Lung Function Decline in COPD – Relations to Changes in Symptom Burden, Inflammation, and Comorbidities

• Published in: Chronic obstructive pulmonary disease Vol. 22; no. 1; p. 2525433
• Main Authors: Wang, Juan, Ställberg, Björn, Hårdstedt, Maria, Bröms, Kristina, Gonzalez Lindh, Margareta, Farkhooy, Amir, Palm, Andreas, Lisspers, Karin, Högman, Marieann, Malinovschi, Andrei
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Group 01.07.2025
• Subjects: Aged; Biomarkers - blood; C-reactive protein; C-Reactive Protein - metabolism; Chronic obstructive pulmonary disease; Comorbidity; Disease Progression; Dyspnea - etiology; Dyspnea - physiopathology; Female; FEV1; Follow-Up Studies; Forced Expiratory Volume; Humans; Inflammation - blood; Inflammation - physiopathology; inflammatory biomarkers; lung function decline; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Severity of Illness Index; Surveys and Questionnaires; Sweden - epidemiology; Symptom Burden; symptom burden assessment; Vital Capacity; Sweden; Chronic obstructive pulmonary disease; FEV1; C-reactive protein; inflammatory biomarkers; lung function decline; symptom burden assessment
• ISSN: 1541-2555; 1541-2563; 1541-2563
• DOI: 10.1080/15412555.2025.2525433

The study aims to improve the knowledge on the associations between comorbidities, symptom burden, inflammatory biomarkers and lung function deterioration in chronic obstructive pulmonary disease (COPD). Of the 572 COPD subjects initially included in the 2014-2016 Tools for Identifying Exacerbations in COPD study in Sweden, 228 had lung function data at the 7-year follow-up. Symptom burden was assessed by the modified British Medical Research Council scale of dyspnoea (mMRC), the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ). Relative lung function decline was assessed as decline in forced expiratory volume in one second (FEV ) from baseline/year. Lower baseline symptom burden (mMRC, CAT and CCQ), higher FEV and FEV % predicted, higher forced vital capacity (FVC) and having atrial fibrillation were associated with larger absolute FEV decline. Associations were found for having atrial fibrillation at baseline and larger relative FEV decline (Beta = -1.60,  = 0.005). Increased symptom burden (value at follow-up minus value at baseline), assessed by mMRC, CAT and CCQ, was positively associated with both larger absolute FEV decline (mMRC: Beta = 6.4,  = 0.009; CAT: Beta = 1.63,  = 0.002; CCQ: Beta = 10.6,  < 0.001) and larger relative FEV decline (mMRC: Beta = 0.44,  = 0.003; CAT: Beta = 0.13,  < 0.002; CCQ: Beta = 0.82,  < 0.001). Moreover, an increase in C-reactive protein (CRP) levels at follow-up was related to larger, both absolute and relative, FEV decline (Beta = 1.14,  = 0.031 and Beta = 0.07,  = 0.019, respectively). Changes in systemic inflammation and symptom burden between two visits were positively associated with a 7-year lung function decline.