Smith, L.J. orcid.org/0000-0002-5769-423X, Marshall, H. orcid.org/0000-0002-7425-1449, Jakymelen, D. et al. (22 more authors) (2025) 129Xe-MRI ventilation and acinar abnormalities highlight the significance of spirometric dysanapsis: findings from the NOVELTY ADPro UK substudy. Thorax. ISSN 0040-6376
Abstract
Rationale: Airways dysanapsis is defined by CT or spirometry as a mismatch between the size of the airways and lung volume and is associated with increased risk of developing chronic obstructive pulmonary disease (COPD). Lung disease in participants with dysanapsis and a label of asthma and/or COPD remains poorly understood.
Methods: In participants with asthma and/or COPD, we used 129Xe-MRI to assess ventilation, acinar dimensions and gas exchange, and pulmonary function tests, and compared people with spirometric dysanapsis (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)<−1.64 z and FEV1>−1.64 z) to those with normal spirometry (FEV1, FVC and FEV1/FVC>−1.64 z).
Results: From 165 participants assessed in the NOVELTY (NOVEL observational longiTudinal studY) ADPro (advanced diagnostic profiling) study with a physician-assigned diagnosis of asthma and/or COPD, 43 had spirometric dysanapsis and were age-matched to 43 participants with normal spirometry. Participants with dysanapsis had significantly increased ventilation defects (median difference (md) (95% CI) = 4.0% (1.42% to 5.38%), p<0.001), ventilation heterogeneity (md (95% CI) = 2.56% (1.31% to 3.56%), p<0.001) and measures of acinar dimensions (md (95% CI) = 0.004 cm2.s−1 (0.0009 to 0.007), p=0.009) from 129Xe-MRI, than those with normal spirometry. At the 1-year follow-up, only participants with dysanapsis had a significant increase in ventilation defects (md (95% CI)=0.45% (0.09% to 2.1%),p=0.016). Lower FEV1/FVC in the dysanapsis cohort was associated with increased ventilation defects (r=−0.64, R2=0.41, p<0.001) and increased acinar dimensions (r=−0.52, R2=0.38, p<0.001), with the highest values seen in those with an FVC above the upper limit of normal.
Conclusions: Participants with asthma and/or COPD, presenting to primary care with spirometric dysanapsis, exhibited increased lung abnormalities on 129Xe-MRI, when compared with those with normal spirometry. Spirometric dysanapsis in asthma and/or COPD is therefore associated with significant lung disease, and the FEV1/FVC is related to the degree of airways abnormality on 129Xe-MRI.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2025 The Authors. Except as otherwise noted, this author-accepted version of a journal article published in Thorax is made available via the University of Sheffield Research Publications and Copyright Policy under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ |
Keywords: | Biomedical and Clinical Sciences; Cardiovascular Medicine and Haematology; Clinical Sciences; Chronic Obstructive Pulmonary Disease; Lung; Asthma; Respiratory |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) |
Funding Information: | Funder Grant number MEDICAL RESEARCH COUNCIL MR/M008894/1 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 03 Jun 2025 15:47 |
Last Modified: | 03 Jun 2025 15:47 |
Status: | Published online |
Publisher: | BMJ |
Refereed: | Yes |
Identification Number: | 10.1136/thorax-2024-222347 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:227339 |