Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;6(5):414-429.
doi: 10.15326/jcopdf.6.5.2019.0155.

Pulmonary Subtypes Exhibit Differential Global Initiative for Chronic Obstructive Lung Disease Spirometry Stage Progression: The COPDGene® Study

Kendra A Young  1 , Matthew Strand  2 , Margaret F Ragland  3 , Gregory L Kinney  1 , Erin E Austin  4 , Elizabeth A Regan  5 , Katherine E Lowe  1 , Barry J Make  5 , Edwin K Silverman  6 , James D Crapo  5 , John E Hokanson  1 ; COPDGene® Investigators
Affiliations

Pulmonary Subtypes Exhibit Differential Global Initiative for Chronic Obstructive Lung Disease Spirometry Stage Progression: The COPDGene® Study

Kendra A Young et al. Chronic Obstr Pulm Dis. 2019 Nov.

Abstract

Rationale: We classified individuals into pulmonary disease subtypes based on 2 underlying pathophysiologic disease axes (airway-predominant and emphysema-predominant) and their increased mortality risk. Our next objective was to determine whether some subcomponents of these subtypes are additionally associated with unique patterns of Global initiative for chronic Obstructive Lung Disease (GOLD) spirometry stage progression.

Methods: After accounting for intra-individual measurement variability in spirometry measures between baseline (Phase 1) and the 5-year follow up (Phase 2) of the COPD Genetic Epidemiology (COPDGene®) study, 4615 individuals had complete data that would characterize patterns of disease progression over 5 years (2033 non-Hispanic whites; 827 African Americans; 48% female). Individuals could express increased risk for mortality on one or both of the primary subtype axes (airway-predominant or emphysema-predominant) and thus they were further classified into 6 groups: high-risk airway-predominant disease only (APD-only), moderate-risk airway-predominant disease only (MR-APD-only), high-risk emphysema-predominant disease only (EPD-only), combined high-risk airway- and emphysema-predominant disease (combined APD-EPD), combined moderate-risk airway- and emphysema-predominant disease (combined MR-APD-EPD), and no high-risk pulmonary subtype. Outcomes were dichotomized for GOLD spirometry stage progression from Phase 1 to Phase 2. Logistic regression of the progression outcomes on the pulmonary subtypes were adjusted for age, sex, race, and change in smoking status.

Results: The MR-APD-only group was associated with conversion from GOLD 0 to preserved ratio-impaired spirometry (PRISm) status (odds ratio [OR] 11.3, 95% confidence interval [CI] 5.7-22.1) and GOLD 0 to GOLD 2-4 (OR 6.0, 95% CI 2.0-18.0). The EPD-only group was associated with conversion from GOLD 0 to GOLD 1 (OR 2.4, 95% CI 1.2-4.6), and GOLD 1 to GOLD 2-4 (OR 2.6, 95% CI 1.0-6.9). Conversion between PRISm and GOLD 2-4 (31%-38%) occurred in both the APD-only and the MR-APD-only groups.

Conclusion: Differential conversion occurs from GOLD 0 to PRISm and GOLD 0 to GOLD 1 based on groups expressing airway-predominant disease or emphysema-predominant disease independently or in combination. Airway-predominant and emphysema-predominant subtypes are highly important in determining patterns of early disease progression.

Keywords: COPD Genetic Epidemiology study; COPDGene; airway-predominant; chronic obstructive pulmonary disease; copd; emphysema-predominant; progression; spirometry; subtypes.

PubMed Disclaimer

Conflict of interest statement

EKS has received grant and travel support from GlaxoSmithKline. All other authors declare they have no conflicting interests.

References

    1. Friedlander AL,Lynch D,Dyar LA,Bowler RP. Phenotypes of chronic obstructive pulmonary disease. COPD. 2007;4(4):355-384. doi: https://doi.org/10.1080/15412550701629663 - PubMed
    1. Rabe KF,Hurd S,Anzueto A,et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-555. doi: https://doi.org/10.1164/rccm.200703-456SO - PubMed
    1. Menezes AM,Wehrmeister FC,Perez-Padilla R,et al. The PLATINO study: description of the distribution, stability, and mortality according to the Global Initiative for Chronic Obstructive Lung Disease classification from 2007 to 2017. Int J Chron Obstruct Pulmon Dis. 2017;12:1491-1501. doi: https://doi.org/10.2147/COPD.S136023 - PMC - PubMed
    1. Agusti A,Edwards LD,Celli B,et al. Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort. Eur Respir J. 2013;42(3):636-646. doi: https://doi.org/10.1183/09031936.00195212 - PubMed
    1. Goossens LM,Leimer I,Metzdorf N,et al. Does the 2013 GOLD classification improve the ability to predict lung function decline, exacerbations and mortality: a post-hoc analysis of the 4-year UPLIFT trial. BMC Pulm Med. 2014;14:163. doi: https://doi.org/10.1186/1471-2466-14-163 - PMC - PubMed

LinkOut - more resources