Longitudinal changes in lung hyperinflation in COPD

PURPOSE: COPD is characterized by an accelerated and progressive decline in forced expiratory volume in 1 second (FEV(1)) and lung hyperinflation. Although lung hyperinflation is the hallmark of COPD, data on the longitudinal changes in lung hyperinflation and any association with the decline in FEV(1) are lacking. The aim of this study was to evaluate the longitudinal changes in lung hyperinflation and to investigate its relationship with FEV(1) decline. PATIENTS AND METHODS: We conducted a prospective cohort study and studied 176 COPD patients with annual lung volume measurements over a period of 5 years or more. We used a random coefficient model to calculate the annual changes in lung volumes and to evaluate the factors associated with changes in lung hyperinflation. Additionally, the relationship between the change in lung hyperinflation and FEV(1) was assessed. RESULTS: Residual volume (RV), inspiratory capacity (IC), and total lung capacity (TLC) declined at a mean rate of 39.5, 49.6, and 63.8 mL/year, respectively. While IC/TLC declined at 0.70%/year, RV/TLC also declined at 0.35%/year. Changes in both IC/TLC and RV/TLC varied significantly. Frequent exacerbations led to an increase in RV/TLC and faster decline in IC/TLC over time. RV/TLC declined in 59.7% and increased in 40.3% of the patients. A significant negative correlation was found between the rates of change in FEV(1) and RV/TLC, and the rate of decline in FEV(1) was greater in patients with an increase in RV/TLC than in those with a decline in RV/TLC (54.2 vs 10.7 mL/year, P<0.001). CONCLUSION: The rate of change in lung hyperinflation varied greatly among COPD patients. Progression of hyperinflation was associated with frequent exacerbations and a faster decline in FEV(1).