TY - JOUR T1 - Journal club JF - Thorax JO - Thorax SP - 106 LP - 106 DO - 10.1136/thoraxjnl-2021-218498 VL - 77 IS - 1 AU - Nicola Smallcombe Y1 - 2022/01/01 UR - http://thorax.bmj.com/content/77/1/106.abstract N2 - Phenotyping patients with Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance to clinicians to support personalised medicine. There is particular interest in identifying patients with early disease at higher risk of progression to inform management decisions. A low diffusing capacity for carbon monoxide (DLCO) is associated with increased mortality in patients with severe COPD but the relationship in mild disease is not clear. de-Torres et al (Chest 2021;160:872) retrospectively analysed 360 patients with a clinical diagnosis of COPD and Global Initiative for Obstructive Lung Disease (GOLD) stage 1 (FEV1:FVC <0.7, FEV1%≥80%) to determine if a low DLCO leads to a worse mortality. This was a multicentre, retrospective, observational study over a mean 9-year follow-up, using three different prospectively recruited cohorts. The authors compared different cut-off values for DLCO %, adjusted for age, body mass index (BMI), sex and smoking status, to select the highest threshold which demonstrated a statistically significant difference in all-cause mortality: <60% predicted (DLCO ≥60%–9% vs DLCO <60% 23%, p=0.01). It was found that at the same Charlson score and FEV1% predicted those with DLCO <60% had more severe clinical manifestations and an increased risk of death over the follow-up period (HR 3.37, 95% CI 1.35 to 8.39; p=0.09). A difference in their overall clinical profile was also identified with … ER -