Description:
<jats:p> Current guidelines recommend severity of chronic obstructive pulmonary disease be graded by using forced expiratory volume in 1 s (FEV<jats:sub>1</jats:sub>). But this measurement is biased by thoracic gas compression depending on lung volume and airflow resistance. The aim of this study was to test the hypothesis that the effect of thoracic gas compression on FEV<jats:sub>1</jats:sub> is greater in emphysema than chronic bronchitis because of larger lung volumes, and this influences severity classification and prognosis. FEV<jats:sub>1</jats:sub> was simultaneously measured by spirometry and body plethysmography (FEV<jats:sub>1-pl</jats:sub>) in 47 subjects with dominant emphysema and 51 with dominant chronic bronchitis. Subjects with dominant emphysema had larger lung volumes, lower diffusion capacity, and lower FEV<jats:sub>1</jats:sub> than those with dominant chronic bronchitis. However, FEV<jats:sub>1-pl</jats:sub>, patient-centered variables (dyspnea, quality of life, exercise tolerance, exacerbation frequency), arterial blood gases, and respiratory impedance were not significantly different between groups. Using FEV<jats:sub>1-pl</jats:sub> instead of FEV<jats:sub>1</jats:sub> shifted severity distribution toward less severe classes in dominant emphysema more than chronic bronchitis. The body mass, obstruction, dyspnea, and exercise (BODE) index was significantly higher in dominant emphysema than chronic bronchitis, but this difference significantly decreased when FEV<jats:sub>1-pl</jats:sub> was substituted for FEV<jats:sub>1</jats:sub>. In conclusion, the FEV<jats:sub>1</jats:sub> is biased by thoracic gas compression more in subjects with dominant emphysema than in those with chronic bronchitis. This variably and significantly affects the severity grading systems currently recommended. </jats:p>