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Vicol C, Arcana RI, Trofor AC, Melinte O, Cernomaz AT. Why making smoking cessation a priority for rare interstitial lung disease smokers? Tob Prev Cessat 2024; 10:TPC-10-29. [PMID: 39015486 PMCID: PMC11249982 DOI: 10.18332/tpc/190591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/06/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Abstract
This review aims to discuss the complex relationship between smoking and interstitial lung diseases (ILDs), emphasizing the significant morbidity and mortality associated with these conditions. While the etiology of ILDs remains multifactorial, cigarette smoking emerges as a prominent modifiable risk factor implicated in their pathogenesis and progression. This narrative review will provide insight into smoking-associated interstitial lung diseases and personalised approaches to smoking cessation. Epidemiological studies consistently link smoking to ILDs such as idiopathic pulmonary fibrosis (IPF), respiratory bronchiolitis-associated ILD (RB-ILD), and desquamative interstitial pneumonia (DIP), highlighting the urgent need for comprehensive tobacco cessation strategies. Despite the established benefits of smoking cessation, adherence to cessation programs remains challenging due to nicotine addiction, psychological factors, and social influences. The modest success rates of smoking cessation in ILD patients, emphasises the importance of tailored interventions and ongoing support is needed to overcome barriers and to improve outcomes of quitting smoking in this category of vulnerable patients.
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Affiliation(s)
- Cristina Vicol
- University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
| | - Raluca Ioana Arcana
- University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
- Clinical Hospital of Pulmonary Diseases, Iasi, Romania
| | - Antigona Carmen Trofor
- University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
- Clinical Hospital of Pulmonary Diseases, Iasi, Romania
| | - Oana Melinte
- University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
- Clinical Hospital of Pulmonary Diseases, Iasi, Romania
| | - Andrei Tudor Cernomaz
- University of Medicine and Pharmacy “Grigore T. Popa”, Iaşi, Romania
- Regional Institute of Oncology, Iaşi, Romania
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2
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Hayashi K, McDermott GC, Juge PA, Moll M, Cho MH, Wang X, Paudel ML, Doyle TJ, Kinney GL, Sansone-Poe D, Young K, Dellaripa PF, Wallace ZS, Regan EA, Hunninghake GM, Silverman EK, Ash SY, San Jose Estepar R, Washko GR, Sparks JA. Rheumatoid arthritis and changes on spirometry by smoking status in two prospective longitudinal cohorts. RMD Open 2024; 10:e004281. [PMID: 38886003 PMCID: PMC11184187 DOI: 10.1136/rmdopen-2024-004281] [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: 02/28/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To compare longitudinal changes in spirometric measures between patients with rheumatoid arthritis (RA) and non-RA comparators. METHODS We analysed longitudinal data from two prospective cohorts: the UK Biobank and COPDGene. Spirometry was conducted at baseline and a second visit after 5-7 years. RA was identified based on self-report and disease-modifying antirheumatic drug use; non-RA comparators reported neither. The primary outcomes were annual changes in the per cent-predicted forced expiratory volume in 1 s (FEV1%) and per cent predicted forced vital capacity (FVC%). Statistical comparisons were performed using multivariable linear regression. The analysis was stratified based on baseline smoking status and the presence of obstructive pattern (FEV1/FVC <0.7). RESULTS Among participants who underwent baseline and follow-up spirometry, we identified 233 patients with RA and 37 735 non-RA comparators. Among never-smoking participants without an obstructive pattern, RA was significantly associated with more FEV1% decline (β=-0.49, p=0.04). However, in ever smokers with ≥10 pack-years, those with RA exhibited significantly less FEV1% decline than non-RA comparators (β=0.50, p=0.02). This difference was more pronounced among those with an obstructive pattern at baseline (β=1.12, p=0.01). Results were similar for FEV1/FVC decline. No difference was observed in the annual FVC% change in RA versus non-RA. CONCLUSIONS Smokers with RA, especially those with baseline obstructive spirometric patterns, experienced lower FEV1% and FEV1/FVC decline than non-RA comparators. Conversely, never smokers with RA had more FEV1% decline than non-RA comparators. Future studies should investigate potential treatments and the pathogenesis of obstructive lung diseases in smokers with RA.
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Affiliation(s)
- Keigo Hayashi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory C McDermott
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Pierre-Antoine Juge
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Moll
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary, Critical Care, Sleep and Allergy, Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA
| | - Michael H Cho
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Xiaosong Wang
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Misti L Paudel
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy J Doyle
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory L Kinney
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Danielle Sansone-Poe
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kendra Young
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul F Dellaripa
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary S Wallace
- Harvard Medical School, Boston, Massachusetts, USA
- Division Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Gary M Hunninghake
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edwin K Silverman
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Raul San Jose Estepar
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - George R Washko
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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3
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Choi B, Liu GY, Sheng Q, Amancherla K, Perry A, Huang X, San José Estépar R, Ash SY, Guan W, Jacobs DR, Martinez FJ, Rosas IO, Bowler RP, Kropski JA, Banovich NE, Khan SS, San José Estépar R, Shah R, Thyagarajan B, Kalhan R, Washko GR. Proteomic Biomarkers of Quantitative Interstitial Abnormalities in COPDGene and CARDIA Lung Study. Am J Respir Crit Care Med 2024; 209:1091-1100. [PMID: 38285918 PMCID: PMC11092953 DOI: 10.1164/rccm.202307-1129oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/29/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: Quantitative interstitial abnormalities (QIAs) are early measures of lung injury automatically detected on chest computed tomography scans. QIAs are associated with impaired respiratory health and share features with advanced lung diseases, but their biological underpinnings are not well understood. Objectives: To identify novel protein biomarkers of QIAs using high-throughput plasma proteomic panels within two multicenter cohorts. Methods: We measured the plasma proteomics of 4,383 participants in an older, ever-smoker cohort (COPDGene [Genetic Epidemiology of Chronic Obstructive Pulmonary Disease]) and 2,925 participants in a younger population cohort (CARDIA [Coronary Artery Disease Risk in Young Adults]) using the SomaLogic SomaScan assays. We measured QIAs using a local density histogram method. We assessed the associations between proteomic biomarker concentrations and QIAs using multivariable linear regression models adjusted for age, sex, body mass index, smoking status, and study center (Benjamini-Hochberg false discovery rate-corrected P ⩽ 0.05). Measurements and Main Results: In total, 852 proteins were significantly associated with QIAs in COPDGene and 185 in CARDIA. Of the 144 proteins that overlapped between COPDGene and CARDIA, all but one shared directionalities and magnitudes. These proteins were enriched for 49 Gene Ontology pathways, including biological processes in inflammatory response, cell adhesion, immune response, ERK1/2 regulation, and signaling; cellular components in extracellular regions; and molecular functions including calcium ion and heparin binding. Conclusions: We identified the proteomic biomarkers of QIAs in an older, smoking population with a higher prevalence of pulmonary disease and in a younger, healthier community cohort. These proteomics features may be markers of early precursors of advanced lung diseases.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Applied Chest Imaging Laboratory, and
| | - Gabrielle Y. Liu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California Davis, Sacramento, California
| | | | | | | | - Xiaoning Huang
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, and
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Samuel Y. Ash
- Department of Critical Care, South Shore Hospital, South Weymouth, Massachusetts
| | | | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, and
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ivan O. Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Jonathan A. Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, and
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine and
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Applied Chest Imaging Laboratory, and
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4
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Shiraishi Y, Tanabe N, Sakamoto R, Maetani T, Kaji S, Shima H, Terada S, Terada K, Ikezoe K, Tanizawa K, Oguma T, Handa T, Sato S, Muro S, Hirai T. Longitudinal assessment of interstitial lung abnormalities on CT in patients with COPD using artificial intelligence-based segmentation: a prospective observational study. BMC Pulm Med 2024; 24:200. [PMID: 38654252 PMCID: PMC11036664 DOI: 10.1186/s12890-024-03002-z] [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: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Interstitial lung abnormalities (ILAs) on CT may affect the clinical outcomes in patients with chronic obstructive pulmonary disease (COPD), but their quantification remains unestablished. This study examined whether artificial intelligence (AI)-based segmentation could be applied to identify ILAs using two COPD cohorts. METHODS ILAs were diagnosed visually based on the Fleischner Society definition. Using an AI-based method, ground-glass opacities, reticulations, and honeycombing were segmented, and their volumes were summed to obtain the percentage ratio of interstitial lung disease-associated volume to total lung volume (ILDvol%). The optimal ILDvol% threshold for ILA detection was determined in cross-sectional data of the discovery and validation cohorts. The 5-year longitudinal changes in ILDvol% were calculated in discovery cohort patients who underwent baseline and follow-up CT scans. RESULTS ILAs were found in 32 (14%) and 15 (10%) patients with COPD in the discovery (n = 234) and validation (n = 153) cohorts, respectively. ILDvol% was higher in patients with ILAs than in those without ILA in both cohorts. The optimal ILDvol% threshold in the discovery cohort was 1.203%, and good sensitivity and specificity (93.3% and 76.3%) were confirmed in the validation cohort. 124 patients took follow-up CT scan during 5 ± 1 years. 8 out of 124 patients (7%) developed ILAs. In a multivariable model, an increase in ILDvol% was associated with ILA development after adjusting for age, sex, BMI, and smoking exposure. CONCLUSION AI-based CT quantification of ILDvol% may be a reproducible method for identifying and monitoring ILAs in patients with COPD.
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Affiliation(s)
- Yusuke Shiraishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, 606-8507, Kyoto, Kyoto, Japan.
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoki Maetani
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shizuo Kaji
- Institute of Mathematics for Industry, Kyusyu University, Fukuoka, Japan
| | - Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Terada
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Respiratory Medicine and General Practice, Terada Clinic, Himeji, Hyogo, Japan
| | - Kunihiko Terada
- Respiratory Medicine and General Practice, Terada Clinic, Himeji, Hyogo, Japan
| | - Kohei Ikezoe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Medicine, Kyoto City Hospital, Kyoto, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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5
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Choi B, Díaz AA, San José Estépar R, Enzer N, Castro V, Han MK, Washko GR, San José Estépar R, Ash SY. Association of Acute Respiratory Disease Events with Quantitative Interstitial Abnormality Progression at CT in Individuals with a History of Smoking. Radiology 2024; 311:e231801. [PMID: 38687222 PMCID: PMC11070608 DOI: 10.1148/radiol.231801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
Background Acute respiratory disease (ARD) events are often thought to be airway-disease related, but some may be related to quantitative interstitial abnormalities (QIAs), which are subtle parenchymal abnormalities on CT scans associated with morbidity and mortality in individuals with a smoking history. Purpose To determine whether QIA progression at CT is associated with ARD and severe ARD events in individuals with a history of smoking. Materials and Methods This secondary analysis of a prospective study included individuals with a 10 pack-years or greater smoking history recruited from multiple centers between November 2007 and July 2017. QIA progression was assessed between baseline (visit 1) and 5-year follow-up (visit 2) chest CT scans. Episodes of ARD were defined as increased cough or dyspnea lasting 48 hours and requiring antibiotics or corticosteroids, whereas severe ARD episodes were those requiring an emergency room visit or hospitalization. Episodes were recorded via questionnaires completed every 3 to 6 months. Multivariable logistic regression and zero-inflated negative binomial regression models adjusted for comorbidities (eg, emphysema, small airway disease) were used to assess the association between QIA progression and episodes between visits 1 and 2 (intercurrent) and after visit 2 (subsequent). Results A total of 3972 participants (mean age at baseline, 60.7 years ± 8.6 [SD]; 2120 [53.4%] women) were included. Annual percentage QIA progression was associated with increased odds of one or more intercurrent (odds ratio [OR] = 1.29 [95% CI: 1.06, 1.56]; P = .01) and subsequent (OR = 1.26 [95% CI: 1.05, 1.52]; P = .02) severe ARD events. Participants in the highest quartile of QIA progression (≥1.2%) had more frequent intercurrent ARD (incidence rate ratio [IRR] = 1.46 [95% CI: 1.14, 1.86]; P = .003) and severe ARD (IRR = 1.79 [95% CI: 1.18, 2.73]; P = .006) events than those in the lowest quartile (≤-1.7%). Conclusion QIA progression was independently associated with higher odds of severe ARD events during and after radiographic progression, with higher frequency of intercurrent severe events in those with faster progression. Clinical trial registration no. NCT00608764 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Little in this issue.
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Affiliation(s)
- Bina Choi
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Alejandro A. Díaz
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Ruben San José Estépar
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Nicholas Enzer
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Victor Castro
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - MeiLan K. Han
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - George R. Washko
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - Samuel Y. Ash
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
| | - for the COPDGene Study
- From the Division of Pulmonary and Critical Care Medicine, Department
of Medicine (B.C., A.A.D., G.R.W.), Applied Chest Imaging Laboratory (B.C.,
A.A.D., Ruben San José Estépar, N.E., G.R.W., Raúl San
José Estépar), and Department of Radiology (Ruben San José
Estépar, Raúl San José Estépar), Brigham and
Women’s Hospital, 15 Francis St, Boston, MA 02115; Boston University
School of Medicine, Boston, Mass (V.C.); Division of Pulmonary and Critical Care
Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor,
Mich (M.K.H.); Department of Critical Care Medicine, South Shore Health, South
Weymouth, Mass (S.Y.A.); and Tufts University School of Medicine, Boston, Mass
(S.Y.A.)
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6
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Fujita R, Iwasawa T, Aoki T, Iwao Y, Ogura T, Utsunomiya D. Detection of the usual interstitial pneumonia pattern in chest CT: effect of computer-aided diagnosis on radiologist diagnostic performance. Acta Radiol 2024; 65:259-266. [PMID: 32064889 DOI: 10.1177/0284185120902393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anti-fibrotic drugs for interstitial pulmonary fibrosis (IPF) have been developed. Physicians are becoming increasingly aware of the need for better diagnosis of IPF. PURPOSE To evaluate whether a computer-aided system can improve the diagnostic performance of general radiologists in detecting the usual interstitial pneumonia (UIP) pattern on computed tomography (CT). MATERIAL AND METHODS We included 60 CT datasets from 30 patients with IPF and 30 with idiopathic fibrosing non-specific interstitial pneumonia (fNSIP), all diagnosed by a multidisciplinary diagnosis (MDD) procedure that included surgical biopsy. We analyzed the CT data using a computer-aided system (Gaussian histogram normalized correlation: GHNC). Five general radiologists with <6 years of experience each interpreted these CT scans with and without the GHNC results. We compared the likelihoods of a UIP-pattern diagnosis with the likelihood of the same diagnosis by MDD using the average area under the curve (AUC) of the receiver operating characteristics (ROC). We also evaluated the association between the radiologists' diagnosis and survival using the Kaplan-Meier method. RESULTS In the ROC analysis, the AUC increased significantly from 0.731 without GHNC to 0.829 with GHNC (P = 0.0396). The diagnosis without GHNC was not significantly associated with survival for any radiologist, but the UIP diagnosis with GHNC was significantly associated with a worse prognosis for four out of five radiologists. CONCLUSION The computer-aided system could increase the confidence level of UIP-pattern diagnosis by non-expert radiologists.
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Affiliation(s)
- Ryo Fujita
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
- Department of Radiology, School of Medicine, Yokohama City University, Yokohama City, Japan
- Ministry of Health, Labour and Welfare, Medical Professions Division, Health Policy Bureau
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
- Department of Radiology, School of Medicine, Yokohama City University, Yokohama City, Japan
| | - Takatoshi Aoki
- Ministry of Health, Labour and Welfare, Medical Professions Division, Health Policy Bureau
| | - Yuma Iwao
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takashi Ogura
- National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, School of Medicine, Yokohama City University, Yokohama City, Japan
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Nakamura H, Hirai T, Kurosawa H, Hamada K, Matsunaga K, Shimizu K, Konno S, Muro S, Fukunaga K, Nakano Y, Kuwahira I, Hanaoka M. Current advances in pulmonary functional imaging. Respir Investig 2024; 62:49-65. [PMID: 37948969 DOI: 10.1016/j.resinv.2023.09.004] [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: 03/21/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 11/12/2023]
Abstract
Recent advances in imaging analysis have enabled evaluation of ventilation and perfusion in specific regions by chest computed tomography (CT) and magnetic resonance imaging (MRI), in addition to modalities including dynamic chest radiography, scintigraphy, positron emission tomography (PET), ultrasound, and electrical impedance tomography (EIT). In this review, an overview of current functional imaging techniques is provided for each modality. Advances in chest CT have allowed for the analysis of local volume changes and small airway disease in addition to emphysema, using the Jacobian determinant and parametric response mapping with inspiratory and expiratory images. Airway analysis can reveal characteristics of airway lesions in chronic obstructive pulmonary disease (COPD) and bronchial asthma, and the contribution of dysanapsis to obstructive diseases. Chest CT is also employed to measure pulmonary blood vessels, interstitial lung abnormalities, and mediastinal and chest wall components including skeletal muscle and bone. Dynamic CT can visualize lung deformation in respective portions. Pulmonary MRI has been developed for the estimation of lung ventilation and perfusion, mainly using hyperpolarized 129Xe. Oxygen-enhanced and proton-based MRI, without a polarizer, has potential clinical applications. Dynamic chest radiography is gaining traction in Japan for ventilation and perfusion analysis. Single photon emission CT can be used to assess ventilation-perfusion (V˙/Q˙) mismatch in pulmonary vascular diseases and COPD. PET/CT V˙/Q˙ imaging has also been demonstrated using "Galligas". Both ultrasound and EIT can detect pulmonary edema caused by acute respiratory distress syndrome. Familiarity with these functional imaging techniques will enable clinicians to utilize these systems in clinical practice.
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Affiliation(s)
- Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Kurosawa
- Center for Environmental Conservation and Research Safety and Department of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Ichiro Kuwahira
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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8
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Ji Y, Chen L, Yang J, Yang X, Yang F. Quantitative assessment of airway wall thickness in COPD patients with interstitial lung abnormalities. Front Med (Lausanne) 2023; 10:1280651. [PMID: 38146423 PMCID: PMC10749311 DOI: 10.3389/fmed.2023.1280651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Background Whether the airway is involved in the pathogenesis of interstitial lung abnormalities (ILA) is not well understood. Also the impact of ILA on lung function in COPD patients remains controversial. We aimed to assess the quantitative CT measurements of airway wall thickness (AWT) and lung function according to ILA status in COPD patients. Methods 157 COPD patients discharged from our hospital from August 1, 2019 through August 31, 2022 who underwent chest CT imagings and pulmonary function tests were retrospectively enrolled. Linear regression analysis and multiple models were used to analyze associations between quantitative assessment of airway wall changes and the presence of ILA. Results In 157 COPD patients, 23 patients (14.6%) had equivocal ILA, 42 patients (26.8%) had definite ILA. The definite ILA group had the highest measurements of Pi10 (square root of theoretical airway wall area with a lumen perimeter of 10 mm), segmental AWT and segmental WA% (percentage of wall area), whereas the no ILA group had the lowest measurements of Pi10, segmental AWT and segmental WA%. In the adjusted analyses (adjusted by age, sex, body mass index, smoking intensity, COPD GOLD stage, lung function, slice thickness and scanner type), compared to COPD patients without ILA, the measurements of Pi10, segmental AWT and segmental WA% were higher in definite ILA group with differences of 0.225 mm (p = 0.012), 0.152 mm (p < 0.001), 4.8% (p < 0.001) respectively. COPD patients with definite ILA tended to have higher FEV1% predicted, FVC% predicted and lower MMEF75/25% predicted, but there were no statistically differences among the three groups. Conclusion Our study demonstrates the higher AWT measures in COPD patients with ILA compared to the patients without ILA. These findings suggest that the airway may be involved in the pathogenesis of ILA.
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Affiliation(s)
- Yingying Ji
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Leqing Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jinrong Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangying Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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9
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McDermott GC, Hayashi K, Yoshida K, Juge PA, Moll M, Cho MH, Doyle TJ, Kinney GL, Dellaripa PF, Wallace ZS, Regan EA, Hunninghake GM, Silverman EK, Ash SY, Estepar RSJ, Washko GR, Sparks JA. Rheumatoid arthritis, quantitative parenchymal lung features, and mortality among smokers. Rheumatology (Oxford) 2023:kead645. [PMID: 38048611 DOI: 10.1093/rheumatology/kead645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES There have been limited investigations of the prevalence and mortality impact of quantitative computed tomography (QCT) parenchymal lung features in rheumatoid arthritis (RA). We examined the cross-sectional prevalence and mortality associations of QCT features, comparing RA and non-RA participants. METHODS We identified participants with and without RA in COPDGene, a multicentre cohort study of current or former smokers. Using a k-nearest neighbor quantifier, high resolution CT chest scans were scored for percentage of normal lung, interstitial changes, and emphysema. We examined associations between QCT features and RA using multivariable linear regression. After dichotomizing participants at the 75th percentile for each QCT feature among non-RA participants, we investigated mortality associations by RA/non-RA status and quartile 4 vs quartiles 1-3 of QCT features using Cox regression. We assessed for statistical interactions between RA and QCT features. RESULTS We identified 82 RA cases and 8820 non-RA comparators. In multivariable linear regression, RA was associated with higher percentage of interstitial changes (β = 1.7 ± 0.5, p= 0.0008) but not emphysema (β = 1.3 ± 1.7, p= 0.44). Participants with RA and >75th percentile of emphysema had significantly higher mortality than non-RA participants (HR 5.86, 95%CI 3.75-9.13) as well as RA participants (HR 5.56, 95%CI 2.71-11.38) with ≤75th percentile of emphysema. There were statistical interactions between RA and emphysema for mortality (multiplicative p= 0.014; attributable proportion 0.53, 95%CI 0.30-0.70). CONCLUSIONS Using machine learning-derived QCT data in a cohort of smokers, RA was associated with higher percentage of interstitial changes. The combination of RA and emphysema conferred >5-fold higher mortality.
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Affiliation(s)
- Gregory C McDermott
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Keigo Hayashi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pierre-Antoine Juge
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Université de Paris Cité, INSERM UMR 1152, Paris, F-75018, France
- Service de Rhumatologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, F-75018, France
| | - Matthew Moll
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Department of Medicine, VA Boston Healthcare System, West Roxbury, USA, MA
| | - Michael H Cho
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tracy J Doyle
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gregory L Kinney
- Colorado School of Public Health, Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Paul F Dellaripa
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Zachary S Wallace
- Harvard Medical School, Boston, MA, USA
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Gary M Hunninghake
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edwin K Silverman
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Samuel Y Ash
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raul San Jose Estepar
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - George R Washko
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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10
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Byanova KL, Abelman R, North CM, Christenson SA, Huang L. COPD in People with HIV: Epidemiology, Pathogenesis, Management, and Prevention Strategies. Int J Chron Obstruct Pulmon Dis 2023; 18:2795-2817. [PMID: 38050482 PMCID: PMC10693779 DOI: 10.2147/copd.s388142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder characterized by airflow limitation and persistent respiratory symptoms. People with HIV (PWH) are particularly vulnerable to COPD development; PWH have demonstrated both higher rates of COPD and an earlier and more rapid decline in lung function than their seronegative counterparts, even after accounting for differences in cigarette smoking. Factors contributing to this HIV-associated difference include chronic immune activation and inflammation, accelerated aging, a predilection for pulmonary infections, alterations in the lung microbiome, and the interplay between HIV and inhalational toxins. In this review, we discuss what is known about the epidemiology and pathobiology of COPD among PWH and outline screening, diagnostic, prevention, and treatment strategies.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca Abelman
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie A Christenson
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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11
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Choi B, San José Estépar R, Godbole S, Curtis JL, Wang JM, San José Estépar R, Rosas IO, Mayers JR, Hobbs BD, Hersh CP, Ash SY, Han MK, Bowler RP, Stringer KA, Washko GR, Labaki WW. Plasma metabolomics and quantitative interstitial abnormalities in ever-smokers. Respir Res 2023; 24:265. [PMID: 37925418 PMCID: PMC10625195 DOI: 10.1186/s12931-023-02576-2] [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: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Quantitative interstitial abnormalities (QIA) are an automated computed tomography (CT) finding of early parenchymal lung disease, associated with worse lung function, reduced exercise capacity, increased respiratory symptoms, and death. The metabolomic perturbations associated with QIA are not well known. We sought to identify plasma metabolites associated with QIA in smokers. We also sought to identify shared and differentiating metabolomics features between QIA and emphysema, another smoking-related advanced radiographic abnormality. METHODS In 928 former and current smokers in the Genetic Epidemiology of COPD cohort, we measured QIA and emphysema using an automated local density histogram method and generated metabolite profiles from plasma samples using liquid chromatography-mass spectrometry (Metabolon). We assessed the associations between metabolite levels and QIA using multivariable linear regression models adjusted for age, sex, body mass index, smoking status, pack-years, and inhaled corticosteroid use, at a Benjamini-Hochberg False Discovery Rate p-value of ≤ 0.05. Using multinomial regression models adjusted for these covariates, we assessed the associations between metabolite levels and the following CT phenotypes: QIA-predominant, emphysema-predominant, combined-predominant, and neither- predominant. Pathway enrichment analyses were performed using MetaboAnalyst. RESULTS We found 85 metabolites significantly associated with QIA, with overrepresentation of the nicotinate and nicotinamide, histidine, starch and sucrose, pyrimidine, phosphatidylcholine, lysophospholipid, and sphingomyelin pathways. These included metabolites involved in inflammation and immune response, extracellular matrix remodeling, surfactant, and muscle cachexia. There were 75 metabolites significantly different between QIA-predominant and emphysema-predominant phenotypes, with overrepresentation of the phosphatidylethanolamine, nicotinate and nicotinamide, aminoacyl-tRNA, arginine, proline, alanine, aspartate, and glutamate pathways. CONCLUSIONS Metabolomic correlates may lend insight to the biologic perturbations and pathways that underlie clinically meaningful quantitative CT measurements like QIA in smokers.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA.
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA.
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Suneeta Godbole
- Anschutz Medical Campus, Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rubén San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Jared R Mayers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
| | - Brian D Hobbs
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Craig P Hersh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Samuel Y Ash
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
- Department of Critical Care, South Shore Hospital, South Weymouth, MA, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Kathleen A Stringer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Pulmonary-PBB-CA-3, Boston, MA, 02115, USA
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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Dai Q, Zhu X, Zhang J, Dong Z, Pompeo E, Zheng J, Shi J. The utility of quantitative computed tomography in cohort studies of chronic obstructive pulmonary disease: a narrative review. J Thorac Dis 2023; 15:5784-5800. [PMID: 37969311 PMCID: PMC10636446 DOI: 10.21037/jtd-23-1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Background and Objective Chronic obstructive pulmonary disease (COPD) is a significant contributor to global morbidity and mortality. Quantitative computed tomography (QCT), a non-invasive imaging modality, offers the potential to assess lung structure and function in COPD patients. Amidst the coronavirus disease 2019 (COVID-19) pandemic, chest computed tomography (CT) scans have emerged as a viable alternative for assessing pulmonary function (e.g., spirometry), minimizing the risk of aerosolized virus transmission. However, the clinical application of QCT measurements is not yet widespread enough, necessitating broader validation to determine its usefulness in COPD management. Methods We conducted a search in the PubMed database in English from January 1, 2013 to April 20, 2023, using keywords and controlled vocabulary related to QCT, COPD, and cohort studies. Key Content and Findings Existing studies have demonstrated the potential of QCT in providing valuable information on lung volume, airway geometry, airway wall thickness, emphysema, and lung tissue density in COPD patients. Moreover, QCT values have shown robust correlations with pulmonary function tests, and can predict exacerbation risk and mortality in patients with COPD. QCT can even discern COPD subtypes based on phenotypic characteristics such as emphysema predominance, supporting targeted management and interventions. Conclusions QCT has shown promise in cohort studies related to COPD, since it can provide critical insights into the pathogenesis and progression of the disease. Further research is necessary to determine the clinical significance of QCT measurements for COPD management.
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Affiliation(s)
- Qi Dai
- School of Medicine, Tongji University, Shanghai, China
- Department of Radiology, Ningbo No.2 Hospitall, Ningbo, China
| | - Xiaoxiao Zhu
- Department of Respiratory and Critical Care Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No.2 Hospitall, Ningbo, China
| | - Zhaoxing Dong
- Department of Respiratory and Critical Care Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Jianjun Zheng
- Department of Radiology, Ningbo No.2 Hospitall, Ningbo, China
| | - Jingyun Shi
- School of Medicine, Tongji University, Shanghai, China
- Department of Radiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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13
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McDermott GC, Hayashi K, Yoshida K, Moll M, Cho MH, Doyle TJ, Kinney GL, Dellaripa PF, Putman RK, San Jose Estepar R, Hata A, Hino T, Hida T, Yanagawa M, Nishino M, Washko G, Regan EA, Hatabu H, Hunninghake GM, Silverman EK, Sparks JA. Prevalence and mortality associations of interstitial lung abnormalities in rheumatoid arthritis within a multicentre prospective cohort of smokers. Rheumatology (Oxford) 2023; 62:SI286-SI295. [PMID: 37871923 PMCID: PMC10593512 DOI: 10.1093/rheumatology/kead277] [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: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE To investigate the prevalence and mortality impact of interstitial lung abnormalities (ILAs) in RA and non-RA comparators. METHODS We analysed associations between ILAs, RA, and mortality in COPDGene, a multicentre prospective cohort study of current and past smokers, excluding known interstitial lung disease (ILD) or bronchiectasis. All participants had research chest high-resolution CT (HRCT) reviewed by a sequential reading method to classify ILA as present, indeterminate or absent. RA cases were identified by self-report RA and DMARD use; non-RA comparators had neither an RA diagnosis nor used DMARDs. We examined the association and mortality risk of RA and ILA using multivariable logistic regression and Cox regression. RESULTS We identified 83 RA cases and 8725 non-RA comparators with HRCT performed for research purposes. ILA prevalence was 16.9% in RA cases and 5.0% in non-RA comparators. After adjusting for potential confounders, including genetics, current/past smoking and other lifestyle factors, ILAs were more common among those with RA compared with non-RA [odds ratio 4.76 (95% CI 2.54, 8.92)]. RA with ILAs or indeterminate for ILAs was associated with higher all-cause mortality compared with non-RA without ILAs [hazard ratio (HR) 3.16 (95% CI 2.11, 4.74)] and RA cases without ILA [HR 3.02 (95% CI 1.36, 6.75)]. CONCLUSIONS In this cohort of smokers, RA was associated with ILAs and this persisted after adjustment for current/past smoking and genetic/lifestyle risk factors. RA with ILAs in smokers had a 3-fold increased all-cause mortality, emphasizing the importance of further screening and treatment strategies for preclinical ILD in RA.
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Affiliation(s)
- Gregory C McDermott
- Division of Rheumatology, Department of Medicine, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Keigo Hayashi
- Division of Rheumatology, Department of Medicine, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kazuki Yoshida
- Division of Rheumatology, Department of Medicine, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Matthew Moll
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Department of Medicine, VA Boston Healthcare System, West Roxbury, MA, USA
| | - Michael H Cho
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Tracy J Doyle
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Gregory L Kinney
- Colorado School of Public Health, Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Paul F Dellaripa
- Division of Rheumatology, Department of Medicine, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rachel K Putman
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Raul San Jose Estepar
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Akinori Hata
- Department of Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyuki Hida
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - George Washko
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Hiroto Hatabu
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Gary M Hunninghake
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Edwin K Silverman
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Department of Medicine, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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14
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Larici AR, Cicchetti G. The Promise of Quantitative Computed Tomographic Analysis in Assessing Progression of Interstitial Lung Abnormalities and Emphysema in Smokers. Am J Respir Crit Care Med 2023; 208:645-647. [PMID: 37478327 PMCID: PMC10515567 DOI: 10.1164/rccm.202306-1063ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023] Open
Affiliation(s)
- Anna Rita Larici
- Dipartimento di Scienze Radiologiche ed Ematologiche Universita' Cattolica del Sacro Cuore di Roma, Italia
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS Roma, Italia
| | - Giuseppe Cicchetti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS Roma, Italia
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15
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Ash SY, Choi B, Oh A, Lynch DA, Humphries SM. Deep Learning Assessment of Progression of Emphysema and Fibrotic Interstitial Lung Abnormality. Am J Respir Crit Care Med 2023; 208:666-675. [PMID: 37364281 PMCID: PMC10515569 DOI: 10.1164/rccm.202211-2098oc] [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: 11/14/2022] [Accepted: 06/26/2023] [Indexed: 06/28/2023] Open
Abstract
Rationale: Although studies have evaluated emphysema and fibrotic interstitial lung abnormality individually, less is known about their combined progression. Objectives: To define clinically meaningful progression of fibrotic interstitial lung abnormality in smokers without interstitial lung disease and evaluate the effects of fibrosis and emphysema progression on mortality. Methods: Emphysema and pulmonary fibrosis were assessed on the basis of baseline and 5-year follow-up computed tomography scans of 4,450 smokers in the COPDGene Study using deep learning algorithms. Emphysema was classified as absent, trace, mild, moderate, confluent, or advanced destructive. Fibrosis was expressed as a percentage of lung volume. Emphysema progression was defined as an increase by at least one grade. A hybrid distribution and anchor-based method was used to determine the minimal clinically important difference in fibrosis. The relationship between progression and mortality was evaluated using multivariable shared frailty models using an age timescale. Measurements and Main Results: The minimal clinically important difference for fibrosis was 0.58%. On the basis of this threshold, 2,822 (63%) had progression of neither emphysema nor fibrosis, 841 (19%) had emphysema progression alone, 512 (12%) had fibrosis progression alone, and 275 (6.2%) had progression of both. Compared with nonprogressors, hazard ratios for mortality were 1.42 (95% confidence interval, 1.11-1.82) in emphysema progressors, 1.49 (1.14-1.94) in fibrosis progressors, and 2.18 (1.58-3.02) in those with progression of both emphysema and fibrosis. Conclusions: In smokers without known interstitial lung disease, small changes in fibrosis may be clinically significant, and combined progression of emphysema and fibrosis is associated with increased mortality.
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Affiliation(s)
- Samuel Y. Ash
- Department of Critical Care, South Shore Hospital, South Weymouth, Massachusetts
- Applied Chest Imaging Laboratory and
| | - Bina Choi
- Applied Chest Imaging Laboratory and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrea Oh
- Department of Radiology, University of California, Los Angeles Health, Los Angeles, California; and
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
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16
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Liu Y, Jiang Y, Sun Y. Interstitial lung abnormality in COPD is associated with higher prevalence of antinuclear antibody. Expert Rev Respir Med 2023; 17:735-742. [PMID: 37698170 DOI: 10.1080/17476348.2023.2257135] [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: 12/13/2022] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
OBJECT To investigate whether the prevalence of positive ANA was increased in COPD with interstitial lung abnormality (ILA). METHODS Patients with COPD from 1 September, 2019 to 31 August, 2022 were consecutively enrolled in this cross-sectional study. The characteristics, PFTs, visual assessment of ILA and emphysema on chest CT, and tests for ANA and CRP were recorded for analysis. RESULTS In the study period, 100 patients with COPD were enrolled, with 90 (90.0%) males, aging 69.4 ± 8.3 years. ILA was present in 42% (n = 42) of the patients, with subpleural non-fibrotic ILA being the most common pattern. In patients with ILA, the prevalence of positive ANA was higher (45.2%) as compared to those without ILA (13.3%); between whom the difference in DLCO was also significant. In patients with positive ANA, the scores of ILA were higher, while FEV1, DLCO, DLCO % predicted, FVC, total lung capacity (TLC), and TLC % predicted were significantly lower, as compared to those with negative ANA. CONCLUSION The presence of ILA in patients with COPD was associated with a higher prevalence of positive ANA. Patients with positive ANA tended to have lower FEV1, DLCO and lung volume.
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Affiliation(s)
- Yujia Liu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital; Research Center of Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
- Department of Respiratory and Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Yanwen Jiang
- Department of Respiratory and Critical Care Medicine, Peking University International Hospital, Beijing, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital; Research Center of Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
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17
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Liu Y, Tang J, Sun Y. Impact of Interstitial Lung Abnormalities on Disease Expression and Outcomes in COPD or Emphysema: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:189-206. [PMID: 36890863 PMCID: PMC9987235 DOI: 10.2147/copd.s392349] [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: 10/09/2022] [Accepted: 02/15/2023] [Indexed: 03/05/2023] Open
Abstract
Background Both COPD and interstitial lung abnormalities (ILAs) are conditions associated with smoking and age. The impact of coexistent ILAs on the manifestations and outcomes of COPD or emphysema awaits evaluation. Methods We searched PubMed and Embase using Medical Subject Headings terms in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Eleven studies were included in the review. The sample size of the studies ranged from 30 to 9579. ILAs were reported in 6.5% to 25.7% of the patients with COPD/emphysema, higher than that reported in the general populations. COPD/emphysema patients with ILAs were older, mostly male, and had a higher smoking index than those without ILAs. Hospital admission and mortality were increased in COPD patients with ILAs compared to those without ILAs, whereas the frequency of COPD exacerbations was discrepant in 2 of the studies. The FEV1 and FEV1% predicted tended to be higher in the group with ILAs, but not significantly in most of the studies. Conclusion ILAs were more frequent in subjects with COPD/emphysema than in the general population. ILAs may have a negative impact on hospital admission and mortality of COPD/emphysema. The impact of ILAs on lung functions and exacerbations of COPD/emphysema was discrepant in these studies. Further prospective studies are warranted to provide high-quality evidence of the association and interaction between COPD/emphysema and ILAs.
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Affiliation(s)
- Yujia Liu
- Department of Respiratory and Critical Medicine, Peking University Third Hospital, Beijing, People's Republic of China.,Department of Respiratory and Critical Medicine, Peking University International Hospital, Beijing, People's Republic of China
| | - Jingyun Tang
- Blood Research Laboratory, Chengdu Blood Center, Chengdu, Sichuan, People's Republic of China
| | - Yongchang Sun
- Department of Respiratory and Critical Medicine, Peking University Third Hospital, Beijing, People's Republic of China
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18
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Choi B, Adan N, Doyle TJ, San José Estépar R, Harmouche R, Humphries SM, Moll M, Cho MH, Putman RK, Hunninghake GM, Kalhan R, Liu GY, Diaz AA, Mason SE, Rahaghi FN, Pistenmaa CL, Enzer N, Poynton C, Sánchez-Ferrero GV, Ross JC, Lynch DA, Martinez FJ, Han MK, Bowler RP, Wilson DO, Rosas IO, Washko GR, San José Estépar R, Ash SY. Quantitative Interstitial Abnormality Progression and Outcomes in the Genetic Epidemiology of COPD and Pittsburgh Lung Screening Study Cohorts. Chest 2023; 163:164-175. [PMID: 35780812 PMCID: PMC9859724 DOI: 10.1016/j.chest.2022.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The risk factors and clinical outcomes of quantitative interstitial abnormality progression over time have not been characterized. RESEARCH QUESTIONS What are the associations of quantitative interstitial abnormality progression with lung function, exercise capacity, and mortality? What are the demographic and genetic risk factors for quantitative interstitial abnormality progression? STUDY DESIGN AND METHODS Quantitative interstitial abnormality progression between visits 1 and 2 was assessed from 4,635 participants in the Genetic Epidemiology of COPD (COPDGene) cohort and 1,307 participants in the Pittsburgh Lung Screening Study (PLuSS) cohort. We used multivariable linear regression to determine the risk factors for progression and the longitudinal associations between progression and FVC and 6-min walk distance, and Cox regression models for the association with mortality. RESULTS Age at enrollment, female sex, current smoking status, and the MUC5B minor allele were associated with quantitative interstitial abnormality progression. Each percent annual increase in quantitative interstitial abnormalities was associated with annual declines in FVC (COPDGene: 8.5 mL/y; 95% CI, 4.7-12.4 mL/y; P < .001; PLuSS: 9.5 mL/y; 95% CI, 3.7-15.4 mL/y; P = .001) and 6-min walk distance, and increased mortality (COPDGene: hazard ratio, 1.69; 95% CI, 1.34-2.12; P < .001; PLuSS: hazard ratio, 1.28; 95% CI, 1.10-1.49; P = .001). INTERPRETATION The objective, longitudinal measurement of quantitative interstitial abnormalities may help identify people at greatest risk for adverse events and most likely to benefit from early intervention.
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Affiliation(s)
- Bina Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | - Najma Adan
- Department of Biology, University of Washington, Bothell, WA
| | - Tracy J Doyle
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ruben San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Rola Harmouche
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Matthew Moll
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rachel K Putman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ravi Kalhan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gabrielle Y Liu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Stefanie E Mason
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Nicholas Enzer
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Clare Poynton
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Gonzalo Vegas Sánchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Russell P Bowler
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ivan O Rosas
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
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19
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Cottin V, Selman M, Inoue Y, Wong AW, Corte TJ, Flaherty KR, Han MK, Jacob J, Johannson KA, Kitaichi M, Lee JS, Agusti A, Antoniou KM, Bianchi P, Caro F, Florenzano M, Galvin L, Iwasawa T, Martinez FJ, Morgan RL, Myers JL, Nicholson AG, Occhipinti M, Poletti V, Salisbury ML, Sin DD, Sverzellati N, Tonia T, Valenzuela C, Ryerson CJ, Wells AU. Syndrome of Combined Pulmonary Fibrosis and Emphysema: An Official ATS/ERS/JRS/ALAT Research Statement. Am J Respir Crit Care Med 2022; 206:e7-e41. [PMID: 35969190 PMCID: PMC7615200 DOI: 10.1164/rccm.202206-1041st] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The presence of emphysema is relatively common in patients with fibrotic interstitial lung disease. This has been designated combined pulmonary fibrosis and emphysema (CPFE). The lack of consensus over definitions and diagnostic criteria has limited CPFE research. Goals: The objectives of this task force were to review the terminology, definition, characteristics, pathophysiology, and research priorities of CPFE and to explore whether CPFE is a syndrome. Methods: This research statement was developed by a committee including 19 pulmonologists, 5 radiologists, 3 pathologists, 2 methodologists, and 2 patient representatives. The final document was supported by a focused systematic review that identified and summarized all recent publications related to CPFE. Results: This task force identified that patients with CPFE are predominantly male, with a history of smoking, severe dyspnea, relatively preserved airflow rates and lung volumes on spirometry, severely impaired DlCO, exertional hypoxemia, frequent pulmonary hypertension, and a dismal prognosis. The committee proposes to identify CPFE as a syndrome, given the clustering of pulmonary fibrosis and emphysema, shared pathogenetic pathways, unique considerations related to disease progression, increased risk of complications (pulmonary hypertension, lung cancer, and/or mortality), and implications for clinical trial design. There are varying features of interstitial lung disease and emphysema in CPFE. The committee offers a research definition and classification criteria and proposes that studies on CPFE include a comprehensive description of radiologic and, when available, pathological patterns, including some recently described patterns such as smoking-related interstitial fibrosis. Conclusions: This statement delineates the syndrome of CPFE and highlights research priorities.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | | | | | - Tamera J. Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | | | - Joseph Jacob
- University College London, London, United Kingdom
| | - Kerri A. Johannson
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Joyce S. Lee
- University of Colorado Denver Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | | | - Fabian Caro
- Hospital de Rehabilitación Respiratoria "María Ferrer", Buenos Aires, Argentina
| | | | - Liam Galvin
- European idiopathic pulmonary fibrosis and related disorders federation
| | - Tae Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | | | - Andrew G. Nicholson
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Don D. Sin
- University of British Columbia, Vancouver, Canada
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Claudia Valenzuela
- Pulmonology Department, Hospital Universitario de la Princesa, Departamento Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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20
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Sangani RG, Ghio AJ, Parker JE. Concerns re Harris et al.: Low-dose CT-detected interstitial lung abnormalities in a population with low asbestos exposure. Am J Ind Med 2022; 65:425-426. [PMID: 35220613 DOI: 10.1002/ajim.23338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Rahul G. Sangani
- Section of Pulmonary, Critical Care and Sleep Medicine West Virginia University Morgantown West Virginia USA
| | - Andrew J. Ghio
- US Environmental Protection Agency Chapel Hill North Carolina USA
| | - John E. Parker
- Section of Pulmonary, Critical Care and Sleep Medicine West Virginia University Morgantown West Virginia USA
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21
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Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection. BMC Pulm Med 2022; 22:172. [PMID: 35488260 PMCID: PMC9055776 DOI: 10.1186/s12890-022-01961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cigarette smoking is a risk factor for interstitial lung abnormalities (ILAs) and interstitial lung diseases (ILDs). Investigation defining the relationships between ILAs/ILDs and clinical, radiographic, and pathologic findings in smokers have been incomplete. Employing a cohort undergoing surgical resection for lung nodules/masses, we (1) define the prevalence of ILAs/ILDs, (2) delineate their clinical, radiographic and pathologic predictors, and (3) determine their associations with mortality. Methods Patients undergoing resection of lung nodules/masses between 2017 and 2020 at a rural Appalachian, tertiary medical center were retrospectively investigated. Predictors for ILAs/ILDs and mortality were assessed using multivariate logistic regression analysis. Results In the total study cohort of 352 patients, radiographic ILAs and ILDs were observed in 35.2% and 17.6%, respectively. Among ILA patterns, subpleural reticular changes (14.8%), non-emphysematous cysts, centrilobular (CL) ground glass opacities (GGOs) (8% each), and mixed CL-GGO and subpleural reticular changes (7.4%) were common. ILD patterns included combined pulmonary fibrosis emphysema (CPFE) (3.1%), respiratory bronchiolitis (RB)-ILD (3.1%), organizing pneumonitis (2.8%) and unclassifiable (4.8%). The group with radiographic ILAs/ILDs had a significantly higher proportion of ever smokers (49% vs. 39.9%), pack years of smoking (44.57 ± 36.21 vs. 34.96 ± 26.22), clinical comorbidities of COPD (35% vs. 26.5%) and mildly reduced diffusion capacity (% predicated 66.29 ± 20.55 vs. 71.84 ± 23). Radiographic centrilobular and paraseptal emphysema (40% vs. 22.2% and 17.6% vs. 9.6%, respectively) and isolated traction bronchiectasis (10.2% vs. 4.2%) were associated with ILAs/ILDs. Pathological variables of emphysema (34.9% vs. 18.5%), any fibrosis (15.9% vs. 4.6%), peribronchiolar metaplasia (PBM, 8% vs. 1.1%), RB (10.3% vs. 2.5%), and anthracosis (21.6% vs. 14.5%) were associated with ILAs/ILDs. Histologic emphysema showed positive correlations with any fibrosis, RB, anthracosis and ≥ 30 pack year of smoking. The group with ILAs/ILDs had significantly higher mortality (9.1% vs. 2.2%, OR 4.13, [95% CI of 1.84–9.25]). Conclusions In a rural cohort undergoing surgical resection, radiographic subclinical ILAs/ILDs patterns were highly prevalent and associated with ever smoking and intensity of smoking. The presence of radiographic ILA/ILD patterns and isolated honeycomb changes were associated with increased mortality. Subclinical ILAs/ILDs and histologic fibrosis correlated with clinical COPD as well as radiographic and pathologic emphysema emphasizing the co-existence of these pulmonary injuries in a heavily smoking population. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01961-9.
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22
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Choi JY, Song JW, Rhee CK. Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease. Tuberc Respir Dis (Seoul) 2022; 85:122-136. [PMID: 35385639 PMCID: PMC8987660 DOI: 10.4046/trd.2021.0141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/06/2021] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.
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Affiliation(s)
- Joon Young Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Song
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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23
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Reyfman PA, Sugar E, Hazucha H, Hixon J, Reynolds C, Bose S, Dransfield MT, Han MK, Estepar RSJ, Rice MB, Washko GR, Carnethon M, Kalhan R. Study protocol for a national cohort of adults focused on respiratory health: the American Lung Association Lung Health Cohort (ALA-LHC) Study. BMJ Open 2021; 11:e053342. [PMID: 34226239 PMCID: PMC8258664 DOI: 10.1136/bmjopen-2021-053342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The current framework for investigating respiratory diseases is based on defining lung health as the absence of lung disease. In order to develop a comprehensive approach to prevent the development of lung disease, there is a need to evaluate the full spectrum of lung health spanning from ideal to impaired lung health. The American Lung Association (ALA) Lung Health Cohort is a new, population-based, cohort study focused primarily on characterising lung health in members of the millennial generation without diagnosed severe respiratory disease. Participants will be enrolled for the baseline study visit starting in 2021, and funding will be sought to support future study exams as part of a longitudinal cohort study. This study will be crucial for developing a novel paradigm of lung health throughout the adult life course. METHODS AND ANALYSIS This study will leverage the existing infrastructure of the ALA Airways Clinical Research Centers network to enrol 4000 participants between ages 25 and 35 years old at 39 sites across the USA between April 2021 and December 2024. Study procedures will include physical assessment, spirometry, chest CT scan, accelerometry and collection of nasal epithelial lining fluid, nasal epithelial cells, blood and urine. Participants will complete questionnaires about their sociodemographic characteristics, home address histories and exposures, work history and exposure, medical histories, lung health and health behaviours and activity. ETHICS AND DISSEMINATION The study was approved by the Johns Hopkins Medicine Institutional Review Board. Findings will be disseminated to the scientific community through peer-reviewed journals and at professional conferences. The lay public will receive scientific findings directly through the ALA infrastructure including the official public website. Deidentified datasets will be deposited to BioLINCC, and deidentified biospecimens may be made available to qualified investigators along with a limited-use datasets.
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Affiliation(s)
- Paul A Reyfman
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elizabeth Sugar
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Heather Hazucha
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jenny Hixon
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Curt Reynolds
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sonali Bose
- Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark T Dransfield
- Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - MeiLan K Han
- Pulmonary and Critical Care Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Raul San Jose Estepar
- Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mary B Rice
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - George R Washko
- Harvard Medical School, Boston, Massachusetts, USA
- Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mercedes Carnethon
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ravi Kalhan
- Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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24
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Lynch DA. Interstitial Lung Abnormality Incidentally Detected on CT: An Important Prognostic Indicator. Chest 2021; 159:5-6. [PMID: 33422230 DOI: 10.1016/j.chest.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO.
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25
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Billatos E, Ash SY, Duan F, Xu K, Romanoff J, Marques H, Moses E, Han MK, Regan EA, Bowler RP, Mason SE, Doyle TJ, San José Estépar R, Rosas IO, Ross JC, Xiao X, Liu H, Liu G, Sukumar G, Wilkerson M, Dalgard C, Stevenson C, Whitney D, Aberle D, Spira A, San José Estépar R, Lenburg ME, Washko GR. Distinguishing Smoking-Related Lung Disease Phenotypes Via Imaging and Molecular Features. Chest 2021; 159:549-563. [PMID: 32946850 PMCID: PMC8039011 DOI: 10.1016/j.chest.2020.08.2115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Chronic tobacco smoke exposure results in a broad range of lung pathologies including emphysema, airway disease and parenchymal fibrosis as well as a multitude of extra-pulmonary comorbidities. Prior work using CT imaging has identified several clinically relevant subgroups of smoking related lung disease, but these investigations have generally lacked organ specific molecular correlates. RESEARCH QUESTION Can CT imaging be used to identify clinical phenotypes of smoking related lung disease that have specific bronchial epithelial gene expression patterns to better understand disease pathogenesis? STUDY DESIGN AND METHODS Using K-means clustering, we clustered participants from the COPDGene study (n = 5,273) based on CT imaging characteristics and then evaluated their clinical phenotypes. These clusters were replicated in the Detection of Early Lung Cancer Among Military Personnel (DECAMP) cohort (n = 360), and were further characterized using bronchial epithelial gene expression. RESULTS Three clusters (preserved, interstitial predominant and emphysema predominant) were identified. Compared to the preserved cluster, the interstitial and emphysema clusters had worse lung function, exercise capacity and quality of life. In longitudinal follow-up, individuals from the emphysema group had greater declines in exercise capacity and lung function, more emphysema, more exacerbations, and higher mortality. Similarly, genes involved in inflammatory pathways (tumor necrosis factor-α, interferon-β) are more highly expressed in bronchial epithelial cells from individuals in the emphysema cluster, while genes associated with T-cell related biology are decreased in these samples. Samples from individuals in the interstitial cluster generally had intermediate levels of expression of these genes. INTERPRETATION Using quantitative CT imaging, we identified three groups of individuals in older ever-smokers that replicate in two cohorts. Airway gene expression differences between the three groups suggests increased levels of inflammation in the most severe clinical phenotype, possibly mediated by the tumor necrosis factor-α and interferon-β pathways. CLINICAL TRIAL REGISTRATION COPDGene (NCT00608764), DECAMP-1 (NCT01785342), DECAMP-2 (NCT02504697).
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Affiliation(s)
- Ehab Billatos
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Boston University, Boston, MA; Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA.
| | - Samuel Y Ash
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Ke Xu
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA; Bioinformatics Program, Boston University College of Engineering, Boston, MA
| | - Justin Romanoff
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Helga Marques
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Elizabeth Moses
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - MeiLan K Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Elizabeth A Regan
- Department of Medicine, Division of Rheumatology, National Jewish Health, Denver, CO
| | - Russell P Bowler
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Stefanie E Mason
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Tracy J Doyle
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rubén San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Ivan O Rosas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Xiaohui Xiao
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - Hanqiao Liu
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - Gang Liu
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - Gauthaman Sukumar
- Department of Anatomy, Physiology & Genetics, The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Matthew Wilkerson
- Department of Anatomy, Physiology & Genetics, The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Clifton Dalgard
- Department of Anatomy, Physiology & Genetics, The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Duncan Whitney
- Lung Cancer Initiative at Johnson & Johnson, New Brunswick, NJ
| | - Denise Aberle
- Department of Radiology, University of California at Los Angeles, Los Angeles, CA
| | - Avrum Spira
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Boston University, Boston, MA; Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA; Lung Cancer Initiative at Johnson & Johnson, New Brunswick, NJ
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Marc E Lenburg
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA; Bioinformatics Program, Boston University College of Engineering, Boston, MA
| | - George R Washko
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
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Mori Y, Kondoh Y. What parameters can be used to identify early idiopathic pulmonary fibrosis? Respir Investig 2021; 59:53-65. [PMID: 33277230 DOI: 10.1016/j.resinv.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 06/12/2023]
Abstract
Elucidating the disease process of early idiopathic pulmonary fibrosis (IPF) will help clinicians in addressing the contentious issues of when and in which patients, therapeutic intervention should be initiated. Here, we discuss several possible parameters for diagnosing early IPF and their clinical impacts. Physiologically, early IPF can be considered as IPF with normal or mild impairment in pulmonary function. Radiologically, early IPF can be considered as IPF with a small extent and/or early features of fibrosis. Symptomatically, early IPF can be considered as asymptomatic or less symptomatic IPF. IPF at Gender-Age-Physiology index stage I can be considered early IPF. Interstitial lung abnormalities are defined as parenchymal abnormalities in more than 5% of the lung in patients with no prior history of interstitial lung disease, and in some cases, this seems to be equivalent to early IPF. Previous clinical trials showed the effect of antifibrotic therapies in early IPF, but the effects of therapy are uncertain in early IPF outside of clinical trials, such as in cases of IPF with normal pulmonary function, IPF without honeycombing or traction bronchiectasis, and asymptomatic IPF. Moreover, little has been reported on disease progression in such conditions. Because the conceptual framework of early IPF may vary depending on its definition, not only is a diagnosis of early IPF important but prediction of disease progression is also crucial. Further investigations are needed to identify biomarkers that can detect patients who may experience greater degrees of disease progression and require treatment even with those forms of early IPF.
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Affiliation(s)
- Yuta Mori
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan; Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
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27
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Lee TS, Jin KN, Lee HW, Yoon SY, Park TY, Heo EY, Kim DK, Chung HS, Lee JK. Interstitial Lung Abnormalities and the Clinical Course in Patients With COPD. Chest 2020; 159:128-137. [PMID: 32805240 DOI: 10.1016/j.chest.2020.08.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The presence and progression of interstitial lung abnormalities (ILAs) is known to be associated with a decline of lung function and increased risk of mortality. RESEARCH QUESTION We aimed to elucidate the clinical course according to ILAs in patients with COPD. STUDY DESIGN AND METHODS A retrospective study was conducted between January 2013 and December 2018 of COPD patients who underwent chest CT imaging and longitudinal pulmonary function tests. We evaluated radiologic findings, history of acute exacerbations of COPD, and lung function changes during the longitudinal follow-up. RESULTS Of 363 patients with COPD, 44 and 103 patients had equivocal and definite ILAs, respectively. Patients with ILAs were significantly older and had lower FEV1 and FVC than patients without ILAs. During the mean follow-up period of 5.2 years, ILAs were associated significantly with the annual incidence of moderate to severe acute exacerbation of COPD (β ± SD, 0.38 ± 0.12; P = .002) and with the risk of frequent exacerbation (adjusted OR, 2.03; P = .045). Patients with progressive ILAs showed a significantly higher rate of annual decline in FEV1 and FVC than those showing no change in, or improved, ILAs. INTERPRETATION ILAs were associated significantly with moderate to severe acute exacerbation in patients with COPD, and the progression of ILAs was associated with an accelerated decline in lung function.
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Affiliation(s)
- Tae Seung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Seo-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hee Soon Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
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28
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Hida T, Nishino M, Hino T, Lu J, Putman RK, Gudmundsson EF, Araki T, Valtchinov VI, Honda O, Yanagawa M, Yamada Y, Hata A, Jinzaki M, Tomiyama N, Honda H, Estepar RSJ, Washko GR, Johkoh T, Christiani DC, Lynch DA, Gudnason V, Gudmundsson G, Hunninghake GM, Hatabu H. Traction Bronchiectasis/Bronchiolectasis is Associated with Interstitial Lung Abnormality Mortality. Eur J Radiol 2020; 129:109073. [PMID: 32480316 DOI: 10.1016/j.ejrad.2020.109073] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate if the presence and severity of traction bronchiectasis/bronchiolectasis are associated with poorer survival in subjects with ILA. METHOD The study included 3,594 subjects (378 subjects with ILA and 3,216 subjects without ILA) in AGES-Reykjavik Study. Chest CT scans of 378 subjects with ILA were evaluated for traction bronchiectasis/bronchiolectasis, defined as dilatation of bronchi/bronchioles within areas demonstrating ILA. Traction bronchiectasis/bronchiolectasis Index (TBI) was assigned as: TBI = 0, ILA without traction bronchiectasis/bronchiolectasis: TBI = 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion: TBI = 2, ILA with mild to moderate traction bronchiectasis: TBI = 3, ILA and severe traction bronchiectasis and/or honeycombing. Overall survival (OS) was compared among the subjects in different TBI groups and those without ILA. RESULTS The median OS was 12.93 years (95%CI; 12.67 - 13.43) in the subjects without ILA; 11.95 years (10.03 - not reached) in TBI-0 group; 8.52 years (7.57 - 9.30) in TBI-1 group; 7.63 years (6.09 - 9.10) in TBI-2 group; 5.40 years (1.85 - 5.98) in TBI-3 group. The multivariable Cox models demonstrated significantly shorter OS of TBI-1, TBI-2, and TBI-3 groups compared to subjects without ILA (P < 0.0001), whereas TBI-0 group had no significant OS difference compared to subjects without ILA, after adjusting for age, sex, and smoking status. CONCLUSIONS The presence and severity of traction bronchiectasis/bronchiolectasis are associated with shorter survival. The traction bronchiectasis/bronchiolectasis is an important contributor to increased mortality among subjects with ILA.
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Affiliation(s)
- Tomoyuki Hida
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 8128582, Japan
| | - Mizuki Nishino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Junwei Lu
- Department of Biostatistics, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Rachel K Putman
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Elias F Gudmundsson
- Icelandic Heart Association, Hjartavernd, Holtasmári 1, 201 Kópavogur, Iceland
| | - Tetsuro Araki
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Vladimir I Valtchinov
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Osamu Honda
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Akinori Hata
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 8128582, Japan
| | - Raul San Jose Estepar
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - George R Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan
| | - David C Christiani
- Department of Environmental Health, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Hjartavernd, Holtasmári 1, 201 Kópavogur, Iceland; University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101 Reykjavík, Iceland
| | - Gunnar Gudmundsson
- University of Iceland, Faculty of Medicine, Vatnsmyrarvegur 16, 101 Reykjavík, Iceland; Department of Respiratory Medicine, Landspitali University Hospital, University of Iceland, Faculty of Medicine, Hringbraut, 101 Reykjavík, Iceland
| | - Gary M Hunninghake
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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29
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Washko GR, Nardelli P, Ash SY, Rahaghi FN, Vegas Sanchez-Ferrero G, Come CE, Dransfield MT, Kalhan R, Han MK, Bhatt SP, Wells JM, Pistenmaa CL, Diaz AA, Ross JC, Rennard S, Querejeta Roca G, Shah AM, Young K, Kinney GL, Hokanson JE, Agustí A, San José Estépar R. Smaller Left Ventricle Size at Noncontrast CT Is Associated with Lower Mortality in COPDGene Participants. Radiology 2020; 296:208-215. [PMID: 32368963 PMCID: PMC7299752 DOI: 10.1148/radiol.2020191793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Smokers with chronic obstructive pulmonary disease (COPD) have smaller left ventricles (LVs) due to reduced preload. Skeletal muscle wasting is also common in COPD, but less is known about its contribution to LV size. Purpose To explore the relationships between CT metrics of emphysema, venous vascular volume, and sarcopenia with the LV epicardial volume (LVEV) (myocardium and chamber) estimated from chest CT images in participants with COPD and then to determine the clinical relevance of the LVEV in multivariable models, including sex and anthropomorphic metrics. Materials and Methods The COPDGene study (ClinicalTrials.gov identifier: NCT00608764) is an ongoing prospective longitudinal observational investigation that began in 2006. LVEV, distal pulmonary venous blood volume for vessels smaller than 5 mm2 in cross section (BV5), CT emphysema, and pectoralis muscle area were retrospectively extracted from 3318 nongated, unenhanced COPDGene CT scans. Multivariable linear and Cox regression models were used to explore the association between emphysema, venous BV5, pectoralis muscle area, and LVEV as well as the association of LVEV with health status using the St George's Respiratory Questionnaire, 6-minute walk distance, and all-cause mortality. Results The median age of the cohort was 64 years (interquartile range, 57-70 years). Of the 2423 participants, 1806 were men and 617 were African American. The median LVEV between Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 and GOLD 4 COPD was reduced by 13.9% in women and 17.7% in men (P < .001 for both). In fully adjusted models, higher emphysema percentage (β = -4.2; 95% confidence interval [CI]: -5.0, -3.4; P < .001), venous BV5 (β = 7.0; 95% CI: 5.7, 8.2; P < .001), and pectoralis muscle area (β = 2.7; 95% CI: 1.2, 4.1; P < .001) were independently associated with reduced LVEV. Reductions in LVEV were associated with improved health status (β = 0.3; 95% CI: 0.1, 0.4) and 6-minute walk distance (β = -12.2; 95% CI: -15.2, -9.3). These effects were greater in women than in men. The effect of reduced LVEV on mortality (hazard ratio: 1.07; 95% CI: 1.05, 1.09) did not vary by sex. Conclusion In women more than men with chronic obstructive pulmonary disease, a reduction in the estimated left ventricle epicardial volume correlated with a loss of pulmonary venous vasculature, greater pectoralis muscle sarcopenia, and lower all-cause mortality. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- George R Washko
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Pietro Nardelli
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Samuel Y Ash
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Farbod N Rahaghi
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Gonzalo Vegas Sanchez-Ferrero
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Carolyn E Come
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Mark T Dransfield
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Ravi Kalhan
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - MeiLan K Han
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Surya P Bhatt
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - J Michael Wells
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Carrie L Pistenmaa
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Alejandro A Diaz
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - James C Ross
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Stephen Rennard
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Gabriela Querejeta Roca
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Amil M Shah
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Kendra Young
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Gregory L Kinney
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - John E Hokanson
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Alvar Agustí
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
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- From the Division of Pulmonary and Critical Care, Department of Medicine, Applied Chest Imaging Laboratory (G.R.W., S.Y.A., F.N.R., C.E.C., C.L.P., A.A.D.), Department of Radiology, Applied Chest Imaging Laboratory (P.N., G.V.S.F., J.C.R., R.S.J.E.), Department of Anesthesia (G.Q.R.), and Division of Cardiology (A.M.S.), Brigham and Women's Hospital, 1249 Boylston St, Boston, MA 02215; Lung Health Center, University of Alabama at Birmingham, Birmingham, Ala (M.T.D., S.P.B., J.M.W.); Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (R.K.); Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Mich (M.K.H.); BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom (S.R.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Neb (S.R.); Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colo (K.Y., G.L.K., J.E.H.); and Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red Enfermedades Respiratorias, University of Barcelona, Barcelona, Spain (A.A.)
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Questions and Answers on Smoking in Patients With Diffuse ILD. Use of PICO Methodology. Arch Bronconeumol 2019; 56:435-440. [PMID: 31753676 DOI: 10.1016/j.arbres.2019.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/12/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The Smoking and the Diffuse Interstitial Lung Diseases (ILD) groups of ALAT and SEPAR collaborated in the preparation of this document. MATERIALS AND METHODS This document uses PICO methodology to answer various questions on the relationship between tobacco use and diffuse ILD. RESULTS AND CONCLUSIONS The main recommendations are: a) moderate level of evidence and strong recommendation to consider smoking as a risk factor for the development and/or modification of the progression of diffuse ILD; b) moderate level of evidence to identify an increase in mortality in diffuse ILD, irrespective of histologic pattern. Low evidence for ascribing it to smoking and strong recommendation for the early identification of patients with diffuse ILD. Further studies are needed to evaluate the effect of smoking cessation in patients with diffuse ILD; c) low level of evidence and weak recommendation for defining the impact of passive smoking in diffuse ILD; d) low level of evidence to demonstrate that smoking cessation improves the outcomes of patients diagnosed with diffuse ILD and strong recommendation to advise smoking cessation in smokers with diffuse ILD, and e) low level of evidence to support the clinical or epidemiological usefulness of active case finding for diffuse ILD in smoking cessation programs, and strong recommendation justifying the performance of spirometry in active case finding, based not on current smoking status, but on previous accumulated consumption, even in asymptomatic cases.
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Janssen K, Schertz K, Rubin N, Begnaud A. Incidental Findings in a Decentralized Lung Cancer Screening Program. Ann Am Thorac Soc 2019; 16:1198-1201. [PMID: 31251089 PMCID: PMC6812160 DOI: 10.1513/annalsats.201812-908rl] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Washko GR, Nardelli P, Ash SY, Vegas Sanchez-Ferrero G, Rahaghi FN, Come CE, Dransfield MT, Kalhan R, Han MK, Bhatt SP, Wells JM, Aaron CP, Diaz AA, Ross JC, Cuttica MJ, Labaki WW, Querejeta Roca G, Shah AM, Young K, Kinney GL, Hokanson JE, Agustí A. Arterial Vascular Pruning, Right Ventricular Size, and Clinical Outcomes in Chronic Obstructive Pulmonary Disease. A Longitudinal Observational Study. Am J Respir Crit Care Med 2019; 200:454-461. [PMID: 30758975 PMCID: PMC6701031 DOI: 10.1164/rccm.201811-2063oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023] Open
Abstract
Rationale: Cor pulmonale (right ventricular [RV] dilation) and cor pulmonale parvus (RV shrinkage) are both described in chronic obstructive pulmonary disease (COPD). The identification of emphysema as a shared risk factor suggests that additional disease characterization is needed to understand these widely divergent cardiac processes.Objectives: To explore the relationship between computed tomography measures of emphysema and distal pulmonary arterial morphology with RV volume, and their association with exercise capacity and mortality in ever-smokers with COPD enrolled in the COPDGene Study.Methods: Epicardial (myocardium and chamber) RV volume (RVEV), distal pulmonary arterial blood vessel volume (arterial BV5: vessels <5 mm2 in cross-section), and objective measures of emphysema were extracted from 3,506 COPDGene computed tomography scans. Multivariable linear and Cox regression models and the log-rank test were used to explore the association between emphysema, arterial BV5, and RVEV with exercise capacity (6-min-walk distance) and all-cause mortality.Measurements and Main Results: The RVEV was approximately 10% smaller in Global Initiative for Chronic Obstructive Lung Disease stage 4 versus stage 1 COPD (P < 0.0001). In multivariable modeling, a 10-ml decrease in arterial BV5 (pruning) was associated with a 1-ml increase in RVEV. For a given amount of emphysema, relative preservation of the arterial BV5 was associated with a smaller RVEV. An increased RVEV was associated with reduced 6-minute-walk distance and in those with arterial pruning an increased mortality.Conclusions: Pulmonary arterial pruning is associated with clinically significant increases in RV volume in smokers with COPD and is related to exercise capacity and mortality in COPD.Clinical trial registered with www.clinicaltrials.gov (NCT00608764).
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Affiliation(s)
| | | | - Samuel Y. Ash
- Division of Pulmonary and Critical Care, Department of Medicine
| | | | | | - Carolyn E. Come
- Division of Pulmonary and Critical Care, Department of Medicine
| | - Mark T. Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ravi Kalhan
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Surya P. Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - J. Michael Wells
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - James C. Ross
- Applied Chest Imaging Laboratory, Department of Radiology
| | - Michael J. Cuttica
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Amil M. Shah
- Division of Cardiovascular, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
| | | | - for the COPDGene Investigators
- Division of Pulmonary and Critical Care, Department of Medicine
- Applied Chest Imaging Laboratory, Department of Radiology
- Department of Anesthesia, and
- Division of Cardiovascular, Brigham and Women’s Hospital, Boston, Massachusetts
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama
- Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and
- Hospital Clinic Barcelona, Barcelona, Spain
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Iwasawa T, Okudela K, Takemura T, Fukuda T, Matsushita S, Baba T, Ogura T, Tajiri M, Yoshizawa A. Computer-aided Quantification of Pulmonary Fibrosis in Patients with Lung Cancer: Relationship to Disease-free Survival. Radiology 2019; 292:489-498. [DOI: 10.1148/radiol.2019182466] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hatabu H, Hunninghake GM, Lynch DA. Interstitial Lung Abnormality: Recognition and Perspectives. Radiology 2019; 291:1-3. [DOI: 10.1148/radiol.2018181684] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hiroto Hatabu
- From the Department of Radiology (H.H.) and Pulmonary and Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215; and Department of Radiology, National Jewish Medical and Research Center, Denver, Colo (D.A.L.)
| | - Gary M. Hunninghake
- From the Department of Radiology (H.H.) and Pulmonary and Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215; and Department of Radiology, National Jewish Medical and Research Center, Denver, Colo (D.A.L.)
| | - David A. Lynch
- From the Department of Radiology (H.H.) and Pulmonary and Critical Care Division (G.M.H.), Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02215; and Department of Radiology, National Jewish Medical and Research Center, Denver, Colo (D.A.L.)
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Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome. J Thorac Imaging 2019; 34:126-135. [DOI: 10.1097/rti.0000000000000393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bhatt SP, Washko GR, Hoffman EA, Newell JD, Bodduluri S, Diaz AA, Galban CJ, Silverman EK, San José Estépar R. Imaging Advances in Chronic Obstructive Pulmonary Disease. Insights from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) Study. Am J Respir Crit Care Med 2019; 199:286-301. [PMID: 30304637 PMCID: PMC6363977 DOI: 10.1164/rccm.201807-1351so] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/02/2018] [Indexed: 12/27/2022] Open
Abstract
The Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study, which began in 2007, is an ongoing multicenter observational cohort study of more than 10,000 current and former smokers. The study is aimed at understanding the etiology, progression, and heterogeneity of chronic obstructive pulmonary disease (COPD). In addition to genetic analysis, the participants have been extensively characterized by clinical questionnaires, spirometry, volumetric inspiratory and expiratory computed tomography, and longitudinal follow-up, including follow-up computed tomography at 5 years after enrollment. The purpose of this state-of-the-art review is to summarize the major advances in our understanding of COPD resulting from the imaging findings in the COPDGene study. Imaging features that are associated with adverse clinical outcomes include early interstitial lung abnormalities, visual presence and pattern of emphysema, the ratio of pulmonary artery to ascending aortic diameter, quantitative evaluation of emphysema, airway wall thickness, and expiratory gas trapping. COPD is characterized by the early involvement of the small conducting airways, and the addition of expiratory scans has enabled measurement of small airway disease. Computational advances have enabled indirect measurement of nonemphysematous gas trapping. These metrics have provided insights into the pathogenesis and prognosis of COPD and have aided early identification of disease. Important quantifiable extrapulmonary findings include coronary artery calcification, cardiac morphology, intrathoracic and extrathoracic fat, and osteoporosis. Current active research includes identification of novel quantitative measures for emphysema and airway disease, evaluation of dose reduction techniques, and use of deep learning for phenotyping COPD.
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Affiliation(s)
- Surya P. Bhatt
- UAB Lung Imaging Core and UAB Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Eric A. Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - John D. Newell
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Sandeep Bodduluri
- UAB Lung Imaging Core and UAB Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Craig J. Galban
- Department of Radiology and Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan; and
| | | | - Raúl San José Estépar
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - for the COPDGene Investigators
- UAB Lung Imaging Core and UAB Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
- Division of Pulmonary and Critical Care Medicine
- Channing Division of Network Medicine, and
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Radiology and Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan; and
- Department of Radiology, National Jewish Health, Denver, Colorado
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Grenier PA. Relationship between Interstitial Lung Abnormalities and Emphysema in Smokers with and Those without COPD. Radiology 2018; 288:610-611. [DOI: 10.1148/radiol.2018180270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Philippe A. Grenier
- From the Service de Radiologie Polyvalente et Oncologique, Sorbonne Université, Hôpital Pitié-Salpêtrière/APHP, 47/83 Boulevard de l’Hôpital, 75651 Paris Cedex 13, France
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