{"title":"Clinical and Prognostic Differences in Mild to Moderate COPD With and Without Emphysema.","authors":"Huajing Yang, Yuqiong Yang, Fengyan Wang, Chengyu Miao, Zizheng Chen, Shanshan Zha, Xueping Li, Jiawei Chen, Aiqi Song, Rongchang Chen, Zhenyu Liang","doi":"10.1016/j.chest.2024.10.020","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The clinical and prognostic characteristics of mild-to-moderate COPD with and without emphysema remain inadequately investigated.</p><p><strong>Research question: </strong>Do the clinical and prognostic characteristics differ between mild-to-moderate COPD with and without emphysema?</p><p><strong>Study design and methods: </strong>We obtained clinical data of 989 participants with mild-to-moderate COPD from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). They were categorized into two groups based on their baseline low-attention lung voxels with a density < -950 Hounsfield units of < 5% on CT scans: mild-to-moderate COPD with emphysema (EC) group and mild-to-moderate COPD without emphysema (NEC) group. Linear mixed-effects models were used to assess the differences in the decline of lung function, health-related quality of life, and quantitative CT indexes between these two groups. Zero-inflated negative binomial regressions were used to evaluate the rates of acute respiratory exacerbations between the groups.</p><p><strong>Results: </strong>Among participants with mild-to-moderate COPD, 428 (43.3%) exhibited emphysema on CT scans. The annual decline in FEV<sub>1</sub> was -56.1 mL/y for the EC group and -46.9 mL/y for the NEC group, with a nonsignificant between-group difference of 9.1 mL/y (95% CI, -24.0 to 5.7 mL/y). The rate of emphysema progression in the EC group was significantly lower than in the NEC group (natural logarithm(%LAA<sub>-950</sub>), -0.173%; 95% CI, -0.252% to -0.094%). The EC group also showed a more pronounced annual increase in the St. George's Respiratory Questionnaire score (0.9 points) compared with the NEC group. The EC group had a higher rate of acute respiratory exacerbations (0.36 per person-year) than the NEC group (0.25 per person-year), with a rate ratio of 1.42 (95% CI, 1.27-1.54).</p><p><strong>Interpretation: </strong>The EC group did not have accelerated rates of decline in FEV<sub>1</sub>, but they experienced significantly worse health-related quality of life and a higher rate of acute respiratory exacerbations. The nonemphysema subtype demonstrated increased emphysema progression.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT01969344; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"724-735"},"PeriodicalIF":9.5000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2024.10.020","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The clinical and prognostic characteristics of mild-to-moderate COPD with and without emphysema remain inadequately investigated.
Research question: Do the clinical and prognostic characteristics differ between mild-to-moderate COPD with and without emphysema?
Study design and methods: We obtained clinical data of 989 participants with mild-to-moderate COPD from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). They were categorized into two groups based on their baseline low-attention lung voxels with a density < -950 Hounsfield units of < 5% on CT scans: mild-to-moderate COPD with emphysema (EC) group and mild-to-moderate COPD without emphysema (NEC) group. Linear mixed-effects models were used to assess the differences in the decline of lung function, health-related quality of life, and quantitative CT indexes between these two groups. Zero-inflated negative binomial regressions were used to evaluate the rates of acute respiratory exacerbations between the groups.
Results: Among participants with mild-to-moderate COPD, 428 (43.3%) exhibited emphysema on CT scans. The annual decline in FEV1 was -56.1 mL/y for the EC group and -46.9 mL/y for the NEC group, with a nonsignificant between-group difference of 9.1 mL/y (95% CI, -24.0 to 5.7 mL/y). The rate of emphysema progression in the EC group was significantly lower than in the NEC group (natural logarithm(%LAA-950), -0.173%; 95% CI, -0.252% to -0.094%). The EC group also showed a more pronounced annual increase in the St. George's Respiratory Questionnaire score (0.9 points) compared with the NEC group. The EC group had a higher rate of acute respiratory exacerbations (0.36 per person-year) than the NEC group (0.25 per person-year), with a rate ratio of 1.42 (95% CI, 1.27-1.54).
Interpretation: The EC group did not have accelerated rates of decline in FEV1, but they experienced significantly worse health-related quality of life and a higher rate of acute respiratory exacerbations. The nonemphysema subtype demonstrated increased emphysema progression.
期刊介绍:
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.