Current guidelines recommend severity of
chronic obstructive pulmonary disease be graded by using forced expiratory volume in 1 s (FEV1). But this measurement is biased by thoracic gas compression depending on lung volume and airflow resistance. The aim of this study was to test the hypothesis that the effect of thoracic gas compression on FEV1 is greater in
emphysema than
chronic bronchitis because of larger lung volumes, and this influences severity classification and prognosis. FEV1 was simultaneously measured by spirometry and body plethysmography (FEV1-pl) in 47 subjects with dominant
emphysema and 51 with dominant
chronic bronchitis. Subjects with dominant
emphysema had larger lung volumes, lower diffusion capacity, and lower FEV1 than those with dominant
chronic bronchitis. However, FEV1-pl, patient-centered variables (
dyspnea, quality of life, exercise tolerance, exacerbation frequency), arterial blood
gases, and respiratory impedance were not significantly different between groups. Using FEV1-pl instead of FEV1 shifted severity distribution toward less severe classes in dominant
emphysema more than
chronic bronchitis. The body mass, obstruction,
dyspnea, and exercise (BODE) index was significantly higher in dominant
emphysema than
chronic bronchitis, but this difference significantly decreased when FEV1-pl was substituted for FEV1. In conclusion, the FEV1 is biased by thoracic gas compression more in subjects with dominant
emphysema than in those with
chronic bronchitis. This variably and significantly affects the severity grading systems currently recommended.