Decline in Lung Function Study

COPD is a progressive disease causing inexorable decline in lung function, right? We were all taught it, but maybe no one checked first. Vestbo et al’s ECLIPSE, a simple but large and elegant observational study that continues to furnish new insights into COPD, shows the truth is far more nuanced and complicated.

After following 2,163 patients with COPD of varying severity for 3 years, a complex tapestry of patients emerged. The mean rate of decline in FEV1 was 33 mL/year — not far off from the 20 to 30 mL/year loss observed in healthy nonsmokers in one major study. But people with COPD varied widely in their rates of FEV1 decline: the standard deviation between individuals was 59 mL — almost twice the mean (that’s big). Other interesting points included:

•Only 38% had a decline of more than 40 mL/year over the 3 years.

•Fewer than half exceeded a loss of 30 mL/year (the upper limit of physiologic decline).

•Fully 8% had an increase in FEV1 of more than 20 mL/year.

•The worse the COPD stage (FEV1), the slower the rate of decline, suggesting COPD may “burn out” over time (authors’ words). Conversely, those with milder COPD had faster FEV1 loss.

•Cumulative smoking (pack-years) had no effect on rate of FEV1 decline.

•Current smoking did markedly accelerate FEV1 decline, by an additional 21 mL/year.

•Exacerbations were only weakly associated with accelerated decline of FEV1, by 2 mL/year per exacerbation experienced during the study.

•Emphysema on CT was associated with an increased FEV1 decline of 13 mL/year. Interestingly, a bronchodilator response on spirometry predicted an accelerated FEV1 decline of 17 mL/year.

Treatment may have slowed the rate of FEV1 decline in some patients (making this even more complicated): patients were on standard care throughout, and medications such as inhaled corticosteroids/long-acting beta agonists slow decline in lung function.

Vestbo J et al (ECLIPSE investigators). Changes in Forced Expiratory Volume in 1 Second over Time in COPD. N Engl J Med 2011; 365:1184-1192.

35 Replies

  • Looks like a great deal of good info there,,,, pity i dont understand any of it... :)

  • Not your fault mate,, more chance of getting blood out of a stone than info out of my gp :)

  • me too - but then I'm dense....

  • Yes, it looked good..and so I read it..... didn't understand. But hey,' they' tried!!

  • Thanks Martin that,s very interesting reading, & it must have taken ages to type it out for us.

    Karen xx

  • Did you understand any of it.... ? Totally went over my head :(

  • Yes a little, (but how it relates to me not so much) but thats cause I have no idea what my stats are & I had a little bit of nurse training years ago !!

    Not that smart I understood it all hun :( xxx

  • Hey, what does it mean with a peak flow meter, blowing 60? Is that good, bad or indifferent?

  • To me, it would depend on age, weight, & medical diagnosis, but you,d be better off asking the nurses on the BLF hepl line they,re more up todate with this sort of thing hun

    Give em a bell tomorrow & they,l put you right


  • Thanks x x

  • This is interesting to me as I took part in the Eclipse study for GSK at the MEU, Wythenshawe Hospital and Prof.Vestbo was my consultant at the North West Lung Centre! During those 3 years my lung function declined by 9%, but mainly because I had pneumonia halfway through it. Have never understand FEV etc. because my lung function has always been explained to me in percentages. Libby

  • Forced expiratory volume in 1 second (FEV1)

    FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration.[8] Average values for FEV1 in healthy people depend mainly on sex and age, according to the diagram at left. Values of between 80% and 120% of the average value are considered normal.[9] Predicted normal values for FEV1 can be calculated online and depend on age, sex, height, weight and ethnicity as well as the research study that they are based on.

    FEV1/FVC ratio (FEV1%)

    FEV1/FVC (FEV1%) is the ratio of FEV1 to FVC. In healthy adults this should be approximately 75–80%. In obstructive diseases (asthma, COPD, chronic bronchitis, emphysema) FEV1 is diminished because of increased airway resistance to expiratory flow; the FVC may be decreased as well, due to the premature closure of airway in expiration, just not in the same proportion as FEV1 (for instance, both FEV1 and FVC are reduced, but the former is more affected because of the increased airway resistance). This generates a reduced value (<80%, often ~45%). In restrictive diseases (such as pulmonary fibrosis) the FEV1 and FVC are both reduced proportionally and the value may be normal or even increased as a result of decreased lung compliance.

    A derived value of FEV1% is FEV1% predicted, which is defined as FEV1% of the patient divided by the average FEV1% in the population for any person of similar age, sex and body composition.

  • Hi Martin,

    Good article!

    Does this make a difference?

    These days, as patients we are more aware of what is wrong with us. We take a more active interest in controlling our medical problems than we did a few years ago. Collectively we know more about what affects the way the damage progresses, and take steps to slow that process, by eating 'better' foods, better antibiotics, exercise, even supporting each other psychologically makes us feel better, and so that helps.

    For some time, I have thought that one of the biggest factors in whether or not we developed Emphysema was if we 'caught' the childhood respiratory illnesses, as these leave scaring which starts the process. Smoking, while not being good for us, may not have been the primary cause after all. Now that might make an interesting poll (how many of those with emphysema had childhood pneumonia, whooping cough, scarlet fever, even glue ear).

    breathe easy all,


  • I had mumps, glandular fever, recurring tonsillitis, nothing spotty though LOL

  • My bad chest started after a bad case of measles at the age of six. My mother said I always had an awful cough after that.

  • I had scarlet fever and measles!



  • Oh and chicken pox!

  • this is a point I was thinking about this morning, up to last year 2012 January I had emphysema with pretty quiet lungs and no significant infections, in January I started an infection and sent sample to GP for test nothing was said so I presumed it was clear but the infection continued I rang in the February the GP said that pseudomonas was present and as it is all around us no treatment necessary ?

    3 further samples came back clear, and then the fourth came back with pseudomonas, they did contact me and I had one course of antibiotics, there was an improvement so I did my home work and found how important pseudomonas is, I went to see the specialist who wrote to the GP and told them increase the dose of clarithromycin to 750 over a longer period,

    late last year I had the same problem but no sample so asked GP for clarithromycin he gave it to me I said about the increased dose he said no so I had two courses, and an improvement,

    I recently sent off samples twice obviously infected and the no treatment given.

    so I was concerned so contacted the surgery and asked questions two weeks later I got a two line reply, when taking a sample into the surgery I was to phone first so the paper work could be organised ?

    the only thing I can see in this is that the sample was sent with no information other than the name, and so the recommendation was that of a normal person.

    my point is 14 months later I am left with a sample in hand oxygen by my side, and my health has declined and my mobility, is this the progression of the COPD, or one of the many mistakes and prevarications that the GP makes,

    a point is if GP's cured their patients we wouldn't need as many! and we wouldn't need to go as often.

  • I had pseudomonas and the doctor (hospital consultant, that is) had me in hospital sharpish. I was treated with ciprofloxacin and prednisilone for a few weeks, but when that was not enough to get rid of the bugs, she wanted to admit me straight from clinic! Spent 2 weeks inside for iv antibiotic treatment and I was lucky to get rid o the nasty things. If not taken seriuosly and treated appropriately, pseudomonas has a nasty habit of colonising the lungs and that is very bad news.

    Pseudomonas is everywhere but we don't want it setting up home in our lungs! I was lucky that time but have been told it's probably only a matter of time before I have a return visit. Best of luck...

  • hi i had TB as a child also in the 40s 50s and longer, we had a lot of fog . I grew up in a mill town ,yes i smoked for 30years but when i started smoking pensionrs got vouchers for cigs as part of there pension !!! my gran gave hers to someone up the street

  • Hi I also had TB as a child and lots of tonsilitis and sinusitis. I now have mild COPD and Bronchiectasis.

    I also smoked for 35 years. They say that smoking does not help but does not cause

    Bronchiectasis. I don't know how true this is, just something I read.

  • I have bronchiectasis and obliterative bronchiolitis - but have never smoked in my life! Had measles, chicken pox and tonsillitis when young.

  • Yeah, Newlands, I think that a lot of people including doctors forget about the terrible 'Smog' that people of our generation were subjected to !

    It was really bad in London, a horrible yellow colour and you could 'cut it with a knife'.

  • I lived in London for 30 + years and I think the pollution is still pretty bad. I have been so much better since I moved out of London, and when I returned recently, spending 5 days taking the children about and visiting friends, My peak flow was down by 100 by the time I got home! Took a couple of weeks to recover.

  • Great article Martin1945.

    I had actually read it before and it's one of the reasons I keep banging on about people getting fitter. We know from this site that we have very different levels of ability with the same FEV1 reading, so ther factors must also influence this. Some if these we have no control over, but some we do.

    I have said before, we really must take some responsibility for helping ourselves.

    Lynne xx

  • Agree so much - it really makes a difference.

  • Agreed Lynne. With exercise even those with very limited fitness can improve it if they start from where they are - e.g. maybe just one or two extra steps a day walking at home if your fitness is very impaired (and important to talk to gp). If our quality of life is improved or maintained, and if we take control where we can, we can get a sense of having more overall control of our lives.

  • This was a very good, informative article and some of the replies. As I understand it Fev 1 readings are the ones obtained without inhaler use,based on age, sex, height,weight ect. Does the use of inhalers not keep our Fev i normal except during exasperations, hence the reason for doing spiros when you have not taken inhalers for several hours, or is that just in the case of asthma? Also I thought Fev1 was not a good guide necessayily to the severity of COPD.I like many others find all of this confusing and it does not help me in the least when I can't breath, or coughing so much I can't catch my breath either but thanks for the article and the time typing it

  • oophs spelling error should read necessarily

  • I have always thought that Pete developed sarcoidosis because of the job he did as a cargo worker at Heathrow many years ago. The GP did say that, although he smoked then, smoking was not to blame. Pete was diagnosed with copd (bronchitis) 3 years ago because his lungs and airways are badly scarred although the sarc seems to have burnt out according to the Brompton. I am not sure if that is the case or not. What I don't really understand is that, when Pete has a chest infection, his sats are still pretty good considering he is struggling to breathe. It is all very complicated to me but very interesting too and thanks martin1945 for a great article. xx

  • hi martin can you break your comment down to simple english,i have copd,lung cancer and diabetic Not a degree in medicine thanks jim

  • Oh dear , it has gone straight over my head too

  • Hello Martin,

    Very many thanks for posting the results of this study.Mmmmmm very interesting isn't it, especially when there is so much gloom, doom and misrepresentation about the progress of COPD.

    Especially valuable to know that continuing to smoke accelerates the decline, so can confidently encourage people to stop the cigarettes.

    Think then I will carry on doing what I have doing for last 10 years, no smoking, healthy eating, exercise, postive attitude, continue good self care and carry on working-yay!

  • This is a great thread and some really good information to digest. Thanks everyone for the posts. :)

  • For anyone interested, here's the BLF link to information about Pseudomonas :)

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