Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China
Abstract Background Small airway dysfunction (SAD) is common but little is known about the longitudinal prognosis of spirometry-defined SAD. Therefore, we aimed to evaluate the risk of lung function decline and incident chronic obstructive pulmonary disease (COPD) of spirometry-defined SAD. Methods...
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2025-04-01
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| Online Access: | https://doi.org/10.1186/s12931-025-03244-3 |
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| author | Yumin Zhou Fan Wu Zhishan Deng Zihui Wang Heshen Tian Peiyu Huang Youlan Zheng Huajing Yang Ningning Zhao Cuiqiong Dai Changli Yang Shuqing Yu Jia Tian Jiangyu Cui Shengming Liu Dali Wang Xiaoping Wang Jiachun Lu Nanshan Zhong Pixin Ran |
| author_facet | Yumin Zhou Fan Wu Zhishan Deng Zihui Wang Heshen Tian Peiyu Huang Youlan Zheng Huajing Yang Ningning Zhao Cuiqiong Dai Changli Yang Shuqing Yu Jia Tian Jiangyu Cui Shengming Liu Dali Wang Xiaoping Wang Jiachun Lu Nanshan Zhong Pixin Ran |
| author_sort | Yumin Zhou |
| collection | DOAJ |
| description | Abstract Background Small airway dysfunction (SAD) is common but little is known about the longitudinal prognosis of spirometry-defined SAD. Therefore, we aimed to evaluate the risk of lung function decline and incident chronic obstructive pulmonary disease (COPD) of spirometry-defined SAD. Methods It was a population-based prospective cohort study conducted in Guangdong, China. Participants were enrolled in the years 2002, 2008, 2012, 2017, and 2019, and those who completed baseline demographic data, a standardized epidemiological questionnaire for COPD, and spirometry were included. Follow-up visits were conducted every three years after enrolment, with a maximum follow-up time of 15 years and a minimum follow-up time of 3 years. Spirometry-defined SAD was defined as having at least two out of three parameters (maximal mid-expiratory flow, forced expiratory flow 50%, and forced expiratory flow 75%) below 65% of the predicted value. Non-obstructive SAD and obstructive SAD were further differentiated based on the presence of airflow obstruction (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] < 0.70). Pre- and post-bronchodilator spirometry measurements were analyzed separately. Results Pre-bronchodilator spirometry dataset included 4680 participants (mean age 55.3 [10.8] years, 2194 [46.9%] males). Participants with pre-bronchodilator SAD had a significantly faster annual decline of FEV1 % of predicted value (0.31 ± 0.05 vs. 0.20 ± 0.03 %/year; difference: 0.12 [95% confidence interval: 0.01–0.23]; P = 0.023), FVC, and FVC % of predicted value compared to those without pre-bronchodilator SAD. The annual decline of lung function in participants with pre-bronchodilator non-obstructive SAD was not significantly different from that in pre-bronchodilator healthy controls, but they were more likely to progress to spirometry-defined COPD (adjusted hazard ratio: 2.92 [95% confidence interval: 2.28–3.76], P < 0.001). Post-bronchodilator spirometry dataset yielded similar results. Conclusions Individuals with spirometry-defined SAD have a faster decline in lung function compared to those without SAD, and non-obstructive SAD is more likely to progress to spirometry-defined COPD. Trial registration Chinese Clinical Trials Registration ChiCTR1900024643. Registered on 19 July 2019. |
| format | Article |
| id | doaj-art-d054f5813ec6460aa5b95e266fa70149 |
| institution | DOAJ |
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| publishDate | 2025-04-01 |
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| spelling | doaj-art-d054f5813ec6460aa5b95e266fa701492025-08-20T02:55:29ZengBMCRespiratory Research1465-993X2025-04-0126111110.1186/s12931-025-03244-3Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in ChinaYumin Zhou0Fan Wu1Zhishan Deng2Zihui Wang3Heshen Tian4Peiyu Huang5Youlan Zheng6Huajing Yang7Ningning Zhao8Cuiqiong Dai9Changli Yang10Shuqing Yu11Jia Tian12Jiangyu Cui13Shengming Liu14Dali Wang15Xiaoping Wang16Jiachun Lu17Nanshan Zhong18Pixin Ran19State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Wengyuan County People’s HospitalLianping County People’s Hospital, Lianping County Hospital of Traditional Chinese MedicineDepartment of Pulmonary and Critical Care Medicine, The Second People’s Hospital of Hunan ProvinceState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityDepartment of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Jinan UniversityThe Second Hospital of Liwan District of GuangzhouThe First Municipal People Hospital of ShaoguanState Key Laboratory of Respiratory Disease, Institute of Public Health, Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityState Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical UniversityAbstract Background Small airway dysfunction (SAD) is common but little is known about the longitudinal prognosis of spirometry-defined SAD. Therefore, we aimed to evaluate the risk of lung function decline and incident chronic obstructive pulmonary disease (COPD) of spirometry-defined SAD. Methods It was a population-based prospective cohort study conducted in Guangdong, China. Participants were enrolled in the years 2002, 2008, 2012, 2017, and 2019, and those who completed baseline demographic data, a standardized epidemiological questionnaire for COPD, and spirometry were included. Follow-up visits were conducted every three years after enrolment, with a maximum follow-up time of 15 years and a minimum follow-up time of 3 years. Spirometry-defined SAD was defined as having at least two out of three parameters (maximal mid-expiratory flow, forced expiratory flow 50%, and forced expiratory flow 75%) below 65% of the predicted value. Non-obstructive SAD and obstructive SAD were further differentiated based on the presence of airflow obstruction (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] < 0.70). Pre- and post-bronchodilator spirometry measurements were analyzed separately. Results Pre-bronchodilator spirometry dataset included 4680 participants (mean age 55.3 [10.8] years, 2194 [46.9%] males). Participants with pre-bronchodilator SAD had a significantly faster annual decline of FEV1 % of predicted value (0.31 ± 0.05 vs. 0.20 ± 0.03 %/year; difference: 0.12 [95% confidence interval: 0.01–0.23]; P = 0.023), FVC, and FVC % of predicted value compared to those without pre-bronchodilator SAD. The annual decline of lung function in participants with pre-bronchodilator non-obstructive SAD was not significantly different from that in pre-bronchodilator healthy controls, but they were more likely to progress to spirometry-defined COPD (adjusted hazard ratio: 2.92 [95% confidence interval: 2.28–3.76], P < 0.001). Post-bronchodilator spirometry dataset yielded similar results. Conclusions Individuals with spirometry-defined SAD have a faster decline in lung function compared to those without SAD, and non-obstructive SAD is more likely to progress to spirometry-defined COPD. Trial registration Chinese Clinical Trials Registration ChiCTR1900024643. Registered on 19 July 2019.https://doi.org/10.1186/s12931-025-03244-3Small airway dysfunctionSpirometryLung function declineChronic obstructive pulmonary disease |
| spellingShingle | Yumin Zhou Fan Wu Zhishan Deng Zihui Wang Heshen Tian Peiyu Huang Youlan Zheng Huajing Yang Ningning Zhao Cuiqiong Dai Changli Yang Shuqing Yu Jia Tian Jiangyu Cui Shengming Liu Dali Wang Xiaoping Wang Jiachun Lu Nanshan Zhong Pixin Ran Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China Respiratory Research Small airway dysfunction Spirometry Lung function decline Chronic obstructive pulmonary disease |
| title | Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China |
| title_full | Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China |
| title_fullStr | Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China |
| title_full_unstemmed | Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China |
| title_short | Lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry-defined small airway dysfunction: a 15-year prospective cohort study in China |
| title_sort | lung function decline and incidence of chronic obstructive pulmonary disease in participants with spirometry defined small airway dysfunction a 15 year prospective cohort study in china |
| topic | Small airway dysfunction Spirometry Lung function decline Chronic obstructive pulmonary disease |
| url | https://doi.org/10.1186/s12931-025-03244-3 |
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