J Korean Med Sci.  2015 Oct;30(10):1459-1465. 10.3346/jkms.2015.30.10.1459.

The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease

• Shin TR
• Oh YM
• Park JH
• Lee KS
• Oh S
• Kang DR
• Sheen S
• Seo JB
• Yoo KH
• Lee JH
• Kim TH
• Lim SY
• Yoon HI
• Rhee CK
• Choe KH
• Lee JS
• Lee SD

• KMID: 2344179
• DOI: http://doi.org/10.3346/jkms.2015.30.10.1459

Abstract

The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC > or = 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P < 0.001), higher St. George Respiratory Questionnaire (SGRQ) score (P = 0.019), and higher emphysema index (P = 0.010) were associated independently with resting hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P < 0.001) were independent predictors of all-cause mortality. Our data showed that older age, higher emphysema index, higher SGRQ score, and lower FEV1 were associated independently with resting pulmonary hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.

Keyword

COPD; Hyperinflation; Survival; Residual Volume; Total Lung Capacity

MeSH Terms

Aged
Dyspnea/diagnosis/physiopathology
Exercise Test
Exercise Tolerance
Female
Forced Expiratory Flow Rates/physiology
Forced Expiratory Volume
Humans
Lung/*physiopathology
Male
Middle Aged
Prognosis
Pulmonary Disease, Chronic Obstructive/*diagnosis/mortality/physiopathology
Pulmonary Emphysema/*diagnosis/mortality/physiopathology
Republic of Korea
Residual Volume/*physiology
Respiratory Function Tests
Surveys and Questionnaires
Total Lung Capacity/*physiology
Vital Capacity
Walking/physiology

Figure

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  Fig. 1 Flow diagram of the subjects who were enrolled in this study.

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  Fig. 2 Rate of hyperinflators (RV/TLC ≥ 40%) according to FEV1.

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  Fig. 3 Rate of frequent exacerbations according to RV/TLC. Frequency of frequent exacerbations in (A) the year before enrollment and (B) during the first year of follow-up. RV/TLC, residual volume/total lung capacity.

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