{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:36:11Z","timestamp":1792787771271,"version":"4.5.0"},"reference-count":37,"publisher":"European Respiratory Society (ERS)","issue":"3","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014131","name":"McGill University Health Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014131","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Respiratory Epidemiology and Clinical Research Unit (RECRU) Summer Studentship Research Award"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2024,12,23]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dynamic hyperinflation is central to dyspnoea, exercise limitation and exacerbations in COPD. While studied previously in moderate-to-severe COPD, the relevance of diaphragm dome height (DDH) on clinically important outcomes has been under-investigated in mild-to-moderate COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Canadian Cohort Obstructive Lung Disease (CanCOLD) participants with spirometry-confirmed COPD, symptom-limited incremental cardiopulmonary exercise testing and computed tomography image data were included. Base-to-apex left DDH (LDDH) and right DDH (RDDH) were automatically segmented, with increased height implying less flattening and thus less hyperinflation. Dynamic hyperinflation was defined as \u2265150\u2005mL reduction in inspiratory capacity (IC) from rest to peak exercise. Cross-sectional linear regression models were fitted between LDDH and RDDH (predictor variables) with peak IC (IC\n                      <jats:sub>peak<\/jats:sub>\n                      ), peak workload (\n                      <jats:italic>W<\/jats:italic>\n                      <jats:sub>peak<\/jats:sub>\n                      ), forced expiratory volume in 1\u2005s (FEV\n                      <jats:sub>1<\/jats:sub>\n                      ) and COPD Assessment Test (CAT) score (outcome variables), and in longitudinal (Anderson\u2013Gill) models with \u201csymptom-based\u201d and \u201cevent-based\u201d exacerbations. Results are reported as parameter estimates or hazard ratios (HRs) with 95% confidence intervals per interquartile range dome height increment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Amongst 304 participants (mean\u00b1\n                      <jats:sc>sd<\/jats:sc>\n                      age 64.7\u00b110.3\u2005years, 41.8% female, 44.4% with mild COPD), each LDDH and RDDH increment, respectively, was associated with IC\n                      <jats:sub>peak<\/jats:sub>\n                      (0.21 (95% CI 0.13\u20130.29)\u2005L and 0.13 (95% CI 0.07\u20130.19)\u2005L),\n                      <jats:italic>W<\/jats:italic>\n                      <jats:sub>peak<\/jats:sub>\n                      (9.54 (95% CI 5.03\u201314.04)\u2005W and 6.04 (95% CI 2.45\u20139.62)\u2005W), FEV\n                      <jats:sub>1<\/jats:sub>\n                      (0.17 (95% CI 0.10\u20130.25)\u2005L and 0.08 (95% CI 0.02\u20130.14)\u2005L) and CAT score (\u22121.36 (95% CI \u22122.39\u2013\u2009\u22120.33) and \u22120.82 (95% CI \u22121.63\u20130.00)). LDDH alone was associated with both symptom-based (HR 0.82 (95% CI 0.74\u20130.91)) and event-based (HR 0.83 (95% CI 0.73\u20130.95)) exacerbations. Of 167 out of 304 participants with confirmed dynamic hyperinflation (\u0394IC \u22120.47\u00b10.25\u2005L), LDDH alone was associated with all outcomes (IC\n                      <jats:sub>peak<\/jats:sub>\n                      ,\n                      <jats:italic>W<\/jats:italic>\n                      <jats:sub>peak<\/jats:sub>\n                      , FEV\n                      <jats:sub>1<\/jats:sub>\n                      , CAT and symptom-based\/event-based exacerbations).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LDDH appears to be a clinically important marker for operational lung volume changes, lung function, exercise performance, disease burden and exacerbations in mild-to-moderate COPD.<\/jats:p>\n                  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