Does FEV1/FVC STAR relate better to sensory-physiological responses to exercise than FEV1 z-scores in patients with COPD?

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Background: Gradation of obstruction severity by FEV1 z-scores has been endorsed by ATS/ERS (ERJ 2022;60:2101499). More recently, the FEV1/FVC ratio (STAR classification) has been postulated to better categorize disablement than FEV1 in COPD (AJRCCM 2023;208:676). Aim: To investigate whether STAR would better grade dynamic (dyn) ventilatory abnormalities and dyspnoea compared to z-scores (A:>-1.645, B: -1.645 to -2.5; C: -2.51 to -4.0; and D: < -4 ) based on GLI standards in COPD of varied severity. Methods: 354 patients (196 ♂, 38-86 yrs, FEV1 17-125 %) underwent an incremental CPET with inspiratory capacity measurements. An AI-based software (DyVe-X) determined the overall burden of sex- and age-adjusted submaximal dyspnoeadyn (Borg 0-10), ventilatory reserve (VRdyn), and inspiratory reserve (IRdyn). Results: STAR and z-scores significantly disagreed, particularly in patients with intermediate dysfunction (p<0.05). Overall, ~30% (112/354) were classified as less impaired by STAR than z-score (STAR 2), more frequently women (59 vs 27%), and showed lower lung volumes (p<0.05). These patients did not show (p>0.05) less impaired exercise responses compared to STAR>z-score. erj;66/suppl_69/PA5191/F1 F1 F1 Conclusions: STAR is not superior to z-score in grading the severity of sensory and physiological abnormalities during exercise in mild-very severe COPD.

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