{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T05:01:40Z","timestamp":1786770100327,"version":"build-2736575974"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2016,4,1]],"date-time":"2016-04-01T00:00:00Z","timestamp":1459468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"publisher","award":["R01 HL089856"],"award-info":[{"award-number":["R01 HL089856"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"NHLBI","doi-asserted-by":"publisher","award":["R01 Hl089897"],"award-info":[{"award-number":["R01 Hl089897"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The Global Lung Initiative (GLI) provides age-appropriate criteria for establishing spirometric impairment, including mild, moderate, and severe chronic obstructive pulmonary disease (COPD) and restrictive pattern, but its association with respiratory-related phenotypes has not been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate respiratory-related phenotypes in GLI-defined spirometric impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In COPDGene (N\u2009=\u200910,131 patients; age range, 45\u201381 yr; average smoking history, 44.3 pack-years), we evaluated spirometry, dyspnea (modified Medical Research Council grade, \u22652), poor respiratory health-related quality of life (St. George\u2019s Respiratory Questionnaire total score, \u226525), poor exercise performance (6-minute-walk distance, &amp;lt;391 m), bronchodilator reversibility (FEV1 change, &amp;gt;12% and \u2265200 ml), and computed tomography\u2013diagnosed emphysema and gas trapping (&amp;gt;5% and &amp;gt;15% of lung, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>GLI established normal spirometry in 5,100 patients (50.3%), mild COPD in 669 (6.6%), moderate COPD in 865 (8.5%), severe COPD in 2,522 (24.9%), and restrictive pattern in 975 (9.6%). Relative to normal spirometry, graded associations with respiratory-related phenotypes were found for mild, moderate, and severe COPD, with respective adjusted odds ratios (95% confidence intervals) as follows: dyspnea\u20141.31 (1.10\u20131.56), 2.20 (1.81\u20132.68), and 10.73 (8.04\u201314.33); poor respiratory health-related quality of life\u20141.49 (1.28\u20131.75), 2.69 (2.08\u20133.47), and 14.61 (10.09\u201321.17); poor exercise performance\u20141.11 (0.94\u20131.31), 1.58 (1.33\u20131.88), and 4.58 (3.42\u20136.12); bronchodilator reversibility\u20142.76 (2.24\u20133.40), 5.18 (4.29\u20136.27), and 6.21 (5.06\u20137.62); emphysema\u20144.86 (3.16\u20137.47), 6.41 (4.09\u201310.05), and 17.79 (10.79\u201329.32); and gas trapping\u20143.92 (3.12\u20134.93), 5.20 (3.82\u20137.07), and 16.28 (9.71\u201327.30). Restrictive pattern was also associated with multiple respiratory-related phenotypes at a level similar to moderate COPD, but it was otherwise not associated with emphysema (0.89 [0.60\u20131.32]) or gas trapping (1.15 [0.92\u20131.42]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GLI-defined spirometric impairment establishes clinically meaningful respiratory disease, as validated by graded associations with respiratory-related phenotypes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201508-1603oc","type":"journal-article","created":{"date-parts":[[2015,11,5]],"date-time":"2015-11-05T11:45:41Z","timestamp":1446723941000},"page":"727-735","source":"Crossref","is-referenced-by-count":62,"title":["Phenotype of Spirometric Impairment in an Aging Population"],"prefix":"10.1093","volume":"193","author":[{"given":"Carlos A.","family":"Vaz Fragoso","sequence":"first","affiliation":[{"name":"Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut"},{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"McAvay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Van Ness","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Casaburi","sequence":"additional","affiliation":[{"name":"Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Jensen","sequence":"additional","affiliation":[{"name":"LDS Hospital and University of Utah, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"MacIntyre","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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