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- Title
FEV<sub>1</sub>/FVC Severity Stages for Chronic Obstructive Pulmonary Disease.
- Authors
Bhatt, Surya P.; Nakhmani, Arie; Fortis, Spyridon; Strand, Matthew J.; Silverman, Edwin K.; Sciurba, Frank C.; Bodduluri, Sandeep
- Abstract
Rationale: The diagnosis of chronic obstructive pulmonary disease (COPD) is based on a low FEV1/FVC ratio, but the severity of COPD is classified using FEV1% predicted (ppFEV1). Objectives: To test a new severity classification scheme for COPD using FEV1/FVC ratio, a more robust measure of airflow obstruction than ppFEV1. Methods: In COPDGene (Genetic Epidemiology of COPD) (N= 10,132), the severity of airflow obstruction was categorized by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1--4 (ppFEV1 of >80%, >50--80%, >30--50%, and,30%). A new severity classification (STaging of Airflow obstruction by Ratio; STAR) was tested in COPDGene--FEV1/ FVC >0.60 to,0.70, >0.50 to,0.60, >0.40 to,0.50, and,0.40, respectively, for stages 1--4--andappliedtothecombinedPittsburgh SCCOR and Emphysema COPD Research Registry for replication (N= 2,017). Measurements and Main Results: The agreements (weighted Bangdiwala B values) between GOLD and the new FEV1/FVC ratio severity stages were 0.89 in COPDGene and 0.88 in the Pittsburgh cohort. In COPDGene and the Pittsburgh cohort, compared with GOLD staging, STAR provided significant discrimination between the absence of airflow obstruction and stage 1 for all-cause mortality, respiratory quality of life, dyspnea, airway wall thickness, exacerbations, and lung function decline. No major differences were noted for emphysema, small airway disease, and 6-minute-walk distance. The STAR classification system identified a greater number of adults with stage 3/4 disease who would be eligible for lung transplantation and lung volume reduction procedure evaluations. Conclusions: The new STAR severity classification scheme provides discrimination for mortality that is similar to the GOLD classification but with a more uniform gradation of disease severity. STAR differentiates patients' symptoms, disease burden, and prognosis better than the existing scheme based on ppFEV1, and is less sensitive to race/ethnicity and other demographic characteristics.
- Subjects
PITTSBURGH (Pa.); CHRONIC obstructive pulmonary disease; OBSTRUCTIVE lung diseases; RESPIRATORY obstructions; RACE; LUNG volume
- Publication
American Journal of Respiratory & Critical Care Medicine, 2023, Vol 208, Issue 6, p676
- ISSN
1073-449X
- Publication type
Article
- DOI
10.1164/rccm.202303-0450OC