Effects of BMI on static lung volumes in patients with airway obstruction

Background: Both chronic airway obstruction and obesity are increasing in prevalence but the effect of their combination on pulmonary function parameters across the range of airway obstruction is unknown. Methods: We studied the impact of increasing BMI on static lung volumes and airway function in a cohort of 2,265 subjects from a large pulmonary function laboratory database who were 40 to 80 years of age and met GOLD (Global Initiative for Chronic Obstructive Lung Disease) spirometric criteria for COPD (postbronchodilator FEV1/FVC < 0.7). We also evaluated the influence of severity of airway obstruction (by GOLD criteria) on these relationships. Results: With increasing BMI in the group as a whole, functional residual capacity, residual volume, expiratory reserve volume, and specific airway resistance (sRaw) decreased exponentially (all P < .001); total lung capacity (TLC) decreased linearly (P < .001); and inspiratory capacity (IC) and IC/TLC increased linearly(P < .001). However, vital capacity was not influenced significantly. The effects of increasing BMI on FEV1/FVC and sRaw were greatest in GOLD stage III/IV (P < .05), whereas increasing BMI had greater effects on IC in GOLD stage I(P < .001). Conclusions: With increasing BMI, subjects with airway obstruction had consistent reductions in lung hyperinflation, with significant improvements in IC and the FEV1/FVC ratio; this effect was greatest in patients with the most severe airway obstruction. These results have important implications for the clinical assessment of patients with combined obesity and airway obstruction.