Peter Alter, Klaus F Rabe, Holger Schulz, Claus F Vogelmeier, Rudolf A Jörres

For interpretation of body plethysmographic static hyperinflation, reference values are of crucial importance. Earliest reference values have been published by the European Coal and Steel Community (ECSC) and are based on sex, body height and age as predictors. As obesity can lead to a reduction of functional residual capacity (FRC) in lung-healthy subjects, more recent approaches included body weight or body surface area. This raises the question whether these models are appropriate in patients with COPD-induced hyperinflation. Several FRC prediction models and their relation to body weight were analyzed in 1513 patients with stable COPD (mean [SD] age: 64.5 [8.2] years; GOLD grades 1-4: 219/722/484/88), a subset of the multicenter COPD and Systemic Consequences - Comorbidities Network cohort. Absolute values of FRC were inversely related to body mass index (p<0.001). Applying the ECSC equations to calculate predicted values, this pattern was maintained (p<0.001). By contrast, an inverted, ie, positive, relation occurred when using equations that include body weight or surface area (p<0.001). The present analysis confirmed the inverse relation of body mass and FRC in COPD, resulting from a restrictive ventilatory pattern by diaphragm elevation and decreased chest wall compliance in obesity. The weight influence in the prediction models, as obtained from lung-healthy controls, appears to lead to an overcorrection and consequently to an inappropriate overestimation of hyperinflation as indicated by FRC %predicted in COPD. It is concluded that models not including body weight as predictor, like the classical ECSC equations, could be superior in the interpretation of FRC in COPD.