecular endotypes and pathobiological mechanisms that underpins these endotypes. It provided new concepts about the complexity of molecular pathways that define these diseases. In the longer term, such information will help to refine treatment options for defined groups.

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

Abstract: Emphysema severity is independently associated with a rapid annual decline in FEV1 in COPD. Sustainers and Rapid decliners warrant specific attention in clinical practice.

Cited by 299 publications

References 39 publications

The natural history of COPD: confirming and going beyond Fletcher and Peto

The natural history of COPD: confirming and going beyond Fletcher and Peto

Reply: Prognostic Value of Functional Decline in Middle-Aged Smokers

Large‐scale plasma proteomics can reveal distinct endotypes in chronic obstructive pulmonary disease and severe asthma

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