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Role of inspiratory capacity on dyspnea evaluation in COPD with or without emphysematous lesions: a pilot study

Authors Cui L, Ji X, Xie M, Dou S, Wang W, Xiao W

Received 17 May 2017

Accepted for publication 1 August 2017

Published 30 September 2017 Volume 2017:12 Pages 2823—2830

DOI https://doi.org/10.2147/COPD.S142016

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 3

Editor who approved publication: Dr Richard Russell

Liwei Cui,1 Xiuli Ji,2 Mengshuang Xie,1 Shuang Dou,1 Wei Wang,1 Wei Xiao1

1Department of Respiratory Disease, Qilu Hospital, Shandong University, 2Department of Pulmonary Disease, Jinan Traditional Chinese Medicine Hospital, Jinan, People’s Republic of China

Background: Since forced expiratory volume in 1 second (FEV1) shows a weak correlation with patients’ symptoms in COPD, some volume parameters may better reflect the change in dyspnea symptoms after treatment. In this article, we investigated the role of inspiratory capacity (IC) on dyspnea evaluation among COPD patients with or without emphysematous lesions.
Methods: In this prospective study, 124 patients with stable COPD were recruited. During the baseline visit, patients performed pulmonary function tests and dyspnea evaluation using the modified Medical Research Council (mMRC) scale. Partial patients underwent quantitative computerized tomography scans under physicians’ recommendations, and emphysematous changes were assessed using the emphysema index (EI; low attenuation area [LAA]% −950). These subjects were then divided into the emphysema-predominant group (LAA% −950≥9.9%) and the non-emphysema-predominant group (LAA% −950<9.9%). After treatment for ~1 month, subjects returned for reevaluation of both pulmonary function parameters and dyspnea severity. Correlation analysis between the change in IC (∆IC) and dyspnea (∆mMRC) was performed.
Results: Correlation analysis revealed that ∆IC was negatively correlated with ∆mMRC (correlation coefficient [cc], −0.490, P<0.001) in the total study population, which was stronger than that between ∆FEV1 and ∆mMRC (cc, −0.305, P=0.001). Patients with absolute ∆mMRC >1 were more likely to exhibit a marked increase in IC (≥300 mL) than those with absolute ∆mMRC ≤1 (74.36% versus 35.29%; odds ratio [OR], 5.317; P<0.001). In the emphysema-predominant group, only ∆IC strongly correlated with ∆mMRC (cc, −0.459, P=0.005), while ∆FEV1 did not (P>0.05).
Conclusion: IC could serve as an effective complement to FEV1 in COPD patients undergoing dyspnea evaluation after treatment. For COPD patients with predominant emphysematous lesions, an increase in IC is particularly more suitable for explaining dyspnea relief than FEV1.

Keywords: IC, COPD, mMRC score, quantitative computerized tomography, emphysema index

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