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Clinical Trial Report

Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis

Igor Z Barjaktarevic1 Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

Russell G Buhr1 Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA;2 Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA

https://orcid.org/0000-0001-6159-7435

Xiaoyan Wang3 Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA

Scott Hu1 Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

David Couper4 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

https://orcid.org/0000-0002-4313-9235

Wayne Anderson4 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

Richard E Kanner5 Department of Medicine, University of Utah, Salt Lake City, UT, USA

https://orcid.org/0000-0001-6915-599X

Robert Paine III5 Department of Medicine, University of Utah, Salt Lake City, UT, USA

Surya P Bhatt6 Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

https://orcid.org/0000-0002-8418-4497

Nirav R Bhakta7 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

https://orcid.org/0000-0002-2135-7012

Mehrdad Arjomandi7 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

https://orcid.org/0000-0002-0116-9217

Robert J Kaner8 Department of Medicine, Weill Cornell Weill Cornell Medical Center, New York, NY, USA

https://orcid.org/0000-0003-0527-576X

Cheryl S Pirozzi5 Department of Medicine, University of Utah, Salt Lake City, UT, USA

https://orcid.org/0000-0002-1533-1916

Jeffrey L Curtis9 Department of Medicine, University of Michigan, Ann Arbor, MI, USA;10 Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

https://orcid.org/0000-0001-5191-4847

Wanda K O’Neal4 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

Prescott G Woodruff7 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

MeiLan K Han9 Department of Medicine, University of Michigan, Ann Arbor, MI, USA

Fernando J Martinez8 Department of Medicine, Weill Cornell Weill Cornell Medical Center, New York, NY, USA

https://orcid.org/0000-0002-2412-3182

Nadia Hansel11 Department of Medicine, John Hopkins University, Baltimore, MD, USA

James Michael Wells6 Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

Victor E Ortega12 Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA

Eric A Hoffman13 Department of Medicine, University of Iowa, Iowa City, IA, USA

https://orcid.org/0000-0001-8456-9437

Claire M Doerschuk4 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

Victor Kim14 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

https://orcid.org/0000-0002-1385-1571

Mark T Dransfield6 Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

M Bradley Drummond4 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

https://orcid.org/0000-0002-6968-4610

Russell Bowler15 Department of Medicine, National Jewish Health Systems, Denver, CO, USA

Gerard Criner14 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA

Stephanie A Christenson7 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

Bonnie Ronish5 Department of Medicine, University of Utah, Salt Lake City, UT, USA

Stephen P Peters12 Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA

https://orcid.org/0000-0003-4176-7999

Jerry A Krishnan16 Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA

https://orcid.org/0000-0001-5525-4778

Donald P Tashkin1 Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

Christopher B Cooper1 Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USACorrespondence[email protected]

& On behalf of the NHLBI SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) show all

Figures & data

Table 1 Demographic Data in SPIROMICS Cohort

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Figure 1 Overall BDR defined by different spirometric measures in the SPIROMICS cohort.

Table 2 Baseline Clinical Characteristics of FVC-BD Responders and FVC-BD Nonresponders

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Figure 2 Distribution of flow (FEV₁) and volume (FVC) BDR in COPD based on (A) spirometric GOLD grades, (B) GOLD groups defined by symptoms, exacerbations, and spirometric grades (revision 2011), (C) GOLD groups defined by symptoms and exacerbations only (revision 2019), and (D) percentage emphysema <−950 HU.

Figure 2 Distribution of flow (FEV1) and volume (FVC) BDR in COPD based on (A) spirometric GOLD grades, (B) GOLD groups defined by symptoms, exacerbations, and spirometric grades (revision 2011), (C) GOLD groups defined by symptoms and exacerbations only (revision 2019), and (D) percentage emphysema <−950 HU.

Figure 3 Parametric Response Mapping analysis. The extent of small airway disease (PRM^fSAD) shows that FVC-BD responders have more PRM^fSAD on functional imaging in comparison to FVC-BD nonresponders. There is no difference between FEV₁ BD responders and nonresponders in the extent pf PRM^fsad.

Figure 4 Kaplan–Meier plot of overall survival up to 3 years: FVC-BD responders (88.1%) vs FVC-BD nonresponders (91.7%) (P<0.05).

Figure 5 Comparison of isolated BDR_FVC among individuals with COPD in comparison to dual FVC and FEV₁ BDR, isolated BDR_FEV1 without BDR_FVC and complete nonresponsiveness by either FEV₁ or FVC: (A) FVC-BD responders who do not show BDR_FEV1 have more emphysema in comparison to the other three groups, (B) FVC-BD responders who do not show BDR_FEV1 have a higher median rate of exacerbations in comparison to the other groups.

Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis

Table 1 Demographic Data in SPIROMICS Cohort

Table 2 Baseline Clinical Characteristics of FVC-BD Responders and FVC-BD Nonresponders

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Clinical Significance of Bronchodilator Responsiveness Evaluated by Forced Vital Capacity in COPD: SPIROMICS Cohort Analysis

Figures & data

Table 1 Demographic Data in SPIROMICS Cohort

Table 2 Baseline Clinical Characteristics of FVC-BD Responders and FVC-BD Nonresponders

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