Beyond Spirometry: Integrating Morphometry and Mechanics for Precision Medicine

"Beyond Spirometry: Integrating Morphometry and Mechanics for Precision Medicine Although spirometry remains fundamental to respiratory assessment, conventional indices alone do not fully account for the substantial heterogeneity observed in chronic respiratory diseases. Patients with comparable airflow limitation may exhibit marked differences in symptoms, gas exchange impairment, functional capacity, prognosis, and treatment response. This underscores the need to incorporate additional morphological and physiological dimensions into disease assessment. Flow–volume curves contain valuable yet underutilized information beyond FEV₁ and FEV₁/FVC, including mid- and late-expiratory flows, inspiratory–expiratory relationships, and curve-shape or area-based metrics. When interpreted with careful attention to effort dependence, volume dependence, and technical quality, these features may provide further insight into underlying disease mechanisms. Recent developments in imaging-based morphometry have broadened phenotyping beyond the traditional assessment of emphysema severity. Previous research demonstrated that computed tomography (CT)-derived airway wall dimensions and emphysema provide complementary information regarding pulmonary function, supporting the view that airway and parenchymal abnormalities represent distinct yet interacting contributors to airflow limitation. More recent studies suggest that different CT phenotypes carry distinct clinical implications, with differential associations with longitudinal decline in FEV1 and diffusing capacity, as well as prognosis. In addition, airway structural abnormalities, including airway wall thickening and mucus plugging, may be linked not only to airflow limitation and adverse outcomes, but also to specific disease backgrounds such as a history of asthma. Moreover, the scope of imaging-based morphometry may extend beyond the airways and parenchyma to include extrapulmonary and vascular features, such as muscle dysfunction, thereby providing additional functional and prognostic insights. These findings support an integrated framework in which respiratory disease is understood through the interplay between structural abnormalities and their mechanical consequences. In this presentation, I will discuss how integrating imaging-based morphometry with spirometry and broader physiological assessment may move respiratory medicine beyond a spirometry-centered paradigm toward more precise phenotyping, improved risk stratification, and individualized patient care. "