Ciro Casanova1, Enrique Gonzalez-Dávila2, Cristina Martínez-Gonzalez3, Borja G Cosio4, Antonia Fuster5, Nuria Feu6, Ingrid Solanes7, Carlos Cabrera8, José M Marin9, Eva Balcells10, Germán Peces-Barba11, Juan P de Torres12, Marta Marín-Oto13, Myriam Calle14, Rafael Golpe15, Elena Ojeda16, Miguel Divo17, Victor Pinto-Plata18, Carlos Amado19, José Luis López-Campos20, Bartolome R Celli17. 1. Pulmonary Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain; Pulmonary Department, Universidad de La Laguna, Tenerife, Spain. Electronic address: casanovaciro@gmail.com. 2. Pulmonary Department, Universidad de La Laguna, Tenerife, Spain. 3. Pulmonary Department, Hospital Central de Asturias, Oviedo, Spain. 4. Pulmonary Department, Hospital Son Espases-l'Institut d'Investigació Sanitària de les Illes Balears, Palma de Mallorca, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. 5. Pulmonary Department, Hospital Son Llátzer, Palma de Mallorca, Spain. 6. Pulmonary Department, Hospital Universitario Reina Sofia, IMIBIC, UCO, Córdoba, Spain. 7. Pulmonary Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain. 8. Pulmonary Department, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain. 9. Pulmonary Department, Hospital Universitario Miguel Servet, Saragossa, Spain. 10. Pulmonary Department, Hospital del Mar, Barcelona, Spain. 11. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Pulmonary Department, Fundación Jimenez Díaz, Madrid, Spain. 12. Pulmonary Department, Kingston General Hospital, Kingston, ON, Canada. 13. Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain. 14. Pulmonary Department, Hospital Clínico San Carlos, Madrid, Spain. 15. Pulmonary Department, Hospital Lucus Agusti, Lugo, Spain. 16. Pulmonary Department, Hospital Gregorio Marañón, Madrid, Spain. 17. Pulmonary and Critical Care Department, Brigham and Women's Hospital, Boston, MA. 18. Baystate Medical Center, Springfield, MA. 19. Pulmonary Department, Hospital Marqués de Valdecilla, Santander, Spain. 20. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Seville, Spain.
Abstract
BACKGROUND: The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression. RESEARCH QUESTION: What is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression? STUDY DESIGN AND METHODS: We phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time. RESULTS: The mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV1 % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039). INTERPRETATION: Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
BACKGROUND: The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression. RESEARCH QUESTION: What is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression? STUDY DESIGN AND METHODS: We phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time. RESULTS: The mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV1 % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039). INTERPRETATION: Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
Authors: Franziska C Trudzinski; Rudolf A Jörres; Peter Alter; Julia Walter; Henrik Watz; Andrea Koch; Matthias John; Marek Lommatzsch; Claus F Vogelmeier; Hans-Ulrich Kauczor; Tobias Welte; Jürgen Behr; Amanda Tufman; Robert Bals; Felix J F Herth; Kathrin Kahnert Journal: Sci Rep Date: 2022-05-24 Impact factor: 4.996