J Korean Med Sci.  2025 Feb;40(6):e32. 10.3346/jkms.2025.40.e32.

Risk Factors of FEV 1 /FVC Decline in COPD Patients

• Kim NY
• Kim DK
• Park S
• Hwang YI
• Seo H
• Park D
• Park SJ
• Lee JH
• Yoo KH
• Lee HW

• KMID: 2565148
• DOI: http://doi.org/10.3346/jkms.2025.40.e32

Abstract

Background
Factors influencing the decline in forced expiratory volume in one second (FEV₁ )/forced vital capacity (FVC) for chronic obstructive pulmonary disease (COPD) progression remain uncertain. We aimed to identify risk factors associated with rapid FEV₁ / FVC decline in patients with COPD.
Methods
This multi-center observational study was conducted from January 2012 to December 2022. Eligible patients were monitored with symptoms, spirometric tests, and treatment patterns over 3 years. Rapid FEV₁ /FVC decliners were defined as the quartile of patients exhibiting the highest annualized percentage decline in FEV₁ /FVC.
Results
Among 1,725 patients, 435 exhibited rapid FEV₁ /FVC decline, with an annual change of −2.5%p (interquartile range, −3.5 to −2.0). Rapid FEV₁ /FVC decliners exhibited lower body mass index (BMI), higher smoking rates, elevated post-bronchodilator (BD) FEV₁ , higher post-BD FEV₁ / FVC, and a lower prevalence of Staging of Airflow Obstruction by Ratio (STAR) stage IV. Rapid FEV₁ /FVC decline was not linked to the annual exacerbation rate, but there was an association with symptom deterioration and FEV₁ decline. In multivariable analyses, low BMI, current smoking, increased modified Medical Research Council dyspnoea score, low post-BD FEV₁ , low STAR stage, high forced mid-expiratory flow (FEF _25-75% ), accelerated FEV₁ decline, and not initiating dual BD therapy were identified as independent risk factors for rapid FEV₁ /FVC decline.
Conclusion
We identified the risk factors for rapid FEV₁ /FVC decline, including BMI, smoking, symptoms deterioration, FEV₁ decline, and adherence to standard inhaler treatment. Our findings underscore the potential benefits of maintaining consistent use of long-acting beta-agonist/long-acting muscarinic antagonist even in the presence of worsening symptoms, in attenuating FEV₁ /FVC decline.

Keyword

Chronic Obstructive Pulmonary Disease; Cohort Studies; Forced Expiratory Volume; Forced Vital Capacity; Respiratory Function Tests; Risk Factors

Figure

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  Fig. 1 Flow diagram for the inclusion of patients.COPD = chronic obstructive pulmonary disease, FEV1 = forced expiratory volume in 1 second, FVC = forced vital capacity.

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  Fig. 2 Dynamic treatment changes in rapid and non-rapid FEV1/FVC decliners. For the evaluation of dynamic treatment changes, a total of 662 patients were analyzed, comprising 514 in the non-rapid FEV1/FVC group and 148 in the rapid FEV1/FVC group.FEV1 = forced expiratory volume in 1 second, FVC = forced vital capacity, LABA = long-acting beta-agonist, LAMA = long-acting muscarinic antagonist, ICS = inhaled corticosteroid.*P < 0.05.

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