1
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Phillips DB, James MD, Vincent SG, Elbehairy AF, Neder JA, Kirby M, Ora J, Day AG, Tan WC, Bourbeau J, O'Donnell DE. Physiological Characterization of Preserved Ratio Impaired Spirometry in the CanCOLD Study: Implications for Exertional Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2024; 209:1314-1327. [PMID: 38170674 DOI: 10.1164/rccm.202307-1184oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
Rationale: It is increasingly recognized that adults with preserved ratio impaired spirometry (PRISm) are prone to increased morbidity. However, the underlying pathophysiological mechanisms are unknown. Objectives: Evaluate the mechanisms of increased dyspnea and reduced exercise capacity in PRISm. Methods: We completed a cross-sectional analysis of the CanCOLD (Canadian Cohort Obstructive Lung Disease) population-based study. We compared physiological responses in 59 participants meeting PRISm spirometric criteria (post-bronchodilator FEV1 < 80% predicted and FEV1/FVC ⩾ 0.7), 264 control participants, and 170 ever-smokers with chronic obstructive pulmonary disease (COPD), at rest and during cardiopulmonary exercise testing. Measurements and Main Results: Individuals with PRISm had lower total lung, vital, and inspiratory capacities than healthy controls (all P < 0.05) and minimal small airway, pulmonary gas exchange, and radiographic parenchymal lung abnormalities. Compared with healthy controls, individuals with PRISm had higher dyspnea/[Formula: see text]o2 ratio at peak exercise (4.0 ± 2.2 vs. 2.9 ± 1.9 Borg units/L/min; P < 0.001) and lower [Formula: see text]o2peak (74 ± 22% predicted vs. 96 ± 25% predicted; P < 0.001). At standardized submaximal work rates, individuals with PRISm had greater Vt/inspiratory capacity (Vt%IC; P < 0.001), reflecting inspiratory mechanical constraint. In contrast to participants with PRISm, those with COPD had characteristic small airways dysfunction, dynamic hyperinflation, and pulmonary gas exchange abnormalities. Despite these physiological differences among the three groups, the relationship between increasing dyspnea and Vt%IC during cardiopulmonary exercise testing was similar. Resting IC significantly correlated with [Formula: see text]o2peak (r = 0.65; P < 0.001) in the entire sample, even after adjusting for airflow limitation, gas trapping, and diffusing capacity. Conclusions: In individuals with PRISm, lower exercise capacity and higher exertional dyspnea than healthy controls were mainly explained by lower resting lung volumes and earlier onset of dynamic inspiratory mechanical constraints at relatively low work rates. Clinical trial registered with www.clinicaltrials.gov (NCT00920348).
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Affiliation(s)
- Devin B Phillips
- School of Kinesiology and Health Science, Faculty of Health, and
- Muscle Health Research Center, York University, Toronto, Ontario, Canada
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity, and Respiratory Medicine, The University of Manchester, and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Andrew G Day
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; and
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, and
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
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2
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Choi B, Díaz AA, San José Estépar R, Enzer N, Castro V, Han MK, Washko GR, San José Estépar R, Ash SY. Association of Acute Respiratory Disease Events with Quantitative Interstitial Abnormality Progression at CT in Individuals with a History of Smoking. Radiology 2024; 311:e231801. [PMID: 38687222 PMCID: PMC11070608 DOI: 10.1148/radiol.231801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
Background Acute respiratory disease (ARD) events are often thought to be airway-disease related, but some may be related to quantitative interstitial abnormalities (QIAs), which are subtle parenchymal abnormalities on CT scans associated with morbidity and mortality in individuals with a smoking history. Purpose To determine whether QIA progression at CT is associated with ARD and severe ARD events in individuals with a history of smoking. Materials and Methods This secondary analysis of a prospective study included individuals with a 10 pack-years or greater smoking history recruited from multiple centers between November 2007 and July 2017. QIA progression was assessed between baseline (visit 1) and 5-year follow-up (visit 2) chest CT scans. Episodes of ARD were defined as increased cough or dyspnea lasting 48 hours and requiring antibiotics or corticosteroids, whereas severe ARD episodes were those requiring an emergency room visit or hospitalization. Episodes were recorded via questionnaires completed every 3 to 6 months. Multivariable logistic regression and zero-inflated negative binomial regression models adjusted for comorbidities (eg, emphysema, small airway disease) were used to assess the association between QIA progression and episodes between visits 1 and 2 (intercurrent) and after visit 2 (subsequent). Results A total of 3972 participants (mean age at baseline, 60.7 years ± 8.6 [SD]; 2120 [53.4%] women) were included. Annual percentage QIA progression was associated with increased odds of one or more intercurrent (odds ratio [OR] = 1.29 [95% CI: 1.06, 1.56]; P = .01) and subsequent (OR = 1.26 [95% CI: 1.05, 1.52]; P = .02) severe ARD events. Participants in the highest quartile of QIA progression (≥1.2%) had more frequent intercurrent ARD (incidence rate ratio [IRR] = 1.46 [95% CI: 1.14, 1.86]; P = .003) and severe ARD (IRR = 1.79 [95% CI: 1.18, 2.73]; P = .006) events than those in the lowest quartile (≤-1.7%). Conclusion QIA progression was independently associated with higher odds of severe ARD events during and after radiographic progression, with higher frequency of intercurrent severe events in those with faster progression. Clinical trial registration no. NCT00608764 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Little in this issue.
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Affiliation(s)
- Bina Choi
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Alejandro A. Díaz
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Ruben San José Estépar
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Nicholas Enzer
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Victor Castro
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - MeiLan K. Han
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - George R. Washko
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Samuel Y. Ash
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - for the COPDGene Study
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
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3
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Ash S, Doyle TJ, Choi B, San Jose Estepar R, Castro V, Enzer N, Kalhan R, Liu G, Bowler R, Wilson DO, San Jose Estepar R, Rosas IO, Washko GR. Utility of peripheral protein biomarkers for the prediction of incident interstitial features: a multicentre retrospective cohort study. BMJ Open Respir Res 2024; 11:e002219. [PMID: 38485250 PMCID: PMC10941119 DOI: 10.1136/bmjresp-2023-002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION/RATIONALE Protein biomarkers may help enable the prediction of incident interstitial features on chest CT. METHODS We identified which protein biomarkers in a cohort of smokers (COPDGene) differed between those with and without objectively measured interstitial features at baseline using a univariate screen (t-test false discovery rate, FDR p<0.001), and which of those were associated with interstitial features longitudinally (multivariable mixed effects model FDR p<0.05). To predict incident interstitial features, we trained four random forest classifiers in a two-thirds random subset of COPDGene: (1) imaging and demographic information, (2) univariate screen biomarkers, (3) multivariable confirmation biomarkers and (4) multivariable confirmation biomarkers available in a separate testing cohort (Pittsburgh Lung Screening Study (PLuSS)). We evaluated classifier performance in the remaining one-third of COPDGene, and, for the final model, also in PLuSS. RESULTS In COPDGene, 1305 biomarkers were available and 20 differed between those with and without interstitial features at baseline. Of these, 11 were associated with feature progression over a mean of 5.5 years of follow-up, and of these 4 were available in PLuSS, (angiopoietin-2, matrix metalloproteinase 7, macrophage inflammatory protein 1 alpha) over a mean of 8.8 years of follow-up. The area under the curve (AUC) of classifiers using demographics and imaging features in COPDGene and PLuSS were 0.69 and 0.59, respectively. In COPDGene, the AUC of the univariate screen classifier was 0.78 and of the multivariable confirmation classifier was 0.76. The AUC of the final classifier in COPDGene was 0.75 and in PLuSS was 0.76. The outcome for all of the models was the development of incident interstitial features. CONCLUSIONS Multiple novel and previously identified proteomic biomarkers are associated with interstitial features on chest CT and may enable the prediction of incident interstitial diseases such as idiopathic pulmonary fibrosis.
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Affiliation(s)
- Samuel Ash
- Department of Critical Care Medicine, South Shore Hospital, South Weymouth, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Tracy J Doyle
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bina Choi
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Victor Castro
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nicholas Enzer
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ravi Kalhan
- Division of Pulmonary/Critical Care, Northwestern University, Chicago, Illinois, USA
| | - Gabrielle Liu
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - David O Wilson
- Medicine, Pulmonary Division, University of Pittsburgh, pittsburgh, Pennsylvania, USA
| | - Raul San Jose Estepar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ivan O Rosas
- Department of Medicine: Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - George R Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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4
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Shiraishi Y, Tanabe N, Shimizu K, Oguma A, Shima H, Sakamoto R, Yamazaki H, Oguma T, Sato A, Suzuki M, Makita H, Muro S, Nishimura M, Sato S, Konno S, Hirai T. Stronger Associations of Centrilobular Than Paraseptal Emphysema With Longitudinal Changes in Diffusing Capacity and Mortality in COPD. Chest 2023; 164:327-338. [PMID: 36736486 DOI: 10.1016/j.chest.2023.01.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/27/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The factors associated with longitudinal changes in diffusing capacity remain unclear among patients with COPD. Centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are major emphysema subtypes that may have distinct clinical-physiological impacts in these patients. RESEARCH QUESTION Are CLE and PSE differently associated with longitudinal changes in diffusing capacity and mortality in patients with COPD? STUDY DESIGN AND METHODS This pooled analysis included 399 patients with COPD from two prospective observational COPD cohorts. CLE and PSE were visually assessed on CT scan according to the Fleischner Society statement. The diffusing capacity and transfer coefficient of the lung for carbon monoxide (Dlco and KCO) and FEV1 were evaluated at least annually over a 5-year period. Mortality was recorded over 10 years. Longitudinal changes in FEV1, Dlco, and KCO and mortality were compared between mild or less severe and moderate or more severe CLE and between present and absent PSE in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. RESULTS The Dlco and KCO decline was weakly associated with FEV1 and greater in GOLD stage 3 or higher than in GOLD stages 1 and 2. Furthermore, moderate or more severe CLE, but not present PSE, was associated with steeper declines in Dlco for GOLD stages 1 and 3 or higher and KCO for all GOLD stages independent of age, sex, height, and smoking history. The moderate or more severe CLE, but not present PSE, was associated with additional FEV1 decline and higher 10-year mortality among patients with GOLD stage 3 or higher. INTERPRETATION A CT scan finding of moderate or more severe CLE, but not PSE, was associated with a subsequent accelerated impairment in diffusing capacity and higher long-term mortality in severe GOLD stage among patients with COPD.
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Affiliation(s)
- Yusuke Shiraishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Akira Oguma
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuyasu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hironi Makita
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan; Hokkaido Medical Research Institute for Respiratory Diseases, Sapporo, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Japan
| | - Masaharu Nishimura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan; Hokkaido Medical Research Institute for Respiratory Diseases, Sapporo, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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5
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Zheng J, Zhou R, Zhang Y, Su K, Chen H, Li F, Hukportie DN, Niu F, Yiu KH, Wu X. Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes: A Large Prospective Cohort Study. Chest 2023; 163:610-623. [PMID: 36372304 DOI: 10.1016/j.chest.2022.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) findings are a heterogeneous condition characterized by a normal FEV1 to FVC ratio with underlying impairment of pulmonary function. Data relating to the association of baseline and trajectories of PRISm findings with diverse cardiovascular outcomes are sparse. RESEARCH QUESTION How do baseline and trajectories of PRISm findings impact subsequent cardiovascular events? STUDY DESIGN AND METHODS In the UK Biobank cohort study, we included participants free of cardiovascular disease (CVD) with spirometry (FEV1 and FVC values) at baseline (2006-2010). Participants with baseline spirometry and follow-up spirometry (2014-2020) were included in the lung function trajectory analysis. Cox proportional hazards multivariate regression was performed to evaluate the outcomes of major adverse cardiovascular events (MACEs), incident myocardial infarction (MI), stroke, heart failure (HF), and CVD mortality in association with lung function. RESULTS For baseline analysis (329,954 participants), the multivariate adjusted hazard ratios (HRs) for participants had PRISm findings (vs normal spirometry findings) were 1.26 (95% CI, 1.17-1.35) for MACE, 1.12 (95% CI, 1.01-1.25) for MI, 1.88 (95% CI, 1.72-2.05) for HF, 1.26 (95% CI, 1.13-1.40) for stroke, and 1.55 (95% CI, 1.37-1.76) for CVD mortality, respectively. A total of 22,781 participants underwent follow-up spirometry after an average of 8.9 years. Trajectory analysis showed that persistent PRISm findings (HR, 1.96; 95% CI, 1.24-3.09) and airflow obstruction (HR, 1.43; 95% CI, 1.00-2.04) was associated with a higher incidence of MACE vs consistently normal lung function. Compared with persistent PRISm findings, changing from PRISm to normal spirometry findings was associated with a lower incidence of MACE (HR, 0.42; 95% CI, 0.19-0.99). INTERPRETATION Individuals with baseline or persistent PRISm findings were at a higher risk of diverse cardiovascular outcomes even after adjusting for a wide range of confounding factors. However, individuals who transitioned from PRISm to normal findings showed a similar cardiovascular risk as those with normal lung function.
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Affiliation(s)
- Jiazhen Zheng
- Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangdong, China; Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China; Bioscience and Biomedical Engineering Thrust, Systems Hub, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong SAR, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong SAR, China
| | - Kelei Su
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu, China
| | - Haowen Chen
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China; Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Furong Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Guangdong, China
| | - Daniel Nyarko Hukportie
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Fangbing Niu
- Department of Tuberculosis, Hebei Chest Hospital, Hebei, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shenzhen, Guangdong, China; Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Island, Hong Kong, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China.
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6
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Choi B, Adan N, Doyle TJ, San José Estépar R, Harmouche R, Humphries SM, Moll M, Cho MH, Putman RK, Hunninghake GM, Kalhan R, Liu GY, Diaz AA, Mason SE, Rahaghi FN, Pistenmaa CL, Enzer N, Poynton C, Sánchez-Ferrero GV, Ross JC, Lynch DA, Martinez FJ, Han MK, Bowler RP, Wilson DO, Rosas IO, Washko GR, San José Estépar R, Ash SY. Quantitative Interstitial Abnormality Progression and Outcomes in the Genetic Epidemiology of COPD and Pittsburgh Lung Screening Study Cohorts. Chest 2023; 163:164-175. [PMID: 35780812 PMCID: PMC9859724 DOI: 10.1016/j.chest.2022.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The risk factors and clinical outcomes of quantitative interstitial abnormality progression over time have not been characterized. RESEARCH QUESTIONS What are the associations of quantitative interstitial abnormality progression with lung function, exercise capacity, and mortality? What are the demographic and genetic risk factors for quantitative interstitial abnormality progression? STUDY DESIGN AND METHODS Quantitative interstitial abnormality progression between visits 1 and 2 was assessed from 4,635 participants in the Genetic Epidemiology of COPD (COPDGene) cohort and 1,307 participants in the Pittsburgh Lung Screening Study (PLuSS) cohort. We used multivariable linear regression to determine the risk factors for progression and the longitudinal associations between progression and FVC and 6-min walk distance, and Cox regression models for the association with mortality. RESULTS Age at enrollment, female sex, current smoking status, and the MUC5B minor allele were associated with quantitative interstitial abnormality progression. Each percent annual increase in quantitative interstitial abnormalities was associated with annual declines in FVC (COPDGene: 8.5 mL/y; 95% CI, 4.7-12.4 mL/y; P < .001; PLuSS: 9.5 mL/y; 95% CI, 3.7-15.4 mL/y; P = .001) and 6-min walk distance, and increased mortality (COPDGene: hazard ratio, 1.69; 95% CI, 1.34-2.12; P < .001; PLuSS: hazard ratio, 1.28; 95% CI, 1.10-1.49; P = .001). INTERPRETATION The objective, longitudinal measurement of quantitative interstitial abnormalities may help identify people at greatest risk for adverse events and most likely to benefit from early intervention.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | - Najma Adan
- Department of Biology, University of Washington, Bothell, WA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Rola Harmouche
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gabrielle Y Liu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Stefanie E Mason
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Nicholas Enzer
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Clare Poynton
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Gonzalo Vegas Sánchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Russell P Bowler
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ivan O Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
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7
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Wang JM, Ram S, Labaki WW, Han MK, Galbán CJ. CT-Based Commercial Software Applications: Improving Patient Care Through Accurate COPD Subtyping. Int J Chron Obstruct Pulmon Dis 2022; 17:919-930. [PMID: 35502294 PMCID: PMC9056100 DOI: 10.2147/copd.s334592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/03/2022] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is heterogenous in its clinical manifestations and disease progression. Patients often have disease courses that are difficult to predict with readily available data, such as lung function testing. The ability to better classify COPD into well-defined groups will allow researchers and clinicians to tailor novel therapies, monitor their effects, and improve patient-centered outcomes. Different modalities of assessing these COPD phenotypes are actively being studied, and an area of great promise includes the use of quantitative computed tomography (QCT) techniques focused on key features such as airway anatomy, lung density, and vascular morphology. Over the last few decades, companies around the world have commercialized automated CT software packages that have proven immensely useful in these endeavors. This article reviews the key features of several commercial platforms, including the technologies they are based on, the metrics they can generate, and their clinical correlations and applications. While such tools are increasingly being used in research and clinical settings, they have yet to be consistently adopted for diagnostic work-up and treatment planning, and their full potential remains to be explored.
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Affiliation(s)
- Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sundaresh Ram
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Craig J Galbán
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA,Correspondence: Craig J Galbán, Department of Radiology, University of Michigan, BSRB, Room A506, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA, Tel +1 734-764-8726, Fax +1 734-615-1599, Email
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8
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Anami K, Murata S, Nakano H, Nonaka K, Iwase H, Shiraiwa K, Abiko T, Goda A, Horie J. Physical performance in relation to preserved ratio impaired spirometry: a cross-sectional study of community-dwelling older Japanese adults. Sci Rep 2021; 11:17411. [PMID: 34465800 PMCID: PMC8408254 DOI: 10.1038/s41598-021-96830-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022] Open
Abstract
Preserved ratio impaired spirometry (PRISm) is associated with an increased mortality rate; however, its characteristics have not been clearly identified in Japan. This cross-sectional study of community-dwelling older adults compared physical function between people with PRISm and those with no respiratory issues, from 2014 to 2019. We collected demographic data through interviews and measured respiratory and physical functions. We included 668 older adults (male, 23.5%; mean age, 72.8 ± 5.6 years); the prevalence of PRISm was 12%, while the prevalence of obstruction was 6.9%. Propensity score matching was used to identify control subjects with normal spirometry (n = 80) while minimizing the effects of confounders during comparisons with the PRISm population (n = 80). Compared with community-dwelling older adults with normal lung capacity, older adults with PRISm had a lower forced vital capacity (%FVC; 68.7 ± 9.1% vs. 92.5 ± 12.7%, p < 0.001), lower core muscle endurance (sit-up test: 6.7 ± 5.8 vs. 8.7 ± 6.0, p = 0.032), and a longer one-leg stance duration (52.4 ± 41.1 s vs. 36.4 ± 34.1 s, p = 0.008). In multivariable logistic regression, %FVC and increased one-leg stance were independent predictors of PRISm status. The prevalence of PRISm among community-dwelling elderly Japanese exceeds that of obstructive lung disease and is associated with reduced %FVC and better performance on balance testing.
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Affiliation(s)
- Kunihiko Anami
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, 3-15-1, Nakatomigaoka, Nara-shi, Nara, 631-8524, Japan.
| | - Shin Murata
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Hideki Nakano
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Koji Nonaka
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, 3-15-1, Nakatomigaoka, Nara-shi, Nara, 631-8524, Japan
| | - Hiroaki Iwase
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe, 658-0032, Japan
| | - Kayoko Shiraiwa
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Teppei Abiko
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
| | - Jun Horie
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, 607-8175, Japan
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9
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El Kaddouri B, Strand MJ, Baraghoshi D, Humphries SM, Charbonnier JP, van Rikxoort EM, Lynch DA. Fleischner Society Visual Emphysema CT Patterns Help Predict Progression of Emphysema in Current and Former Smokers: Results from the COPDGene Study. Radiology 2021; 298:441-449. [PMID: 33320065 PMCID: PMC8824777 DOI: 10.1148/radiol.2020200563] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The correlation between visual emphysema patterns and subsequent progression of disease may provide a way to enrich a study population for treatment trials of emphysema. Purpose To evaluate the potential relationship between emphysema visual subtypes and progression of emphysema and gas trapping. Materials and Methods Current and former smokers with and without chronic obstructive pulmonary disease (COPD) enrolled in the prospective Genetic Epidemiology of COPD (COPDGene) study (ClinicalTrials.gov identifier: NCT02445183) between 2008 and 2011 had their Fleischner Society visual CT scores assessed at baseline, quantitative inspiratory, and expiratory CT and at 5 years. They also underwent pulmonary function testing at baseline CT and at 5 years. The dependent variables were inspiratory lung density at 15th percentile (adjusted for lung volume) as a measure of emphysema and percentage of lung volume with attenuation less than -856 HU at expiratory CT as a measure of air trapping. Statistical analysis used a linear mixed model, adjusted for age, height, sex, race, smoking status, and scanner make. Results A total of 4166 participants (mean age, 60 years ± 9 [standard deviation]; 2091 [50%] men) were evaluated. In participants with COPD (1655 participants, 40%), those with visual presence of mild, moderate, and confluent emphysema at baseline CT showed a mean decline in lung density of 4.6 g/L ± 1.1 (P < .001), 6.7 g/L ± 1.1 (P < .001), and 6.4 g/L ± 1.2 (P < .001), respectively, compared with 2.4 g/L ± 1.3 (P < .001) for those with trace emphysema. For participants without COPD, those with visual presence of mild and moderate emphysema at baseline CT showed a mean decline in lung density of 3.6 g/L ± 1.0 (P < .001) and 3.1 g/L ± 1.6 (P < .001), respectively, compared with 1.8 g/L ± 1.0 (P < .001) for those with trace emphysema. Conclusion The pattern of parenchymal emphysema at baseline CT was an independent predictor of subsequent progression of emphysema in participants who are current or former cigarette smokers with and without chronic obstructive pulmonary disease. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Bilal El Kaddouri
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Matthew J Strand
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - David Baraghoshi
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Stephen M Humphries
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Jean-Paul Charbonnier
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - Eva M van Rikxoort
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
| | - David A Lynch
- From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium (B.E.K.); Division of Biostatistics & Bioinformatics (M.J.S., D.B.) and Department of Radiology (S.H., D.A.L.), National Jewish Health, Denver, Colo; and Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (J.P.C., E.M.v.R.)
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10
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Dolliver WR, Diaz AA. Advances in Chronic Obstructive Pulmonary Disease Imaging. ACTA ACUST UNITED AC 2020; 6:128-143. [PMID: 33758787 DOI: 10.23866/brnrev:2019-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chest computed tomography (CT) imaging is a useful tool that provides in vivo information regarding lung structure. Imaging has contributed to a better understanding of COPD, allowing for the detection of early structural changes and the quantification of extra-pulmonary structures. Novel CT imaging techniques have provided insight into the progression of the main COPD subtypes, such as emphysema and small airway disease. This article serves as a review of new information relevant to COPD imaging. CT abnormalities, such as emphysema and loss of airways, are present even in smokers who do not meet the criteria for COPD and in those with mild-to-moderate disease. Subjects with mild-to-moderate COPD, with the highest loss of airways, also experience the highest decline in lung function. Extra-pulmonary manifestations of COPD, such as right ventricle enlargement and low muscle mass measured on CT, are associated with increased risk for all-cause mortality. CT longitudinal data has also given insight into the progression of COPD. Mechanically affected areas of lung parenchyma adjacent to emphysematous areas are associated with a greater decline in FEV1. Subjects with the greatest percentage of small airway disease, as measured on matched inspiratory-expiratory CT scan, also present with the greatest decline in lung function.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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11
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Wijnant SRA, De Roos E, Kavousi M, Stricker BH, Terzikhan N, Lahousse L, Brusselle GG. Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study. Eur Respir J 2020; 55:13993003.01217-2019. [PMID: 31601717 DOI: 10.1183/13993003.01217-2019] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/20/2019] [Indexed: 11/05/2022]
Abstract
Preserved ratio impaired spirometry (PRISm) is a heterogeneous condition but its course and disease progression remain to be elucidated. We aimed to examine its prevalence, trajectories and prognosis in the general population.In the Rotterdam Study (population-based prospective cohort) we examined prevalence, trajectories and prognosis of subjects with normal spirometry (controls; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7, FEV1 ≥80%), PRISm (FEV1/FVC ≥0.7, FEV1 <80%) and chronic obstructive pulmonary disease (COPD) (FEV1/FVC <0.7) at two study visits. Hazard ratios with 95% confidence intervals for mortality (until December 30, 2018) were adjusted for age, sex, body mass index, current smoking and pack-years.Of 5487 subjects (age 69.1±8.9 years; 7.1% PRISm), 1603 were re-examined after 4.5 years. Of the re-examined PRISm subjects, 15.7% transitioned to normal spirometry and 49.4% to COPD. Median lung function decline was highest in subjects with incident PRISm (FEV1 -92.8 mL·year-1, interquartile range (IQR) -131.9- -65.8 mL·year-1; FVC -93.3 mL·year-1, IQR -159.8- -49.1 mL·year-1), but similar in persistent PRISm (FEV1 -30.2 mL·year-1, IQR -67.9- -7.5 mL·year-1; FVC -20.1 mL·year-1, IQR -47.7-21.7 mL·year-1) and persistent controls (FEV1 -39.6 mL·year-1, IQR -64.3--12.7 mL·year-1; FVC -20.0 mL·year-1, IQR -55.4-18.8 mL·year-1). Of 5459 subjects with informed consent for follow-up, 692 (12.7%) died during 9.3 years (maximum) follow-up: 10.3% of controls, 18.7% of PRISm subjects and 20.8% of COPD subjects. Relative to controls, subjects with PRISm and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2-4 had increased all-cause mortality (PRISm: HR 1.6, 95% CI 1.2-2.0; COPD GOLD 2-4: HR 1.7, 95% CI 1.4-2.1) and cardiovascular mortality (PRISm: HR 2.8, 95% CI 1.5-5.1; COPD 2-4: HR 2.1, 95% CI 1.2-3.6). Mortality within <1 year was highest in PRISm, with patients often having cardiovascular comorbidities (heart failure or coronary heart disease; 70.0%).PRISm is associated with increased mortality and this population encompasses at least three distinct subsets: one that develops COPD during follow-up, a second with high cardiovascular burden and early mortality, and a third with persistent PRISm and normal age-related lung function decline.
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Affiliation(s)
- Sara Renata Alex Wijnant
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Emmely De Roos
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno Hugo Stricker
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Natalie Terzikhan
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Both authors contributed equally
| | - Guy G Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium .,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,Both authors contributed equally
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12
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Coste F, Benlala I, Dournes G, Girodet PO, Laurent F, Berger P. Assessing pulmonary hypertension in COPD. Is there a role for computed tomography? Int J Chron Obstruct Pulmon Dis 2019; 14:2065-2079. [PMID: 31564854 PMCID: PMC6732516 DOI: 10.2147/copd.s207363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/10/2019] [Indexed: 12/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity and mortality. Reference standard method to diagnose PH is right heart catheterization. Several non-invasive imaging techniques have been employed in the detection of PH. Among them, computed tomography (CT) is the most commonly used for phenotyping and detecting complications of COPD. Several CT findings have also been described in patients with severe PH. Nevertheless, CT analysis is currently based on visual findings which can lead to reproducibility failure. Therefore, there is a need for quantification in order to assess objective criteria. In this review, progresses in automated analyses of CT parameters and their values in predicting PH and COPD outcomes are presented.
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Affiliation(s)
- Florence Coste
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France
| | - Ilyes Benlala
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Gaël Dournes
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Pierre-Olivier Girodet
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - François Laurent
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Patrick Berger
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
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Kim W, Cho MH, Sakornsakolpat P, Lynch DA, Coxson HO, Tal-Singer R, Silverman EK, Beaty TH. DSP variants may be associated with longitudinal change in quantitative emphysema. Respir Res 2019; 20:160. [PMID: 31324189 PMCID: PMC6642569 DOI: 10.1186/s12931-019-1097-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Background Emphysema, characterized by lung destruction, is a key component of Chronic Obstructive Pulmonary Disease (COPD) and is associated with increased morbidity and mortality. Genome-wide association studies (GWAS) have identified multiple genetic factors associated with cross-sectional measures of quantitative emphysema, but the genetic determinants of longitudinal change in quantitative measures of emphysema remain largely unknown. Our study aims to identify genetic variants associated with longitudinal change in quantitative emphysema measured by computed tomography (CT) imaging. Methods We included current and ex-smokers from two longitudinal cohorts: COPDGene, a study of Non-Hispanic Whites (NHW) and African Americans (AA), and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE). We calculated annual change in two quantitative measures of emphysema based on chest CT imaging: percent low attenuation area (≤ − 950HU) (%LAA-950) and adjusted lung density (ALD). We conducted GWAS, separately in 3030 NHW and 1158 AA from COPDGene and 1397 Whites from ECLIPSE. We further explored effects of 360 previously reported variants and a lung function based polygenic risk score on annual change in quantitative emphysema. Results In the genome-wide association analysis, no variants achieved genome-wide significance (P < 5e-08). However, in the candidate region analysis, rs2076295 in the DSP gene, previously associated with COPD, lung function and idiopathic pulmonary fibrosis, was associated with change in %LAA-950 (β (SE) = 0.09 (0.02), P = 3.79e-05) and in ALD (β (SE) = − 0.06 (0.02), P = 2.88e-03). A lung function based polygenic risk score was associated with annual change in %LAA-950 (P = 4.03e-02) and with baseline measures of quantitative emphysema (P < 1e-03) and showed a trend toward association with annual change in ALD (P = 7.31e-02). Conclusions DSP variants may be associated with longitudinal change in quantitative emphysema. Additional investigation of the DSP gene are likely to provide further insights into the disease progression in emphysema and COPD. Trial registration Clinicaltrials.gov Identifier: NCT00608764, NCT00292552. Electronic supplementary material The online version of this article (10.1186/s12931-019-1097-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Woori Kim
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.,Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael H Cho
- Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Phuwanat Sakornsakolpat
- Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, British Columbia, Canada
| | | | - Edwin K Silverman
- Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Benlala I, Berger P, Girodet PO, Dromer C, Macey J, Laurent F, Dournes G. Automated Volumetric Quantification of Emphysema Severity by Using Ultrashort Echo Time MRI: Validation in Participants with Chronic Obstructive Pulmonary Disease. Radiology 2019; 292:216-225. [DOI: 10.1148/radiol.2019190052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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15
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Silva M, Milanese G, Sverzellati N. Interstitial lung abnormalities: prognostic stratification of subtle radiological findings. Curr Opin Pulm Med 2019; 24:432-439. [PMID: 29939864 DOI: 10.1097/mcp.0000000000000497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide the radiological description of interstitial lung abnormalities (ILA) as an increasingly reported entity on high-resolution computed tomography (HRCT), and to discuss their prospective interpretation. RECENT FINDINGS Elementary findings consistent with ILA are described on HRCT, yet the diagnostic confidence for the interpretation of these subtle features might be challenging and further hampered by interobserver variability. Quantitative analysis is expected to provide standardized and reproducible description of ILA. There is affinity between ILA morphology and histopathological pattern, either fibrosis or atypical adenomatous hyperplasia. Beyond radiology, there are predictors of risk of ILA, such as: age, smoking habit, circulating biomarkers, and genetic sequencing. ILA with fibrotic morphology show prognostic impact including progression to interstitial lung disease, mortality from respiratory disease, and all-cause mortality. The association between ILA and susceptibility to lung damage further includes the interlacing connection between interstitial findings and lung cancer, both as a risk factor for diagnosis and as a predictor of survival. SUMMARY ILA are a (minor) finding on HRCT and they should be reported by radiologists for optimal management within the specific clinic-functional scenario. ILA encompass a number of semiological characteristics associated with either fibrotic or nonfibrotic disease.
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Affiliation(s)
- Mario Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma.,bioMILD Lung Cancer Screening Trial, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gianluca Milanese
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma
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16
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CT Imaging-Based Low-Attenuation Super Clusters in Three Dimensions and the Progression of Emphysema. Chest 2018; 155:79-87. [PMID: 30292758 DOI: 10.1016/j.chest.2018.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/31/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Distributions of low-attenuation areas in two-dimensional (2-D) CT lung slices are used to quantify parenchymal destruction in patients with COPD. However, these segmental approaches are limited and may not reflect the true three-dimensional (3-D) tissue processes that drive emphysematous changes in the lung. The goal of this study was to instead evaluate distributions of 3-D low-attenuation volumes, which we hypothesized would follow a power law distribution and provide a more complete assessment of the mechanisms underlying disease progression. METHODS CT scans and pulmonary function test results were acquired from an observational database for N = 12 patients with COPD and N = 12 control patients. The data set included baseline and two annual follow-up evaluations in patients with COPD. Three-dimensional representations of the lungs were reconstructed from 2-D axial CT slices, with low-attenuation volumes identified as contiguous voxels < -960 Hounsfield units. RESULTS Low-attenuation sizes generally followed a power law distribution, with the exception of large, individual outliers termed "super clusters," which deviated from the expected distribution. Super cluster volume was correlated with disease severity (% total low attenuation, ρ = 0.950) and clinical measures of lung function including FEV1 (ρ = -0.849) and diffusing capacity of the lung for carbon monoxide Dlco (ρ = -0.874). To interpret these results, we developed a personalized computational model of super cluster emergence. Simulations indicated disease progression was more likely to occur near existing emphysematous regions, giving rise to a biomechanical, force-induced mechanism of super cluster growth. CONCLUSIONS Low-attenuation super clusters are defining, quantitative features of parenchymal destruction that dominate disease progression, particularly in advanced COPD.
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Park HJ, Byun MK, Rhee CK, Kim K, Kim HJ, Yoo KH. Significant predictors of medically diagnosed chronic obstructive pulmonary disease in patients with preserved ratio impaired spirometry: a 3-year cohort study. Respir Res 2018; 19:185. [PMID: 30249256 PMCID: PMC6154818 DOI: 10.1186/s12931-018-0896-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022] Open
Abstract
Background Preserved ratio impaired spirometry (PRISm) is an incompletely understood respiratory condition. We investigated the incidence and significant predictive factors of chronic obstructive pulmonary disease (COPD) in PRISm patients. Methods From 11,922 subjects registered in the Korea National Health and Nutrition Examination Survey, never or light smokers, young subjects, and those already medically diagnosed with COPD (defined by ICD-10 code and prescribed medication) were excluded. The 2666 remaining subjects were categorized into PRISm (normal forced expiratory volume in the first second [FEV1]/force vital capacity [FVC] [≥ 0.7] and low FEV1 (< 80%); n = 313); normal (n = 1666); and unrevealed COPD groups (FEV1/FVC ratio < 0.7; n = 687). These groups were compared using matched Health Insurance Review and Assessment Service data over a 3-year follow-up. Results COPD incidence in PRISm patients (17/1000 person-year [PY]) was higher than that in normal subjects (4.3/1000 PY; P < 0.001), but lower than that in unrevealed COPD patients (45/1000 PY; P < 0.001). PRISm patients visited hospitals, took COPD medication, and incurred hospitalization costs more frequently than normal subjects, but less frequently than unrevealed COPD patients. In the overall sample, age, FVC, FEV1, dyspnea, and wheezing were significant predictors of COPD, but in PRISm patients, only age (OR, 1.14; P = 0.002) and wheezing (OR, 4.56; P = 0.04) were significant predictors. Conclusion PRISm patients are likely to develop COPD, and should be monitored carefully, especially older patients and those with wheezing, regardless of lung function.
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Affiliation(s)
- Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro Gangnam-gu, Seoul, 06273, Korea
| | - Min Kwang Byun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro Gangnam-gu, Seoul, 06273, Korea.
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungjoo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Jung Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro Gangnam-gu, Seoul, 06273, Korea
| | - Kwang-Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Wei X, Ding Q, Yu N, Mi J, Ren J, Li J, Xu S, Gao Y, Guo Y. Imaging Features of Chronic Bronchitis with Preserved Ratio and Impaired Spirometry (PRISm). Lung 2018; 196:649-658. [PMID: 30218155 DOI: 10.1007/s00408-018-0162-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to investigate the quantitative chest tomographic features of chronic bronchitis with preserved ratio and impaired spirometry (PRISm), including airway wall area, emphysema index, and lung capacity. METHODS An observational, cross-sectional study of 343 patients at the Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University between October 2014 and September 2017. The patients were divided into three groups: 77 cases of chronic bronchitis with normal lung function (forced expiratory volume in one second/forced vital capacity) (FEV1/FVC > 70%, FEV1%pred > 80%), 80 cases of chronic bronchitis with PRISm (FEV1/FVC > 70%, FEV1%pred < 80%), and 186 cases of the early chronic obstructive pulmonary disease (COPD) (FEV1/FVC < 70%, FEV1%pred > 50%, that is, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade 1 + 2). We compared and analyzed the differences in imaging between the chronic bronchitis with PRISm and the other two groups. RESULTS Compared with the early COPD group, the PRISm group revealed significant differences in airway wall area, emphysema index, and lung capacity (P < 0.05). Compared with the chronic bronchitis with normal lung function group, the PRISm group showed increased WA%LUL5, decreased lung capacity, and higher mean lung density. CONCLUSION In terms of airway wall area and emphysema index, patients with chronic bronchitis with PRISm were essentially no different than those with chronic bronchitis without abnormal spirometry, whereas for symptoms, they are more like GOLD 1 and 2 patients. Our findings show that it is not yet clear whether it constitutes an intermediate stage of chronic bronchitis with normal lung function that progression to early COPD.
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Affiliation(s)
- Xia Wei
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, 151 East Section of South Second Ring Road, Xi'an, 710054, China. .,Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Qi Ding
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, 151 East Section of South Second Ring Road, Xi'an, 710054, China
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, China
| | - Jiuyun Mi
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, 151 East Section of South Second Ring Road, Xi'an, 710054, China
| | - Jingting Ren
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, 151 East Section of South Second Ring Road, Xi'an, 710054, China
| | - Jie Li
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, 151 East Section of South Second Ring Road, Xi'an, 710054, China
| | - Shudi Xu
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, 151 East Section of South Second Ring Road, Xi'an, 710054, China
| | - Yanzhong Gao
- Department of Radiology, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Youmin Guo
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, 151 East Section of South Second Ring Road, Xi'an, 710054, China
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