Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease

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

Research output: Contribution to journalArticlepeer-review

283 Citations (Scopus)


Rationale: Although the rate of annual decline in FEV 1 is one of the most important outcome measures in chronic obstructive pulmonary disease (COPD), little is known about intersubject variability based on clinical phenotypes. Objectives: To examine the intersubject variability in a 5-year observational cohort study, particularly focusing on emphysema severity. Methods: A total of 279 eligible patients with COPD (stages I-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. Measurements and Main Results: Using mixed effects model analysis, the annual decline in post-bronchodilator FEV 1 was -32 ± 24 (SD) ml/yr (n = 261). We classified the subjects of less than the 25th percentile as Rapid decliners, the 25th to 75th percentile as Slow decliners, and greater than the 75th percentile as Sustainers (-63 ± 2, -31 ± 1, and -2 ± 1 [SE] ml/yr). Emphysema severity, but not %FEV 1, 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 carbon monoxide transfer coefficient. The Sustainers displayed less emphysema and higher levels of circulating eosinophils. Conclusions: Emphysema severity is independently associated with a rapid annual decline in FEV 1 in COPD. Sustainers and Rapid decliners warrant specific attention in clinical practice.

Original languageEnglish
Pages (from-to)44-52
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Issue number1
Publication statusPublished - 2012 Jan 1
Externally publishedYes


  • Annual decline in FEV
  • Diffusing capacity
  • Emphysema
  • Rapid declines
  • Sustainers

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


Dive into the research topics of 'Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease'. Together they form a unique fingerprint.

Cite this