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
- Affiliations
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- 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- 3Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- 5Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- 6Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
- 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea
- 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- 9Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- 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.
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