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Title: Disproportionally Impaired Diffusion Capacity Relative to Airflow Limitation in COPD
Authors: Tanabe, Naoya
Rhee, Kook, Chin
Sato, Susumu  kyouindb  KAKEN_id  orcid (unconfirmed)
Muro, Shigeo
Shima, Hiroshi
Tanimura, Kazuya
Jung, Ki-Suck
Yoo, Ha, Kwang
Hirai, Toyohiro
Author's alias: 田辺, 直也
佐藤, 晋
平井, 豊博
Keywords: Chronic obstructive pulmonary disease
computed tomography
pulmonary function
Issue Date: 23-Nov-2020
Publisher: Taylor & Francis Group
Journal title: COPD: Journal of Chronic Obstructive Pulmonary Disease
Volume: 17
Issue: 6
Start page: 627
End page: 634
Abstract: Forced expiratory volume in 1 s (FEV₁) is a standard physiological index of chronic obstructive pulmonary disease (COPD), but reflects emphysema and vascular abnormalities less sensitively than diffusion capacity for carbon monoxide (D_LCO). This study tested whether a disproportionally impaired D_LCO relative to FEV₁ (FEV₁ z-score>-3 and D_LCO z-score≤-3) is a common functional COPD phenotype associated with distinct clinical and structural features and the prognosis of two cohorts. The cross-sectional analyses of the Korea COPD Subgroup Study (KOCOSS) cohort (multicenter study in Korea) included 743 males with COPD whose D_LCO was available. The cross-sectional and longitudinal analyses of the Kyoto University Cohort (single-center study in Japan) included 195 males with COPD who were prospectively followed for 10 years. A disproportionally impaired D_LCO relative to FEV₁ was observed in 29% and 31% of patients in the KOCOSS and Kyoto University cohorts, respectively. In the multivariable analysis, the disproportionally impaired D_LCO was associated with worse symptoms, shorter 6-minute walking distance, paraseptal and centrilobular emphysema on computed tomography, and reduced arterial oxygen and carbon dioxide pressures compared to the reference (FEV₁ z-score>-3 and D_LCO z-score>-3). In the multivariable Cox proportional hazard model, a higher long-term mortality was observed in the disproportionally impaired D_LCO group than in the reference group (hazard ratio [95% confidence interval] = 3.09 [1.52–6.29]) and similar to the D_LCO z-score≤-3 and FEV₁ z-score≤-3 group. The disproportionally impaired D_LCO relative to FEV₁ is common and associated with increased symptoms, emphysema, arterial blood gas abnormalities, and increased long-term mortality in patients with COPD.
Rights: This is an Accepted Manuscript of an article published by Taylor & Francis in 'COPD: Journal of Chronic Obstructive Pulmonary Disease' on 2020, available online:
The full-text file will be made open to the public on 23 Nov 2021 in accordance with publisher's 'Terms and Conditions for Self-Archiving'
This is not the published version. Please cite only the published version.
DOI(Published Version): 10.1080/15412555.2020.1845639
PubMed ID: 33222554
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