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Purpose: <p> Spirometry, the standard for diagnosing chronic obstructive pulmonary disease, has limited sensitivity for early identification of tobacco-exposed individuals with preserved spirometry (TEPS) at risk for respiratory decline. We aimed to determine whether abnormalities in residual volume to total lung capacity ratio (RV/TLC) and total lung capacity (TLC) identify TEPS at higher risk of subsequent spirometric decline. </p> Methods: <p> 1986 tobacco-exposed individuals (≥ 25&#xa0;years, ≥ 10 pack-years) with preserved spirometry (FEV<sub>1</sub>/FVC ≥ lower limit of normal, z-scores, ≥ − 1.645) over ≥ 4&#xa0;years follow-up from the population-based Austrian LEAD study were analysed. Participants were stratified by into four groups according to RV/TLC and TLC abnormalities. </p> Results: <p> High RV/TLC (≥ upper limit of normal, ULN, z-scores &gt; + 1.645) was present in 6.5% of TEPS, predominantly with normal TLC (87.6%) and associated with greater smoking intensity. Notably, elevated RV/TLC associated with disproportionate declines in FEV1/FVC driven by discordant reductions in FEV<sub>1</sub> and increases in FVC. While FEV<sub>1</sub> z-scores remained largely normal, RV/TLC variability was pronounced, suggesting its potential as an early marker of pre-COPD progression. </p> Conclusion: <p> These findings underscore the limitations of spirometry alone and advocate for routine lung volume assessment in at-risk smokers. </p>

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Lung Volumes in Tobacco-Exposed Individuals with Preserved Spirometry: An Overlooked Pointer of Respiratory Health?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月14日

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  • Charmaine J. M. Lim,
  • Emiel F. M. Wouters,
  • Tobias L. Mraz,
  • Charles G. Irvin,
  • Marie-Kathrin Breyer,
  • Robab Breyer-Kohansal

摘要

Purpose:

Spirometry, the standard for diagnosing chronic obstructive pulmonary disease, has limited sensitivity for early identification of tobacco-exposed individuals with preserved spirometry (TEPS) at risk for respiratory decline. We aimed to determine whether abnormalities in residual volume to total lung capacity ratio (RV/TLC) and total lung capacity (TLC) identify TEPS at higher risk of subsequent spirometric decline.

Methods:

1986 tobacco-exposed individuals (≥ 25 years, ≥ 10 pack-years) with preserved spirometry (FEV1/FVC ≥ lower limit of normal, z-scores, ≥ − 1.645) over ≥ 4 years follow-up from the population-based Austrian LEAD study were analysed. Participants were stratified by into four groups according to RV/TLC and TLC abnormalities.

Results:

High RV/TLC (≥ upper limit of normal, ULN, z-scores > + 1.645) was present in 6.5% of TEPS, predominantly with normal TLC (87.6%) and associated with greater smoking intensity. Notably, elevated RV/TLC associated with disproportionate declines in FEV1/FVC driven by discordant reductions in FEV1 and increases in FVC. While FEV1 z-scores remained largely normal, RV/TLC variability was pronounced, suggesting its potential as an early marker of pre-COPD progression.

Conclusion:

These findings underscore the limitations of spirometry alone and advocate for routine lung volume assessment in at-risk smokers.