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Abdo, Mustafa; Watz, Henrik; Ewert, Ralf; Obst, Anne; Völzke, Henry ORCID logoORCID: https://orcid.org/0000-0001-7003-399X; Flexeder, Claudia ORCID logoORCID: https://orcid.org/0000-0003-3974-1482; Heier, Margit ORCID logoORCID: https://orcid.org/0000-0002-7317-7566; Peters, Annette ORCID logoORCID: https://orcid.org/0000-0001-6645-0985; Herth, Felix ORCID logoORCID: https://orcid.org/0000-0002-7638-2506; Trinkmann, Frederik; Rabe, Klaus F. ORCID logoORCID: https://orcid.org/0000-0002-7020-1401; Stubbe, Beate und Karrasch, Stefan ORCID logoORCID: https://orcid.org/0000-0001-9807-2915 (2025): Late Breaking Abstract - Oscillometry to Predict FEV₁ Decline and Incidental Abnormal Spirometry in Smokers with Initially Normal Spirometry. ERS Congress 2025: European Respiratory Society Congress, Amsterdam, 27. September - 01. Oktober 2025. Chalmers, James D. (Hrsg.): European Respiratory Journal. Bd. 66, Nr. Supplement 69, OA6432 Sheffield: European Respiratory Society.

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Abstract

Background: Oscillometry provides a sensitive measure of airway resistance, a surrogate of airflow obstruction. We investigated whether oscillometry predicts accelerated FEV₁ decline and future abnormal spirometry in smokers with initially normal spirometry.

Methods: Current and former smokers (35–65 y) with normal baseline spirometry (FEV₁/FVC ≥ 0.70 and FEV₁ ≥ 80% predicted) and no known airway disease were included from two population-based cohorts (KORA, SHIP). Subjects were stratified by baseline resistance at 5 Hz (R5) relative to the upper limit of normal: normal (R5 ≤ ULN) vs. high (R5 > ULN). We compared annual FEV₁ decline and incident abnormal spirometry (FEV₁/FVC < 0.70 or FEV₁ < 80%) between groups.

Results: In both cohorts, 17% of smokers had high R5 despite normal spirometry. These subjects showed greater mean annual FEV₁ decline (mL/year) vs. those with normal R5 (KORA: 139±70 vs. 96±70, p=0.002; SHIP: 111±130 vs. 53±80, p=0.034). A pooled analysis (median FU: 44 months) showed a 6-fold higher risk of abnormal spirometry in the high-R5 group (Fig. 1), after adjusting for smoking status, chronic bronchitis, and baseline FEV₁ and FVC. Of 61 subjects who developed abnormal spirometry, 50 showed airflow obstruction.

Conclusion: High airway resistance on oscillometry predicts accelerated FEV₁ decline and future abnormal spirometry, supporting its role in early COPD risk stratification.

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