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Elbehairy AF, Marshall H, Naish JH, Wild JM, Parraga G, Horsley A, Vestbo J. Advances in COPD imaging using CT and MRI: linkage with lung physiology and clinical outcomes. Eur Respir J 2024; 63:2301010. [PMID: 38548292 DOI: 10.1183/13993003.01010-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/16/2024] [Indexed: 05/04/2024]
Abstract
Recent years have witnessed major advances in lung imaging in patients with COPD. These include significant refinements in images obtained by computed tomography (CT) scans together with the introduction of new techniques and software that aim for obtaining the best image whilst using the lowest possible radiation dose. Magnetic resonance imaging (MRI) has also emerged as a useful radiation-free tool in assessing structural and more importantly functional derangements in patients with well-established COPD and smokers without COPD, even before the existence of overt changes in resting physiological lung function tests. Together, CT and MRI now allow objective quantification and assessment of structural changes within the airways, lung parenchyma and pulmonary vessels. Furthermore, CT and MRI can now provide objective assessments of regional lung ventilation and perfusion, and multinuclear MRI provides further insight into gas exchange; this can help in structured decisions regarding treatment plans. These advances in chest imaging techniques have brought new insights into our understanding of disease pathophysiology and characterising different disease phenotypes. The present review discusses, in detail, the advances in lung imaging in patients with COPD and how structural and functional imaging are linked with common resting physiological tests and important clinical outcomes.
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Affiliation(s)
- 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 Academic Health Sciences Centre, Manchester, UK
| | - Helen Marshall
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Josephine H Naish
- MCMR, Manchester University NHS Foundation Trust, Manchester, UK
- Bioxydyn Limited, Manchester, UK
| | - Jim M Wild
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, Sheffield, UK
| | - Grace Parraga
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Division of Respirology, Western University, London, ON, Canada
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [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] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
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Lee HJ, Jin KN, Lee HW, Lee JK, Park TY, Heo EY, Kim DK. Radiographic Phenotypes Affect the Risk of Inhaled Corticosteroid-Associated Pneumonia in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:2301-2315. [PMID: 36159655 PMCID: PMC9503700 DOI: 10.2147/copd.s372735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Few studies have reported the association between the radiographic characteristics and the development of pneumonia in patients with chronic obstructive pulmonary disease (COPD) treated with inhaled corticosteroids (ICSs). Our study aimed to assess the effect of radiographic phenotypes on the risk of pneumonia in patients treated with ICSs. Patients and Methods This study retrospectively analysed all patients with COPD treated with ICSs in a subset of the Korea Chronic Obstructive Pulmonary Disorders Subgroup Study registry between January 2017 and December 2019. The association between radiographic phenotypes including the presence and severity of emphysema, airway wall thickening, or bronchiectasis on chest computed tomography were determined visually/qualitatively and the risk of pneumonia was analyzed using the Cox regression model. Results Among the 90 patients with COPD treated with ICSs, 41 experienced pneumonia more than once during the median follow-up of 29 (interquartile range, 8–35) months. In univariate Cox regression analysis, older age, longer use of ICSs, use of fluticasone propionate or metered dose inhaler, and severe exacerbation events increased the risk of pneumonia. In multivariate analysis, the presence of emphysema (adjusted hazard ratio [aHR]=3.73, P=0.033), severity measured using the visual sum score (mild-to-moderate, aHR=8.58, P=0.016; severe, aHR=3.58, P=0.042), Goddard sum score (mild-to-moderate, aHR=3.31, P=0.058; severe, aHR=5.38, P=0.014), and the upper lobe distribution of emphysema (aHR=3.76, P=0.032) were associated with a higher risk of pneumonia. Subtypes of centrilobular and panlobular emphysema had a higher risk of pneumonia compared with paraseptal emphysema (aHR=3.98, P=0.033; HR=3.91, P=0.041 vs HR=2.74, P=0.304). The presence of bronchiectasis (aHR=2.41, P=0.02) and emphysema/bronchiectasis overlap phenotype (aHR=2.19, P=0.053) on chest CT was a risk factor for pneumonia in this population. However, severity of bronchiectasis and the presence or severity of bronchial wall thickening according to the visual sum score were not associated with the risk of pneumonia. Conclusion Among patients with COPD treated with ICSs, radiographic phenotypes including the presence of emphysema, bronchiectasis or emphysema/bronchiectasis overlap phenotype, severity with emphysema, subtypes of centrilobular or panlobular emphysema, and upper lobe distribution of emphysema may help predict the risk of pneumonia.
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Affiliation(s)
- Hyo Jin Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyun Woo Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jung-Kyu Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Yeon Park
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Eun Young Heo
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Deog Kyeom Kim
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Kaza N, Lin VY, Stanford D, Hussain SS, Falk Libby E, Kim H, Borgonovi M, Conrath K, Mutyam V, Byzek SA, Tang LP, Trombley JE, Rasmussen L, Schoeb T, Leung HM, Tearney GJ, Raju SV, Rowe SM. Evaluation of a novel CFTR potentiator in COPD ferrets with acquired CFTR dysfunction. Eur Respir J 2022; 60:13993003.01581-2021. [PMID: 34916262 PMCID: PMC10079430 DOI: 10.1183/13993003.01581-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/21/2021] [Indexed: 11/05/2022]
Abstract
RATIONALE The majority of chronic obstructive pulmonary disease (COPD) patients have chronic bronchitis, for which specific therapies are unavailable. Acquired cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction is observed in chronic bronchitis, but has not been proven in a controlled animal model with airway disease. Furthermore, the potential of CFTR as a therapeutic target has not been tested in vivo, given limitations to rodent models of COPD. Ferrets exhibit cystic fibrosis-related lung pathology when CFTR is absent and COPD with bronchitis following cigarette smoke exposure. OBJECTIVES To evaluate CFTR dysfunction induced by smoking and test its pharmacological reversal by a novel CFTR potentiator, GLPG2196, in a ferret model of COPD with chronic bronchitis. METHODS Ferrets were exposed for 6 months to cigarette smoke to induce COPD and chronic bronchitis and then treated with enteral GLPG2196 once daily for 1 month. Electrophysiological measurements of ion transport and CFTR function, assessment of mucociliary function by one-micron optical coherence tomography imaging and particle-tracking microrheology, microcomputed tomography imaging, histopathological analysis and quantification of CFTR protein and mRNA expression were used to evaluate mechanistic and pathophysiological changes. MEASUREMENTS AND MAIN RESULTS Following cigarette smoke exposure, ferrets exhibited CFTR dysfunction, increased mucus viscosity, delayed mucociliary clearance, airway wall thickening and airway epithelial hypertrophy. In COPD ferrets, GLPG2196 treatment reversed CFTR dysfunction, increased mucus transport by decreasing mucus viscosity, and reduced bronchial wall thickening and airway epithelial hypertrophy. CONCLUSIONS The pharmacologic reversal of acquired CFTR dysfunction is beneficial against pathological features of chronic bronchitis in a COPD ferret model.
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Affiliation(s)
- Niroop Kaza
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.,Equal contributions
| | - Vivian Y Lin
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.,Equal contributions
| | - Denise Stanford
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.,Equal contributions
| | - Shah S Hussain
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily Falk Libby
- The Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harrison Kim
- Dept of Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Venkateshwar Mutyam
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen A Byzek
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Li Ping Tang
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - John E Trombley
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lawrence Rasmussen
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Trenton Schoeb
- Dept of Genetics, The University of Alabama at Birmingham, Birmingham, AL, USA.,Animal Resources Program, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hui Min Leung
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Dept of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - S Vamsee Raju
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.,The Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, USA.,Dept of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA.,Co-senior authors
| | - Steven M Rowe
- Dept of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA .,The Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, USA.,Dept of Cell, Developmental, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL, USA.,Co-senior authors
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Guillem JS, Schiborra F, Rossanese M, Maddox TW, Mortier JR. Prevalence of bronchial wall thickening and collapse in brachycephalic dogs with and without brachycephalic obstructive airway syndrome and in nonbrachycephalic dogs. J Am Vet Med Assoc 2022; 261:1-8. [PMID: 35905164 DOI: 10.2460/javma.21.10.0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the prevalence of bronchial wall thickening (BWT) and collapse in brachycephalic dogs with and without brachycephalic obstructive airway syndrome (BOAS) and in nonbrachycephalic dogs. ANIMALS 85 dogs with no history of lower respiratory tract disease that underwent CT of the thorax. PROCEDURES Electronical medical records for March 2011 through August 2019 were reviewed to identify brachycephalic dogs with BOAS (BOAS group) and brachycephalic dogs without BOAS (BDWB group) that did not have any evidence of lower respiratory tract disease and had undergone thoracic CT. A population of nonbrachycephalic dogs of similar weight (control dogs) was also retrospectively recruited. RESULTS BWT was identified in 28 of 30 (93.3%; 95% CI, 80.3% to 98.6%) dogs in the BOAS group, 15 of 26 (57.7%; 95% CI, 38.7% to 75.0%) dogs in the BDWB group, and 10 of 28 (35.7%; 95% CI, 20.1% to 54.2%) control dogs. On multivariable analysis, only brachycephalic conformation (P < 0.01) and body weight (P = 0.02) were significantly associated with the presence of BWT. Bronchial collapse was identified in 17 of 30 (56.7%; 95% CI, 39.0% to 73.1%) dogs in the BOAS group, 17 of 26 (65.4%; 95% CI, 46.3% to 81.3%) dogs in the BDWB group, and 3 of 28 (10.7%; 95% CI, 3.1% to 25.9%) control dogs. On multivariable analysis, only brachycephalic conformation was significantly (P < 0.01) associated with the presence of bronchial collapse. CLINICAL RELEVANCE A relationship between brachycephalic conformation and body weight with BWT was established, with heavier dogs having thicker bronchial walls. However, further studies are required to investigate the cause. Bronchial collapse was also more common in dogs with brachycephalic conformation, which is in agreement with the previously published literature.
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Affiliation(s)
- James S Guillem
- 1Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Frederike Schiborra
- 1Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Matteo Rossanese
- 2The Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, UK
| | - Thomas W Maddox
- 1Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Jeremy R Mortier
- 3Unité de Médecine-Imagerie Médicale, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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Kang HS, Bak SH, Oh HY, Lim MN, Cha YK, Yoon HJ, Kim WJ. Computed tomography-based visual assessment of chronic obstructive pulmonary disease: comparison with pulmonary function test and quantitative computed tomography. J Thorac Dis 2021; 13:1495-1506. [PMID: 33841942 PMCID: PMC8024830 DOI: 10.21037/jtd-20-3041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) has variable subtypes involving mixture of large airway inflammation, small airway disease, and emphysema. This study evaluated the relationship between visually assessed computed tomography (CT) subtypes and clinical/imaging characteristics. Methods In total, 452 participants were enrolled in this study between 2012 and 2017. Seven subtypes were defined by visual evaluation of CT images using Fleischner Society classification: normal, paraseptal emphysema (PSE), bronchial disease, and centrilobular emphysema (trace, mild, moderate and confluent/advanced destructive). The differences in several variables, including clinical, laboratory, spirometric, and quantitative CT features among CT-based visual subtypes, were compared using the chi-square tests and one-way analysis of variance. Results Subjects who had PSE had better forced expiratory volume in 1 second (FEV1) (P=0.03) percentage and higher lung density (P<0.05) than those with moderate to confluent/advanced destructive centrilobular emphysema. As the visual grade of centrilobular emphysema worsened, pulmonary function declined and modified Medical Research Council, COPD assessment test (CAT) score, and quantitative assessment (emphysema index and air trapping) increased. The bronchial subtype was associated with higher body mass index (BMI), better lung function and higher lung density. Participants with trace emphysema showed a rapid increase in functional small airway disease. Conclusions Classifying subtypes using visual CT imaging features can reflect heterogeneity and pathological processes of COPD.
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Affiliation(s)
- Han Sol Kang
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - So Hyeon Bak
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ha Yeun Oh
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myoung-Nam Lim
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Yoon Ki Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Yoon
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine and Environmental Health Center, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
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7
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Stanford D, Kim H, Bodduluri S, LaFontaine J, Byzek SA, Schoeb TR, Harris ES, Nath HP, Bhatt SP, Raju SV, Rowe SM. Airway remodeling in ferrets with cigarette smoke-induced COPD using µCT imaging. Am J Physiol Lung Cell Mol Physiol 2020; 319:L11-L20. [PMID: 32374671 PMCID: PMC7468842 DOI: 10.1152/ajplung.00328.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022] Open
Abstract
Structural changes to airway morphology, such as increased bronchial wall thickness (BWT) and airway wall area, are cardinal features of chronic obstructive pulmonary disease (COPD). Ferrets are a recently established animal model uniquely exhibiting similar clinical and pathological characteristics of COPD as humans, including chronic bronchitis. Our objective was to develop a microcomputed tomography (µCT) method for evaluating structural changes to the airways in ferrets and assess whether the effects of smoking induce changes consistent with chronic bronchitis in humans. Ferrets were exposed to mainstream cigarette smoke or air control twice daily for 6 mo. µCT was conducted in vivo at 6 mo; a longitudinal cohort was imaged monthly. Manual measurements of BWT, luminal diameter (LD), and BWT-to-LD ratio (BWT/LD) were conducted and confirmed by a semiautomated algorithm. The square root of bronchial wall area (√WA) versus luminal perimeter was determined on an individual ferret basis. Smoke-exposed ferrets reproducibly demonstrated 34% increased BWT (P < 0.001) along with increased LD and BWT/LD versus air controls. Regression indicated that the effect of smoking on BWT persisted despite controlling for covariates. Semiautomated measurements replicated findings. √WA for the theoretical median airway luminal perimeter of 4 mm (Pi4) was elevated 4.4% in smoke-exposed ferrets (P = 0.015). Increased BWT and Pi4 developed steadily over time. µCT-based airway measurements in ferrets are feasible and reproducible. Smoke-exposed ferrets develop increased BWT and Pi4, changes similar to humans with chronic bronchitis. µCT can be used as a significant translational platform to measure dynamic airway morphological changes.
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Affiliation(s)
- Denise Stanford
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harrison Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sandeep Bodduluri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer LaFontaine
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephen A Byzek
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Trenton R Schoeb
- Genetics and Animal Resources Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elex S Harris
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hrudaya P Nath
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Surya P Bhatt
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, Alabama
| | - S Vamsee Raju
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven M Rowe
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
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Kim T, Choi H, Kim J. Association Between Dietary Nutrient Intake and Chronic Obstructive Pulmonary Disease Severity: A Nationwide Population-Based Representative Sample. COPD 2019; 17:49-58. [PMID: 31833439 DOI: 10.1080/15412555.2019.1698530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Several nutrients have been suggested to protect against airway destruction via antioxidant activity. The present study aimed to evaluate the association between disease severity and dietary nutrient intake in chronic obstructive pulmonary disease (COPD) patients using the Korea National Health and Nutrition Examination Survey. Of the 22,948 participants, 702 patients (418 men and 284 women) with COPD, who were defined as the fifth percentile from a reference population were selected. The severity of airflow limitation was measured by the predicted percentage of forced expiratory volume in 1 second (FEV1%). The Jonckheere-Terpstra test was used to evaluate the dose-dependent association between nutrient intake and disease severity. Multivariate linear regression analysis was used to evaluate the relationship between dietary nutrient intake and predicted FEV1%. Vitamin A intake showed a positive association with FEV1% in men in a model adjusted for covariates. Carbohydrate, protein, fiber, thiamin, riboflavin, niacin, and vitamin C intake were significantly associated with decreased disease severity in elderly men (aged ≥60 years). On the contrary, statistical significance was not observed for all the nutrients in women. In conclusion, intake of carbohydrate, protein, fiber, thiamin, riboflavin, niacin, and vitamin C was associated with decreased severity of airway impairment in elderly men with COPD. Our results are in line with those of previous studies into the importance of nutritional status in airway disease. A longitudinal study is required to clarify the mechanisms underlying the association between dietary nutrient intake and COPD severity.
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Affiliation(s)
- Taeyun Kim
- Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Hyunji Choi
- Department of Laboratory Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Jehun Kim
- Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
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Yu Q, Peng H, Li B, Qian H, Zhang H. Characteristics and related factors of bronchiectasis in chronic obstructive pulmonary disease. Medicine (Baltimore) 2019; 98:e17893. [PMID: 31764784 PMCID: PMC6882597 DOI: 10.1097/md.0000000000017893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to understand the incidence, clinical characteristics and related factors of bronchiectasis in chronic obstructive pulmonary disease (COPD) patients.From January 2015 to January 2017, 133 patients with moderate to severe COPD admitted to our hospital were enrolled in the study. Bronchiectasis analysis was performed by high resolution CT of the chest, the clinical data of all patients were collected including increasing state of COPD, peripheral blood samples, pulmonary function, blood gas. And sputum samples were collected for detection of microorganisms.the patients were aged 70.18 ± 8.31 years, and 62.4% of the patients were male. FEV1 accounted for an estimated value of 37.91 ± 10.68%, and 104 (78.2%) were severe COPD, and 43 (32.3%) had bronchiectasis. Bronchiectasis is mainly bilateral, multiple and columnar bronchiectasis. The most easily involved sites are the left lower lobe, left lingual lobe and right middle lobe. Bronchiectasis is associated with history of disease (P = .027), at least one hospitalization exacerbated by COPD in the past year (P = .025), and the separation of potential pathogenic microorganisms from sputum (P = .022). The most commonly isolated pathogen was Pseudomonas aeruginosa (P < .001).Bronchiectasis should be noted in patients with COPD who often suffer from exacerbation or repeated respiratory infections, especially in those who isolate P aeruginosa from respiratory specimens.
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Affiliation(s)
- Qihong Yu
- Respiratory and Critical Care Department
| | | | - Bo Li
- Respiratory and Critical Care Department
| | | | - Hong Zhang
- Radiology Department, Tianjin Chest Hospital, Tianjin, China
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10
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Tanabe N, Shima H, Sato S, Oguma T, Kubo T, Kozawa S, Koizumi K, Sato A, Togashi K, Hirai T. Direct evaluation of peripheral airways using ultra-high-resolution CT in chronic obstructive pulmonary disease. Eur J Radiol 2019; 120:108687. [DOI: 10.1016/j.ejrad.2019.108687] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022]
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11
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Recent Advances in Computed Tomography Imaging in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2019; 15:281-289. [PMID: 28812906 DOI: 10.1513/annalsats.201705-377fr] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lung imaging is increasingly being used to diagnose, quantify, and phenotype chronic obstructive pulmonary disease (COPD). Although spirometry is the gold standard for the diagnosis of COPD and for severity staging, the role of computed tomography (CT) imaging has expanded in both clinical practice and research. COPD is a heterogeneous disease with considerable variability in clinical features, radiographic disease, progression, and outcomes. Recent studies have examined the utility of CT imaging in enhancing diagnostic certainty, improving phenotyping, predicting disease progression and prognostication, selecting patients for intervention, and also in furthering our understanding of the complex pathophysiology of this disease. Multiple CT metrics show promise for use as imaging biomarkers in COPD.
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12
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Rutting S, Papanicolaou M, Xenaki D, Wood LG, Mullin AM, Hansbro PM, Oliver BG. Dietary ω-6 polyunsaturated fatty acid arachidonic acid increases inflammation, but inhibits ECM protein expression in COPD. Respir Res 2018; 19:211. [PMID: 30390648 PMCID: PMC6215599 DOI: 10.1186/s12931-018-0919-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background The obesity paradox in COPD describes protective effects of obesity on lung pathology and inflammation. However, the underlying relationships between obesity, diet and disease outcomes in COPD are not fully understood. In this study we measured the response to dietary fatty acids upon markers of inflammation and remodelling in human lung cells from people with and without COPD. Methods Pulmonary fibroblasts were challenged with ω-3 polyunsaturated fatty acids (PUFAs), ω-6 PUFAs, saturated fatty acids (SFAs) or the obesity-associated cytokine TNFα. After 48–72 h release of the pro-inflammatory cytokines interleukin (IL)-6 and CXCL8 was measured using ELISA and mRNA expression and deposition of the extracellular matrix (ECM) proteins fibronectin, type I collagen, tenascin and perlecan were measured using qPCR or ECM ELISA, respectively. Results Challenge with the ω-6 PUFA arachidonic acid (AA), but not ω-3 PUFAs or SFAs, resulted in increased IL-6 and CXCL8 release from fibroblasts, however IL-6 and CXCL8 release was reduced in COPD (n = 19) compared to non-COPD (n = 36). AA-induced cytokine release was partially mediated by downstream mediators of cyclooxygenase (COX)-2 in both COPD and non-COPD. In comparison, TNFα-induced IL-6 and CXCL8 release was similar in COPD and non-COPD, indicating a specific interaction of AA in COPD. In patients with or without COPD, regression analysis revealed no relationship between BMI and cytokine release. In addition, AA, but not SFAs or ω-3 PUFAs reduced the basal deposition of fibronectin, type I collagen, tenascin and perlecan into the ECM in COPD fibroblasts. In non-COPD fibroblasts, AA-challenge decreased basal deposition of type I collagen and perlecan, but not fibronectin and tenascin. Conclusions This study shows that AA has disease-specific effects on inflammation and ECM protein deposition. The impaired response to AA in COPD might in part explain why obesity appears to have less detrimental effects in COPD, compared to other lung diseases. Electronic supplementary material The online version of this article (10.1186/s12931-018-0919-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Rutting
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Michael Papanicolaou
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, Australia
| | - Dia Xenaki
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Alexander M Mullin
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and The University of Newcastle, Newcastle, NSW, Australia
| | - Brian G Oliver
- Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia. .,School of Life Sciences, University of Technology Sydney, Sydney, Australia.
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13
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Bodduluri S, Puliyakote ASK, Gerard SE, Reinhardt JM, Hoffman EA, Newell JD, Nath HP, Han MK, Washko GR, San José Estépar R, Dransfield MT, Bhatt SP. Airway fractal dimension predicts respiratory morbidity and mortality in COPD. J Clin Invest 2018; 128:5374-5382. [PMID: 30256767 DOI: 10.1172/jci120693] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by airway remodeling. Characterization of airway changes on computed tomography has been challenging due to the complexity of the recurring branching patterns, and this can be better measured using fractal dimensions. METHODS We analyzed segmented airway trees of 8,135 participants enrolled in the COPDGene cohort. The fractal complexity of the segmented airway tree was measured by the Airway Fractal Dimension (AFD) using the Minkowski-Bougliand box-counting dimension. We examined associations between AFD and lung function and respiratory morbidity using multivariable regression analyses. We further estimated the extent of peribronchial emphysema (%) within 5 mm of the airway tree, as this is likely to affect AFD. We classified participants into 4 groups based on median AFD, percentage of peribronchial emphysema, and estimated survival. RESULTS AFD was significantly associated with forced expiratory volume in one second (FEV1; P < 0.001) and FEV1/forced vital capacity (FEV1/FVC; P < 0.001) after adjusting for age, race, sex, smoking status, pack-years of smoking, BMI, CT emphysema, air trapping, airway thickness, and CT scanner type. On multivariable analysis, AFD was also associated with respiratory quality of life and 6-minute walk distance, as well as exacerbations, lung function decline, and mortality on longitudinal follow-up. We identified a subset of participants with AFD below the median and peribronchial emphysema above the median who had worse survival compared with participants with high AFD and low peribronchial emphysema (adjusted hazards ratio [HR]: 2.72; 95% CI: 2.20-3.35; P < 0.001), a substantial number of whom were not identified by traditional spirometry severity grades. CONCLUSION Airway fractal dimension as a measure of airway branching complexity and remodeling in smokers is associated with respiratory morbidity and lung function change, offers prognostic information additional to traditional CT measures of airway wall thickness, and can be used to estimate mortality risk. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00608764. FUNDING This study was supported by NIH K23 HL133438 (SPB) and the COPDGene study (NIH Grant Numbers R01 HL089897 and R01 HL089856). The COPDGene project is also supported by the COPD Foundation through contributions made to an Industry Advisory Board comprised of AstraZeneca, Boehringer Ingelheim, Novartis, Pfizer, Siemens, Sunovion and GlaxoSmithKline.
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Affiliation(s)
- Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine.,UAB Lung Imaging Core, and.,UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Sarah E Gerard
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Joseph M Reinhardt
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Eric A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - John D Newell
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Hrudaya P Nath
- UAB Lung Imaging Core, and.,Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine.,UAB Lung Imaging Core, and.,UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine.,UAB Lung Imaging Core, and.,UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
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- The COPDGene Investigators are detailed in the Supplemental Acknowledgments
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14
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Lim JU, Lee JH, Kim TH, Lee JS, Lee SD, Oh YM, Rhee CK. Alternative definitions of chronic bronchitis and their correlation with CT parameters. Int J Chron Obstruct Pulmon Dis 2018; 13:1893-1899. [PMID: 29942122 PMCID: PMC6005312 DOI: 10.2147/copd.s164055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Phenotyping of chronic bronchitis (CB) using COPD assessment tool (CAT) scores and St George's Respiratory Questionnaire (SGRQ) has rarely been attempted. The present study defined CB using CAT 1 and 2 scores and the questions on the severity of cough and sputum from the SGRQ. Furthermore, the predictability of CT parameters was also assessed for each CB definition. Materials and methods Patients enrolled in the Korean Obstructive Lung Disease study from June 2005 to October 2015 were evaluated for this study. The patients were spirometrically diagnosed with COPD and had a smoking history of >10 pack-years. Volumetric CT scans were performed for each patient upon enrollment in the cohort. Two definitions of CB using CAT 1/2 scores and SGRQ questions were used to phenotype CB among the study patients. Receiver operating characteristic curve analysis was performed to estimate the predictability of CT parameters for the CB phenotypes. Results Using CAT 1/2 scores, 57 of 279 (20.4%) patients had CB, and 178 of 573 (31.1%) had CB when the SGRQ questions were used to phenotype it. Total CAT and SGRQ scores were significantly higher in the CB group than those in the non-CB group for both definitions of CB. Forced expiratory volume in 1 second was lower for both CAT-defined and SGRQ-defined CB than that in the non-CB group. Mean wall thickness was significantly higher for both CB groups than in the non-CB group. Expiratory lung volume was higher and mean lung density was significantly lower for the SGRQ-defined CB group than non-CB group. Conclusion The 2 CB definitions using CAT scores and the SGRQ questions correlated with associated CT airway parameters. SGRQ-defined CB better reflected the accompaniment of small airway obstruction when compared with CAT-defined CB.
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Affiliation(s)
- Jeong Uk Lim
- 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
| | - Ji-Hyun Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Tae-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 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
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15
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Gawlitza J, Haubenreisser H, Henzler T, Akin I, Schönberg S, Borggrefe M, Trinkmann F. Finding the right spot: Where to measure airway parameters in patients with COPD. Eur J Radiol 2018; 104:87-93. [PMID: 29857872 DOI: 10.1016/j.ejrad.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The importance of spirometry for management of COPD was reduced in the 2017 revision of the GOLD report. CT derived airway measurements show strong correlations with lung function tests and symptoms. However, these correlations are specific to the airway localization, and currently there is no evidence for the ideal spot. Therefore, the aim of this prospective study was to systematically correlate CT derived airway measurements with extensive lung function testing. METHODS AND MATERIALS 65 patients with diagnosed COPD underwent body plethysmography, impulse oscillometry and dose optimized qCT examination (Somatom Force, Healthineers, Germany) in inspiration and expiration. Eight airway parameters (e.g. outer diameter, maximal wall thickness) were acquired for both scans in every lobe for the third to fifth generation bronchus and correlated with the lung function tests. RESULTS The most significant correlations between airway parameters were found for the third generation bronchus of the upper left lobe during expiration (25 out of 48 correlation pairs, mean r = -0.39) and for the third generation bronchus of the upper right lobe during inspiration (9 out of 48 correlation pairs, mean r = -0.25). No significant correlations were for example found for the upper right lobe in expiration. CONCLUSION Correlations between airway parameters and lung function tests vary widely between lobes, bronchus generations and breathing states. Our work suggests that the third generation bronchus of the upper left lobe in expiration could be the preferred localization for airway quantification in future studies.
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Affiliation(s)
- Joshua Gawlitza
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Ibrahim Akin
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Mannheim, Germany.
| | - Stefan Schönberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Mannheim, Germany.
| | - Martin Borggrefe
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Mannheim, Germany.
| | - Frederik Trinkmann
- 1st Department of Medicine (Cardiology, Angiology, Pulmonary and Intensive Care), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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16
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Calle Rubio M, Rodríguez Hermosa JL, Soler-Cataluña JJ, López-Campos JL, Alcazar Navarrete B, Soriano JB, Rodríguez Gónzalez-Moro JM, Fuentes Ferrer ME, Miravitlles M. Atención médica según el nivel de riesgo y su adecuación a las recomendaciones de la guía española de la enfermedad pulmonar obstructiva crónica (EPOC) (GesEPOC): Estudio EPOCONSUL. Arch Bronconeumol 2018; 54:270-279. [DOI: 10.1016/j.arbres.2017.11.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/09/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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17
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MacNee W. Computed tomography-derived pathological phenotypes in COPD. Eur Respir J 2018; 48:10-3. [PMID: 27365503 DOI: 10.1183/13993003.00958-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 11/05/2022]
Affiliation(s)
- William MacNee
- University of Edinburgh/MRC Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, UK
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18
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Choi S, Haghighi B, Choi J, Hoffman EA, Comellas AP, Newell JD, Wenzel SE, Castro M, Fain SB, Jarjour NN, Schiebler ML, Barr RG, Han MK, Bleecker ER, Cooper CB, Couper D, Hansel N, Kanner RE, Kazerooni EA, Kleerup EAC, Martinez FJ, O'Neal WK, Woodruff PG, Lin CL. Differentiation of quantitative CT imaging phenotypes in asthma versus COPD. BMJ Open Respir Res 2017; 4:e000252. [PMID: 29435345 PMCID: PMC5687530 DOI: 10.1136/bmjresp-2017-000252] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Quantitative CT (QCT) imaging-based metrics have quantified disease alterations in asthma and chronic obstructive pulmonary disease (COPD), respectively. We seek to characterise the similarity and disparity between these groups using QCT-derived airway and parenchymal metrics. Methods Asthma and COPD subjects (former-smoker status) were selected with a criterion of post-bronchodilator FEV1 <80%. Healthy non-smokers were included as a control group. Inspiratory and expiratory QCT images of 75 asthmatic, 215 COPD and 94 healthy subjects were evaluated. We compared three segmental variables: airway circularity, normalised wall thickness and normalised hydraulic diameter, indicating heterogeneous airway shape, wall thickening and luminal narrowing, respectively. Using an image registration, we also computed six lobar variables including per cent functional small-airway disease, per cent emphysema, tissue fraction at inspiration, fractional-air-volume change, Jacobian and functional metric characterising anisotropic deformation. Results Compared with healthy subjects, both asthma and COPD subjects demonstrated a decreased airway circularity especially in large and upper lobar airways, and a decreased normalised hydraulic diameter in segmental airways. Besides, COPD subjects had more severe emphysema and small-airway disease, as well as smaller regional tissue fraction and lung deformation, compared with asthmatic subjects. The difference of emphysema, small-airway disease and tissue fraction between asthma and COPD was more prominent in upper and middle lobes. Conclusions Patients with asthma and COPD, with a persistent FEV1 <80%, demonstrated similar alterations in airway geometry compared with controls, but different degrees of alterations in parenchymal regions. Density-based metrics measured at upper and middle lobes were found to be discriminant variables between patients with asthma and COPD.
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Affiliation(s)
- Sanghun Choi
- Department of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Babak Haghighi
- Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, Iowa, USA.,IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Jiwoong Choi
- Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, Iowa, USA.,IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA.,Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - John D Newell
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA.,Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario Castro
- Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sean B Fain
- Departments of Radiology and Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medical Physics and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
| | - Nizar N Jarjour
- Departments of Radiology and Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Mark L Schiebler
- Departments of Radiology and Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - R Graham Barr
- Mailman School of Public Health, Columbia University, New York, USA
| | - MeiLan K Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eugene R Bleecker
- Center for Genomics and Personalized Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Christopher B Cooper
- Department of Physiology, University of California, Los Angeles, California, USA
| | - David Couper
- Department of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nadia Hansel
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard E Kanner
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric A C Kleerup
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Fernando J Martinez
- Department of Medicine, Weill Cornell School of Medicine, Cornell University, New York, USA
| | - Wanda K O'Neal
- Marsico Lung Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Prescott G Woodruff
- School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Ching-Long Lin
- Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, Iowa, USA.,IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa, USA
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19
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Proceso de la atención inicial al paciente con EPOC. Estrategias de cribado. Arch Bronconeumol 2017. [DOI: 10.1016/s0300-2896(17)30359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Martinez-Garcia MA, Miravitlles M. Bronchiectasis in COPD patients: more than a comorbidity? Int J Chron Obstruct Pulmon Dis 2017; 12:1401-1411. [PMID: 28546748 PMCID: PMC5436792 DOI: 10.2147/copd.s132961] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Computed tomography scan images have been used to identify different radiological COPD phenotypes based on the presence and severity of emphysema, bronchial wall thickening, and bronchiectasis. Bronchiectasis is defined as an abnormal dilation of the bronchi, usually as a result of chronic airway inflammation and/or infection. The prevalence of bronchiectasis in patients with COPD is high, especially in advanced stages. The identification of bronchiectasis in COPD has been defined as a different clinical COPD phenotype with greater symptomatic severity, more frequent chronic bronchial infection and exacerbations, and poor prognosis. A causal association has not yet been proven, but it is biologically plausible that COPD, and particularly the infective and exacerbator COPD phenotypes, could be the cause of bronchiectasis without any other known etiology, beyond any mere association or comorbidity. The study of the relationship between COPD and bronchiectasis could have important clinical implications, since both diseases have different and complementary therapeutic approaches. Longitudinal studies are needed to investigate the development of bronchiectasis in COPD, and clinical trials with treatments aimed at reducing bacterial loads should be conducted to investigate their impact on the reduction of exacerbations and improvements in the long-term evolution of the disease.
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Affiliation(s)
- Miguel Angel Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Spain
| | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Spain.,Pneumology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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21
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Choi S, Hoffman EA, Wenzel SE, Castro M, Fain S, Jarjour N, Schiebler ML, Chen K, Lin CL. Quantitative computed tomographic imaging-based clustering differentiates asthmatic subgroups with distinctive clinical phenotypes. J Allergy Clin Immunol 2017; 140:690-700.e8. [PMID: 28143694 DOI: 10.1016/j.jaci.2016.11.053] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/15/2016] [Accepted: 11/21/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Imaging variables, including airway diameter, wall thickness, and air trapping, have been found to be important metrics when differentiating patients with severe asthma from those with nonsevere asthma and healthy subjects. OBJECTIVE The objective of this study was to identify imaging-based clusters and to explore the association of the clusters with existing clinical metrics. METHODS We performed an imaging-based cluster analysis using quantitative computed tomography-based structural and functional variables extracted from the respective inspiration and expiration scans of 248 asthmatic patients. The imaging-based metrics included a broader set of multiscale variables, such as inspiratory airway dimension, expiratory air trapping, and registration-based lung deformation (inspiration vs expiration). Asthma subgroups derived from a clustering method were associated with subject demographics, questionnaire results, medication history, and biomarker variables. RESULTS Cluster 1 was composed of younger patients with early-onset nonsevere asthma and reversible airflow obstruction and normal airway structure. Cluster 2 was composed of patients with a mix of patients with nonsevere and severe asthma with marginal inflammation who exhibited airway luminal narrowing without wall thickening. Clusters 3 and 4 were dominated by patients with severe asthma. Cluster 3 patients were obese female patients with reversible airflow obstruction who exhibited airway wall thickening without airway narrowing. Cluster 4 patients were late-onset older male subjects with persistent airflow obstruction who exhibited significant air trapping and reduced regional deformation. Cluster 3 and 4 patients also showed decreased lymphocyte and increased neutrophil counts, respectively. CONCLUSIONS Four image-based clusters were identified and shown to be correlated with clinical characteristics. Such clustering serves to differentiate asthma subgroups that can be used as a basis for the development of new therapies.
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Affiliation(s)
- Sanghun Choi
- Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, Iowa; IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa; Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Eric A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa; Department of Radiology, University of Iowa, Iowa City, Iowa; Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Sally E Wenzel
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Mario Castro
- Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - Sean Fain
- School of Medicine & Public Health, University of Wisconsin, Madison, Wis
| | - Nizar Jarjour
- School of Medicine & Public Health, University of Wisconsin, Madison, Wis
| | - Mark L Schiebler
- School of Medicine & Public Health, University of Wisconsin, Madison, Wis
| | - Kun Chen
- Department of Statistics, University of Connecticut, Storrs, Conn
| | - Ching-Long Lin
- Department of Mechanical and Industrial Engineering, University of Iowa, Iowa City, Iowa; IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa; Department of Radiology, University of Iowa, Iowa City, Iowa.
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22
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Nambu A, Zach J, Schroeder J, Jin G, Kim SS, Kim YI, Schnell C, Bowler R, Lynch DA. Quantitative computed tomography measurements to evaluate airway disease in chronic obstructive pulmonary disease: Relationship to physiological measurements, clinical index and visual assessment of airway disease. Eur J Radiol 2016; 85:2144-2151. [PMID: 27776670 DOI: 10.1016/j.ejrad.2016.09.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To correlate currently available quantitative CT measurements for airway disease with physiological indices and the body-mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS This study was approved by our institutional review board (IRB number 2778). Written informed consent was obtained from all subjects. The subjects included 188 current and former cigarette smokers from the COPDGene cohort who underwent inspiratory and expiratory CT and also had physiological measurements for the evaluation of airflow limitation, including FEF25-75%, airway resistance (Raw), and specific airway conductance (sGaw). The BODE index was used as the index of clinical symptoms. Quantitative CT measures included % low attenuation areas [% voxels≤950 Hounsfield unit (HU) on inspiratory CT, %LAA-950ins], percent gas trapping (% voxels≤-856HU on expiratory CT, %LAA -856exp), relative inspiratory to expiratory volume change of voxels with attenuation values from -856 to -950HU [Relative Volume Change (RVC)-856 to -950], expiratory to inspiratory ratio of mean lung density (E/I-ratio MLD), Pi10, and airway wall thickness (WT), luminal diameter (LD) and airway wall area percent (WA%) in the segmental, subsegmental and subsubsegmental bronchi on inspiratory CT. Correlation coefficients were calculated between the QCT measurements and physiological measurements in all subjects and in the subjects with mild emphysema (%LAA-950ins <10%). Univariate and multiple variable analysis for the BODE index were also performed. Adjustments were made for age, gender, smoking pack years, FEF25-75%, Raw, and sGaw. RESULTS Quantitative CT measurements had significant correlations with physiological indices. Among them, E/I-ratio MLD had the strongest correlations with FEF25-75% (r=-0.648, <0.001) and sGaw (r=-0.624, <0.001) while in the subjects with mild emphysema subsegmental WA% and segmental WA% had the strongest correlation with FEF25-75% (r=-0.669, <0.001) and sGaw (r=-0.638, <0.001), respectively. The multiple variable analyses showed that RVC-856 to -950 was an independent predictor of the BODE index showing the highest R2 (0.468) as an independent variable among the QCT measurements. CONCLUSION Quantitative CT measurements of gas trapping such as E/I-ratio MLD, correlate better with physiological indices for airway disease than those of airway such as WA% or LD. In mild emphysema, however, quantitative CT measurements of airway correlate better with the physiological indices. RVC-856 to -950 is a predictor of the BODE index.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Jordan Zach
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Joyce Schroeder
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Gongyoung Jin
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Song Soo Kim
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
| | - Yu-Il Kim
- Department of Medicine, National Jewish Health, Denver, CO, USA.
| | | | - Russell Bowler
- Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA.
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Saure EW, Bakke PS, Lind Eagan TM, Aanerud M, Jensen RL, Grydeland TB, Johannessen A, Nilsen RM, Thorsen E, Hardie JA. Diffusion capacity and CT measures of emphysema and airway wall thickness - relation to arterial oxygen tension in COPD patients. Eur Clin Respir J 2016; 3:29141. [PMID: 27178139 PMCID: PMC4867045 DOI: 10.3402/ecrj.v3.29141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is associated with emphysema. DLCO is also related to decreased arterial oxygen tension (PaO2), but there are limited data on associations between PaO2 and computed tomography (CT) derived measures of emphysema and airway wall thickness. OBJECTIVE To examine whether CT measures of emphysema and airway wall thickness are associated with level of arterial oxygen tension beyond that provided by measurements of diffusion capacity and spirometry. METHODS The study sample consisted of 271 smoking or ex-smoking COPD patients from the Bergen COPD Cohort Study examined in 2007-2008. Emphysema was assessed as percent of low-attenuation areas<-950 Hounsfield units (%LAA), and airway wall thickness as standardised measure at an internal perimeter of 10 mm (AWT-Pi10). Multiple linear regression models were fitted with PaO2 as the outcome variable, and %LAA, AWT-Pi10, DLCO and carbon monoxide transfer coefficient (KCO) as main explanatory variables. The models were adjusted for sex, age, smoking status, and haemoglobin concentration, as well as forced expiratory volume in one second (FEV1). RESULTS Sixty two per cent of the subjects were men, mean (SD) age was 64 (7) years, mean (SD) FEV1 in percent predicted was 50 (15)%, and mean PaO2 (SD) was 9.3 (1.1) kPa. The adjusted regression coefficient (CI) for PaO2 was -0.32 (-0.04-(-0.019)) per 10% increase in %LAA (p<0.01). When diffusion capacity and FEV1 were added to the model, respectively, the association lost its statistical significance. No relationship between airway wall thickness and PaO2 was found. CONCLUSION CT assessment of airway wall thickness is not associated with arterial oxygen tension in COPD patients. Emphysema score measured by chest CT, is related to decreased PaO2, but cannot replace measurements of diffusion capacity in the clinical evaluation of hypoxaemia.
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Affiliation(s)
- Eirunn Waatevik Saure
- Department of Clinical Science, Pulmonary Division, University of Bergen, Bergen, Norway;
| | - Per Sigvald Bakke
- Department of Clinical Science, Pulmonary Division, University of Bergen, Bergen, Norway
| | - Tomas Mikal Lind Eagan
- Department of Clinical Science, Pulmonary Division, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marianne Aanerud
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Robert Leroy Jensen
- Internal Medicine, Pulmonary Division, University of Utah, Salt Lake City, Utah, USA
| | | | - Ane Johannessen
- Department of Clinical Science, Pulmonary Division, University of Bergen, Bergen, Norway
| | - Roy Miodini Nilsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Einar Thorsen
- Department of Clinical Science, Pulmonary Division, University of Bergen, Bergen, Norway
| | - Jon Andrew Hardie
- Department of Clinical Science, Pulmonary Division, University of Bergen, Bergen, Norway
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Putcha N, Barr RG, Han MK, Woodruff PG, Bleecker ER, Kanner RE, Martinez FJ, Smith BM, Tashkin DP, Bowler RP, Eisner MD, Rennard SI, Wise RA, Hansel NN. Understanding the impact of second-hand smoke exposure on clinical outcomes in participants with COPD in the SPIROMICS cohort. Thorax 2016; 71:411-420. [PMID: 26962015 PMCID: PMC5235992 DOI: 10.1136/thoraxjnl-2015-207487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Second-hand smoke (SHS) exposure has been linked to the development of and morbidity from lung disease. We sought to advance understanding of the impact of SHS on health-related outcomes in individuals with COPD. METHODS Among the participants with COPD in SPIROMICS, recent SHS exposure was quantified as (1) hours of reported exposure in the past week or (2) reported living with a smoker. We performed adjusted regression for SHS with outcomes, testing for interactions with gender, race, smoking and obesity. RESULTS Of the 1580 participants with COPD, 20% reported living with a smoker and 27% reported exposure in the past week. Living with a smoker was associated with worse St George's Respiratory Questionnaire score (SGRQ, β 3.10; 95% CI 0.99 to 5.21), COPD Assessment Test score (β 1.43; 95% CI 0.52 to 2.35) and increased risk for severe exacerbations (OR 1.51, 95% CI 1.04 to 2.17). SHS exposure in the past week was associated with worse SGRQ (β 2.52; 95% CI 0.47 to 4.58), nocturnal symptoms (OR 1.58; 95% CI 1.19 to 2.10), wheezing (OR 1.34; 95% CI 1.02 to 1.77), chronic productive cough (OR 1.77; 95% CI 1.33 to 2.35) and difficulty with cough and sputum (Ease of Cough and Sputum scale, β 0.84; 95% CI 0.42 to 1.25). SHS was associated with increased airway wall thickness on CT but not emphysema. Active smokers, obese individuals and individuals with less severe airflow obstruction also had higher susceptibility to SHS for some outcomes. CONCLUSION Individuals with COPD, including active smokers, have significant SHS exposure, associated with worse outcomes and airway wall thickness. Active smokers and obese individuals may have worse outcomes associated with SHS. TRIAL REGISTRATION NUMBER NCT01969344 (clinicaltrials.gov).
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Affiliation(s)
- Nirupama Putcha
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R. Graham Barr
- Columbia University School of Medicine, New York, NY, USA
| | - Meilan K. Han
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Prescott G. Woodruff
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Eugene R. Bleecker
- Wake Forest University Center for Genomics and Personalized Medicine Research, Winston-Salem, NC, USA
| | - Richard E. Kanner
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | | | - Donald P. Tashkin
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Mark D. Eisner
- University of California San Francisco School of Medicine, San Francisco, CA, USA
- Genentech, Inc., South San Francisco, CA
| | | | - Robert A. Wise
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia N. Hansel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Cheng T, Wan HY, Cheng QJ, Guo Y, Qian YR, Fan L, Feng Y, Song YY, Zhou M, Li QY, Shi GC, Huang SG. Obvious emphysema on computed tomography during an acute exacerbation of chronic obstructive pulmonary disease predicts a poor prognosis. Intern Med J 2016; 45:517-26. [PMID: 25684314 DOI: 10.1111/imj.12723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emphysematous change on computed tomography (CT) during the stable phase of chronic obstructive pulmonary disease (COPD) is reported to correlate with COPD prognosis. Acute exacerbation of COPD (AECOPD) is associated with a high risk of mortality and a poor prognosis. AIMS This study aims to study the relationship between prognosis and emphysematous changes on CT during an AECOPD. METHODS Histories were recorded, and CT acquired for 106 patients who visited the emergency department for an AECOPD. Emphysematous change was quantified by measuring the percentage of low-attenuation areas (LAA%) in the entire lung on CT images with a threshold of -950 Hounsfield units. Other factors that could influence AECOPD prognosis were also recorded on admission and analysed. At follow ups conducted in 1 year, patient survival, the modified Medical Research Council (mMRC) Dyspnoea Scale, and performance status (PS) were evaluated, and a COPD Assessment Test (CAT) was completed. RESULTS The 1-year follow up was completed by 103 of 106 patients. The median LAA% was significantly higher in non-survivors (11%, n = 16) than in survivors (5.69%, n = 87) (P = 0.006) at the 1-year follow up. LAA% was significantly correlated with mMRC grade (r = 0.285, P = 0.008), PS (r = 0.397, P < 0.001) and CAT score (r = 0.27, P = 0.017) at the 3-month follow up, and with mMRC grade (r = 0.405, P < 0.001) and PS (r = 0.377, P < 0.001) at the 1-year follow up. LAA% > 7.5% was a significant predictor of 1-year mortality, higher mMRC and PS at the 3-month and 1-year follow ups, after adjustment for other prognostic predictors. CONCLUSION Obvious emphysematous changes on CT (LAA% > 7.5%) during an AECOPD predicts a poor prognosis independent of other known indicators.
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Affiliation(s)
- T Cheng
- Department of Respiratory Medicine, Ruijin Hospital, North, China
| | - H Y Wan
- Department of Respiratory Medicine, Ruijin Hospital, North, China
| | - Q J Cheng
- Department of Respiratory Medicine, Ruijin Hospital, North, China
| | - Y Guo
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
| | - Y R Qian
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
| | - L Fan
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
| | - Y Feng
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
| | - Y Y Song
- Department of Biostatistics, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - M Zhou
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
| | - Q Y Li
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
| | - G C Shi
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
| | - S G Huang
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai, China
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26
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Lange P, Halpin DM, O’Donnell DE, MacNee W. Diagnosis, assessment, and phenotyping of COPD: beyond FEV₁. Int J Chron Obstruct Pulmon Dis 2016; 11 Spec Iss:3-12. [PMID: 26937185 PMCID: PMC4765947 DOI: 10.2147/copd.s85976] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
COPD is now widely recognized as a complex heterogeneous syndrome, having both pulmonary and extrapulmonary features. In clinical practice, the diagnosis of COPD is based on the presence of chronic airflow limitation, as assessed by post-bronchodilator spirometry. The severity of the airflow limitation, as measured by percent predicted FEV1, provides important information to the physician to enable optimization of management. However, in order to accurately assess the complexity of COPD, there need to be other measures made beyond FEV1. At present, there is a lack of reliable and simple blood biomarkers to confirm and further assess the diagnosis of COPD. However, it is possible to identify patients who display different phenotypic characteristics of COPD that relate to clinically relevant outcomes. Currently, validated phenotypes of COPD include alpha-1 antitrypsin deficiency, and "frequent exacerbators". Recently, a definition and assessment of a new phenotype comprising patients with overlapping features of asthma and COPD has been suggested and is known as "asthma COPD overlap syndrome". Several other phenotypes have been proposed, but require validation against clinical outcomes. Defining phenotypes requires the assessment of multiple factors indicating disease severity, its impact, and its activity. Recognition and validation of COPD phenotypes has an important role to play in the selection of evidence-based targeted therapy in the future management of COPD, but regardless of the diagnostic terms, patients with COPD should be assessed and treated according to their individual treatable characteristics.
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Affiliation(s)
- Peter Lange
- Respiratory Section, Hvidovre Hospital, Copenhagen, Denmark
- Department of Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Denis E O’Donnell
- Respiratory Investigation Unit, Queen’s University and Kingston General Hospital, Kingston, ON, Canada
| | - William MacNee
- MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Dubé BP, Guerder A, Morelot-Panzini C, Laveneziana P. The clinical relevance of the emphysema-hyperinflated phenotype in COPD. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40749-015-0017-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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28
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Lutchmedial SM, Creed WG, Moore AJ, Walsh RR, Gentchos GE, Kaminsky DA. How Common Is Airflow Limitation in Patients With Emphysema on CT Scan of the Chest? Chest 2015; 148:176-184. [PMID: 25539080 DOI: 10.1378/chest.14-1556] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND COPD has traditionally been defined by the presence of irreversible airflow limitation on spirometry using either the GOLD (Global Initiative for Chronic Obstructive Lung Disease) or American Thoracic Society/European Respiratory Society criteria (lower limit of normal [LLN]). We have observed that some patients with clinical COPD and emphysema on chest CT scan have no obstruction on spirometry. The purpose of this study was to assess the prevalence of obstruction by GOLD and LLN criteria in patients with emphysema on CT scan and determine which radiographic criteria were associated with a clinical diagnosis of COPD. METHODS We retrospectively analyzed the clinical records and spirometry of all patients who had radiographically defined emphysema on chest CT scans completed at the University of Vermont in 2011. We compared spirometric criteria and CT scan factors with the presence of clinical COPD based on chart review. RESULTS We identified 274 patients with CT scan-defined emphysema. GOLD criteria detected obstruction in 228 patients (83%), and LLN detected obstruction in 206 patients (75%). However, GOLD failed to correctly identify 19 patients (6.9%) and LLN failed to identify 38 patients (13.9%) (average 10.4%) who had radiographic emphysema and a clinical diagnosis of COPD. Obese patients had a lower prevalence of obstruction whether classified by LLN or GOLD. Among patients with spirometric obstruction, there were greater degrees of emphysema and more severely increased airway wall thickness. Factors that were independently associated with clinical COPD were lower FVC % predicted, lower FEV1/FVC ratio, and increasing airway wall thickness. CONCLUSIONS Spirometry missed 10.4% of patients with clinical COPD who have significant emphysema on chest CT scan.
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Affiliation(s)
| | | | | | | | | | - David A Kaminsky
- Division of Pulmonary and Critical Care Medicine, Burlington, VT.
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29
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Dijkstra AE, Postma DS, van Ginneken B, Wielpütz MO, Schmidt M, Becker N, Owsijewitsch M, Kauczor HU, de Koning HJ, Lammers JW, Oudkerk M, Brandsma CA, Bossé Y, Nickle DC, Sin DD, Hiemstra PS, Wijmenga C, Smolonska J, Zanen P, Vonk JM, van den Berge M, Boezen HM, Groen HJM. Novel Genes for Airway Wall Thickness Identified with Combined Genome-Wide Association and Expression Analyses. Am J Respir Crit Care Med 2015; 191:547-56. [DOI: 10.1164/rccm.201405-0840oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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30
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Chronic respiratory symptoms associated with airway wall thickening measured by thin-slice low-dose CT. AJR Am J Roentgenol 2014; 203:W383-90. [PMID: 25247967 DOI: 10.2214/ajr.13.11536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In lung cancer screening, the prevalence of chronic respiratory symptoms is high among heavy smokers. The purpose of this study was to compare CT-derived airway wall measurements between male smokers with and those without chronic respiratory symptoms. MATERIALS AND METHODS Fifty male heavy smokers with chronic respiratory symptoms (cough, excessive mucus secretion, dyspnea, and wheezing) and 50 without any respiratory symptom were randomly selected from the Dutch-Belgian Randomized Lung Cancer Screening Trial. Thin-slice low-dose CT images were evaluated with dedicated software for airway measurements. Wall area percentage and airway wall thickness were measured from trachea to bronchi in five different pulmonary lobes of airways with a luminal diameter of 5 mm or greater. Association between airway wall measurements and respiratory symptoms was analyzed by multiple linear regression adjusted for age, body mass index, smoking status, emphysema, and pulmonary function. RESULTS After adjustment for relevant factors, a significant positive association between airway wall measurements and respiratory symptoms was found in airways with a luminal diameter between 5 to 10 mm (p < 0.01), but not in airways measuring 10 mm or greater (p > 0.05). At the airway level between 5 to 10 mm, the mean wall area percentages were 51.5% ± 7.9%. Airway wall thicknesses were 1.54 ± 0.39 mm and 1.37 ± 0.35 mm (p < 0.001). CONCLUSION Male heavy smokers with chronic respiratory symptoms in lung cancer screening, who are at high-risk of chronic bronchitis, have bronchial wall thickening in airways with a luminal diameter of 5-10 mm but not in larger airways.
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31
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Bhatt SP, Wells JM, Kim V, Criner GJ, Hersh CP, Hardin M, Bailey WC, Nath H, Kim YI, Foreman MG, Stinson DS, Wilson CG, Rennard SI, Silverman EK, Make BJ, Dransfield MT. Radiological correlates and clinical implications of the paradoxical lung function response to β₂ agonists: an observational study. THE LANCET RESPIRATORY MEDICINE 2014; 2:911-918. [PMID: 25217076 DOI: 10.1016/s2213-2600(14)70185-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bronchodilator response has been noted in a significant proportion of patients with chronic obstructive pulmonary disease (COPD). However, there are also reports of a paradoxical response to β₂ agonists resulting in bronchoconstriction. Asymptomatic bronchoconstriction is likely to be far more common than is symptomatic bronchoconstriction with β₂ agonists, but no systematic studies have been done. We assessed the prevalence of paradoxical response in current and former smokers with and without COPD, and its radiological correlates and clinical implications. METHODS Non-Hispanic white and African-American patients (aged 45-80 years) from a large multicentre study COPDGene were classified into two groups on the basis of a paradoxical response, defined as at least a 12% and 200 mL reduction in forced expiratory volume in 1 sec (FEV₁) or forced vital capacity (FVC), or both, after administration of a shortacting β₂ agonist (180 μg salbutamol). FINDINGS Patients were recruited from January, 2008, to June, 2011. 9986 (96%) of 10,364 patients enrolled in the COPDGene study were included in the analysis population (mean age 59·6 years [SD 9·0]). Paradoxical response was noted in 453 (5%) of 9986 patients and the frequency was similar in patients with COPD (198 [4%] of 4439) and smokers without airflow obstruction (255 [5%] of 5547). Compared with white patients, a paradoxical response was twice as common in African-American patients (227 [7%] of 3282 vs 226 [3%] of 6704; p<0·0001). In the multivariate analyses, African-American ethnic origin (adjusted odds ratio 1·89, 95% CI 1·50-2·39; p<0·0001), less emphysema (0·96, 0·92-0·99; p=0·023), and increased wall-area percentage of the segmental airways (1·04, 1·01-1·08; p=0·023) were independently associated with a paradoxical response. A paradoxical response was independently associated with worse dyspnoea (adjusted β for Modified Medical Research Council Dyspnoea Scale 0·12 [95% CI 0·00 to 0·24]; p=0·05), lower 6 min walk distance (-45·8 [-78·5 to -13·2]; p=0·006), higher Body Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) index (0·31 [0·19 to 0·43]; p<0·0001), and a greater frequency of severe exacerbations (increased by a factor of 1·35, 1·00-1·81; p=0·048). INTERPRETATION Paradoxical response to β₂ agonists is associated with respiratory morbidity and is more common in African-Americans. These findings might have implications for the use of β2agonists in some patients. FUNDING National Institutes of Health.
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Affiliation(s)
- Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, AL, USA; Lung Health Center, University of Alabama, Birmingham, AL, USA.
| | - James M Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, AL, USA; Lung Health Center, University of Alabama, Birmingham, AL, USA
| | - Victor Kim
- Division of Pulmonary and Critical Care, Temple University Hospital, Philadelphia, PA, USA
| | - Gerard J Criner
- Division of Pulmonary and Critical Care, Temple University Hospital, Philadelphia, PA, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan Hardin
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William C Bailey
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, AL, USA; Lung Health Center, University of Alabama, Birmingham, AL, USA
| | - Hrudaya Nath
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Young-Il Kim
- Department of Preventive Medicine, University of Alabama, Birmingham, AL, USA
| | | | - Douglas S Stinson
- Quantitative Imaging Laboratory, National Jewish Health, Denver, CO, USA
| | - Carla G Wilson
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO, USA
| | - Stephen I Rennard
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry J Make
- Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, AL, USA; Lung Health Center, University of Alabama, Birmingham, AL, USA
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Mohamed Hoesein FA, de Jong PA, Lammers JWJ, Mali WPTM, Mets OM, Schmidt M, de Koning HJ, Aalst CVD, Oudkerk M, Vliegenthart R, Ginneken BV, van Rikxoort EM, Zanen P. Contribution of CT Quantified Emphysema, Air Trapping and Airway Wall Thickness on Pulmonary Function in Male Smokers With and Without COPD. COPD 2014; 11:503-9. [DOI: 10.3109/15412555.2014.933952] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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33
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Kim SS, Yagihashi K, Stinson DS, Zach JA, McKenzie AS, Curran-Everett D, Wan ES, Silverman EK, Crapo JD, Lynch DA. Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in The COPDGene ® Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2014; 1:88-96. [PMID: 25197723 DOI: 10.15326/jcopdf.1.1.2013.0001#sthash.l0atdpjm.dpuf] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.
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Affiliation(s)
- Song Soo Kim
- Department of Radiology, National Jewish Health, Denver, CO ; Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | | | | | - Jordan A Zach
- Department of Radiology, National Jewish Health, Denver, CO
| | | | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health, and Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, CO
| | - Emily S Wan
- Channing Division of Network Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James D Crapo
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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Discriminating dominant computed tomography phenotypes in smokers without or with mild COPD. Respir Med 2014; 108:136-43. [DOI: 10.1016/j.rmed.2013.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/14/2013] [Accepted: 08/20/2013] [Indexed: 11/17/2022]
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Cardiovascular function in pulmonary emphysema. BIOMED RESEARCH INTERNATIONAL 2013; 2013:184678. [PMID: 24369007 PMCID: PMC3866814 DOI: 10.1155/2013/184678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/18/2013] [Indexed: 01/31/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and chronic cardiovascular disease, such as coronary artery disease, congestive heart failure, and cardiac arrhythmias, have a strong influence on each other, and systemic inflammation has been considered as the main linkage between them. On the other hand, airflow limitation may markedly affect lung mechanics in terms of static and dynamic hyperinflation, especially in pulmonary emphysema, and they can in turn influence cardiac performance as well. Skeletal mass depletion, which is a common feature in COPD especially in pulmonary emphysema patients, may have also a role in cardiovascular function of these patients, irrespective of lung damage. We reviewed the emerging evidence that highlights the role of lung mechanics and muscle mass impairment on ventricular volumes, stroke volume, and stroke work at rest and on exercise in the presence of pulmonary emphysema. Patients with emphysema may differ among COPD population even in terms of cardiovascular function.
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Hansel NN, Washko GR, Foreman MG, Han MK, Hoffman EA, DeMeo DL, Barr RG, Van Beek EJR, Kazerooni EA, Wise RA, Brown RH, Black-Shinn J, Hokanson JE, Hanania NA, Make B, Silverman EK, Crapo JD, Dransfield MT. Racial differences in CT phenotypes in COPD. COPD 2013; 10:20-7. [PMID: 23413893 DOI: 10.3109/15412555.2012.727921] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Whether African Americans (AA) are more susceptible to COPD than non-Hispanic Whites (NHW) and whether racial differences in disease phenotype exist is controversial. The objective is to determine racial differences in the extent of emphysema and airway remodeling in COPD. METHODS First, 2,500 subjects enrolled in the COPDGene study were used to evaluate racial differences in quantitative CT (QCT) parameters of% emphysema, air trapping and airway wall thickness. Independent variables studied included race, age, gender, education, BMI, pack-years, smoking status, age at smoking initiation, asthma, previous work in dusty job, CT scanner and center of recruitment. RESULTS Of the 1,063 subjects with GOLD Stage II-IV COPD, 200 self-reported as AA. AAs had a lower mean% emphysema (13.1% vs. 16.1%, p = 0.005) than NHW and proportionately less emphysema in the lower lung zones. After adjustment for covariates, there was no statistical difference by race in air trapping or airway wall thickness. Measured QCT parameters were more predictive of poor functional status in NHWs compared to AAs. CONCLUSIONS AAs have less emphysema than NHWs but the same degree of airway disease. Additional factors not easily assessed by current QCT techniques may account for the poor functional status in AAs.
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Lutey BA, Conradi SH, Atkinson JJ, Zheng J, Schechtman KB, Senior RM, Gierada DS. Accurate measurement of small airways on low-dose thoracic CT scans in smokers. Chest 2013; 143:1321-1329. [PMID: 23172175 DOI: 10.1378/chest.12-0034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Partial volume averaging and tilt relative to the scan plane on transverse images limit the accuracy of airway wall thickness measurements on CT scan, confounding assessment of the relationship between airway remodeling and clinical status in COPD. The purpose of this study was to assess the effect of partial volume averaging and tilt corrections on airway wall thickness measurement accuracy and on relationships between airway wall thickening and clinical status in COPD. METHODS Airway wall thickness measurements in 80 heavy smokers were obtained on transverse images from low-dose CT scan using the open-source program Airway Inspector. Measurements were corrected for partial volume averaging and tilt effects using an attenuation- and geometry-based algorithm and compared with functional status. RESULTS The algorithm reduced wall thickness measurements of smaller airways to a greater degree than larger airways, increasing the overall range. When restricted to analyses of airways with an inner diameter < 3.0 mm, for a theoretical airway of 2.0 mm inner diameter, the wall thickness decreased from 1.07 ± 0.07 to 0.29 ± 0.10 mm, and the square root of the wall area decreased from 3.34 ± 0.15 to 1.58 ± 0.29 mm, comparable to histologic measurement studies. Corrected measurements had higher correlation with FEV₁, differed more between BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index scores, and explained a greater proportion of FEV1 variability in multivariate models. CONCLUSIONS Correcting for partial volume averaging improves accuracy of airway wall thickness estimation, allowing direct measurement of the small airways to better define their role in COPD.
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Affiliation(s)
- Barbara A Lutey
- Division of Medical Education, Washington University School of Medicine, St Louis, MO.
| | - Susan H Conradi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Jeffrey J Atkinson
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO
| | - Jie Zheng
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO
| | - Robert M Senior
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO
| | - David S Gierada
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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Thomson NC, Chaudhuri R, Messow CM, Spears M, MacNee W, Connell M, Murchison JT, Sproule M, McSharry C. Chronic cough and sputum production are associated with worse clinical outcomes in stable asthma. Respir Med 2013; 107:1501-8. [PMID: 23927851 DOI: 10.1016/j.rmed.2013.07.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/16/2013] [Accepted: 07/18/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Chronic cough and sputum production (chronic mucus hypersecretion) is a poorly described clinical feature of asthma. Our objective was to identify clinical, immunological and computed tomography (CT) measures of airway wall dimensions associated with these symptoms in smokers and never smokers with asthma. METHODS Cross-sectional data was analysed from 120 smokers and never smokers with asthma. Participants with and without a history of chronic mucus hypersecretion were compared for clinical outcomes, sputum differential cell counts and CT measures of airway dimensions (wall thickness, luminal area and percent wall area). RESULTS Chronic mucus hypersecretion occurred in a higher proportion of smokers with asthma (56%) than never smokers with asthma (20%), (p < 0.001) and the proportion of patients with these symptoms increased with asthma severity (p = 0.003). Smokers with asthma and chronic mucus hypersecretion had worse current clinical control than smokers without those symptoms [ACQ score 2.3 versus 1.6, p = 0.002]. A greater proportion of never smokers with chronic mucus hypersecretion required short courses of oral corticosteroids in the last year (58% versus 19%, p = 0.011). Sputum neutrophil and eosinophil counts were similar in asthma patients with or without chronic mucus hypersecretion. Of those with severe asthma and chronic mucus hypersecretion, a CT measure of airway lumen area was reduced in smokers compared to never smokers (11.4 mm(2) versus 18.4 mm(2); p = 0.017). CONCLUSIONS Chronic mucus hypersecretion occurs frequently in adults with stable asthma, particularly in smokers with severe disease and is associated with worse current clinical control in smokers and more exacerbations in never smokers.
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Affiliation(s)
- Neil C Thomson
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK.
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Martínez-García MA, de la Rosa Carrillo D, Soler-Cataluña JJ, Donat-Sanz Y, Serra PC, Lerma MA, Ballestín J, Sánchez IV, Selma Ferrer MJ, Dalfo AR, Valdecillos MB. Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 187:823-31. [PMID: 23392438 DOI: 10.1164/rccm.201208-1518oc] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and it has been associated with exacerbations and bacterial colonization. These have demonstrated some degree of prognostic value in patients with COPD but no information about the relationship between bronchiectasis and mortality in patients with COPD is currently available. OBJECTIVES To assess the prognostic value of bronchiectasis in patients with moderate-to-severe COPD. METHODS Multicenter prospective observational study in consecutive patients with moderate-to-severe COPD. Bronchiectasis was diagnosed by high-resolution computed tomography scan. A complete standardized protocol was used in all patients covering general, anthrophometric, functional, clinical, and microbiologic data. After follow-up, the vital status was recorded in all patients. Multivariate Cox analysis was used to determine the independent adjusted prognostic value of bronchiectasis. MEASUREMENTS AND MAIN RESULTS Ninety-nine patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) II, 85 in GOLD III, and 17 in GOLD IV stages were included. Bronchiectasis was present in 115 (57.2%) patients. During the follow-up (median, 48 mo [interquartile range, 35-53]) there were 51 deaths (43 deaths in the bronchiectasic group). Bronchiectasis was associated with an increased risk of fully adjusted mortality (hazard ratio, 2.54; 95% confidence interval, 1.16-5.56; P = 0.02). CONCLUSIONS Bronchiectasis was associated with an independent increased risk of all-cause mortality in patients with moderate-to-severe COPD.
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Mets OM, Schmidt M, Buckens CF, Gondrie MJ, Isgum I, Oudkerk M, Vliegenthart R, de Koning HJ, van der Aalst CM, Prokop M, Lammers JWJ, Zanen P, Mohamed Hoesein FA, Mali WP, van Ginneken B, van Rikxoort EM, de Jong PA. Diagnosis of chronic obstructive pulmonary disease in lung cancer screening Computed Tomography scans: independent contribution of emphysema, air trapping and bronchial wall thickening. Respir Res 2013; 14:59. [PMID: 23711184 PMCID: PMC3673831 DOI: 10.1186/1465-9921-14-59] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/24/2013] [Indexed: 01/21/2023] Open
Abstract
Background Beyond lung cancer, screening CT contains additional information on other smoking related diseases (e.g. chronic obstructive pulmonary disease, COPD). Since pulmonary function testing is not regularly incorporated in lung cancer screening, imaging biomarkers for COPD are likely to provide important surrogate measures for disease evaluation. Therefore, this study aims to determine the independent diagnostic value of CT emphysema, CT air trapping and CT bronchial wall thickness for COPD in low-dose screening CT scans. Methods Prebronchodilator spirometry and volumetric inspiratory and expiratory chest CT were obtained on the same day in 1140 male lung cancer screening participants. Emphysema, air trapping and bronchial wall thickness were automatically quantified in the CT scans. Logistic regression analysis was performed to derivate a model to diagnose COPD. The model was internally validated using bootstrapping techniques. Results Each of the three CT biomarkers independently contributed diagnostic value for COPD, additional to age, body mass index, smoking history and smoking status. The diagnostic model that included all three CT biomarkers had a sensitivity and specificity of 73.2% and 88.%, respectively. The positive and negative predictive value were 80.2% and 84.2%, respectively. Of all participants, 82.8% was assigned the correct status. The C-statistic was 0.87, and the Net Reclassification Index compared to a model without any CT biomarkers was 44.4%. However, the added value of the expiratory CT data was limited, with an increase in Net Reclassification Index of 4.5% compared to a model with only inspiratory CT data. Conclusion Quantitatively assessed CT emphysema, air trapping and bronchial wall thickness each contain independent diagnostic information for COPD, and these imaging biomarkers might prove useful in the absence of lung function testing and may influence lung cancer screening strategy. Inspiratory CT biomarkers alone may be sufficient to identify patients with COPD in lung cancer screening setting.
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Affiliation(s)
- Onno M Mets
- Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Dijkstra AE, Postma DS, ten Hacken N, Vonk JM, Oudkerk M, van Ooijen PMA, Zanen P, Mohamed Hoesein FA, van Ginneken B, Schmidt M, Groen HJM. Low-dose CT measurements of airway dimensions and emphysema associated with airflow limitation in heavy smokers: a cross sectional study. Respir Res 2013; 14:11. [PMID: 23356533 PMCID: PMC3570364 DOI: 10.1186/1465-9921-14-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/17/2013] [Indexed: 11/13/2022] Open
Abstract
Background Increased airway wall thickness (AWT) and parenchymal lung destruction both contribute to airflow limitation. Advances in computed tomography (CT) post-processing imaging allow to quantify these features. The aim of this Dutch population study is to assess the relationships between AWT, lung function, emphysema and respiratory symptoms. Methods AWT and emphysema were assessed by low-dose CT in 500 male heavy smokers, randomly selected from a lung cancer screening population. AWT was measured in each lung lobe in cross-sectionally reformatted images with an automated imaging program at locations with an internal diameter of 3.5 mm, and validated in smaller cohorts of patients. The 15th percentile method (Perc15) was used to assess the severity of emphysema. Information about respiratory symptoms and smoking behavior was collected by questionnaires and lung function by spirometry. Results Median AWT in airways with an internal diameter of 3.5 mm (AWT3.5) was 0.57 (0.44 - 0.74) mm. Median AWT in subjects without symptoms was 0.52 (0.41-0.66) and in those with dyspnea and/or wheezing 0.65 (0.52-0.81) mm (p<0.001). In the multivariate analysis only AWT3.5 and emphysema independently explained 31.1%and 9.5%of the variance in FEV1%predicted, respectively, after adjustment for smoking behavior. Conclusions Post processing standardization of airway wall measurements provides a reliable and useful method to assess airway wall thickness. Increased airway wall thickness contributes more to airflow limitation than emphysema in a smoking male population even after adjustment for smoking behavior.
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Affiliation(s)
- Akkelies E Dijkstra
- University of Groningen, Department of Pulmonary Diseases, University Medical Center Groningen, GRIAC research institute, Groningen, the Netherlands.
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Hackx M, Bankier AA, Gevenois PA. Chronic obstructive pulmonary disease: CT quantification of airways disease. Radiology 2012; 265:34-48. [PMID: 22993219 DOI: 10.1148/radiol.12111270] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide and results in substantial social and economic burdens. COPD is a heterogeneous disease with both extrapulmonary and pulmonary components. The pulmonary component is characterized by an airflow limitation that is not fully reversible. In the authors' opinion, none of the currently available classifications combining airflow limitation measurements with clinical parameters is sufficient to determine the prognosis and treatment of a particular patient with COPD. With regard to the causes of airflow limitation, CT can be used to quantify the two main contributions to COPD: emphysema, and small airways disease (a narrowing of the airways). CT quantification--with subsequent COPD phenotyping--can contribute to improved patient care, assessment of COPD progression, and identification of severe COPD with increasing risk of mortality. Small airways disease can be quantified through measurements reflecting morphology, quantification of obstruction, and changes in airways walls. This article details these three approaches and concludes with perspectives and directions for further research.
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Affiliation(s)
- Maxime Hackx
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
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Serrano-Mollar A. [Alveolar epithelial cell injury as an etiopathogenic factor in pulmonary fibrosis]. Arch Bronconeumol 2012; 48 Suppl 2:2-6. [PMID: 23116901 PMCID: PMC7131261 DOI: 10.1016/s0300-2896(12)70044-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by a progressive accumulation of extracellular matrix and an imbalance between profibrotic and antifibrotic mediators. In the last few years, understanding of the mechanisms of the biology of IPF has increased. One of the most significant discoveries is the finding that alveolar epithelial cell injury plays an important role in the pathogenesis of this disease. In this review, we describe some of the mechanisms involved in alveolar cell injury and their contribution to the development of IPF.
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Affiliation(s)
- Anna Serrano-Mollar
- Departamento de Patología Experimental, Institut d'Investigacions Biomèdiques de Barcelona, España.
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TANABE NAOYA, MURO SHIGEO, FUSEYA YOSHINORI, SATO SUSUMU, OGUMA TSUYOSHI, KIYOKAWA HIROFUMI, TAKAHASHI TAMAKI, KINOSE DAISUKE, HOSHINO YUMA, KUBO TAKESHI, HIRAI TOYOHIRO, MISHIMA MICHIAKI. Peri-diaphragmatic lung volume assessed by computed tomography correlates with quality of life in patients with chronic obstructive pulmonary disease. Respirology 2012; 17:1137-43. [DOI: 10.1111/j.1440-1843.2012.02221.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martinez CH, Chen YH, Westgate PM, Liu LX, Murray S, Curtis JL, Make BJ, Kazerooni EA, Lynch DA, Marchetti N, Washko GR, Martinez FJ, Han MK. Relationship between quantitative CT metrics and health status and BODE in chronic obstructive pulmonary disease. Thorax 2012; 67:399-406. [PMID: 22514236 DOI: 10.1136/thoraxjnl-2011-201185] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The value of quantitative CT (QCT) to identify chronic obstructive pulmonary disease (COPD) phenotypes is increasingly appreciated. The authors hypothesised that QCT-defined emphysema and airway abnormalities relate to St George's Respiratory Questionnaire (SGRQ) and Body-Mass Index, Airflow Obstruction, Dyspnea and Exercise Capacity Index (BODE). METHODS 1200 COPDGene subjects meeting Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD with QCT analysis were included. Total lung emphysema was measured using the density mask technique with a -950 Hounsfield unit threshold. An automated programme measured mean wall thickness (WT), wall area percentage (WA%) and 10 mm lumenal perimeter (pi10) in six segmental bronchi. Separate multivariate analyses examined the relative influence of airway measures and emphysema on SGRQ and BODE. RESULTS In separate models predicting SGRQ score, a 1 unit SD increase in each airway measure predicted higher SGRQ scores (for WT, 1.90 points higher, p=0.002; for WA%, 1.52 points higher, p=0.02; for pi10, 2.83 points higher p<0.001). The comparable increase in SGRQ for a 1 unit SD increase in emphysema percentage in these models was relatively weaker, significant only in the pi10 model (for emphysema percentage, 1.45 points higher, p=0.01). In separate models predicting BODE, a 1 unit SD increase in each airway measure predicted higher BODE scores (for WT, 1.07-fold increase, p<0.001; for WA%, 1.20-fold increase, p<0.001; for pi10, 1.16-fold increase, p<0.001). In these models, emphysema more strongly influenced BODE (range 1.24-1.26-fold increase, p<0.001). CONCLUSION Emphysema and airway disease both relate to clinically important parameters. The relative influence of airway disease is greater for SGRQ; the relative influence of emphysema is greater for BODE.
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Affiliation(s)
- Carlos H Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 3916 Taubman Center, Box 5360, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5360, USA
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Paré PD, Nagano T, Coxson HO. Airway imaging in disease: gimmick or useful tool? J Appl Physiol (1985) 2012; 113:636-46. [PMID: 22604891 PMCID: PMC3424064 DOI: 10.1152/japplphysiol.00372.2012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/15/2012] [Indexed: 01/06/2023] Open
Abstract
Airway remodeling is an important pathophysiological mechanism in a variety of chronic airway diseases. Historically investigators have had to use invasive techniques such as histological examination of excised tissue to study airway wall structure. The last several years has seen a proliferation of relatively noninvasive techniques to assess the airway branching pattern, wall thickness, and more recently, airway wall tissue components. These methods include computed tomography, magnetic resonance imaging, and optical coherence tomography. These new imaging technologies have become popular because to understand the physiology of lung disease it is important we understand the underlying anatomy. However, these new approaches are not standardized or available in all centers so a review of their validity and clinical utility is appropriate. This review documents how investigators are working hard to correct for inconsistencies between techniques so that they become more accepted and utilized in clinical settings. These new imaging techniques are very likely to play a frontline role in the study of lung disease and will, hopefully, allow clinicians and investigators to better understand disease pathogenesis and to design and assess new therapeutic interventions.
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Affiliation(s)
- Peter D Paré
- University of British Columbia James Hogg Research Centre and Institute for Heart + Lung Health, Vancouver, British Columbia, Canada
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Tanabe N, Muro S, Oguma T, Sato S, Kiyokawa H, Takahashi T, Kudo M, Kinose D, Kubo T, Hoshino Y, Ogawa E, Hirai T, Mishima M. Computed tomography assessment of pharmacological lung volume reduction induced by bronchodilators in COPD. COPD 2012; 9:401-8. [DOI: 10.3109/15412555.2012.674986] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Naoya Tanabe
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Shigeo Muro
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Tsuyoshi Oguma
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Susumu Sato
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Hirofumi Kiyokawa
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Tamaki Takahashi
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Megumi Kudo
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Daisuke Kinose
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Takeshi Kubo
- 2Department of Diagnostic Imaging and Nuclear Medicine,
Kyoto University, Kyoto, Japan
| | - Yuma Hoshino
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Emiko Ogawa
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Toyohiro Hirai
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
| | - Michiaki Mishima
- 1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
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Tanabe N, Muro S, Tanaka S, Sato S, Oguma T, Kiyokawa H, Takahashi T, Kinose D, Hoshino Y, Kubo T, Ogawa E, Hirai T, Mishima M. Emphysema distribution and annual changes in pulmonary function in male patients with chronic obstructive pulmonary disease. Respir Res 2012; 13:31. [PMID: 22512922 PMCID: PMC3478996 DOI: 10.1186/1465-9921-13-31] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The progression of chronic obstructive pulmonary disease (COPD) considerably varies among patients. Those with emphysema identified by quantitative computed tomography (CT) are associated with the rapid progression assessed by forced expiratory volume in one second (FEV1). However, whether the rate of the decline in lung function is independently affected by the regional distribution or the severity of emphysema in the whole lung is unclear. METHODS We followed up 131 male patients with COPD for a median of 3.7 years. We measured wall area percent (WA%) in right apical segmental bronchus, total lung volume, percent low attenuation volume (LAV%), and the standard deviation (SD) of LAV% values from CT images of 10 isovolumetric partitions (SD-LAV) as an index of cranial-caudal emphysema heterogeneity. Annual changes in FEV1 were then determined using a random coefficient model and relative contribution of baseline clinical parameters, pulmonary function, and CT indexes including LAV%, SD-LAV, and WA% to annual changes in FEV1 were examined. RESULTS The mean (SD) annual change in FEV1 was -44.4 (10.8) mL. Multivariate random coefficient model showed that higher baseline FEV1, higher LAV%, current smoking, and lower SD-LAV independently contributed to an excessive decline in FEV1, whereas ratio of residual volume to total lung capacity, ratio of diffusing capacity to alveolar ventilation, and WA% did not, after adjusting for age, height, weight, and ratio of CT-measured total lung volume to physiologically-measured total lung capacity. CONCLUSIONS A more homogeneous distribution of emphysema contributed to an accelerated decline in FEV1 independently of baseline pulmonary function, whole-lung emphysema severity, and smoking status. In addition to whole-lung analysis of emphysema, CT assessment of the cranial-caudal distribution of emphysema might be useful for predicting rapid, progressive disease and for developing a targeted strategy with which to prevent disease progression.
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Affiliation(s)
- Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical Phenotypes of COPD: Identification, Definition and Implications for Guidelines. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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