title: The rapid FEV(1) decline in chronic obstructive pulmonary disease is associated with predominant emphysema: a longitudinal study.
abstract: BACKGROUND
  Early identification of patients with COPD and prone to more rapid decline in lung function is of particular interest from both a prognostic and therapeutic point of view. The aim of this study was to identify the clinical, functional and imaging characteristics associated with the rapid FEV(1) decline in COPD.
  
  
  METHODS
  Between 2001 and 2005, 131 outpatients with moderate COPD in stable condition under maximum inhaled therapy underwent clinical interview, pulmonary function tests and HRCT imaging of the chest and were followed for at least 3 years.
  
  
  RESULTS
  Twenty-six percent of patients had emphysema detected visually using HRCT. The FEV(1) decline was 42 ± 66 mL/y in the total sample, 88 ± 76 mL/y among rapid decliners and 6 ± 54 mL/y among the other patients. In the univariable analysis, the decline of FEV(1) was positively associated with pack-years (p < 0.05), emphysema at HRCT (p < 0.001), RV (p < 0.05), FRC (p < 0.05), FEV(1) (p < 0.01) at baseline and with number of hospitalizations per year (p < 0.05) during the follow-up. Using multivariable analysis, the presence of emphysema proved to be an independent prognostic factor of rapid decline (p = 0.001). When emphysema was replaced by RV, the model still remained significant.
  
  
  CONCLUSIONS
  The rapid decline in lung function may be identified by the presence of emphysema at HRCT or increased RV in patients with a long smoking history.
authors.affiliation: Division of Respiratory Diseases, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Isa
authors.initials: I
authors.lastname: Cerveri
authors.forename: Angelo G
authors.initials: AG
authors.lastname: Corsico
authors.forename: Amelia
authors.initials: A
authors.lastname: Grosso
authors.forename: Federica
authors.initials: F
authors.lastname: Albicini
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ronzoni
authors.forename: Bianca
authors.initials: B
authors.lastname: Tripon
authors.forename: Federica
authors.initials: F
authors.lastname: Imberti
authors.forename: Thomas
authors.initials: T
authors.lastname: Galasso
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Maurizio
authors.initials: M
authors.lastname: Luisetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Pistolesi
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012115:Residual Volume; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed