1
|
Park H, Hwang EJ, Goo JM. Deep Learning-Based Kernel Adaptation Enhances Quantification of Emphysema on Low-Dose Chest CT for Predicting Long-Term Mortality. Invest Radiol 2024; 59:278-286. [PMID: 37428617 DOI: 10.1097/rli.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVES The aim of this study was to ascertain the predictive value of quantifying emphysema using low-dose computed tomography (LDCT) post deep learning-based kernel adaptation on long-term mortality. MATERIALS AND METHODS This retrospective study investigated LDCTs obtained from asymptomatic individuals aged 60 years or older during health checkups between February 2009 and December 2016. These LDCTs were reconstructed using a 1- or 1.25-mm slice thickness alongside high-frequency kernels. A deep learning algorithm, capable of generating CT images that resemble standard-dose and low-frequency kernel images, was applied to these LDCTs. To quantify emphysema, the lung volume percentage with an attenuation value less than or equal to -950 Hounsfield units (LAA-950) was gauged before and after kernel adaptation. Low-dose chest CTs with LAA-950 exceeding 6% were deemed emphysema-positive according to the Fleischner Society statement. Survival data were sourced from the National Registry Database at the close of 2021. The risk of nonaccidental death, excluding causes such as injury or poisoning, was explored according to the emphysema quantification results using multivariate Cox proportional hazards models. RESULTS The study comprised 5178 participants (mean age ± SD, 66 ± 3 years; 3110 males). The median LAA-950 (18.2% vs 2.6%) and the proportion of LDCTs with LAA-950 exceeding 6% (96.3% vs 39.3%) saw a significant decline after kernel adaptation. There was no association between emphysema quantification before kernel adaptation and the risk of nonaccidental death. Nevertheless, after kernel adaptation, higher LAA-950 (hazards ratio for 1% increase, 1.01; P = 0.045) and LAA-950 exceeding 6% (hazards ratio, 1.36; P = 0.008) emerged as independent predictors of nonaccidental death, upon adjusting for age, sex, and smoking status. CONCLUSIONS The application of deep learning for kernel adaptation proves instrumental in quantifying pulmonary emphysema on LDCTs, establishing itself as a potential predictive tool for long-term nonaccidental mortality in asymptomatic individuals.
Collapse
Affiliation(s)
- Hyungin Park
- From the Department of Radiology, Seoul National University Hospital, Seoul, South Korea (H.P., E.J.H., J.M.G.); and Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.)
| | | | | |
Collapse
|
2
|
Xu K, Li TZ, Terry JG, Krishnan AR, Deppen SA, Huo Y, Maldonado F, Carr JJ, Landman BA, Sandler KL. Age-related Muscle Fat Infiltration in Lung Screening Participants: Impact of Smoking Cessation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299258. [PMID: 38106099 PMCID: PMC10723505 DOI: 10.1101/2023.12.05.23299258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Rationale Skeletal muscle fat infiltration progresses with aging and is worsened among individuals with a history of cigarette smoking. Many negative impacts of smoking on muscles are likely reversible with smoking cessation. Objectives To determine if the progression of skeletal muscle fat infiltration with aging is altered by smoking cessation among lung cancer screening participants. Methods This was a secondary analysis based on the National Lung Screening Trial. Skeletal muscle attenuation in Hounsfield unit (HU) was derived from the baseline and follow-up low-dose CT scans using a previously validated artificial intelligence algorithm. Lower attenuation indicates greater fatty infiltration. Linear mixed-effects models were constructed to evaluate the associations between smoking status and the muscle attenuation trajectory. Measurements and Main Results Of 19,019 included participants (age: 61 years, 5 [SD]; 11,290 males), 8,971 (47.2%) were actively smoking cigarettes. Accounting for body mass index, pack-years, percent emphysema, and other confounding factors, actively smoking predicted a lower attenuation in both males (β0 =-0.88 HU, P<.001) and females (β0 =-0.69 HU, P<.001), and an accelerated muscle attenuation decline-rate in males (β1=-0.08 HU/y, P<.05). Age-stratified analyses indicated that the accelerated muscle attenuation decline associated with smoking likely occurred at younger age, especially in females. Conclusions Among lung cancer screening participants, active cigarette smoking was associated with greater skeletal muscle fat infiltration in both males and females, and accelerated muscle adipose accumulation rate in males. These findings support the important role of smoking cessation in preserving muscle health.
Collapse
Affiliation(s)
- Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Thomas Z. Li
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - James G. Terry
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aravind R. Krishnan
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
| | - Stephen A. Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuankai Huo
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
| | - Fabien Maldonado
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bennett A. Landman
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kim L. Sandler
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
3
|
Urban T, Sauter AP, Frank M, Willer K, Noichl W, Bast H, Schick R, Herzen J, Koehler T, Gassert FT, Bodden JH, Fingerle AA, Gleich B, Renger B, Makowski MR, Pfeiffer F, Pfeiffer D. Dark-Field Chest Radiography Outperforms Conventional Chest Radiography for the Diagnosis and Staging of Pulmonary Emphysema. Invest Radiol 2023; 58:775-781. [PMID: 37276130 PMCID: PMC10581407 DOI: 10.1097/rli.0000000000000989] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Dark-field chest radiography (dfCXR) has recently reached clinical trials. Here we compare dfCXR to conventional radiography for the detection and staging of pulmonary emphysema. MATERIALS AND METHODS Subjects were included after a medically indicated computed tomography (CT) scan, showing either no lung impairments or different stages of emphysema. To establish a ground truth, all CT scans were assessed by 3 radiologists assigning emphysema severity scores based on the Fleischner Society classification scheme.Participants were imaged at a commercial chest radiography device and at a prototype for dfCXR, yielding both attenuation-based and dark-field images. Three radiologists blinded to CT score independently assessed images from both devices for presence and severity of emphysema (no, mild, moderate, severe).Statistical analysis included evaluation of receiver operating characteristic curves and pairwise comparison of adjacent Fleischner groups using an area under the curve (AUC)-based z test with a significance level of 0.05. RESULTS A total of 88 participants (54 men) with a mean age of 64 ± 12 years were included. Compared with conventional images (AUC = 0.73), readers were better able to identify emphysema with images from the dark-field prototype (AUC = 0.85, P = 0.005). Although ratings of adjacent emphysema severity groups with conventional radiographs differed only for trace and mild emphysema, ratings based on images from the dark-field prototype were different for trace and mild, mild and moderate, and moderate and confluent emphysema. CONCLUSIONS Dark-field chest radiography is superior to conventional chest radiography for emphysema diagnosis and staging, indicating the technique's potential as a low-dose diagnostic tool for emphysema assessment.
Collapse
|
4
|
Angelini ED, Yang J, Balte PP, Hoffman EA, Manichaikul AW, Sun Y, Shen W, Austin JHM, Allen NB, Bleecker ER, Bowler R, Cho MH, Cooper CS, Couper D, Dransfield MT, Garcia CK, Han MK, Hansel NN, Hughes E, Jacobs DR, Kasela S, Kaufman JD, Kim JS, Lappalainen T, Lima J, Malinsky D, Martinez FJ, Oelsner EC, Ortega VE, Paine R, Post W, Pottinger TD, Prince MR, Rich SS, Silverman EK, Smith BM, Swift AJ, Watson KE, Woodruff PG, Laine AF, Barr RG. Pulmonary emphysema subtypes defined by unsupervised machine learning on CT scans. Thorax 2023; 78:1067-1079. [PMID: 37268414 PMCID: PMC10592007 DOI: 10.1136/thorax-2022-219158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Treatment and preventative advances for chronic obstructive pulmonary disease (COPD) have been slow due, in part, to limited subphenotypes. We tested if unsupervised machine learning on CT images would discover CT emphysema subtypes with distinct characteristics, prognoses and genetic associations. METHODS New CT emphysema subtypes were identified by unsupervised machine learning on only the texture and location of emphysematous regions on CT scans from 2853 participants in the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), a COPD case-control study, followed by data reduction. Subtypes were compared with symptoms and physiology among 2949 participants in the population-based Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study and with prognosis among 6658 MESA participants. Associations with genome-wide single-nucleotide-polymorphisms were examined. RESULTS The algorithm discovered six reproducible (interlearner intraclass correlation coefficient, 0.91-1.00) CT emphysema subtypes. The most common subtype in SPIROMICS, the combined bronchitis-apical subtype, was associated with chronic bronchitis, accelerated lung function decline, hospitalisations, deaths, incident airflow limitation and a gene variant near DRD1, which is implicated in mucin hypersecretion (p=1.1 ×10-8). The second, the diffuse subtype was associated with lower weight, respiratory hospitalisations and deaths, and incident airflow limitation. The third was associated with age only. The fourth and fifth visually resembled combined pulmonary fibrosis emphysema and had distinct symptoms, physiology, prognosis and genetic associations. The sixth visually resembled vanishing lung syndrome. CONCLUSION Large-scale unsupervised machine learning on CT scans defined six reproducible, familiar CT emphysema subtypes that suggest paths to specific diagnosis and personalised therapies in COPD and pre-COPD.
Collapse
Affiliation(s)
- Elsa D Angelini
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
- LTCI, Institut Polytechnique de Paris, Telecom Paris, Palaiseau, France
- NIHR Imperial Biomedical Research Centre, ITMAT Data Science Group, Imperial College, London, UK
| | - Jie Yang
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Pallavi P Balte
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric A Hoffman
- Departments of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Ani W Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Yifei Sun
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Wei Shen
- Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University Irving Medical Center, New York, New York, USA
| | - John H M Austin
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Norrina B Allen
- Institute for Public Health and Medicine (IPHAM) - Center for Epidemiology and Population Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eugene R Bleecker
- Department of Medicine, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - David Couper
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Christine Kim Garcia
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - MeiLan K Han
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emlyn Hughes
- Department of Physics, Columbia University, New York, New York, USA
| | - David R Jacobs
- Division of Epidemiology and Community Public Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Silva Kasela
- Department of Systems Biology, Columbia University Irving Medical Center, New York, New York, USA
- New York Genome Center, New York, New York, USA
| | - Joel Daniel Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - John Shinn Kim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Tuuli Lappalainen
- Department of Systems Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Malinsky
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | - Fernando J Martinez
- Department of Medicine, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Victor E Ortega
- Department of Pulmonary Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Wendy Post
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tess D Pottinger
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin M Smith
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew J Swift
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Prescott G Woodruff
- Department of Medicine, University of California, San Francisco, California, USA
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, New York, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University Irving Medical Center, New York, New York, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
5
|
Zhang Q, Cai G, Cui F, Li F, Liang H, Gao L, Guo W, Li M, Chen Y. The relationship of airflow limitation with lung squamous cell carcinoma: evidence from mendelian randomization analysis. J Cancer Res Clin Oncol 2023; 149:6999-7006. [PMID: 36853385 DOI: 10.1007/s00432-023-04612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Observational studies showed associations between smoking, and airflow limitation, with lung squamous cell carcinoma (LUSC). However, the causal association of airflow limitation with LUSC and the modification by smoking status for the association remains unclear. METHODS Genetic summary data were obtained from large genome-wide association studies (GWAS). One hundred two single nucleotide polymorphisms (SNPs) for airflow limitation (i.e., FEV1/FVC < 0.7) and 153 SNPs for smoking behavior were used as instrumental variables and the main MR analysis methods. The univariable and multivariable Mendelian Randomization (MR) in a two-sample setting were performed to assess the association of airflow limitation, and smoking behavior with LUSC. RESULTS In the univariable MR analysis, genetic predisposition towards airflow limitation [Inverse Variance-Weighted (IVW) method Odds Ratio (OR) = 4.83, 95% Confidence Interval (CI) 1.55 to 15.06, P = 0.006], age of smoking initiation (IVW method OR = 0.10, 95%CI 0.02 to 0.36, P < 0.001), cigarettes smoked per day (IVW method OR = 3.10, 95%CI 2.07 to 4.63, P < 0.001), ex-smoking (IVW method OR = 0.47, 95%CI 0.31 to 0.69, P < 0.001), current smoking status (IVW method OR = 13.08, 95%CI 2.53 to 67.84, P = 0.002), pack-years of smoking (Weighted median method OR = 11.49, 95%CI 3.71 to 35.63, P < 0.001) were associated with LUSC. In the multivariable MR analysis, the causal effect of airflow limitation was still observed on LUSC (IVW method OR = 2.97, 95% CI 1.09 to 8.04, P = 0.032 adjusted for age of smoking initiation and cigarettes smoked per day; IVW method OR = 3.24, 95% CI 1.09 to 9.58, P = 0.033 adjusted for ex-smoking, current smoking status, and pack years of smoking; IVW method OR = 2.91, 95% CI 1.01 to 8.41, P = 0.049 adjusted for 5 smoking behaviors mentioned above). CONCLUSIONS Our MR analysis demonstrated that airflow limitation is likely to be an independent predictor of LUSC.
Collapse
Affiliation(s)
- Qing Zhang
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Guannan Cai
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Fei Cui
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Feng Li
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Hengrui Liang
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Limei Gao
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Wenwei Guo
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Meihua Li
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China
| | - Ying Chen
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, No. 195 Dongfeng Xi Road, Guangzhou, 510000, China.
| |
Collapse
|
6
|
Yao S, Zeng L, Wang F, Chen K. Obesity Paradox in Lung Diseases: What Explains It? Obes Facts 2023; 16:411-426. [PMID: 37463570 PMCID: PMC10601679 DOI: 10.1159/000531792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Obesity is a globally increasing health problem that impacts multiple organ systems and a potentially modifiable risk factor for many diseases. Obesity has a significant impact on lung function and is strongly linked to the pathophysiology that contributes to lung diseases. On the other hand, reports have emerged that obesity is associated with a better prognosis than for normal weight individuals in some lung diseases, including pneumonia, acute lung injury/acute respiratory distress syndrome, chronic obstructive pulmonary disease, and lung cancer. The lesser mortality and better prognosis in patients with obesity is known as obesity paradox. While obesity paradox is both recognized and disputed in epidemiological studies, recent research has suggested possible mechanisms. SUMMARY In this review, we attempted to explain and summarize these factors and mechanisms, including immune response, pulmonary fibrosis, lung function, microbiota, fat and muscle reserves, which are significantly altered by obesity and may contribute to the obesity paradox in lung diseases. We also discuss contrary literature that attributes the "obesity paradox" to confounding. KEY MESSAGES The review will illustrate the possible role of obesity in the prognosis or course of lung diseases, leading to a better understanding of the obesity paradox and provide hints for further basic and clinical research in lung diseases.
Collapse
Affiliation(s)
- Surui Yao
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Lei Zeng
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Fengyuan Wang
- College of Animal and Veterinary Sciences, Southwest Minzu University, Chengdu, PR China
| | - Kejie Chen
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| |
Collapse
|
7
|
Balbi M, Sabia F, Ledda RE, Milanese G, Ruggirello M, Silva M, Marchianò AV, Sverzellati N, Pastorino U. Automated Coronary Artery Calcium and Quantitative Emphysema in Lung Cancer Screening: Association With Mortality, Lung Cancer Incidence, and Airflow Obstruction. J Thorac Imaging 2023; 38:W52-W63. [PMID: 36656144 PMCID: PMC10287055 DOI: 10.1097/rti.0000000000000698] [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: 01/20/2023]
Abstract
PURPOSE To assess automated coronary artery calcium (CAC) and quantitative emphysema (percentage of low attenuation areas [%LAA]) for predicting mortality and lung cancer (LC) incidence in LC screening. To explore correlations between %LAA, CAC, and forced expiratory value in 1 second (FEV 1 ) and the discriminative ability of %LAA for airflow obstruction. MATERIALS AND METHODS Baseline low-dose computed tomography scans of the BioMILD trial were analyzed using an artificial intelligence software. Univariate and multivariate analyses were performed to estimate the predictive value of %LAA and CAC. Harrell C -statistic and time-dependent area under the curve (AUC) were reported for 3 nested models (Model survey : age, sex, pack-years; Model survey-LDCT : Model survey plus %LAA plus CAC; Model final : Model survey-LDCT plus selected confounders). The correlations between %LAA, CAC, and FEV 1 and the discriminative ability of %LAA for airflow obstruction were tested using the Pearson correlation coefficient and AUC-receiver operating characteristic curve, respectively. RESULTS A total of 4098 volunteers were enrolled. %LAA and CAC independently predicted 6-year all-cause (Model final hazard ratio [HR], 1.14 per %LAA interquartile range [IQR] increase [95% CI, 1.05-1.23], 2.13 for CAC ≥400 [95% CI, 1.36-3.28]), noncancer (Model final HR, 1.25 per %LAA IQR increase [95% CI, 1.11-1.37], 3.22 for CAC ≥400 [95%CI, 1.62-6.39]), and cardiovascular (Model final HR, 1.25 per %LAA IQR increase [95% CI, 1.00-1.46], 4.66 for CAC ≥400, [95% CI, 1.80-12.58]) mortality, with an increase in concordance probability in Model survey-LDCT compared with Model survey ( P <0.05). No significant association with LC incidence was found after adjustments. Both biomarkers negatively correlated with FEV 1 ( P <0.01). %LAA identified airflow obstruction with a moderate discriminative ability (AUC, 0.738). CONCLUSIONS Automated CAC and %LAA added prognostic information to age, sex, and pack-years for predicting mortality but not LC incidence in an LC screening setting. Both biomarkers negatively correlated with FEV 1 , with %LAA enabling the identification of airflow obstruction with moderate discriminative ability.
Collapse
Affiliation(s)
- Maurizio Balbi
- Departments of Thoracic Surgery
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | | | - Roberta E. Ledda
- Departments of Thoracic Surgery
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | | | - Mario Silva
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | | | - Nicola Sverzellati
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Parma, Italy
| | | |
Collapse
|
8
|
Raoof S, Shah M, Make B, Allaqaband H, Bowler R, Fernando S, Greenberg H, Han MK, Hogg J, Humphries S, Lee KS, Lynch D, Machnicki S, Mehta A, Mina B, Naidich D, Naidich J, Naqvi Z, Ohno Y, Regan E, Travis WD, Washko G, Braman S. Lung Imaging in COPD Part 1: Clinical Usefulness. Chest 2023; 164:69-84. [PMID: 36907372 PMCID: PMC10403625 DOI: 10.1016/j.chest.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/23/2023] [Accepted: 03/04/2023] [Indexed: 03/13/2023] Open
Abstract
COPD is a condition characterized by chronic airflow obstruction resulting from chronic bronchitis, emphysema, or both. The clinical picture is usually progressive with respiratory symptoms such as exertional dyspnea and chronic cough. For many years, spirometry was used to establish a diagnosis of COPD. Recent advancements in imaging techniques allow quantitative and qualitative analysis of the lung parenchyma as well as related airways and vascular and extrapulmonary manifestations of COPD. These imaging methods may allow prognostication of disease and shed light on the efficacy of pharmacologic and nonpharmacologic interventions. This is the first of a two-part series of articles on the usefulness of imaging methods in COPD, and it highlights useful information that clinicians can obtain from these imaging studies to make more accurate diagnosis and therapeutic decisions.
Collapse
Affiliation(s)
- Suhail Raoof
- Northwell Health, Lenox Hill Hospital, New York, NY.
| | - Manav Shah
- Northwell Health, Lenox Hill Hospital, New York, NY
| | | | | | | | | | | | | | - James Hogg
- University of British Columbia, Vancouver, BC, Canada
| | | | - Kyung Soo Lee
- Sungkyunkwan University School of Medicine, Samsung ChangWon Hospital, ChangWon, South Korea
| | | | | | | | - Bushra Mina
- Northwell Health, Lenox Hill Hospital, New York, NY
| | | | | | - Zarnab Naqvi
- Northwell Health, Lenox Hill Hospital, New York, NY
| | | | | | | | | | - Sidney Braman
- Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
9
|
CT-based emphysema characterization per lobe: A proof of concept. Eur J Radiol 2023; 160:110709. [PMID: 36731401 DOI: 10.1016/j.ejrad.2023.110709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE The Fleischner society criteria are global criteria to visually evaluate and classify pulmonary emphysema on CT. It may group heterogeneous disease severity within the same category, potentially obscuring clinically relevant differences in emphysema severity. This proof-of-concept study proposes to split emphysema into more categories and to assess each lobe separately, and applies this to two general population-based cohort samples to assess what information such an extension adds. METHOD From a consecutive sample in two general population-based cohorts with low-dose chest CT, 117 participants with more than a trace of emphysema were included. Two independent readers performed an extended per-lobe classification and assessed overall severity semi-quantitatively. An emphysema sum score was determined by adding the severity score of all lobes. Inter-reader agreement was quantified with Krippendorff Alpha. RESULTS Based on Fleischner society criteria, 69 cases had mild to severe centrilobular emphysema, and 90 cases had mild or moderate paraseptal emphysema (42 had both types of emphysema). The emphysema sum score was significantly different between mild (10.7 ± 4.3, range 2-22), moderate (20.1 ± 3.1, range: 15-24), and severe emphysema (23.6 ± 3.4, range: 17-28, p < 0.001), but ranges showed significant overlap. Inter-reader agreement for the extended classification and sum score was substantial (alpha 0.79 and 0.85, respectively). Distribution was homogenous across lobes in never-smokers, yet heterogenous in current smokers, with upper-lobe predominance. CONCLUSIONS The proposed emphysema evaluation method adds information to the original Fleischner society classification. Individuals in the same Fleischner category have diverse emphysema sum scores, and lobar emphysema distribution differs between smoking groups.
Collapse
|
10
|
Xu K, Khan MS, Li T, Gao R, Antic SL, Huo Y, Sandler KL, Maldonado F, Landman BA. Stratification of Lung Cancer Risk with Thoracic Imaging Phenotypes. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2023; 12464:1246407. [PMID: 37465098 PMCID: PMC10353831 DOI: 10.1117/12.2654018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
In lung cancer screening, estimation of future lung cancer risk is usually guided by demographics and smoking status. The role of constitutional profiles of human body, a.k.a. body habitus, is increasingly understood to be important, but has not been integrated into risk models. Chest low dose computed tomography (LDCT) is the standard imaging study in lung cancer screening, with the capability to discriminate differences in body composition and organ arrangement in the thorax. We hypothesize that the primary phenotypes identified using lung screening chest LDCT can form a representation of body habitus and add predictive power for lung cancer risk stratification. In this pilot study, we evaluated the feasibility of body habitus image-based phenotyping on a large lung screening LDCT dataset. A thoracic imaging manifold was estimated based on an intensity-based pairwise (dis)similarity metric for pairs of spatial normalized chest LDCT images. We applied the hierarchical clustering method on this manifold to identify the primary phenotypes. Body habitus features of each identified phenotype were evaluated and associated with future lung cancer risk using time-to-event analysis. We evaluated the method on the baseline LDCT scans of 1,200 male subjects sampled from National Lung Screening Trial. Five primary phenotypes were identified, which were associated with highly distinguishable clinical and body habitus features. Time-to-event analysis against future lung cancer incidences showed two of the five identified phenotypes were associated with elevated future lung cancer risks (HR=1.61, 95% CI = [1.08, 2.38], p=0.019; HR=1.67, 95% CI = [0.98, 2.86], p=0.057). These results indicated that it is feasible to capture the body habitus by image-base phenotyping using lung screening LDCT and the learned body habitus representation can potentially add value for future lung cancer risk stratification.
Collapse
Affiliation(s)
- Kaiwen Xu
- Vanderbilt University, 2201 West End Ave, Nashville, TN, USA 37235
| | - Mirza S Khan
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA 37232
| | - Thomas Li
- Vanderbilt University, 2201 West End Ave, Nashville, TN, USA 37235
| | - Riqiang Gao
- Vanderbilt University, 2201 West End Ave, Nashville, TN, USA 37235
| | - Sanja L Antic
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA 37232
| | - Yuankai Huo
- Vanderbilt University, 2201 West End Ave, Nashville, TN, USA 37235
| | - Kim L Sandler
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA 37232
| | - Fabien Maldonado
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA 37232
| | - Bennett A Landman
- Vanderbilt University, 2201 West End Ave, Nashville, TN, USA 37235
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA 37232
| |
Collapse
|
11
|
Zhao G, Li X, Lei S, Zhao H, Zhang H, Li J. Prevalence of lung cancer in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front Oncol 2022; 12:947981. [PMID: 36185264 PMCID: PMC9523743 DOI: 10.3389/fonc.2022.947981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background There is growing evidence that chronic obstructive pulmonary disease (COPD) can increase the risk of lung cancer, which poses a serious threat to treatment and management. Therefore, we performed a meta-analysis of lung cancer prevalence in patients with COPD with the aim of providing better prevention and management strategies. Methods We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library databases from their inception to 20 March 2022 to collect studies on the prevalence of lung cancer in patients with COPD. We evaluated the methodological quality of the included studies using the tool for assessing the risk of bias in prevalence studies. Meta-analysis was used to determine the prevalence and risk factors for lung cancer in COPD. Subgroup and sensitivity analyses were conducted to explore the data heterogeneity. Funnel plots combined with Egger’s test were used to detect the publication biases. Results Thirty-one studies, covering 829,490 individuals, were included to investigate the prevalence of lung cancer in patients with COPD. Pooled analysis demonstrated that the prevalence of lung cancer in patients with COPD was 5.08% (95% confidence interval [CI]: 4.17–6.00%). Subgroup analysis showed that the prevalence was 5.09% (95% CI: 3.48–6.70%) in male and 2.52% (95% CI: 1.57–4.05%) in female. The prevalence of lung cancer in patients with COPD who were current and former smokers was as high as 8.98% (95% CI: 4.61–13.35%) and 3.42% (95% CI: 1.51–5.32%); the incidence rates in patients with moderate and severe COPD were 6.67% (95% CI: 3.20–10.14%) and 5.57% (95% CI: 1.89–16.39%), respectively, which were higher than the 3.89% (95% CI: 2.14–7.06%) estimated in patients with mild COPD. Among the types of lung cancer, adenocarcinoma and squamous cell carcinoma were the most common, with incidence rates of 1.59% (95% CI: 0.23–2.94%) and 1.35% (95% CI: 0.57–3.23%), respectively. There were also differences in regional distribution, with the highest prevalence in the Western Pacific region at 7.78% (95% CI: 5.06–10.5%), followed by the Americas at 3.25% (95% CI: 0.88–5.61%) and Europe at 3.21% (95% CI: 2.36–4.06%). Conclusions This meta-analysis shows that patients with COPD have a higher risk of developing lung cancer than those without COPD. More attention should be given to this result in order to reduce the risk of lung cancer in these patients with appropriate management and prevention. Systematic review registration International prospective register of systematic reviews, identifier CRD42022331872.
Collapse
Affiliation(s)
- Guixiang Zhao
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuanlin Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Siyuan Lei
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hulei Zhao
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Hailong Zhang
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiansheng Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Jiansheng Li,
| |
Collapse
|
12
|
Noda Y, Shiroyama T, Masuhiro K, Amiya S, Enomoto T, Adachi Y, Hara R, Niitsu T, Naito Y, Miyake K, Koyama S, Hirata H, Nagatomo I, Takeda Y, Kumanogoh A. Quantitative evaluation of emphysema for predicting immunotherapy response in patients with advanced non-small-cell lung cancer. Sci Rep 2022; 12:8881. [PMID: 35614345 PMCID: PMC9133115 DOI: 10.1038/s41598-022-13131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
The efficacy of immune checkpoint inhibitors (ICIs) in patients with advanced non-small-cell lung cancer (NSCLC) might depend on the presence of emphysema, but this association is not established. We aimed to investigate if quantitively and automatically measuring emphysema can predict the effect of ICIs. We retrospectively analyzed 56 patients with NSCLC who underwent immunotherapy at our hospital. We used the Goddard scoring system (GS) to evaluate the severity of emphysema on baseline CT scans using three-dimensional image analysis software. The emphysema group (GS ≥ 1) showed better progression-free survival (PFS) than the non-emphysema group (GS = 0) (6.5 vs. 2.3 months, respectively, p < 0.01). Multivariate analyses revealed that good performance status, GS of ≥ 1, and high expression of PD-L1 were independently associated with better PFS, while smoking status was not. In conclusion, quantitative evaluation of emphysema can be an objective parameter for predicting the therapeutic effects of ICIs in patients with NSCLC. Our findings can be used to generate hypotheses for future studies.
Collapse
Affiliation(s)
- Yoshimi Noda
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Takayuki Shiroyama
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Kentaro Masuhiro
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Saori Amiya
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Takatoshi Enomoto
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuichi Adachi
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Reina Hara
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Takayuki Niitsu
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yujiro Naito
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Kotaro Miyake
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Shohei Koyama
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Izumi Nagatomo
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yoshito Takeda
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.,Department of Immunopathology, WPI, Immunology Frontier Research Center (iFReC), Osaka University, Suita, Osaka, Japan.,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Osaka, Japan.,Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Osaka, Japan
| |
Collapse
|
13
|
Elmaleh-Sachs A, Balte P, Oelsner EC, Allen NB, Baugh AD, Bertoni AG, Hankinson JL, Pankow J, Post WS, Schwartz JE, Smith BM, Watson K, Barr RG. Race/Ethnicity, Spirometry Reference Equations and Prediction of Incident Clinical Events: The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. Am J Respir Crit Care Med 2021; 205:700-710. [PMID: 34913853 DOI: 10.1164/rccm.202107-1612oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Normal values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) are currently calculated using cross-sectional reference equations that include terms for race/ethnicity, an approach that may reinforce disparities and is of unclear clinical benefit. OBJECTIVES To determine whether race/ethnic-based spirometry reference equations improve the prediction of incident chronic lower respiratory disease (CLRD) events and mortality compared to race/ethnic-neutral equations. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, a population-based, prospective cohort study of White, Black, Hispanic, and Asian adults, performed standardized spirometry in 2004-06. Predicted values for spirometry were calculated using race/ethnic-based equations following guidelines and, alternatively, race/ethnic-neutral equations without terms for race/ethnicity. Participants were followed for events through 2019. MEASUREMENTS AND MAIN RESULTS The mean age of 3,344 participants was 65 years and self-reported race/ethnicity was 36% White, 25% Black, 23% Hispanic, and 17% Asian. There were 181 incident CLRD-related events and 547 deaths over a median of 11.6 years. There was no evidence that percent-predicted FEV1 or FVC calculated by race/ethnic-based equations improved the prediction of CLRD-related events compared to that calculated by race/ethnic-neutral equations (difference in C-statistics -0.005, 95% CI -0.013, 0.003, and -0.008, 95% CI -0.016, -0.0006, respectively). Findings were similar for mortality (difference in C-statistics -0.002, 95% CI -0.008, 0.003, and -0.004, 95% CI -0.009, 0.001, respectively). CONCLUSIONS There was no evidence that race/ethnic-based spirometry reference equations improved the prediction of clinical events compared to race/ethnic-neutral equations. The inclusion of race/ethnicity in spirometry reference equations should be reconsidered.
Collapse
Affiliation(s)
- Arielle Elmaleh-Sachs
- Columbia University Irving Medical Center, 21611, General Medicine, New York, New York, United States
| | - Pallavi Balte
- Columbia University, Medicine, New York, New York, United States
| | | | | | - Aaron D Baugh
- UCSF, Division of Pulmonary and Critical Care Medicine, Department of Medicine and CVRI, San Francisco, California, United States
| | - Alain G Bertoni
- Wake Forest University, Department of Epidemiology and Prevention, Winston-Salem, North Carolina, United States
| | | | - Jim Pankow
- University of Minnesota School of Public Health, 43353, Minneapolis, Minnesota, United States
| | - Wendy S Post
- Johns Hopkins University, Medicine, Baltimore, Maryland, United States
| | - Joseph E Schwartz
- Columbia University Medical Center, Department of Medicine, New York, New York, United States
| | - Benjamin M Smith
- Columbia University Medical Center, Medicine, New York, New York, United States
| | - Karol Watson
- University of California at Los Angeles, Medicine, Los Angeles, California, United States
| | - R Graham Barr
- Columbia University, Epidemiology, New York, New York, United States;
| |
Collapse
|
14
|
Hatt CR, Oh AS, Obuchowski NA, Charbonnier JP, Lynch DA, Humphries SM. Comparison of CT Lung Density Measurements between Standard Full-Dose and Reduced-Dose Protocols. Radiol Cardiothorac Imaging 2021; 3:e200503. [PMID: 33969308 DOI: 10.1148/ryct.2021200503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the reproducibility and predicted clinical outcomes of CT-based quantitative lung density measurements using standard fixed-dose (FD) and reduced-dose (RD) scans. Materials and Methods In this retrospective analysis of prospectively acquired data, 1205 participants (mean age, 65 years ± 9 [standard deviation]; 618 men) enrolled in the COPDGene study who underwent FD and RD CT image acquisition protocols between November 2014 and July 2017 were included. Of these, the RD scans of 640 participants were also reconstructed using iterative reconstruction (IR). Median filtering was applied to the RD scans (RD-MF) to investigate an alternative noise reduction strategy. CT attenuation at the 15th percentile of the lung CT histogram (Perc15) was computed for all image types (FD, RD, RD-MF, and RD-IR). Reproducibility coefficients were calculated to quantify the measurement differences between FD and RD scans. The ability of Perc15 to predict chronic obstructive pulmonary disease (COPD) diagnosis and exacerbation frequency was investigated using receiver operating characteristic analysis. Results The Perc15 reproducibility coefficients with and without volume adjustment were as follows: RD, 29.43 HU ± 0.62 versus 32.81 HU ± 1.70; RD-MF, 7.42 HU ± 0.42 versus 19.40 HU ± 2.65; and RD-IR, 7.10 HU ± 0.52 versus 22.46 HU ± 3.91. Receiver operating characteristic curve analysis indicated that Perc15 on volume-adjusted FD and RD scans were both predictive for COPD diagnosis (area under the receiver operating characteristic curve [AUC]: FD, 0.724 ± 0.045; RD, 0.739 ± 0.045) and for having one or more exacerbation per year (AUCs: FD, 0.593 ± 0.068; RD, 0.589 ± 0.066). Similar trends were observed when volume adjustment was not applied. Conclusion A combination of volume adjustment and noise reduction filtering improved the reproducibility of lung density measurements computed using serial FD and RD CT scans.Supplemental material is available for this article.© RSNA, 2021.
Collapse
Affiliation(s)
- Charles R Hatt
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Andrea S Oh
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Nancy A Obuchowski
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Jean-Paul Charbonnier
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - David A Lynch
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| | - Stephen M Humphries
- Imbio LLC, 1015 Glenwood Ave, Minneapolis, MN 55405 (C.R.H.); School of Medicine and Public Health, Division of Radiology, University of Michigan, Ann Arbor, Mich (C.R.H.); Department of Radiology, National Jewish Health, Denver, Colo (A.S.O., D.A.L., S.M.H.); Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (N.A.O.); and Thirona, Nijmegen, the Netherlands (J.P.C.)
| |
Collapse
|
15
|
Predicting long-term mortality with two different criteria of exercise-induced desaturation in COPD. Respir Med 2021; 182:106393. [PMID: 33895625 DOI: 10.1016/j.rmed.2021.106393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are few reports on exercise-induced desaturation (EID) as a predictor of mortality in chronic obstructive pulmonary disease (COPD). However, the definitions of EID vary in published reports. The main purpose was to evaluate the association between EID and long-term mortality by applying two criteria of EID. METHODS A total of 507 subjects were selected from the Korean Obstructive Lung Disease cohort. EID was assessed using the 6-min walk test (6MWT) and defined using two different criteria [1]: post-6MWT oxygen saturation (SpO2) of ≤88% (criterion A) and [2] post-6MWT SpO2 < 90% or a decrease of ≥4% compared to baseline (criterion B). RESULTS The prevalence of EID was 5.1% based on criterion A and 13.0% based on criterion B. Regardless of the criteria used, mortality was higher in the EID group than in the non-EID group (A: 50 vs. 11.4%, B: 33.3 vs. 10.4%) during up to 161 months of follow-up. COPD patients without EID survived significantly longer than those with EID (A: 143.5 vs. 92.9, B: 144.8 vs. 115.2 months). Multivariate Cox regression analysis revealed that COPD patients with EID had a 2.4-fold increased risk of death by criterion A (adjusted HR 2.375; 95% CI: 1.217-4.637; P = 0.011). The risk of death increased in COPD patients with EID by criterion B, but the difference was not statistically significant. CONCLUSIONS COPD patients with EID demonstrated significantly higher long-term mortality than those without EID. The EID criterion A has a better predictive value for mortality in COPD.
Collapse
|
16
|
Steiger D, Siddiqi MF, Yip R, Yankelevitz DF, Henschke CI. The importance of low-dose CT screening to identify emphysema in asymptomatic participants with and without a prior diagnosis of COPD. Clin Imaging 2021; 78:136-141. [PMID: 33799061 DOI: 10.1016/j.clinimag.2021.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. METHODS We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. RESULTS Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (ORage10 = 0.72, p < 0.0001), lower pack-years of smoking (OR10pack-years = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was ORmoderate = 0.58(p = 0.0007) and for severe emphysema, it was ORsevere = 0.23(p < 0.0001). CONCLUSION Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation.
Collapse
Affiliation(s)
- David Steiger
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai St. Lukes, Mount Sinai West, Mount Sinai Beth Israel, New York, NY, United States of America
| | - M Faisal Siddiqi
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai St. Lukes, Mount Sinai West, Mount Sinai Beth Israel, New York, NY, United States of America
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States of America
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States of America
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States of America; Phoenix Veterans Health Care System, Phoenix, AZ, United States of America.
| | | |
Collapse
|
17
|
Wisselink HJ, Pelgrim GJ, Rook M, Imkamp K, van Ooijen PMA, van den Berge M, de Bock GH, Vliegenthart R. Ultra-low-dose CT combined with noise reduction techniques for quantification of emphysema in COPD patients: An intra-individual comparison study with standard-dose CT. Eur J Radiol 2021; 138:109646. [PMID: 33721769 DOI: 10.1016/j.ejrad.2021.109646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Phantom studies in CT emphysema quantification show that iterative reconstruction and deep learning-based noise reduction (DLNR) allow lower radiation dose. We compared emphysema quantification on ultra-low-dose CT (ULDCT) with and without noise reduction, to standard-dose CT (SDCT) in chronic obstructive pulmonary disease (COPD). METHOD Forty-nine COPD patients underwent ULDCT (third generation dual-source CT; 70ref-mAs, Sn-filter 100kVp; median CTDIvol 0.38 mGy) and SDCT (64-multidetector CT; 40mAs, 120kVp; CTDIvol 3.04 mGy). Scans were reconstructed with filtered backprojection (FBP) and soft kernel. For ULDCT, we also applied advanced modelled iterative reconstruction (ADMIRE), levels 1/3/5, and DLNR, levels 1/3/5/9. Emphysema was quantified as Low Attenuation Value percentage (LAV%, ≤-950HU). ULDCT measures were compared to SDCT as reference standard. RESULTS For ULDCT, the median radiation dose was 84 % lower than for SDCT. Median extent of emphysema was 18.6 % for ULD-FBP and 15.4 % for SDCT (inter-quartile range: 11.8-28.4 % and 9.2 %-28.7 %, p = 0.002). Compared to SDCT, the range in limits of agreement of emphysema quantification as measure of variability was 14.4 for ULD-FBP, 11.0-13.1 for ULD-ADMIRE levels and 10.1-13.9 for ULD-DLNR levels. Optimal settings were ADMIRE 3 and DLNR 3, reducing variability of emphysema quantification by 24 % and 27 %, at slight underestimation of emphysema extent (-1.5 % and -2.9 %, respectively). CONCLUSIONS Ultra-low-dose CT in COPD patients allows dose reduction by 84 %. State-of-the-art noise reduction methods in ULDCT resulted in slight underestimation of emphysema compared to SDCT. Noise reduction methods (especially ADMIRE 3 and DLNR 3) reduced variability of emphysema quantification in ULDCT by up to 27 % compared to FBP.
Collapse
Affiliation(s)
- H J Wisselink
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - G J Pelgrim
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - M Rook
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands; Martini Hospital Groningen, Department of Radiology, Groningen, the Netherlands
| | - K Imkamp
- University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, the Netherlands
| | - P M A van Ooijen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - M van den Berge
- University of Groningen, University Medical Center Groningen, Department of Pulmonology, Groningen, the Netherlands
| | - G H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - R Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands.
| |
Collapse
|
18
|
Tubío-Pérez RA, Torres-Durán M, Pérez-Ríos M, Fernández-Villar A, Ruano-Raviña A. Lung emphysema and lung cancer: what do we know about it? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1471. [PMID: 33313216 PMCID: PMC7723574 DOI: 10.21037/atm-20-1180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Emphysema and lung cancer (LC) are two diseases which share common risk factors, e.g., smoking. In recent years, many studies have sought to analyse this association. By way of illustration, we conducted a review of the scientific literature of the studies published to date, whose main designated aim was to demonstrate the relationship between emphysema and LC, and this association's influence on the histology, prognosis and molecular mechanisms responsible. We included over 40 studies (ranging from case-control and cohort studies to systematic reviews and meta-analyses), which highlight the association between emphysema and LC, independently of smoking habit. These studies also report a possible influence on histology, with adenocarcinoma being the most frequent lineage, and an association with poor prognosis, which affects both survival and post-operative complications. Oxidative stress, which generates chronic inflammatory status as well as the presence of certain polymorphisms in various genes (CYP1A1, TERT, CLPTM1L, ERK), gives rise-in the case of patients with emphysema-to alteration of cellular repair mechanisms, which in turn favours the proliferation of neoplastic epithelial cells responsible for the origin of LC.
Collapse
Affiliation(s)
- Ramón A Tubío-Pérez
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Galicia, Spain
| | - María Torres-Durán
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Galicia, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Galicia, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.,CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| |
Collapse
|
19
|
Quantification of Perinodular Emphysema in High-risk Patients Offers No Benefit in Lung Nodule Risk-Stratification of Malignancy Potential. J Thorac Imaging 2020; 35:108-114. [PMID: 31876554 DOI: 10.1097/rti.0000000000000465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pulmonary nodules, found either incidentally or on lung cancer screening, are common. Evaluating the benign or malignant nature of these nodules is costly in terms of patient risk and expense. The presence of both global and regional emphysema has been linked to increased lung cancer risk. We sought to determine whether the measurement of emphysema directly adjacent to a lung nodule could inform the likelihood of a nodule being malignant. MATERIALS AND METHODS Within a population of Veterans at high risk for lung cancer, 58 subjects with malignant nodules found on computerized tomographic chest scans were matched by lobe and nodule size to 58 controls. Lung densitometry was measured via determination of the low attenuation area percentage at -950 Hounsfield units (LAA950) and the Hounsfield unit (HU) value at which 15% of lung voxels have a lower lung density (Perc15), at predefined lung volumes that encompassed the nodule to evaluate both perinodular and regional lung fields. The association between measured lung density and malignancy was investigated using conditional logistic regression models, with densitometry measurements used as the primary predictor, adjusting for age alone, or age and computerized tomographic scan characteristics. RESULTS No significant differences in emphysema measurements between malignant and benign nodules were identified at lung volumes encompassing both perinodular and regional emphysema. Furthermore, emphysema quantification remained stable across lung volumes within individuals. CONCLUSIONS In this study, quantifying the degree of perinodular or regional emphysema did not offer any benefit in the risk stratification of lung nodules.
Collapse
|
20
|
Quantitative Emphysema on Low-Dose CT Imaging of the Chest and Risk of Lung Cancer and Airflow Obstruction: An Analysis of the National Lung Screening Trial. Chest 2020; 159:1812-1820. [PMID: 33326807 DOI: 10.1016/j.chest.2020.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/08/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lung cancer risk prediction models do not routinely incorporate imaging metrics available on low-dose CT (LDCT) imaging of the chest ordered for lung cancer screening. RESEARCH QUESTION What is the association between quantitative emphysema measured on LDCT imaging and lung cancer incidence and mortality, all-cause mortality, and airflow obstruction in individuals who currently or formerly smoked and are undergoing lung cancer screening? STUDY DESIGN AND METHODS In 7,262 participants in the CT arm of the National Lung Screening Trial, percent low attenuation area (%LAA) was defined as the percentage of lung volume with voxels less than -950 Hounsfield units on the baseline examination. Multivariable Cox proportional hazards models, adjusting for competing risks where appropriate, were built to test for association between %LAA and lung cancer incidence, lung cancer mortality, and all-cause mortality with censoring at 6 years. In addition, multivariable logistic regression models were built to test the cross-sectional association between %LAA and airflow obstruction on spirometry, which was available in 2,700 participants. RESULTS The median %LAA was 0.8% (interquartile range, 0.2%-2.7%). Every 1% increase in %LAA was independently associated with higher hazards of lung cancer incidence (hazard ratio [HR], 1.02; 95% CI, 1.01-1.03; P = .004), lung cancer mortality (HR, 1.02; 95% CI, 1.00-1.05; P = .045), and all-cause mortality (HR, 1.01; 95% CI, 1.00-1.03; P = .042). Among participants with spirometry, 892 had airflow obstruction. The likelihood of airflow obstruction increased with every 1% increase in %LAA (odds ratio, 1.07; 95% CI, 1.06-1.09; P < .001). A %LAA cutoff of 1% had the best discriminative accuracy for airflow obstruction in participants aged > 65 years. INTERPRETATION Quantitative emphysema measured on LDCT imaging of the chest can be leveraged to improve lung cancer risk prediction and help diagnose COPD in individuals who currently or formerly smoked and are undergoing lung cancer screening.
Collapse
|
21
|
Dolan DP, White A, Mazzola E, Lee DN, Gill R, Kucukak S, Bueno R, Jaklitsch MT, Mentzer SJ, Swanson SJ. Outcomes of superior segmentectomy versus lower lobectomy for superior segment Stage I non-small-cell lung cancer are equivalent: An analysis of 196 patients at a single, high volume institution. J Surg Oncol 2020; 123:570-578. [PMID: 33259656 DOI: 10.1002/jso.26304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine if superior segmentectomy has equivalent overall (OS), disease-free (DFS), and locoregional-recurrence-free survival (LRFS) to lower lobectomy for early-stage non-small-cell lung cancer (NSCLC) in the superior segment. METHODS We retrospectively reviewed all Stage 1 lower lobectomies for superior segment lesions and superior segmentectomies at our hospital from 2000 to 2018. Comparison statistics and Cox hazard modeling were performed to determine differences between groups and attempt to identify risk factors for OS, DFS, and LRFS. RESULTS Superior segmentectomy patients, compared with lower lobectomy patients, had more current smokers, worse forced expiratory volume in 1 s percentage, radiologic emphysema scores, clinically and pathologically smaller tumors, and more occurrences of 0 lymph nodes examined. Outcomes for superior segmentectomy compared with lower lobectomy were equivalent for 5-year OS (67.0% vs. 75.1%, p = 0.70), DFS (56.9% vs. 60.4%, p = 0.59), and LRFS (87.9% vs. 91.3%, p = 0.46). Multivariable Cox modeling lacked utility due to no outcome differences. CONCLUSIONS In well-selected patients, superior segmentectomies can have equivalent OS, DFS, and LRFS compared with lower lobectomies of superior segment tumors for early stage lung cancer. Further data are needed to provide better risk estimates.
Collapse
Affiliation(s)
- Daniel P Dolan
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Abby White
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Emanuele Mazzola
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel N Lee
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Ritu Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Suden Kucukak
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Raphael Bueno
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Michael T Jaklitsch
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Steven J Mentzer
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Scott J Swanson
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Cireli E, Balcı G, Mertoğlu A. How does chronic obstructive pulmonary disease affect the survival of patients with stage 4 lung cancer? CLINICAL RESPIRATORY JOURNAL 2020; 14:1025-1031. [PMID: 32706913 DOI: 10.1111/crj.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/19/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lung cancer risk is increased in COPD. However, it is not clear how COPD affects the course of lung cancer. AIM To determine whether the overall survival of stage 4 lung cancer patients differ in various COPD stages. STUDY DESIGN A cross-sectional retrospective study. METHODS We screened lung cancer patients with ICD code: C34 and included stage 4 lung cancer patients with histological diagnosis and pulmonary function tests at admission in the study. Demographic data, stages, metastasis sites and number of metastases, performance status, pulmonary function tests, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, arterial blood gasses and treatment methods were recorded on a standardised database. We checked their dates of death from national database. Data were evaluated with SPSS programme version 18. RESULTS Out of 900 patients, 146 patients had stage 4 disease at the time of diagnosis and, 127 patients had COPD. There was a significant difference between survivals of stage 4 cancer patients with different COPD stages. As COPD stage increased, overall survival worsened (P = 0.037). Factors affecting survival were bone metastasis (P = 0.01, OR = 1.72), liver metastasis (P = 0.04, OR = 1.87), brain metastasis (P = 0.001, OR = 2.6), having N 2-3 disease (P = 0.01, OR = 1.79) and GOLD 4 COPD (P = 0.01, OR = 2.28). CONCLUSION As COPD becomes more severe, overall survival rates of stage 4 patients worsen. Bone metastasis, liver metastasis, brain metastasis, having N2-3 disease and GOLD 4 COPD worsen the overall survival.
Collapse
Affiliation(s)
- Emel Cireli
- Pulmonary Diseases SUAM, Pulmonary Physician, SBU Izmir Chest Diseases and Surgery Training Hospital, Izmir, Turkey
| | - Günseli Balcı
- Pulmonary Diseases SUAM, Pulmonary Physician, SBU Izmir Chest Diseases and Surgery Training Hospital, Izmir, Turkey
| | - Aydan Mertoğlu
- Pulmonary Diseases SUAM, Pulmonary Physician, SBU Izmir Chest Diseases and Surgery Training Hospital, Izmir, Turkey
| |
Collapse
|
23
|
Abstract
OBJECTIVES Initial studies suggest HIV-positive persons may be at increased risk for chronic lung diseases such as chronic obstructive pulmonary disease, but have commonly relied on single-center designs, lacked HIV-negative controls, or assessed lung function with only spirometry. We tested differences in spirometry and single-breath diffusing capacity for carbon monoxide (DLCO) in persons with and without HIV. DESIGN Cross-sectional, observational study. METHODS Participants were enrolled from the Multicenter AIDS Cohort Study, a longitudinal cohort study of men who have sex with men (both HIV-positive and HIV-negative) at four sites in the United States. Standardized spirometry and DLCO testing were performed in all eligible, consenting participants at routine study visits. We tested associations between HIV status and spirometry and DLCO results, using linear and logistic regression. RESULTS Among 1067 men, median age was 57 years, prevalence of current marijuana (30%), and cigarette (24%) use was high, and another 45% were former cigarette smokers. Median forced expiratory volume in 1 s was 97% of predicted normal and DLCO was 85% of predicted normal. HIV-positive persons demonstrated no statistical difference in forced expiratory volume in 1 s compared with HIV-negative persons, but had worse DLCO (adjusted difference -2.6% of predicted; 95% confidence interval: -4.7 to -0.6%) and a higher risk of DLCO impairment (odds ratio for DLCO < 60% of predicted 2.97; 95% confidence interval: 1.36-6.47). Lower DLCO was associated with lower nadir CD4 cell counts. CONCLUSION HIV-positive men are at increased risk of abnormal gas exchange, indicated by low DLCO, compared with men without HIV.
Collapse
|
24
|
Durawa A, Dziadziuszko K, Jelitto-Górska M, Szurowska E. Emphysema - The review of radiological presentation and its clinical impact in the LDCT screening era. Clin Imaging 2020; 64:85-91. [PMID: 32388002 DOI: 10.1016/j.clinimag.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
Emphysema is one of three main lung pathologies in Chronic Obstructive Pulmonary Disease, along with chronic bronchitis and small airway obstruction. The diagnosis is based on detection of low attenuation areas in lung tissue on chest Computed Tomography, either visual by a radiologist, or automatic by the applied Computed Tomography software. Results of the studies on the association between emphysema and lung cancer incidence are mixed. Many studies have demonstrated, that chronic lung diseases, like Chronic Obstructive Pulmonary Disease, are associated with lung cancer morbidity. There is also evidence, that emphysema can be related with worse prognosis in patients with detected lung cancer. In this review article we aim to summarize current knowledge about emphysema detection and evaluation on Computed Tomography, both quantitative and qualitative. We also summarize current data on correlation between emphysema and lung cancer, as well as its potential use in selecting patients, who would most benefit from lung cancer screening.
Collapse
Affiliation(s)
- Agata Durawa
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland.
| | - Katarzyna Dziadziuszko
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland
| | - Małgorzata Jelitto-Górska
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland
| |
Collapse
|
25
|
Balte PP, Chaves PHM, Couper DJ, Enright P, Jacobs DR, Kalhan R, Kronmal RA, Loehr LR, London SJ, Newman AB, O'Connor GT, Schwartz JE, Smith BM, Smith LJ, White WB, Yende S, Oelsner EC. Association of Nonobstructive Chronic Bronchitis With Respiratory Health Outcomes in Adults. JAMA Intern Med 2020; 180:676-686. [PMID: 32119036 PMCID: PMC7052787 DOI: 10.1001/jamainternmed.2020.0104] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Chronic bronchitis has been associated with cigarette smoking as well as with e-cigarette use among young adults, but the association of chronic bronchitis in persons without airflow obstruction or clinical asthma, described as nonobstructive chronic bronchitis, with respiratory health outcomes remains uncertain. OBJECTIVE To assess whether nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes in adult ever smokers and never smokers. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 22 325 adults without initial airflow obstruction (defined as the ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity [FVC] of <0.70) or clinical asthma at baseline. The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 9 US general population-based cohorts. Thus present study is based on data from 5 of these cohorts. Participants were enrolled from August 1971 through May 2007 and were followed up through December 2018. EXPOSURES Nonobstructive chronic bronchitis was defined by questionnaire at baseline as both cough and phlegm for at least 3 months for at least 2 consecutive years. MAIN OUTCOMES AND MEASURES Lung function was measured by prebronchodilator spirometry. Hospitalizations and deaths due to chronic lower respiratory disease and respiratory disease-related mortality were defined by events adjudication and administrative criteria. Models were stratified by smoking status and adjusted for anthropometric, sociodemographic, and smoking-related factors. The comparison group was participants without nonobstructive chronic bronchitis. RESULTS Among 22 325 adults included in the analysis, mean (SD) age was 53.0 (16.3) years (range, 18.0-95.0 years), 58.2% were female, 65.9% were non-Hispanic white, and 49.6% were ever smokers. Among 11 082 ever smokers with 99 869 person-years of follow-up, participants with nonobstructive chronic bronchitis (300 [2.7%]) had accelerated decreases in FEV1 (4.1 mL/y; 95% CI, 2.1-6.1 mL/y) and FVC (4.7 mL/y; 95% CI, 2.2-7.2 mL/y), increased risks of chronic lower respiratory disease-related hospitalization or mortality (hazard ratio [HR], 2.2; 95% CI, 1.7-2.7), and greater respiratory disease-related (HR, 2.0; 95% CI, 1.1-3.8) and all-cause mortality (HR, 1.5; 95% CI, 1.3-1.8) compared with ever smokers without nonobstructive chronic bronchitis. Among 11 243 never smokers with 120 004 person-years of follow-up, participants with nonobstructive chronic bronchitis (151 [1.3%]) had greater rates of chronic lower respiratory disease-related hospitalization or mortality (HR, 3.1; 95% CI, 2.1-4.5) compared with never smokers without nonobstructive chronic bronchitis. Nonobstructive chronic bronchitis was not associated with FEV1:FVC decline or incident airflow obstruction. The presence of at least 1 of the component symptoms of nonobstructive chronic bronchitis (ie, chronic cough or phlegm), which was common in both ever smokers (11.0%) and never smokers (6.7%), was associated with adverse respiratory health outcomes. CONCLUSIONS AND RELEVANCE The findings suggest that nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes, particularly in ever smokers, and may be a high-risk phenotype suitable for risk stratification and targeted therapies.
Collapse
Affiliation(s)
- Pallavi P Balte
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Paulo H M Chaves
- Benjamin Leon Jr Family Center for Geriatric Research and Education, Florida International University, Miami, Florida
| | - David J Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Paul Enright
- Department of Medicine, University of Arizona, Tucson, Arizona
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Richard A Kronmal
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Laura R Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Stephanie J London
- Epidemiology Branch, Genetics, Environment, and Respiratory Disease Group, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Joseph E Schwartz
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Benjamin M Smith
- Department of Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Lewis J Smith
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Wendy B White
- Jackson Heart Study Undergraduate Training and Education Center, Tougaloo College, Tougaloo, Mississippi
| | - Sachin Yende
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth C Oelsner
- Department of Medicine, Columbia University Medical Center, New York, New York
| |
Collapse
|
26
|
Oelsner EC, Ortega VE, Smith BM, Nguyen JN, Manichaikul AW, Hoffman EA, Guo X, Taylor KD, Woodruff PG, Couper DJ, Hansel NN, Martinez FJ, Paine R, Han MK, Cooper C, Dransfield MT, Criner G, Krishnan JA, Bowler R, Bleecker ER, Peters S, Rich SS, Meyers DA, Rotter JI, Barr RG. A Genetic Risk Score Associated with Chronic Obstructive Pulmonary Disease Susceptibility and Lung Structure on Computed Tomography. Am J Respir Crit Care Med 2020; 200:721-731. [PMID: 30925230 DOI: 10.1164/rccm.201812-2355oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Chronic obstructive pulmonary disease (COPD) has been associated with numerous genetic variants, yet the extent to which its genetic risk is mediated by variation in lung structure remains unknown.Objectives: To characterize associations between a genetic risk score (GRS) associated with COPD susceptibility and lung structure on computed tomography (CT).Methods: We analyzed data from MESA Lung (Multi-Ethnic Study of Atherosclerosis Lung Study), a U.S. general population-based cohort, and SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study). A weighted GRS was calculated from 83 SNPs that were previously associated with lung function. Lung density, spatially matched airway dimensions, and airway counts were assessed on full-lung CT. Generalized linear models were adjusted for age, age squared, sex, height, principal components of genetic ancestry, smoking status, pack-years, CT model, milliamperes, and total lung volume.Measurements and Main Results: MESA Lung and SPIROMICS contributed 2,517 and 2,339 participants, respectively. Higher GRS was associated with lower lung function and increased COPD risk, as well as lower lung density, smaller airway lumens, and fewer small airways, without effect modification by smoking. Adjustment for CT lung structure, particularly small airway measures, attenuated associations between the GRS and FEV1/FVC by 100% and 60% in MESA and SPIROMICS, respectively. Lung structure (P < 0.0001), but not the GRS (P > 0.10), improved discrimination of moderate-to-severe COPD cases relative to clinical factors alone.Conclusions: A GRS associated with COPD susceptibility was associated with CT lung structure. Lung structure may be an important mediator of heritability and determinant of personalized COPD risk.
Collapse
Affiliation(s)
- Elizabeth C Oelsner
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| | - Victor E Ortega
- Division of Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Benjamin M Smith
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| | - Jennifer N Nguyen
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Ani W Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Eric A Hoffman
- Department of Radiology.,Department of Medicine, and.,Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | | | | | - Prescott G Woodruff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco, California
| | - David J Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Meilan K Han
- Division of Pulmonary and Critical Care Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Christopher Cooper
- Department of Medicine, and.,Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerard Criner
- Department of Thoracic Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jerry A Krishnan
- Division of Pulmonary and Critical Care, University of Illinois, Chicago, Illinois
| | - Russell Bowler
- Division of Pulmonary and Critical Care, National Jewish, Denver, Colorado; and
| | | | - Stephen Peters
- Division of Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | | | | | - R Graham Barr
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| |
Collapse
|
27
|
Wisselink HJ, Pelgrim GJ, Rook M, van den Berge M, Slump K, Nagaraj Y, van Ooijen P, Oudkerk M, Vliegenthart R. Potential for dose reduction in CT emphysema densitometry with post-scan noise reduction: a phantom study. Br J Radiol 2019; 93:20181019. [PMID: 31724436 DOI: 10.1259/bjr.20181019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of this phantom study was to investigate the effect of scan parameters and noise suppression techniques on the minimum radiation dose for acceptable image quality for CT emphysema densitometry. METHODS The COPDGene phantom was scanned on a third generation dual-source CT system with 16 scan setups (CTDIvol 0.035-10.680 mGy). Images were reconstructed at 1.0/0.7 mm slice thickness/increment, with three kernels (one soft, two hard), filtered backprojection and three grades of third-generation iterative reconstruction (IR). Additionally, deep learning-based noise suppression software was applied. Main outcomes: overlap in area of the normalized histograms of CT density for the emphysema insert and lung material, and the radiation dose required for a maximum of 4.3% overlap (defined as acceptable image quality). RESULTS In total, 384 scan reconstructions were analyzed. Decreasing radiation dose resulted in an exponential increase of the overlap in normalized histograms of CT density. The overlap was 11-91% for the lowest dose setting (CTDIvol 0.035mGy). The soft kernel reconstruction showed less histogram overlap than hard filter kernels. IR and noise suppression also reduced overlap. Using intermediate grade IR plus noise suppression software allowed for 85% radiation dose reduction while maintaining acceptable image quality. CONCLUSION CT density histogram overlap can quantify the degree of discernibility of emphysema and healthy lung tissue. Noise suppression software, IR, and soft reconstruction kernels substantially decrease the dose required for acceptable image quality. ADVANCES IN KNOWLEDGE Noise suppression software, IR, and soft reconstruction kernels allow radiation dose reduction by 85% while still allowing differentiation between emphysema and normal lung tissue.
Collapse
Affiliation(s)
- Hendrik Joost Wisselink
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands.,MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Gert Jan Pelgrim
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands
| | - Mieneke Rook
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands.,Department of Radiology, Martini Hospital, Groningen, The Netherlands
| | - Maarten van den Berge
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
| | - Kees Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Yeshu Nagaraj
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands
| | - Peter van Ooijen
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands.,Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
28
|
Madan A, Turner AM. Identifying the at risk smokers: who goes on to get COPD? Eur Respir J 2019; 54:54/4/1901613. [PMID: 31672906 DOI: 10.1183/13993003.01613-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Arina Madan
- University Hospitals Birmingham, Heartlands Hospital, Birmingham, UK
| | - Alice M Turner
- University Hospitals Birmingham, Heartlands Hospital, Birmingham, UK .,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
29
|
Reyfman PA, Washko GR, Dransfield MT, Spira A, Han MK, Kalhan R. Defining Impaired Respiratory Health. A Paradigm Shift for Pulmonary Medicine. Am J Respir Crit Care Med 2019; 198:440-446. [PMID: 29624449 DOI: 10.1164/rccm.201801-0120pp] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Paul A Reyfman
- 1 Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, and
| | - George R Washko
- 2 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark T Dransfield
- 3 Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Avrum Spira
- 4 BU-BMC Cancer Center and Division of Computational Biomedicine, Boston University School of Medicine, Boston, Massachusetts; and
| | - MeiLan K Han
- 5 Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ravi Kalhan
- 1 Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, and.,6 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
30
|
Benlala I, Berger P, Girodet PO, Dromer C, Macey J, Laurent F, Dournes G. Automated Volumetric Quantification of Emphysema Severity by Using Ultrashort Echo Time MRI: Validation in Participants with Chronic Obstructive Pulmonary Disease. Radiology 2019; 292:216-225. [DOI: 10.1148/radiol.2019190052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
31
|
Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography. J Thorac Imaging 2019; 34:160-169. [DOI: 10.1097/rti.0000000000000379] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
32
|
Janssen R, Piscaer I, Franssen FME, Wouters EFM. Emphysema: looking beyond alpha-1 antitrypsin deficiency. Expert Rev Respir Med 2019; 13:381-397. [DOI: 10.1080/17476348.2019.1580575] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Rob Janssen
- Department of Pulmonary Medicine, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ianthe Piscaer
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F. M. Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- CIRO, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| |
Collapse
|
33
|
Biswas A, Mehta HJ, Folch EE. Chronic obstructive pulmonary disease and lung cancer: inter-relationships. Curr Opin Pulm Med 2019; 24:152-160. [PMID: 29210751 DOI: 10.1097/mcp.0000000000000451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is a well established risk factor for lung cancer. Newer studies reveal a myriad of other mechanisms, some proven and some putative, which may contribute to their association. RECENT FINDINGS There is an ever-growing bundle of evidence that suggests a close association between persistent chronic inflammation and lung cancer. A few potential targets of genetic susceptibility locus for COPD and lung cancer have been suggested. Better characterization of immune dysregulation and identification of signaling pathways may assist the development of strategies to reduce risk of developing lung cancer in patients with COPD. Current lung cancer screening strategies may exclude some patients at high risk of having lung cancer. Prospective studies indicate that a screening criterion that includes variables reflecting the severity of COPD may increase the sensitivity of the screening program and reduce 'over-diagnosis bias' of indolent lung cancers. Examples of such variables include the emphysema score generated from computed tomography scans and diffusion capacity for carbon monoxide derived from lung function tests. SUMMARY A better understanding of the inter-relationship between lung cancer pathogenesis and COPD has been described recently. Improving lung cancer screening strategies by incorporating markers of COPD severity has recently been proposed.
Collapse
Affiliation(s)
- Abhishek Biswas
- Division of Pulmonary and Critical Care Medicine, University of Florida, Florida
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care Medicine, University of Florida, Florida
| | - Erik E Folch
- Complex Chest Disease Center, Massachusetts General Hospital, Massachusetts, USA
| |
Collapse
|
34
|
Young KA, Regan EA, Han MK, Lutz SM, Ragland M, Castaldi PJ, Washko GR, Cho MH, Strand M, Curran-Everett D, Beaty TH, Bowler RP, Wan ES, Lynch DA, Make BJ, Silverman EK, Crapo JD, Hokanson JE, Kinney GL. Subtypes of COPD Have Unique Distributions and Differential Risk of Mortality. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:400-413. [PMID: 31710795 DOI: 10.15326/jcopdf.6.5.2019.0150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Previous attempts to explore the heterogeneity of chronic obstructive pulmonary disease (COPD) clustered individual patients using clinical, demographic, and disease features. We developed continuous multidimensional disease axes based on radiographic and spirometric variables that split into an airway-predominant axis and an emphysema-predominant axis. Methods The COPD Genetic Epidemiology study (COPDGene®) is a cohort of current and former smokers, > 45 years, with at least 10 pack years of smoking history. Spirometry measures, blood pressure and body mass were directly measured. Mortality was assessed through continuing longitudinal follow-up and cause of death was adjudicated. Among 8157 COPDGene® participants with complete spirometry and computed tomography (CT) measures, the top 2 deciles of the airway-predominant and emphysema-predominant axes previously identified were used to categorize individuals into 3 groups having the highest risk for mortality using Cox proportional hazard ratios. These groups were also assessed for causal mortality. Biomarkers of COPD (fibrinogen, soluble receptor for advanced glycation end products [sRAGE], C-reactive protein [CRP], clara cell secretory protein [CC16], surfactant-D [SP-D]) were compared by group. Findings High-risk subtype classification was defined for 2638 COPDGene® participants who were in the highest 2 deciles of either the airway-predominant and/or emphysema-predominant axis (32% of the cohort). These high-risk participants fell into 3 groups: airway-predominant disease only (APD-only), emphysema-predominant disease only (EPD-only) and combined APD-EPD. There was 26% mortality for the APD-only group, 21% mortality for the EPD-only group, and 54% mortality for the combined APD-EPD group. The APD-only group (n=1007) was younger, had a lower forced expiratory volume in 1 second (FEV1) percent (%) predicted and a strong association with the preserved ratio-impaired spirometry (PRISm) quadrant. The EPD-only group (n=1006) showed a relatively higher FEV1 % predicted and included largely GOLD stage 0, 1 and 2 partipants. Individuals in each of the 3 high-risk groups were at greater risk for respiratory mortality, while those in the APD-only group were additionally at greater risk for cardiovascular mortality. Biomarker analysis demonstrated a significant association of the APD-only group with CRP, and sRAGE demonstrated greatest significance with both the EPD-only and the combined APD-EPD groups. Interpretation Among current and former smokers, individuals in the highest 2 deciles for mortality risk on the airway-predominant axis and the emphysema-predominant axis have unique associations to spirometric patterns, different imaging characteristics, biomarkers and causal mortality.
Collapse
Affiliation(s)
- Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | | | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor
| | - Sharon M Lutz
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora
| | - Margaret Ragland
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - George R Washko
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mathew Strand
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, Office of Academic Affairs, National Jewish Health, Denver, Colorado
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - Russell P Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Emily S Wan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora.,VA Boston Healthcare System, Boston, Massachusetts
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado
| | - John E Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | | |
Collapse
|
35
|
Oelsner EC, Balte PP, Cassano PA, Couper D, Enright PL, Folsom AR, Hankinson J, Jacobs DR, Kalhan R, Kaplan R, Kronmal R, Lange L, Loehr LR, London SJ, Navas Acien A, Newman AB, O’Connor GT, Schwartz JE, Smith LJ, Yeh F, Zhang Y, Moran AE, Mwasongwe S, White WB, Yende S, Barr RG. Harmonization of Respiratory Data From 9 US Population-Based Cohorts: The NHLBI Pooled Cohorts Study. Am J Epidemiol 2018; 187:2265-2278. [PMID: 29982273 PMCID: PMC6211239 DOI: 10.1093/aje/kwy139] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 12/13/2022] Open
Abstract
Chronic lower respiratory diseases (CLRDs) are the fourth leading cause of death in the United States. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed prebronchodilator spirometry and were harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for noncardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRD-related or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in 9 cohorts followed-up for CLRD-related mortality over 653,380 person-years during 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% white, 22% black, 28% Hispanic/Latino, and 5% American Indian. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry examinations (13%), there were 105,696 valid examinations (median, 2 per participant). Of 29,351 participants followed for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost to follow-up at 10 years. The NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Body Weights and Measures
- Bronchiectasis/epidemiology
- Bronchiectasis/physiopathology
- Chronic Disease
- Cohort Studies
- Ethnicity/statistics & numerical data
- Female
- Hispanic or Latino/statistics & numerical data
- Hospitalization/statistics & numerical data
- Humans
- Indians, North American/statistics & numerical data
- Inhalation Exposure/statistics & numerical data
- Lung Diseases, Obstructive/epidemiology
- Lung Diseases, Obstructive/ethnology
- Lung Diseases, Obstructive/mortality
- Lung Diseases, Obstructive/physiopathology
- Male
- Middle Aged
- National Heart, Lung, and Blood Institute (U.S.)/organization & administration
- National Heart, Lung, and Blood Institute (U.S.)/standards
- Phenotype
- Racial Groups/statistics & numerical data
- Respiratory Function Tests
- Risk Factors
- Smoking/epidemiology
- Socioeconomic Factors
- United States/epidemiology
- White People/statistics & numerical data
- Young Adult
Collapse
Affiliation(s)
- Elizabeth C Oelsner
- Division of General Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Pallavi P Balte
- Division of General Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Patricia A Cassano
- Division of Nutritional Sciences, Weill Cornell Medical College, Ithaca, New York
| | - David Couper
- Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Paul L Enright
- Department of Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Robert Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York
| | - Richard Kronmal
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Leslie Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado, Denver, Colorado
| | - Laura R Loehr
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie J London
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
| | - Ana Navas Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Anne B Newman
- Department of Epidemiology, Pitt Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George T O’Connor
- Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Joseph E Schwartz
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stony Brook University, Stony Brook, New York
| | | | - Fawn Yeh
- Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yiyi Zhang
- Division of General Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Andrew E Moran
- Division of General Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - Wendy B White
- Jackson Heart Study, Undergraduate Training and Education Center, Tougaloo College, Tougaloo, Mississippi
| | - Sachin Yende
- Division of Pulmonary and Critical Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Graham Barr
- Division of General Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
36
|
Impact of pulmonary emphysema on exercise capacity and its physiological determinants in chronic obstructive pulmonary disease. Sci Rep 2018; 8:15745. [PMID: 30356114 PMCID: PMC6200804 DOI: 10.1038/s41598-018-34014-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/05/2018] [Indexed: 12/27/2022] Open
Abstract
Exercise limitation is common in chronic obstructive pulmonary disease (COPD). We determined the impact of pulmonary emphysema on the physiological response to exercise independent of contemporary measures of COPD severity. Smokers 40–79 years old with COPD underwent computed tomography, pulmonary function tesing, and symptom-limited incremental exercise testing. COPD severity was quantified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) by spirometry (GOLD 1–4); and symptom burden and exacerbation risk (GOLD A-D). Emphysema severity was quantified as the percent lung volume <−950 Hounsfield units. Regression models adjusted for age, gender, body size, smoking status, airflow limitation, symptom burden and exacerbation risk. Among 67 COPD subjects (age 67 ± 8 years; 75% male; GOLD 1–4: 11%, 43%, 30%, 16%), median percent emphysema was 11%, and peak power output (PPO) was 61 ± 32 W. Higher percent emphysema independently predicted lower PPO (−24 W per 10% increment in emphysema; 95%CI −41 to −7 W). Throughout exercise, higher percent emphysema predicted 1) higher minute ventilation, ventilatory equivalent for CO2, and heart rate; and 2) lower oxy-hemoglobin saturation, and end-tidal PCO2. Independent of contemporary measures of COPD severity, the extent of pulmonary emphysema predicts lower exercise capacity, ventilatory inefficiency, impaired gas-exchange and increased heart rate response to exercise.
Collapse
|
37
|
Ronit A, Kristensen T, Çolak Y, Kühl JT, Kalhauge A, Lange P, Nordestgaard BG, Vestbo J, Nielsen SD, Kofoed KF. Validation of lung density indices by cardiac CT for quantification of lung emphysema. Int J Chron Obstruct Pulmon Dis 2018; 13:3321-3330. [PMID: 30349236 PMCID: PMC6188118 DOI: 10.2147/copd.s172695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Cardiovascular disease is often associated with COPD. Lung density quantification of images obtained from cardiac computed tomography (CT) scans would allow simultaneous evaluation of emphysema and coronary artery calcification score and provide further mechanistic insight into the relationship between these syndromes. Patients and methods We assessed the agreement between lung density indices obtained by cardiac and full-lung CT scans. Paired cardiac and chest CT scans were assessed in 156 individuals with and without airflow limitation. Quantitative threshold indices of low attenuation area (LAA) and 15th percentile density index (PD15) were compared in terms of precision using Spearman’s correlation coefficient, accuracy using concordance correlation coefficient (CCC), and relative accuracy using P15 and P30. We also assessed the relationship between visually and quantitatively determined emphysema and used receiver operating characteristic curves to evaluate the ability of lung density indices to discriminate airflow limitation. Results Correlation coefficients between lung density indices obtained from cardiac and chest CT scans were 0.49 for percent LAA (%LAA)-950 and 0.71 for PD15. Corresponding values for CCC, P15, and P30 were 0.33, 3.2, and 5.1, respectively, for %LAA-950, and 0.34, 17.3, and 37.8, respectively, for PD15. For both cardiac and chest CT scans, visually determined emphysema was associated with higher %LAA-950 and lower PD15, and the ability of %LAA-950 and PD15 to discriminate airflow limitation were comparable. Conclusion Although chest CT imaging is preferable, cardiac CT imaging may also be used for lung emphysema quantification where association measures are of primary interest.
Collapse
Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases 8632, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,
| | - Thomas Kristensen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yunus Çolak
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jørgen Tobias Kühl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Kalhauge
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Lange
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Medical Unit, Respiratory Section, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Susanne D Nielsen
- Department of Infectious Diseases 8632, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,
| | - Klaus F Kofoed
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
38
|
Park YB, Rhee CK, Yoon HK, Oh YM, Lim SY, Lee JH, Yoo KH, Ahn JH. Revised (2018) COPD Clinical Practice Guideline of the Korean Academy of Tuberculosis and Respiratory Disease: A Summary. Tuberc Respir Dis (Seoul) 2018; 81:261-273. [PMID: 29926554 PMCID: PMC6148094 DOI: 10.4046/trd.2018.0029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 03/30/2018] [Accepted: 04/01/2018] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) results in high morbidity and mortality among patients nationally and globally. The Korean clinical practice guideline for COPD was revised in 2018. The guideline was drafted by the members of the Korean Academy of Tuberculosis and Respiratory Diseases as well as the participating members of the Health Insurance Review and Assessment Service, Korean Physicians' Association, and Korea Respiration Trouble Association. The revised guideline encompasses a wide range of topics, including the epidemiology, diagnosis, assessment, monitoring, management, exacerbation, and comorbidities of COPD in Korea. We performed systematic reviews assisted by an expert in meta-analysis to draft a guideline on COPD management. We expect this guideline to facilitate the treatment of patients with respiratory conditions by physicians as well other health care professionals and government personnel in South Korea.
Collapse
Affiliation(s)
- Yong Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, 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
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hwa Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
| | - Joong Hyun Ahn
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
| |
Collapse
|
39
|
Abstract
Many unmet needs still remain in the assessment and treatment of patients with chronic obstructive pulmonary disease (COPD), particularly in relation to its under- and misdiagnosis, which lead to under- and mistreatment. This paucity of knowledge about the importance and presence of COPD, as well as its treatment, is seen among patients and carers as well as health care providers. This review considers areas of key educational need, including the clinical characteristics of COPD; factors that contribute to the disease, effective diagnosis, and clinical management of patients; and the implementation of treatment guidelines. As COPD remains the third most frequent cause of death in the world, researchers must continue to expand the scope and reach of their efforts to improve outcomes of this debilitating disease.
Collapse
|
40
|
Ash SY, Harmouche R, Ross JC, Diaz AA, Rahaghi FN, Vegas Sanchez-Ferrero G, Putman RK, Hunninghake GM, Onieva Onieva J, Martinez FJ, Choi AM, Bowler RP, Lynch DA, Hatabu H, Bhatt SP, Dransfield MT, Wells JM, Rosas IO, San Jose Estepar R, Washko GR. Interstitial Features at Chest CT Enhance the Deleterious Effects of Emphysema in the COPDGene Cohort. Radiology 2018; 288:600-609. [PMID: 29869957 PMCID: PMC6069608 DOI: 10.1148/radiol.2018172688] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 12/28/2022]
Abstract
Purpose To determine if interstitial features at chest CT enhance the effect of emphysema on clinical disease severity in smokers without clinical pulmonary fibrosis. Materials and Methods In this retrospective cohort study, an objective CT analysis tool was used to measure interstitial features (reticular changes, honeycombing, centrilobular nodules, linear scar, nodular changes, subpleural lines, and ground-glass opacities) and emphysema in 8266 participants in a study of chronic obstructive pulmonary disease (COPD) called COPDGene (recruited between October 2006 and January 2011). Additive differences in patients with emphysema with interstitial features and in those without interstitial features were analyzed by using t tests, multivariable linear regression, and Kaplan-Meier analysis. Multivariable linear and Cox regression were used to determine if interstitial features modified the effect of continuously measured emphysema on clinical measures of disease severity and mortality. Results Compared with individuals with emphysema alone, those with emphysema and interstitial features had a higher percentage predicted forced expiratory volume in 1 second (absolute difference, 6.4%; P < .001), a lower percentage predicted diffusing capacity of lung for carbon monoxide (DLCO) (absolute difference, 7.4%; P = .034), a 0.019 higher right ventricular-to-left ventricular (RVLV) volume ratio (P = .029), a 43.2-m shorter 6-minute walk distance (6MWD) (P < .001), a 5.9-point higher St George's Respiratory Questionnaire (SGRQ) score (P < .001), and 82% higher mortality (P < .001). In addition, interstitial features modified the effect of emphysema on percentage predicted DLCO, RVLV volume ratio, 6WMD, SGRQ score, and mortality (P for interaction < .05 for all). Conclusion In smokers, the combined presence of interstitial features and emphysema was associated with worse clinical disease severity and higher mortality than was emphysema alone. In addition, interstitial features enhanced the deleterious effects of emphysema on clinical disease severity and mortality.
Collapse
Affiliation(s)
- Samuel Y. Ash
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Rola Harmouche
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - James C. Ross
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Alejandro A. Diaz
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Farbod N. Rahaghi
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Rachel K. Putman
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Gary M. Hunninghake
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Jorge Onieva Onieva
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Fernando J. Martinez
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Augustine M. Choi
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Russell P. Bowler
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - David A. Lynch
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Hiroto Hatabu
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Surya P. Bhatt
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Mark T. Dransfield
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - J. Michael Wells
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Ivan O. Rosas
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - Raul San Jose Estepar
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - George R. Washko
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| | - for the COPDGene Investigators
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory
of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S.,
J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and
Women’s Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department
of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.);
Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health,
Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
(S.P.B., M.T.D., J.M.W.)
| |
Collapse
|
41
|
Kerdidani D, Magkouta S, Chouvardas P, Karavana V, Glynos K, Roumelioti F, Zakynthinos S, Wauters E, Janssens W, Lambrechts D, Kollias G, Tsoumakidou M. Cigarette Smoke-Induced Emphysema Exhausts Early Cytotoxic CD8 + T Cell Responses against Nascent Lung Cancer Cells. THE JOURNAL OF IMMUNOLOGY 2018; 201:1558-1569. [PMID: 30037849 DOI: 10.4049/jimmunol.1700700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/25/2018] [Indexed: 01/08/2023]
Abstract
Chronic obstructive pulmonary disease is a chronic inflammatory disorder with an increased incidence of lung cancer. The emphysema component of chronic obstructive pulmonary disease confers the greatest proportion to lung cancer risk. Although tumors create inflammatory conditions to escape immunity, the immunological responses that control growth of nascent cancer cells in pre-established inflammatory microenvironments are unknown. In this study, we addressed this issue by implanting OVA-expressing cancer cells in the lungs of mice with cigarette smoke-induced emphysema. Emphysema augmented the growth of cancer cells, an effect that was dependent on T cytotoxic cells. OVA-specific OTI T cells showed early signs of exhaustion upon transfer in emphysema tumor hosts that was largely irreversible because sorting, expansion, and adoptive transfer failed to restore their antitumor activity. Increased numbers of PD-L1- and IDO-positive CD11c+ myeloid dendritic cells (DCs) infiltrated emphysema tumors, whereas sorted emphysema tumor DCs poorly stimulated OTI T cells. Upon adoptive transfer in immunocompetent hosts, T cells primed by emphysema tumor DCs were unable to halt tumor growth. DCs exposed to the emphysema tumor microenvironment downregulated MHC class II and costimulatory molecules, whereas they upregulated PD-L1/IDO via oxidative stress-dependent mechanisms. T cell activation increased upon PD-L1 blockade in emphysema DC-T cell cocultures and in emphysema tumor hosts in vivo. Analysis of the transcriptome of primary human lung tumors showed a strong association between computed tomography-based emphysema scoring and downregulation of immunogenic processes. Thus, suppression of adaptive immunity against lung cancer cells links a chronic inflammatory disorder, emphysema, to cancer, with clinical implications for emphysema patients to be considered optimal candidates for cancer immunotherapies.
Collapse
Affiliation(s)
- Dimitra Kerdidani
- Division of Immunology, Biomedical Sciences Research Center 'Alexander Fleming,' 16672 Vari, Athens, Greece.,Department of Intensive Care Medicine, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Sophia Magkouta
- Department of Intensive Care Medicine, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Panagiotis Chouvardas
- Division of Immunology, Biomedical Sciences Research Center 'Alexander Fleming,' 16672 Vari, Athens, Greece.,Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Vassiliki Karavana
- Department of Intensive Care Medicine, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Konstantinos Glynos
- Department of Intensive Care Medicine, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Fani Roumelioti
- Division of Immunology, Biomedical Sciences Research Center 'Alexander Fleming,' 16672 Vari, Athens, Greece
| | - Spyros Zakynthinos
- Department of Intensive Care Medicine, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Els Wauters
- Respiratory Oncology Unit, University Hospitals KU Leuven, 3000 Leuven, Belgium.,Leuven Lung Cancer Group, University Hospitals KU Leuven, 3000 Leuven, Belgium.,Laboratory of Pneumology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, 3000 Leuven, Belgium
| | - Wim Janssens
- Respiratory Oncology Unit, University Hospitals KU Leuven, 3000 Leuven, Belgium.,Leuven Lung Cancer Group, University Hospitals KU Leuven, 3000 Leuven, Belgium.,Laboratory of Pneumology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, 3000 Leuven, Belgium
| | - Diether Lambrechts
- VIB Center for Cancer Biology, VIB, 3000 Leuven, Belgium; and.,Laboratory for Translational Genetics, Department of Oncology, KU Leuven, 3000 Leuven, Belgium
| | - George Kollias
- Division of Immunology, Biomedical Sciences Research Center 'Alexander Fleming,' 16672 Vari, Athens, Greece.,Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Maria Tsoumakidou
- Division of Immunology, Biomedical Sciences Research Center 'Alexander Fleming,' 16672 Vari, Athens, Greece;
| |
Collapse
|
42
|
Oelsner EC, Smith BM, Hoffman EA, Kalhan R, Donohue KM, Kaufman JD, Nguyen JN, Manichaikul AW, Rotter JI, Michos ED, Jacobs DR, Burke GL, Folsom AR, Schwartz JE, Watson K, Barr RG. Prognostic Significance of Large Airway Dimensions on Computed Tomography in the General Population. The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. Ann Am Thorac Soc 2018; 15:718-727. [PMID: 29529382 PMCID: PMC6137677 DOI: 10.1513/annalsats.201710-820oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/12/2018] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Large airway dimensions on computed tomography (CT) have been associated with lung function, symptoms, and exacerbations in chronic obstructive pulmonary disease (COPD), as well as with symptoms in smokers with preserved spirometry. Their prognostic significance in persons without lung disease remains undefined. OBJECTIVES To examine associations between large airway dimensions on CT and respiratory outcomes in a population-based cohort of adults without prevalent lung disease. METHODS The Multi-Ethnic Study of Atherosclerosis recruited participants ages 45-84 years without cardiovascular disease in 2000-2002; we excluded participants with prevalent chronic lower respiratory disease (CLRD). Spirometry was measured in 2004-2006 and 2010-2012. CLRD hospitalizations and deaths were classified by validated criteria through 2014. The average wall thickness for a hypothetical airway of 10-mm lumen perimeter on CT (Pi10) was calculated using measures of airway wall thickness and lumen diameter. Models were adjusted for age, sex, principal components of ancestry, body mass index, smoking, pack-years, scanner, percent emphysema, genetic risk score, and initial forced expiratory volume in 1 second (FEV1) percent predicted. RESULTS Greater Pi10 was associated with 9% faster FEV1 decline (95% confidence interval [CI], 2 to 15%; P = 0.012) and increased incident COPD (odds ratio, 2.22; 95% CI, 1.43-3.45; P = 0.0004) per standard deviation among 1,830 participants. Over 78,147 person-years, higher Pi10 was associated with a 57% higher risk of first CLRD hospitalization or mortality (P = 0.0496) per standard deviation. Of Pi10's component measures, both greater airway wall thickness and narrower lumen predicted incident COPD and CLRD clinical events. CONCLUSIONS In adults without CLRD, large airway dimensions on CT were prospectively associated with accelerated lung function decline and increased risks of COPD and CLRD hospitalization and mortality.
Collapse
Affiliation(s)
- Elizabeth C. Oelsner
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Benjamin M. Smith
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Respiratory Division, McGill University, Montreal, Quebec, Canada
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Ravi Kalhan
- Division of Pulmonary, Northwestern University, Chicago, Illinois
| | - Kathleen M. Donohue
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Jennifer N. Nguyen
- Division of Biostatistics and Epidemiology, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Ani W. Manichaikul
- Division of Biostatistics and Epidemiology, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Jerome I. Rotter
- Division of Genomic Outcomes, University of California, Los Angeles, School of Medicine, Torrance, California
| | - Erin D. Michos
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Gregory L. Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Joseph E. Schwartz
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Karol Watson
- Division of Cardiology, University of California, Los Angeles, School of Medicine, Los Angeles, California
| | - R. Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| |
Collapse
|
43
|
Multifactorial Analysis of Mortality in Screening Detected Lung Cancer. JOURNAL OF ONCOLOGY 2018; 2018:1296246. [PMID: 29861726 PMCID: PMC5976935 DOI: 10.1155/2018/1296246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/12/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
We hypothesized that severity of coronary artery calcification (CAC), emphysema, muscle mass, and fat attenuation can help predict mortality in patients with lung cancer participating in the National Lung Screening Trial (NLST). Following regulatory approval from the Cancer Data Access System (CDAS), all patients diagnosed with lung cancer at the time of the screening study were identified. These subjects were classified into two groups: survivors and nonsurvivors at the conclusion of the NLST trial. These groups were matched based on their age, gender, body mass index (BMI), smoking history, lung cancer stage, and survival time. CAC, emphysema, muscle mass, and subcutaneous fat attenuation were quantified on baseline low-dose chest CT (LDCT) for all patients in both groups. Nonsurvivor group had significantly greater CAC, decreased muscle mass, and higher fat attenuation compared to the survivor group (p < 0.01). No significant difference in severity of emphysema was noted between the two groups (p > 0.1). We thus conclude that it is possible to create a quantitative prediction model for lung cancer mortality for subjects with lung cancer detected on screening low-dose CT (LDCT).
Collapse
|
44
|
Lynch DA, Moore CM, Wilson C, Nevrekar D, Jennermann T, Humphries SM, Austin JHM, Grenier PA, Kauczor HU, Han MK, Regan EA, Make BJ, Bowler RP, Beaty TH, Curran-Everett D, Hokanson JE, Curtis JL, Silverman EK, Crapo JD. CT-based Visual Classification of Emphysema: Association with Mortality in the COPDGene Study. Radiology 2018; 288:859-866. [PMID: 29762095 PMCID: PMC6122195 DOI: 10.1148/radiol.2018172294] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose To determine whether visually assessed patterns of emphysema at CT might provide a simple assessment of mortality risk among cigarette smokers. Materials and Methods Of the first 4000 cigarette smokers consecutively enrolled between 2007 and 2011 in this COPDGene study, 3171 had data available for both visual emphysema CT scores and survival. Each CT scan was retrospectively visually scored by two analysts using the Fleischner Society classification system. Severity of emphysema was also evaluated quantitatively by using percentage lung volume occupied by low-attenuation areas (voxels with attenuation of −950 HU or less) (LAA-950). Median duration of follow-up was 7.4 years. Regression analysis for the relationship between imaging patterns and survival was based on the Cox proportional hazards model, with adjustment for age, race, sex, height, weight, pack-years of cigarette smoking, current smoking status, educational level, LAA-950, and (in a second model) forced expiratory volume in 1 second (FEV1). Results Observer agreement in visual scoring was good (weighted κ values, 0.71–0.80). There were 519 deaths in the study cohort. Compared with subjects who did not have visible emphysema, mortality was greater in those with any grade of emphysema beyond trace (adjusted hazard ratios, 1.7, 2.5, 5.0, and 4.1, respectively, for mild centrilobular emphysema, moderate centrilobular emphysema, confluent emphysema, and advanced destructive emphysema, P < .001). This increased mortality generally persisted after adjusting for LAA-950. Conclusion The visual presence and severity of emphysema is associated with significantly increased mortality risk, independent of the quantitative severity of emphysema. Online supplemental material is available for this article.
Collapse
Affiliation(s)
- David A Lynch
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Camille M Moore
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Carla Wilson
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Dipti Nevrekar
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Theodore Jennermann
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Stephen M Humphries
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - John H M Austin
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Philippe A Grenier
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Hans-Ulrich Kauczor
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - MeiLan K Han
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Elizabeth A Regan
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Barry J Make
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Russell P Bowler
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Terri H Beaty
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Douglas Curran-Everett
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - John E Hokanson
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Jeffrey L Curtis
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - Edwin K Silverman
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | - James D Crapo
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| | -
- From the Department of Radiology (D.A.L., D.N., T.J., S.M.H.), Division of Biostatistics (C.M.M., C.W., D.C.E.), and Department of Medicine (E.A.R., B.J.M., R.P.B., J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206; Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Diagnostic Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Paris, France (P.A.G.); Department of Diagnostic and Interventional Radiology, University of Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg, Germany (H.U.K.); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Mich (M.K.H., J.L.C.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (T.H.B.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo (J.E.H.); Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Mich (J.L.C.); and Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (E.K.S.)
| |
Collapse
|
45
|
Oelsner EC, Smith BM, Hoffman EA, Folsom AR, Kawut SM, Kaufman JD, Manichaikul A, Lederer DJ, Schwartz JE, Watson K, Enright PL, Austin JHM, Lima JAC, Shea SJ, Barr RG. Associations between emphysema-like lung on CT and incident airflow limitation: a general population-based cohort study. Thorax 2018; 73:486-488. [PMID: 29074811 PMCID: PMC5903958 DOI: 10.1136/thoraxjnl-2017-210842] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/20/2017] [Accepted: 10/16/2017] [Indexed: 11/03/2022]
Abstract
Emphysema on CT is associated with accelerated lung function decline in heavy smokers and patients with COPD; however, in the general population, it is not known whether greater emphysema-like lung on CT is associated with incident COPD. We used data from 2045 adult participants without initial prebronchodilator airflow limitation, classified by FEV1/FVC<0.70, in the Multi-Ethnic Study of Atherosclerosis. Emphysema-like lung on baseline cardiac CT, defined as per cent low attenuation areas<-950HU>upper limit of normal, was associated with increased odds of incident airflow limitation at 5-year follow-up on both prebronchodilator (adjusted OR 2.62, 95% CI 1.47 to 4.67) and postbronchodilator (adjusted OR 4.38, 95% CI 1.63 to 11.74) spirometry, independent of smoking history. These results support investigation into whether emphysema-like lung could be informative for COPD risk stratification.
Collapse
Affiliation(s)
- Elizabeth C Oelsner
- Columbia University College of Physicians and Surgeons, Department of Medicine, 630 West 168 Street, New York, NY 10032
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168 Street, New York, New York 10032
| | - Benjamin M Smith
- Columbia University College of Physicians and Surgeons, Department of Medicine, 630 West 168 Street, New York, NY 10032
- McGill University, Respiratory Division, 2155 Guy Street, Suite 500, Montreal, Quebec H3H 2R9, Canada
| | - Eric A Hoffman
- University of Iowa, Department of Radiology, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Aaron R Folsom
- University of Minnesota, Division of Epidemiology and Community Health, 1300 South Second Street, Suite 300, Minneapolis, MN 55454
| | - Steven M Kawut
- University of Pennsylvania School of Medicine, Pulmonary, Allergy, and Critical Care Division, 711 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104
| | - Joel D Kaufman
- University of Washington, Department of Environmental and Occupational Health Sciences, 4225 Roosevelt Way NE, Seattle, WA 98105
| | - Ani Manichaikul
- University of Virginia, Department of Public Health Sciences, Division of Biostatistics and Epidemiology, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - David J Lederer
- Columbia University College of Physicians and Surgeons, Department of Medicine, 630 West 168 Street, New York, NY 10032
| | - Joseph E Schwartz
- Columbia University College of Physicians and Surgeons, Department of Medicine, 630 West 168 Street, New York, NY 10032
| | - Karol Watson
- UCLA School of Medicine, Division of Cardiology, 47-123 CHS, 10833 LeConte Avenue, Los Angeles, CA 90095-1679
| | - Paul L Enright
- University of Arizona, 4460 East Ina Road, Tucson, AZ 85718
| | - John H. M. Austin
- Columbia University College of Physicians and Surgeons, Department of Medicine, 630 West 168 Street, New York, NY 10032
| | - Joao AC Lima
- Johns Hopkins University, Department of Cardiology, 600 North Wolfe Street, Blalock 524, Baltimore, MD 21205
| | - Steven J Shea
- Columbia University College of Physicians and Surgeons, Department of Medicine, 630 West 168 Street, New York, NY 10032
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168 Street, New York, New York 10032
| | - R Graham Barr
- Columbia University College of Physicians and Surgeons, Department of Medicine, 630 West 168 Street, New York, NY 10032
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168 Street, New York, New York 10032
| |
Collapse
|
46
|
Carr LL, Jacobson S, Lynch DA, Foreman MG, Flenaugh EL, Hersh CP, Sciurba FC, Wilson DO, Sieren JC, Mulhall P, Kim V, Kinsey CM, Bowler RP. Features of COPD as Predictors of Lung Cancer. Chest 2018; 153:1326-1335. [PMID: 29452098 DOI: 10.1016/j.chest.2018.01.049] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/09/2018] [Accepted: 01/26/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer is a leading cause of death and hospitalization for patients with COPD. A detailed understanding of which clinical features of COPD increase risk is needed. METHODS We performed a nested case-control study of Genetic Epidemiology of COPD (COPDGene) Study subjects with and without lung cancer, age 45 to 80 years, who smoked at least 10-pack years to identify clinical and imaging features of smokers, with and without COPD, that are associated with an increased risk of lung cancer. The baseline evaluation included spirometry, high-resolution chest CT scanning, and respiratory questionnaires. New lung cancer diagnoses were identified over 8 years of longitudinal follow-up. Cases of lung cancer were matched 1:4 with control subjects for age, race, sex, and smoking history. Multiple logistic regression analyses were used to determine features predictive of lung cancer. RESULTS Features associated with a future risk of lung cancer included decreased FEV1/FVC (OR, 1.28 per 10% decrease [95% CI, 1.12-1.46]), visual severity of emphysema (OR, 2.31, none-trace vs mild-advanced [95% CI, 1.41-3.86]), and respiratory exacerbations prior to study entry (OR, 1.39 per increased events [0, 1, and ≥ 2] [95% CI, 1.04-1.85]). Respiratory exacerbations were also associated with small-cell lung cancer histology (OR, 3.57 [95% CI, 1.47-10]). CONCLUSIONS The degree of COPD severity, including airflow obstruction, visual emphysema, and respiratory exacerbations, was independently predictive of lung cancer. These risk factors should be further studied as inclusion and exclusion criteria for the survival benefit of lung cancer screening. Studies are needed to determine if reduction in respiratory exacerbations among smokers can reduce the risk of lung cancer.
Collapse
Affiliation(s)
- Laurie L Carr
- Department of Medicine, National Jewish Health, Denver, CO.
| | - Sean Jacobson
- Department of Medicine, National Jewish Health, Denver, CO
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care, Morehouse School of Medicine, Atlanta, GA
| | - Eric L Flenaugh
- Division of Pulmonary and Critical Care, Morehouse School of Medicine, Atlanta, GA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Frank C Sciurba
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Patrick Mulhall
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, PA
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, PA
| | - C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington, VT
| | | |
Collapse
|
47
|
Spelta F, Fratta Pasini AM, Cazzoletti L, Ferrari M. Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord 2018; 23:15-22. [PMID: 29110280 DOI: 10.1007/s40519-017-0456-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/22/2017] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED The positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the "obesity paradox". In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present. Interestingly, the "paradox" is more evident for subjects with severe bronchial obstruction (i.e., a lower FEV1), while in mild-moderate conditions, the weight-related mortality shows a behavior similar to that observed in the general population. Several factors may confound the relation between COPD, obesity and mortality. The lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. Due to the modified chest wall mechanical properties-related to increased fat mass-obese COPD patients may present, respect to their lean counterpart, a lower lung hyperinflation which is associated with higher mortality. The traditional classification of COPD attributes to obese "blue bloaters" a low-grade emphysema in opposition to lean "pink puffers"; the fact that emphysema extent is related to mortality may bias the relationship between weight and survival. It is also to underline that the majority of the studies, consider BMI rather than body composition (a better predictor of mortality) when studying the intriguing relation between weight, COPD, and mortality. Reverse bias has also to be taken into account, hypothesizing that an unintentional weight loss may be the deleterious factor related to mortality, rather than considering obesity a protective one. Further prospective studies are needed to shed light on the complexity of this emerging issue. LEVEL OF EVIDENCE Level V: Narrative Review.
Collapse
Affiliation(s)
- Francesco Spelta
- Section of Internal Medicine, University of Verona, Policlinico G.B. Rossi, P.le Scuro, 10, 37134, Verona, Italy.
| | - A M Fratta Pasini
- Section of Internal Medicine, University of Verona, Policlinico G.B. Rossi, P.le Scuro, 10, 37134, Verona, Italy
| | - L Cazzoletti
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - M Ferrari
- Section of Respiratory Disease, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
48
|
Aaron CP, Schwartz JE, Hoffman EA, Angelini E, Austin JHM, Cushman M, Jacobs DR, Kaufman JD, Laine A, Smith LJ, Yang J, Watson KE, Tracy RP, Barr RG. A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging: The MESA Lung Study. Chest 2017; 154:41-50. [PMID: 29246770 DOI: 10.1016/j.chest.2017.11.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/13/2017] [Accepted: 11/20/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation; these factors have been implicated in the pathogenesis of COPD and emphysema. We hypothesized that regular use of aspirin, a platelet inhibitor, would be associated with a slower progression of emphysema-like lung characteristics on CT imaging and a slower decline in lung function. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants 45 to 84 years of age without clinical cardiovascular disease from 2000 to 2002. The MESA Lung Study assessed the percentage of emphysema-like lung below -950 Hounsfield units ("percent emphysema") on cardiac (2000-2007) and full-lung CT scans (2010-2012). Regular aspirin use was defined as 3 or more days per week. Mixed-effect models adjusted for demographics, anthropometric features, smoking, hypertension, angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker use, C-reactive protein levels, sphingomyelin levels, and scanner factors. RESULTS At baseline, the 4,257 participants' mean (± SD) age was 61 ± 10 years, 54% were ever smokers, and 22% used aspirin regularly. On average, percent emphysema increased 0.60 percentage points over 10 years (95% CI, 0.35-0.94). Progression of percent emphysema was slower among regular aspirin users compared with patients who did not use aspirin (fully adjusted model: -0.34% /10 years, 95% CI, -0.60 to -0.08; P = .01). Results were similar in ever smokers and with doses of 81 and 300 to 325 mg and were of greater magnitude among those with airflow limitation. No association was found between aspirin use and change in lung function. CONCLUSIONS Regular aspirin use was associated with a more than 50% reduction in the rate of emphysema progression over 10 years. Further study of aspirin and platelets in emphysema may be warranted.
Collapse
Affiliation(s)
- Carrie P Aaron
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
| | - Joseph E Schwartz
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA
| | - Elsa Angelini
- Department of Biomedical Engineering, Mailman School of Public Health, Columbia University, New York, NY
| | - John H M Austin
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Mary Cushman
- Department of Medicine, Larner College of Medicine at the University of Vermont, Colchester, VT; Department of Pathology, Larner College of Medicine at the University of Vermont, Colchester, VT
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Joel D Kaufman
- Department of Environmental Medicine and Occupational Health Sciences, University of Washington, Seattle, WA
| | - Andrew Laine
- Department of Biomedical Engineering, Mailman School of Public Health, Columbia University, New York, NY
| | - Lewis J Smith
- Department of Medicine, Northwestern University, Chicago, IL
| | - Jie Yang
- Department of Biomedical Engineering, Mailman School of Public Health, Columbia University, New York, NY
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, CA
| | - Russell P Tracy
- Department of Pathology, Larner College of Medicine at the University of Vermont, Colchester, VT
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
49
|
Kurashima K, Takaku Y, Ohta C, Takayanagi N, Yanagisawa T, Kanauchi T, Takahashi O. Smoking history and emphysema in asthma-COPD overlap. Int J Chron Obstruct Pulmon Dis 2017; 12:3523-3532. [PMID: 29263658 PMCID: PMC5724421 DOI: 10.2147/copd.s149382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Emphysema is a distinct feature for classifying COPD, and smoking history (≥10 pack-years) is one of several newly proposed criteria for asthma-COPD overlap (ACO). We studied whether or not a smoking history (≥10 pack-years) and emphysema are useful markers for classifying ACO and differentiating it from asthma with chronic airflow obstruction (CAO). Methods We retrospectively studied the mortalities and frequencies of exacerbation in 256 consecutive patients with ACO (161 with emphysema and 95 without emphysema) who had ≥10 pack-years smoking history, 64 asthma patients with CAO but less of a smoking history (<10 pack-years) and 537 consecutive patients with COPD (452 with emphysema and 85 without emphysema) from 2000 to 2016. In the patients with emergent admission, the causes were classified into COPD exacerbation, asthma attack, and others. Results No asthma patients with CAO had emphysema according to computed tomography findings. The prognoses were significantly better in patients with asthma and CAO than in those with ACO and COPD and better in those with ACO than in those with COPD. In both ACO and COPD patients, the prognoses were better in patients without emphysema than in those with it (P=0.027 and P=0.023, respectively). The frequencies of emergent admission were higher in COPD patients than in ACO patients, and higher in patients with emphysema than in patients without emphysema. ACO/emphysema (+) patients experienced more frequent admission due to COPD exacerbation (P<0.001), while ACO/emphysema (-) patients experienced more frequent admission due to asthma attack (P=0.014). Conclusion A smoking history (≥10 pack-years) was found to be a useful marker for differentiating ACO and asthma with CAO, and emphysema was a useful marker for classifying ACO. These markers are useful for predicting the overall survival and frequency of exacerbation.
Collapse
Affiliation(s)
| | | | | | | | | | - Tetsu Kanauchi
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Kumagaya
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St Luke's International Hospital, Tokyo, Japan
| |
Collapse
|
50
|
Podolanczuk AJ, Oelsner EC, Barr RG, Bernstein EJ, Hoffman EA, Easthausen IJ, Stukovsky KH, RoyChoudhury A, Michos ED, Raghu G, Kawut SM, Lederer DJ. High-Attenuation Areas on Chest Computed Tomography and Clinical Respiratory Outcomes in Community-Dwelling Adults. Am J Respir Crit Care Med 2017; 196:1434-1442. [PMID: 28613921 PMCID: PMC5736977 DOI: 10.1164/rccm.201703-0555oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/13/2017] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Areas of increased lung attenuation visualized by computed tomography are associated with all-cause mortality in the general population. It is uncertain whether this association is attributable to interstitial lung disease (ILD). OBJECTIVES To determine whether high-attenuation areas are associated with the risk of ILD hospitalization and mortality in the general population. METHODS We performed a cohort study of 6,808 adults aged 45-84 years sampled from six communities in the United States. High-attenuation areas were defined as the percentage of imaged lung volume with attenuation values between -600 and -250 Hounsfield units. An adjudication panel determined ILD hospitalization and death. MEASUREMENTS AND MAIN RESULTS After adjudication, 52 participants had a diagnosis of ILD during 75,232 person-years (median, 12.2 yr) of follow-up. There were 48 hospitalizations attributable to ILD (crude rate, 6.4 per 10,000 person-years). Twenty participants died as a result of ILD (crude rate, 2.7 per 10,000 person-years). High-attenuation areas were associated with an increased rate of ILD hospitalization (adjusted hazard ratio, 2.6 per 1-SD increment in high-attenuation areas; 95% confidence interval, 1.9-3.5; P < 0.001), a finding that was stronger among men, African Americans, and Hispanics. High-attenuation areas were also associated with an increased rate of ILD-specific death (adjusted hazard ratio, 2.3; 95% confidence interval, 1.7-3.0; P < 0.001). Our findings were consistent among both smokers and nonsmokers. CONCLUSIONS Areas of increased lung attenuation are a novel risk factor for ILD hospitalization and mortality. Measurement of high-attenuation areas by screening and diagnostic computed tomography may be warranted in at-risk adults.
Collapse
Affiliation(s)
| | | | | | | | - Eric A. Hoffman
- Department of Radiology
- Department of Internal Medicine, and
- Department of Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | | | - Arindam RoyChoudhury
- Department of Biostatistics, Columbia University Medical Center, New York, New York
| | - Erin D. Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; and
| | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, Washington
| | - Steven M. Kawut
- Department of Medicine and
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|