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
. 2024 Nov-Dec:234:107850.
doi: 10.1016/j.rmed.2024.107850. Epub 2024 Oct 31.

Defining a phenotype of severe COPD patients who develop chronic hypercapnia

Renzo Boersma  1 , Jens T Bakker  2 , Maaike de Vries  3 , Tim Raveling  2 , Dirk-Jan Slebos  2 , Peter J Wijkstra  2 , Jorine E Hartman  2 , Marieke L Duiverman  2
Affiliations
Free article

Defining a phenotype of severe COPD patients who develop chronic hypercapnia

Renzo Boersma et al. Respir Med. 2024 Nov-Dec.
Free article

Abstract

Introduction: Chronic hypercapnia, defined by elevated blood CO2 levels, is a serious complication most prevalent in severe COPD. It negatively impacts quality of life, increases hospitalization rates, and elevates mortality risks. However, not all severe COPD patients develop chronic hypercapnia, and its underlying mechanisms remain unclear. Identifying clinical and pathophysiological predictors of hypercapnia is essential for tailored treatment strategies. This study investigates the relationship between hypercapnia and patient characteristics, lung function, and CT scan features to identify potential therapeutic targets.

Methods: This cross-sectional study included 1526 COPD patients from three cohorts: a standard care cohort and two research cohorts (NCT04023409; NCT03053973). Data collected included demographic and clinical information, blood gases, lung function (FEV1, FVC, TLC, RV, DLCOc), and high-resolution CT scans (lung volumes, air trapping, emphysema scores, airway wall thickness (Pi10), and diaphragm indices).

Results: Hypercapnia prevalence increased with COPD severity. Hypercapnic patients were older, more likely to smoke, and had more comorbidities. They exhibited lower FEV1 and FVC, and higher RV/TLC ratios, with CT scans showing lower emphysema scores and greater Pi10. Multivariate analysis identified lower PaO2, FEV1% predicted, and emphysema scores, along with higher RV/TLC ratios and NT-proBNP levels, as independent predictors of PaCO2, collectively explaining 46.3 % of the variance.

Conclusion: COPD patients with chronic hypercapnia are characterized by higher smoking rates, lower PaO2 levels, poorer lung function, less emphysema, and increased airway pathology. These findings underscore the multifactorial nature of hypercapnia in COPD, highlighting the need for personalized therapeutic strategies targeting these factors to improve outcomes.

Keywords: COPD; Computed tomography; Emphysema; Hypercapnia; Lung function.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dirk-Jan Slebos reports relationships with PulmonX Corp, USA (consulting or advisory, funding grants, speaking and lecture fees, and travel reimbursement), Nuvaira, USA (consulting or advisory, funding grants, and speaking and lecture fees), PulmAir, USA (funding grants), Apreo, USA (consulting or advisory and funding grants), MoreAir, USA (consulting or advisory), and FreeFlowMedical, USA (funding grants). Peter J. Wijkstra reports a relationship with the European Respiratory Society (board membership), ResMed (funding grants), and Philips (consulting or advisory and funding grants). Marieke L. Duiverman reports relationships with Vivisol (funding grants and speaking and lecture fees), ResMed (funding grants), Fisher & Paykel (funding grants), Löwenstein B.V. (funding grants), Sencure B.V. (funding grants), Chiesi (speaking and lecture fees), Breas (speaking and lecture fees), and AstraZeneca (speaking and lecture fees). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

MeSH terms

Associated data