ATS 2023 Abstract Exploring Markers of COPD Progression and Incidence

COPD is characterized by progressive lung damage and dyspnea over time in affected individuals, with many clinical manifestations as the disease progresses.

at the 2023 symposium American Thoracic Society International ConferenceHeld May 20-24 in Washington, D.C., researchers COPD and progress markers.

Predict future lung health from baseline lung function

Overall lung health is usually judged by measuring forced expiratory volume in one second (FEV).₁), with a decrease in FEV₁ Risk of COPD increases over time. However, baseline FEV₁ Research as a predictor of long-term respiratory disease and overall health outcomes is understudied, according to the first abstract presented at the session.¹

The researchers hypothesized that the baseline FEV might be low or high.₁ (LLF or HLF) may be an indicator of future lung health in young patients, and we tested this theory in a cohort of 532 Lovelace Smoker Cohort (LSC) participants aged 40 to 60 years. .

All patients had FEV after bronchodilators₁/forced vital capacity (FVC) ≥ 0.7 and were stratified into HLF groups (mean FEV).₁ 105% of predicted value) and LLF group (mean FEV₁ 73% predicted). After 11 years, 56 patients in the HLF group and 24 participants in his LLF group were evaluated, and he had a mean follow-up of 5.5 years.

People in the HLF group observed FEV₁ A reduction of 30 ml versus 20 ml per year in the LLF group. People in the LLF group had a higher incidence of COPD (9% vs. 3%) and a higher risk of death (18% vs. 6%) in him compared with his HLF group. The LLF group also had higher rates of diabetes (13% vs. 4%) and chronic bronchitis (36% vs. 25%).

After adjustment, those with LLF at baseline had a higher risk of COPD, diabetes, hypertension, cardiovascular disease, and death. The findings support the use of spirometry to monitor health status over time in nondisabled smokers.

Effect of exacerbated breathing on lung function in people with normal spirometry

The authors of another abstract said that the effects of exacerbation of respiratory disease were less clear in people with normal spirometry. 2 This study investigated the association between lung function decline and exacerbation in patients from the COPDGene study at least 10 pack years.Former smokers with normal lung function (FEV)₁/FVC <0.7 and/or FEV₁ predicted < 80% at enrollment).

In the study population (n = 2628), all had normal lung function at enrollment and annual exacerbations were associated with COPD at the 5-year follow-up visit, with an odds ratio of 1.32 (95 % CI, 1). -1.74, P. = .045). However, severe exacerbations per year did not show a statistically significant association with his COPD at Visit 2.

“While exacerbations between Visits 1 and 2 were associated with increased mortality, the relationship between respiratory exacerbations and mortality was not significantly affected by COPD incidence during Visit 2. ,” the authors write.

Overall, they concluded that respiratory exacerbation in individuals with normal spirometry causes lung function deterioration and COPD but predicts mortality without first progressing to COPD.

Factors affecting COPD-specific mortality in new risk models

In another abstract presented during the symposium, the authors wrote that although there is a prognostic risk score for COPD, most models are for overall mortality, not COPD-specific mortality. , categorical variables, and censored variables. “

They applied this model to patients in phases 1 and 2 of the COPDGene study to characterize clinical, imaging, and blood-derived gene expression associated with overall and adjudicated COPD-related mortality. I learned.

Overall and COPD-specific mortality was associated with four characteristics: age, 6-minute walking distance (6MWD), resting oxygen saturation, and standard deviation of lung attenuation from CT imaging. .

The feature associated with COPD-specific mortality in the phase 1 group was FEV₁/FVC and ATS/ERS classification of COPD severity. Factors contributing to overall mortality were BMI, heart rate, duration of smoking and overall health status. In the phase 2 group, 6MWD was associated with COPD-specific and overall mortality, and age and airway wall thickness were associated with COPD-specific mortality.gene expression marker flannel 2 and GRB10 was directly associated with overall mortality in the phase 2 cohort, NRG1 It was directly associated with COPD-specific mortality.

The authors concluded that this new method could identify key features associated with COPD-specific mortality, overall mortality, or both.

Abstracts presented at the session considered additional markers, including gene expression and microbiome profiles, highlighting the need for further research in this area and the search for additional markers for COPD and other lung diseases. .

References

1. Tesfaigzi Y, Brown MN, Liu C, et al. FEV₁ As a predictor of future health status in young non-obstructive smokers. Abstract presented at the American Thoracic Society International Conference. May 20-24, 2023. Washington DC. Accessed May 23, 2023. https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A4200

2. Fortis S, Strand M, Bat SP, et al. Smoke-exposed people with normal spirometry have worse breathing and decreased lung function. Abstract presented at the American Thoracic Society International Conference. May 20-24, 2023. Washington DC. Accessed May 23, 2023. https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A4202

3. Lovelace TC, Venos PV. Unravel predictors of global and COPD-specific mortality using probabilistic graphical models. Abstract presented at the American Thoracic Society International Conference. May 20-24, 2023. Washington DC. Accessed May 23, 2023. https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A4208