1
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Menson KE, Coleman SRM. Smoking and pulmonary health in women: A narrative review and behavioral health perspective. Prev Med 2024; 185:108029. [PMID: 38851402 DOI: 10.1016/j.ypmed.2024.108029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/24/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women. METHODS This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment. RESULTS Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking). CONCLUSION Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.
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Affiliation(s)
- Katherine E Menson
- Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT, USA; Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | - Sulamunn R M Coleman
- Department of Psychiatry, University of Vermont, Burlington, VT, USA; Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
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2
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Kim S, Lee KY, Siddiquee AT, Kim HJ, Nam HR, Ko CS, Kim NH, Shin C. Gender differences in association between expiratory dynamic airway collapse and severity of obstructive sleep apnea. Eur Radiol 2024; 34:3730-3741. [PMID: 37962598 PMCID: PMC11166772 DOI: 10.1007/s00330-023-10322-x] [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: 03/31/2023] [Revised: 09/13/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Repetitive unbalances and tensions generated by inspiratory efforts against an obstructive upper airway during sleep predispose the development of expiratory central airway collapse. In addition, structures of the upper airway between men and women have differences and could be the reasons for differences in obstructive sleep apnea (OSA) prevalence between genders. The present study aimed to evaluate the association between parameters of expiratory dynamic tracheal collapse measured using chest multidetector CT and objectively measured OSA severity between men and women. MATERIALS AND METHODS A total of 901 participants who underwent chest CT and overnight in-home polysomnography from the Korean Genome and Epidemiology Study were cross-sectionally analyzed (women: 46.2%). The participants were divided into three groups based on OSA severity by apnea-hypopnea index (AHI). Multivariate linear regression analysis was performed to determine the effects of central airway collapse after adjustment for cardiovascular-related covariates. RESULTS In a multivariate analysis, percentages of expiratory lumen structure reductions involving area, diameter, and perimeter were associated with AHI (all p values < 0.05) and with OSA severity (moderate-to-severe OSA than no OSA: β = 3.30%, p = 0.03; β = 2.05%, p = 0.02; β = 1.97%, p = 0.02, respectively) in women, whereas men had only a greater percentage of expiratory wall thickness reduction in moderate-to-severe OSA than no OSA (β = 0.72%, p = 0.003). In addition, women with both mild OSA and moderate-to-severe OSA had higher expiratory tracheal collapse than men without OSA, and a moderate effect of sex was observed (p for interaction = 0.007). CONCLUSION The expiratory dynamic tracheal collapse was independently associated with severity of OSA in women than in men. CLINICAL RELEVANCE STATEMENT Differences of pharyngeal structures and inherent features of airways by genders may affect the dissimilarities in vulnerability to sleep apnea between men and women. KEY POINTS • The expiratory dynamic tracheal collapse was independently associated with severity of OSA in women than in men. • Women with over mild OSA had higher expiratory tracheal collapse than men without OSA, and moderate effect of sex was observed. • Structural differences of airway may affect differences in susceptibility of sleep apnea between genders.
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Affiliation(s)
- Soriul Kim
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ki Yeol Lee
- Department of Radiology, Korea University Ansan Hospital, #123, Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Republic of Korea.
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Ali Tanweer Siddiquee
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyeon Jin Kim
- Department of Neurology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hye Ryeong Nam
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Chang Seop Ko
- Department of Radiology, Korea University Ansan Hospital, #123, Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Republic of Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Chol Shin
- Institute for Human Genomic Study, College of Medicine, Korea University, Seoul, Republic of Korea.
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Republic of Korea.
- Division of Respiratory and Critical Care, Department of Internal Medicine, Korea University Ansan Hospital, #123, Jeokgeum-Ro, Danwon-Gu, Ansan, 15355, Republic of Korea.
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3
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Pop SI, Procopciuc A, Arsintescu B, Mițariu M, Mițariu L, Pop RV, Cerghizan D, Jánosi KM. Three-Dimensional Assessment of Upper Airway Volume and Morphology in Patients with Different Sagittal Skeletal Patterns. Diagnostics (Basel) 2024; 14:903. [PMID: 38732317 PMCID: PMC11083622 DOI: 10.3390/diagnostics14090903] [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: 03/24/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The relationship between respiratory function and craniofacial morphology has garnered significant attention due to its implications for upper airway and stomatognathic development. Nasal breathing plays a key role in craniofacial growth and dental positioning. This study investigated upper airway morphology and volume differences among individuals with class I, II, and III skeletal anomalies. METHODS Ninety orthodontic patients' CBCT scans were analyzed to assess the oropharynx and hypopharynx volumes. Skeletal diagnosis was established based on the cephalometric analysis. RESULTS A significant volume change in the oropharynx and pharynx was demonstrated when comparing class II with class III anomalies (p = 0.0414, p = 0.0313). The total volume of the pharynx was increased in class III anomalies. The area of the narrowest part of the pharynx (MIN-CSA) significantly decreased in classes I and II compared to class III (p = 0.0289, p = 0.0003). Patients with Angle class III anomalies exhibited higher values in the narrowest pharyngeal segment. Gender differences were significant in pharyngeal volumes and morphologies across malocclusion classes. CONCLUSIONS The narrowest segment of the pharynx had the highest values in patients with Angle class III. The volume of the oropharynx was found to be greater in patients with Angle class III versus patients with Angle class II.
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Affiliation(s)
- Silvia Izabella Pop
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Ana Procopciuc
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Bianca Arsintescu
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Mihai Mițariu
- Faculty of Dental Medicine, Lucian Balga University, Bd-ul. Victoriei, 550024 Sibiu, Romania
| | - Loredana Mițariu
- Faculty of Dental Medicine, Lucian Balga University, Bd-ul. Victoriei, 550024 Sibiu, Romania
| | - Radu Vasile Pop
- Private Practice, Natural Smile Dental Clinic, 76 Gh Doja Str., 540232 Târgu Mureș, Romania
| | - Diana Cerghizan
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
| | - Kinga Mária Jánosi
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 38 Gh. Marinescu Str., 540139 Târgu Mureș, Romania
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Zhang X, Li F, Rajaraman PK, Comellas AP, Hoffman EA, Lin CL. Investigating distributions of inhaled aerosols in the lungs of post-COVID-19 clusters through a unified imaging and modeling approach. Eur J Pharm Sci 2024; 195:106724. [PMID: 38340875 PMCID: PMC10948263 DOI: 10.1016/j.ejps.2024.106724] [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: 12/08/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Recent studies, based on clinical data, have identified sex and age as significant factors associated with an increased risk of long COVID. These two factors align with the two post-COVID-19 clusters identified by a deep learning algorithm in computed tomography (CT) lung scans: Cluster 1 (C1), comprising predominantly females with small airway diseases, and Cluster 2 (C2), characterized by older individuals with fibrotic-like patterns. This study aims to assess the distributions of inhaled aerosols in these clusters. METHODS 140 COVID survivors examined around 112 days post-diagnosis, along with 105 uninfected, non-smoking healthy controls, were studied. Their demographic data and CT scans at full inspiration and expiration were analyzed using a combined imaging and modeling approach. A subject-specific CT-based computational model analysis was utilized to predict airway resistance and particle deposition among C1 and C2 subjects. The cluster-specific structure and function relationships were explored. RESULTS In C1 subjects, distinctive features included airway narrowing, a reduced homothety ratio of daughter over parent branch diameter, and increased airway resistance. Airway resistance was concentrated in the distal region, with a higher fraction of particle deposition in the proximal airways. On the other hand, C2 subjects exhibited airway dilation, an increased homothety ratio, reduced airway resistance, and a shift of resistance concentration towards the proximal region, allowing for deeper particle penetration into the lungs. CONCLUSIONS This study revealed unique mechanistic phenotypes of airway resistance and particle deposition in the two post-COVID-19 clusters. The implications of these findings for inhaled drug delivery effectiveness and susceptibility to air pollutants were explored.
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Affiliation(s)
- Xuan Zhang
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA; Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
| | - Frank Li
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA; Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Prathish K Rajaraman
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA; Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
| | | | - Eric A Hoffman
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA; Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Ching-Long Lin
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA; Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA; Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA; Department of Radiology, University of Iowa, Iowa City, IA, USA.
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5
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Milne KM, Mitchell RA, Ferguson ON, Hind AS, Guenette JA. Sex-differences in COPD: from biological mechanisms to therapeutic considerations. Front Med (Lausanne) 2024; 11:1289259. [PMID: 38572156 PMCID: PMC10989064 DOI: 10.3389/fmed.2024.1289259] [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: 09/05/2023] [Accepted: 02/29/2024] [Indexed: 04/05/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous respiratory condition characterized by symptoms of dyspnea, cough, and sputum production. We review sex-differences in disease mechanisms, structure-function-symptom relationships, responses to therapies, and clinical outcomes in COPD with a specific focus on dyspnea. Females with COPD experience greater dyspnea and higher morbidity compared to males. Imaging studies using chest computed tomography scans have demonstrated that females with COPD tend to have smaller airways than males as well as a lower burden of emphysema. Sex-differences in lung and airway structure lead to critical respiratory mechanical constraints during exercise at a lower absolute ventilation in females compared to males, which is largely explained by sex differences in maximum ventilatory capacity. Females experience similar benefit with respect to inhaled COPD therapies, pulmonary rehabilitation, and smoking cessation compared to males. Ongoing re-assessment of potential sex-differences in COPD may offer insights into the evolution of patterns of care and clinical outcomes in COPD patients over time.
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Affiliation(s)
- Kathryn M. Milne
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Reid A. Mitchell
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Olivia N. Ferguson
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Alanna S. Hind
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Jordan A. Guenette
- Centre for Heart Lung Innovation, The University of British Columbia and Providence Research, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
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6
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Calzetta L, Page C, Matera MG, Cazzola M, Rogliani P. Use of human airway smooth muscle in vitro and ex vivo to investigate drugs for the treatment of chronic obstructive respiratory disorders. Br J Pharmacol 2024; 181:610-639. [PMID: 37859567 DOI: 10.1111/bph.16272] [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: 08/02/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
Isolated airway smooth muscle has been extensively investigated since 1840 to understand the pharmacology of airway diseases. There has often been poor predictability from murine experiments to drugs evaluated in patients with asthma or chronic obstructive pulmonary disease (COPD). However, the use of isolated human airways represents a sensible strategy to optimise the development of innovative molecules for the treatment of respiratory diseases. This review aims to provide updated evidence on the current uses of isolated human airways in validated in vitro methods to investigate drugs in development for the treatment of chronic obstructive respiratory disorders. This review also provides historical notes on the pioneering pharmacological research on isolated human airway tissues, the key differences between human and animal airways, as well as the pivotal differences between human medium bronchi and small airways. Experiments carried out with isolated human bronchial tissues in vitro and ex vivo replicate many of the main anatomical, pathophysiological, mechanical and immunological characteristics of patients with asthma or COPD. In vitro models of asthma and COPD using isolated human airways can provide information that is directly translatable into humans with obstructive lung diseases. Regardless of the technique used to investigate drugs for the treatment of chronic obstructive respiratory disorders (i.e., isolated organ bath systems, videomicroscopy and wire myography), the most limiting factors to produce high-quality and repeatable data remain closely tied to the manual skills of the researcher conducting experiments and the availability of suitable tissue.
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Affiliation(s)
- Luigino Calzetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function Unit, University of Parma, Parma, Italy
| | - Clive Page
- Pulmonary Pharmacology Unit, Institute of Pharmaceutical Science, King's College London, London, UK
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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7
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Giacobbe G, Granata V, Trovato P, Fusco R, Simonetti I, De Muzio F, Cutolo C, Palumbo P, Borgheresi A, Flammia F, Cozzi D, Gabelloni M, Grassi F, Miele V, Barile A, Giovagnoni A, Gandolfo N. Gender Medicine in Clinical Radiology Practice. J Pers Med 2023; 13:jpm13020223. [PMID: 36836457 PMCID: PMC9966684 DOI: 10.3390/jpm13020223] [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: 12/24/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Gender Medicine is rapidly emerging as a branch of medicine that studies how many diseases common to men and women differ in terms of prevention, clinical manifestations, diagnostic-therapeutic approach, prognosis, and psychological and social impact. Nowadays, the presentation and identification of many pathological conditions pose unique diagnostic challenges. However, women have always been paradoxically underestimated in epidemiological studies, drug trials, as well as clinical trials, so many clinical conditions affecting the female population are often underestimated and/or delayed and may result in inadequate clinical management. Knowing and valuing these differences in healthcare, thus taking into account individual variability, will make it possible to ensure that each individual receives the best care through the personalization of therapies, the guarantee of diagnostic-therapeutic pathways declined according to gender, as well as through the promotion of gender-specific prevention initiatives. This article aims to assess potential gender differences in clinical-radiological practice extracted from the literature and their impact on health and healthcare. Indeed, in this context, radiomics and radiogenomics are rapidly emerging as new frontiers of imaging in precision medicine. The development of clinical practice support tools supported by artificial intelligence allows through quantitative analysis to characterize tissues noninvasively with the ultimate goal of extracting directly from images indications of disease aggressiveness, prognosis, and therapeutic response. The integration of quantitative data with gene expression and patient clinical data, with the help of structured reporting as well, will in the near future give rise to decision support models for clinical practice that will hopefully improve diagnostic accuracy and prognostic power as well as ensure a more advanced level of precision medicine.
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Affiliation(s)
- Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Piero Trovato
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Federica Flammia
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Michela Gabelloni
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
| | - Francesca Grassi
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, 80138 Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, 16149 Genoa, Italy
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Ides KM, De Backer WA, Lanclus M, Leemans G, Dierckx W, Lauwers E, Vissers D, Steckel J, De Backer JW. The effect of posture on airflow distribution, airway geometry and air velocity in healthy subjects. BMC Pulm Med 2022; 22:477. [PMID: 36522658 PMCID: PMC9753395 DOI: 10.1186/s12890-022-02276-5] [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: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gravity, and thus body position, can affect the regional distribution of lung ventilation and blood flow. Therefore, body positioning is a potential tool to improve regional ventilation, thereby possibly enhancing the effect of respiratory physiotherapy interventions. In this proof-of-concept study, functional respiratory imaging (FRI) was used to objectively assess effects of body position on regional airflow distribution in the lungs. METHODS Five healthy volunteers were recruited. The participants were asked during FRI first to lie in supine position, afterwards in standardized right lateral position. RESULTS In right lateral position there was significantly more regional ventilation also described as Imaging Airflow Distribution in the right lung than in the left lung (P < 0.001). Air velocity was significantly higher in the left lung (P < 0.05). In right lateral position there was significantly more airflow distribution in the right lung than in the left lung (P < 0.001). Significant changes were observed in airway geometry resulting in a decrease in imaged airway volume (P = 0.024) and a higher imaged airway resistance (P = 0.029) in the dependent lung. In general, the effect of right lateral position caused a significant increase in regional ventilation (P < 0.001) in the dependent lung when compared with the supine position. CONCLUSIONS Changing body position leads to significant changes in regional lung ventilation, objectively assessed by FRI The volume based on the imaging parameters in the dependent lung is smaller in the lateral position than in the supine position. In right lateral decubitus position, airflow distribution is greater in dependent lung compared to the nondependent lung. TRIAL REGISTRATION The trial has been submitted to www. CLINICALTRIALS gov with identification number NCT01893697 on 07/02/2013.
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Affiliation(s)
- Kris M. Ides
- grid.411414.50000 0004 0626 3418Department of Pediatric Medicine, Antwerp University Hospital, drie eikenstraat 655, 2650 Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,grid.5284.b0000 0001 0790 3681Cosys-Lab, Antwerp University, Flanders Make Lommel, Groenenborgerlaan 171, 2020 Antwerp, Belgium ,Medimprove Multidisciplinairy Private Practice, Groeningenlei 132C, 2550 Kontich, Belgium
| | - Wilfried A. De Backer
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,Medimprove Multidisciplinairy Private Practice, Groeningenlei 132C, 2550 Kontich, Belgium
| | - Maarten Lanclus
- grid.428659.4FLUIDDA Inc, 228 EAST 45TH Street STE 9E, New York, USA
| | - Glenn Leemans
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Wendel Dierckx
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,Medimprove Multidisciplinairy Private Practice, Groeningenlei 132C, 2550 Kontich, Belgium
| | - Eline Lauwers
- grid.476361.1FLUIDDA NV, Groeningenlei 132, 2550 Kontich, Belgium ,grid.411414.50000 0004 0626 3418Department of Pediatric Medicine, Antwerp University Hospital, drie eikenstraat 655, 2650 Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Dirk Vissers
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jan Steckel
- grid.5284.b0000 0001 0790 3681Cosys-Lab, Antwerp University, Flanders Make Lommel, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Jan W. De Backer
- grid.428659.4FLUIDDA Inc, 228 EAST 45TH Street STE 9E, New York, USA
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Bhatt SP, Bodduluri S, Nakhmani A, Kim YI, Reinhardt JM, Hoffman EA, Motahari A, Wilson CG, Humphries SM, Regan EA, DeMeo DL. Sex Differences in Airways at Chest CT: Results from the COPDGene Cohort. Radiology 2022; 305:699-708. [PMID: 35916677 PMCID: PMC9713451 DOI: 10.1148/radiol.212985] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/10/2022] [Accepted: 05/24/2022] [Indexed: 11/11/2022]
Abstract
Background The prevalence of chronic obstructive pulmonary disease (COPD) in women is fast approaching that in men, and women experience greater symptom burden. Although sex differences in emphysema have been reported, differences in airways have not been systematically characterized. Purpose To evaluate whether structural differences in airways may underlie some of the sex differences in COPD prevalence and clinical outcomes. Materials and Methods In a secondary analyses of a multicenter study of never-, current-, and former-smokers enrolled from January 2008 to June 2011 and followed up longitudinally until November 2020, airway disease on CT images was quantified using seven metrics: airway wall thickness, wall area percent, and square root of the wall thickness of a hypothetical airway with internal perimeter of 10 mm (referred to as Pi10) for airway wall; and lumen diameter, airway volume, total airway count, and airway fractal dimension for airway lumen. Least-squares mean values for each airway metric were calculated and adjusted for age, height, ethnicity, body mass index, pack-years of smoking, current smoking status, total lung capacity, display field of view, and scanner type. In ever-smokers, associations were tested between each airway metric and postbronchodilator forced expiratory volume in 1 second (FEV1)-to-forced vital capacity (FVC) ratio, modified Medical Research Council dyspnea scale, St George's Respiratory Questionnaire score, and 6-minute walk distance. Multivariable Cox proportional hazards models were created to evaluate the sex-specific association between each airway metric and mortality. Results In never-smokers (n = 420), men had thicker airway walls than women as quantified on CT images for segmental airway wall area percentage (least-squares mean, 47.68 ± 0.61 [standard error] vs 45.78 ± 0.55; difference, -1.90; P = .02), whereas airway lumen dimensions were lower in women than men after accounting for height and total lung capacity (segmental lumen diameter, 8.05 mm ± 0.14 vs 9.05 mm ± 0.16; difference, -1.00 mm; P < .001). In ever-smokers (n = 9363), men had greater segmental airway wall area percentage (least-squares mean, 52.19 ± 0.16 vs 48.89 ± 0.18; difference, -3.30; P < .001), whereas women had narrower segmental lumen diameter (7.80 mm ± 0.05 vs 8.69 mm ± 0.04; difference, -0.89; P < .001). A unit change in each of the airway metrics (higher wall or lower lumen measure) resulted in lower FEV1-to-FVC ratio, more dyspnea, poorer respiratory quality of life, lower 6-minute walk distance, and worse survival in women compared with men (all P < .01). Conclusion Airway lumen sizes quantified at chest CT were smaller in women than in men after accounting for height and lung size, and these lower baseline values in women conferred lower reserves against respiratory morbidity and mortality for equivalent changes compared with men. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Surya P. Bhatt
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Sandeep Bodduluri
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Arie Nakhmani
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Young-il Kim
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Joseph M. Reinhardt
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Eric A. Hoffman
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Amin Motahari
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Carla G. Wilson
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Stephen M. Humphries
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Elizabeth A. Regan
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
| | - Dawn L. DeMeo
- From the UAB Lung Imaging Lab (S.P.B., S.B., A.N.), UAB Lung Health
Center (S.P.B., S.B.), Division of Pulmonary, Allergy and Critical Care Medicine
(S.P.B., S.B.), Department of Electrical and Computer Engineering (A.N.), and
Division of Preventive Medicine (Y.I.K.), University of Alabama at Birmingham,
1720 2nd Ave S, THT 422, Birmingham, AL 35294; Roy J. Carver Department
of Biomedical Engineering (J.M.R.) and Department of Radiology (E.A.H., A.M.),
University of Iowa, Iowa City, Iowa; Departments of Biostatistics and
Bioinformatics (C.G.W.), Radiology (S.M.H.), and Medicine (E.A.R.), National
Jewish Health, Denver, Colo; and Channing Division of Network Medicine and the
Division of Pulmonary and Critical Care Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, Mass (D.L.D.)
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10
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Dudurych I, Muiser S, McVeigh N, Kerstjens HAM, van den Berge M, de Bruijne M, Vliegenthart R. Bronchial wall parameters on CT in healthy never-smoking, smoking, COPD, and asthma populations: a systematic review and meta-analysis. Eur Radiol 2022; 32:5308-5318. [PMID: 35192013 PMCID: PMC9279249 DOI: 10.1007/s00330-022-08600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
Objective Research on computed tomography (CT) bronchial parameter measurements shows that there are conflicting results on the values for bronchial parameters in the never-smoking, smoking, asthma, and chronic obstructive pulmonary disease (COPD) populations. This review assesses the current CT methods for obtaining bronchial wall parameters and their comparison between populations. Methods A systematic review of MEDLINE and Embase was conducted following PRISMA guidelines (last search date 25th October 2021). Methodology data was collected and summarised. Values of percentage wall area (WA%), wall thickness (WT), summary airway measure (Pi10), and luminal area (Ai) were pooled and compared between populations. Results A total of 169 articles were included for methodologic review; 66 of these were included for meta-analysis. Most measurements were obtained from multiplanar reconstructions of segmented airways (93 of 169 articles), using various tools and algorithms; third generation airways in the upper and lower lobes were most frequently studied. COPD (12,746) and smoking (15,092) populations were largest across studies and mostly consisted of men (median 64.4%, IQR 61.5 – 66.1%). There were significant differences between populations; the largest WA% was found in COPD (mean SD 62.93 ± 7.41%, n = 6,045), and the asthma population had the largest Pi10 (4.03 ± 0.27 mm, n = 442). Ai normalised to body surface area (Ai/BSA) (12.46 ± 4 mm2, n = 134) was largest in the never-smoking population. Conclusions Studies on CT-derived bronchial parameter measurements are heterogenous in methodology and population, resulting in challenges to compare outcomes between studies. Significant differences between populations exist for several parameters, most notably in the wall area percentage; however, there is a large overlap in their ranges. Key Points • Diverse methodology in measuring airways contributes to overlap in ranges of bronchial parameters among the never-smoking, smoking, COPD, and asthma populations. • The combined number of never-smoking participants in studies is low, limiting insight into this population and the impact of participant characteristics on bronchial parameters. • Wall area percent of the right upper lobe apical segment is the most studied (87 articles) and differentiates all except smoking vs asthma populations. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08600-1.
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Affiliation(s)
- Ivan Dudurych
- Department of Radiology, EB49, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands
| | - Susan Muiser
- Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Niall McVeigh
- Department of Cardiothoracic Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Huib A M Kerstjens
- Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten van den Berge
- Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marleen de Bruijne
- Department of Radiology and Nuclear Medicine, Biomedical Imaging Group Rotterdam, Erasmus MC, Rotterdam, The Netherlands
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Rozemarijn Vliegenthart
- Department of Radiology, EB49, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700RB, Groningen, The Netherlands.
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11
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Packaging and Delivery of Asthma Therapeutics. Pharmaceutics 2021; 14:pharmaceutics14010092. [PMID: 35056988 PMCID: PMC8777963 DOI: 10.3390/pharmaceutics14010092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022] Open
Abstract
Asthma is a life-altering, chronic disease of heterogenous origin that features a complex interplay of immune and environmental signaling. Although very little progress has been made in prevention, diverse types of medications and delivery systems, including nanoscale systems, have been or are currently being developed to control airway inflammation and prevent exacerbations and fibrosis. These medications are delivered through mechanical methods, with various inhalers (with benefits and drawbacks) existing, and new types offering some variety in delivery. Of particular interest is the progress being made in nanosized materials for efficient penetration into the epithelial mucus layer and delivery into the deepest parts of the lungs. Liposomes, nanoparticles, and extracellular vesicles, both natural and synthetic, have been explored in animal models of asthma and have produced promising results. This review will summarize and synthesize the latest developments in both macro-(inhaler) and micro-sized delivery systems for the purpose of treating asthma patients.
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12
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Yu N, Ma G, Duan H, Guo Y, Yu Y, Dang S. Sex-related Differences in Airway Dimensions: A Study Based on Quantitative Computed Tomography among Chinese Population. HEALTH PHYSICS 2021; 121:581-586. [PMID: 34714270 DOI: 10.1097/hp.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sex-dependent radiation injury may be related to the differences in physiological characteristics between the sexes. This study aimed to better understand variations in airway dimensions among male and female Chinese non-smokers. This study included 970 adults and 45 children who underwent chest CT. All participants were non-smokers, without current or former chronic pulmonary disease, and all underwent CT examination. The CT images were quantitatively assessed, providing airway dimensions. The differences in inner diameter, wall thickness, wall area (WA), and WA% for each airway were compared between male and female patients. Sex is an important influencing factor in airway morphological parameters. These parameters are different between men and women: men have a larger airway diameter (P < 0.05) and smaller wall area (WA%, P < 0.05) compared with women. Younger women (<35 years) have a greater diameter and smaller WA% compared with older women (P < 0.05). Sex-related differences in airway morphology were not observed in pediatric participants. Significant differences were found in quantitative CT measures of WA% and an internal diameter among non-smokers of varying sex. The differences found in this study might explain, in part, sex-dependency of radiation injury and a possible radiological protection scheme.
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Affiliation(s)
- Nan Yu
- Radiology Department, Shaanxi University of Chinese, Western Road, 2#, Xian Yang, China
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13
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Evaluation of sex-based differences in airway size and the physiological implications. Eur J Appl Physiol 2021; 121:2957-2966. [PMID: 34331574 DOI: 10.1007/s00421-021-04778-2] [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: 02/18/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
Recent evidence suggests healthy females have significantly smaller central conducting airways than males when matched for either height or lung volume during analysis. This anatomical sex-based difference could impact the integrative response to exercise. Our review critically evaluates the literature on direct and indirect techniques to measure central conducting airway size and their limitations. We present multiple sources highlighting the difference between male and female central conducting airway size in both pediatric and adult populations. Following the discussion of measurement techniques and results, we discuss the functional implications of these differences in central conducting airway size, including work of breathing, oxygen cost of breathing, and how these impacts will continue into elderly populations. We then discuss a range of topics for the future direction of airway differences and the benefits they could provide to both healthy and diseased populations. Specially, these sex-differences in central conducting airway size could result in different aerosol deposition or how lung disease manifests. Finally, we detail emerging techniques that uniquely allow for high-resolution imaging to be paired with detailed physiological measures.
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14
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Kim NN. Close Encounters in the World of Women's Sexual Health: An Alien's Journey. Sex Med Rev 2021; 9:359-364. [PMID: 34246428 DOI: 10.1016/j.sxmr.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Stanford D, Kim H, Bodduluri S, LaFontaine J, Byzek SA, Schoeb TR, Harris ES, Nath HP, Bhatt SP, Raju SV, Rowe SM. Airway remodeling in ferrets with cigarette smoke-induced COPD using µCT imaging. Am J Physiol Lung Cell Mol Physiol 2020; 319:L11-L20. [PMID: 32374671 PMCID: PMC7468842 DOI: 10.1152/ajplung.00328.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022] Open
Abstract
Structural changes to airway morphology, such as increased bronchial wall thickness (BWT) and airway wall area, are cardinal features of chronic obstructive pulmonary disease (COPD). Ferrets are a recently established animal model uniquely exhibiting similar clinical and pathological characteristics of COPD as humans, including chronic bronchitis. Our objective was to develop a microcomputed tomography (µCT) method for evaluating structural changes to the airways in ferrets and assess whether the effects of smoking induce changes consistent with chronic bronchitis in humans. Ferrets were exposed to mainstream cigarette smoke or air control twice daily for 6 mo. µCT was conducted in vivo at 6 mo; a longitudinal cohort was imaged monthly. Manual measurements of BWT, luminal diameter (LD), and BWT-to-LD ratio (BWT/LD) were conducted and confirmed by a semiautomated algorithm. The square root of bronchial wall area (√WA) versus luminal perimeter was determined on an individual ferret basis. Smoke-exposed ferrets reproducibly demonstrated 34% increased BWT (P < 0.001) along with increased LD and BWT/LD versus air controls. Regression indicated that the effect of smoking on BWT persisted despite controlling for covariates. Semiautomated measurements replicated findings. √WA for the theoretical median airway luminal perimeter of 4 mm (Pi4) was elevated 4.4% in smoke-exposed ferrets (P = 0.015). Increased BWT and Pi4 developed steadily over time. µCT-based airway measurements in ferrets are feasible and reproducible. Smoke-exposed ferrets develop increased BWT and Pi4, changes similar to humans with chronic bronchitis. µCT can be used as a significant translational platform to measure dynamic airway morphological changes.
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Affiliation(s)
- Denise Stanford
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harrison Kim
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sandeep Bodduluri
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer LaFontaine
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stephen A Byzek
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Trenton R Schoeb
- Genetics and Animal Resources Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elex S Harris
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hrudaya P Nath
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Surya P Bhatt
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, Alabama
| | - S Vamsee Raju
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven M Rowe
- Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
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16
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Leemans G, Belmans D, Van Holsbeke C, Kushnarev V, Sugget J, Ides K, Vissers D, De Backer W. A Functional Respiratory Imaging Approach to the Effect of an Oscillating Positive Expiratory Pressure Device in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1261-1268. [PMID: 32581531 PMCID: PMC7280059 DOI: 10.2147/copd.s242191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/03/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) patients are prone to suffer from chronic bronchitis, which ultimately affects their quality of life and overall prognosis. Oscillating positive expiratory pressure (oPEP) devices are designed to aid in the mucus clearance by generating positive pressure pulses in the airways. The main aim of this study was to analyze the impact of a specific oPEP device - Aerobika® - on top of standard of care medication in COPD patients' lung dynamics and drug deposition. Patients and Methods In this single-arm pilot study, patients were assessed using standard spirometry tests and functional respiratory imaging (FRI) before and after a period of 15±3 days of using the oPEP device twice daily (before their standard medication). Results The utilization of the oPEP device led to a significant increase of 2.88% in specific airway volume after two weeks (1.44 (SE: 0.18) vs 1.48 (SE: 0.19); 95% CI = [0.03%,5.81%]; p=0.048). Moreover, the internal airflow distribution (IAD) was affected by the treatment: patients' changes ranged from -6.74% to 4.51%. Furthermore, IAD changes at the lower lobes were also directly correlated with variations in forced expiratory volume in one second and peak expiratory flow; conversely, IAD changes at the upper lobes were inversely correlated with these clinical parameters. Interestingly, this change in IAD was significantly correlated with changes in lobar drug deposition (r 2=0.30, p<0.001). Conclusion Our results support that the Aerobika device utilization leads to an improved airflow, which in turn causes a shift in IAD and impacts the drug deposition patterns of the concomitant medication in patients with COPD.
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Affiliation(s)
- Glenn Leemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Wilrijk, Belgium.,FLUIDDA nv, Antwerp, Kontich, Belgium
| | | | | | | | - Jason Sugget
- Trudell Medical International, London, Ontario, Canada
| | - Kris Ides
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Wilrijk, Belgium
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Wilrijk, Belgium
| | - Wilfried De Backer
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Wilrijk, Belgium
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Vasilescu DM, Phillion AB, Kinose D, Verleden SE, Vanaudenaerde BM, Verleden GM, Van Raemdonck D, Stevenson CS, Hague CJ, Han MK, Cooper JD, Hackett TL, Hogg JC. Comprehensive stereological assessment of the human lung using multiresolution computed tomography. J Appl Physiol (1985) 2020; 128:1604-1616. [PMID: 32298211 DOI: 10.1152/japplphysiol.00803.2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The application of stereology to lung casts and two-dimensional microscopy images is the gold standard for quantification of the human lung anatomy. However, these techniques are labor intensive, involving fixation, embedding, and histological sectioning of samples and thus have prevented comprehensive studies. Our objective was to demonstrate the application of stereology to volumetric multiresolution computed tomography (CT) to efficiently and extensively quantify the human lung anatomy. Nontransplantable donor lungs from individuals with no evidence of respiratory disease (n = 13) were air inflated, frozen at 10 cmH2O, and scanned using CT. Systematic uniform random samples were taken, scanned using micro-CT, and assessed using stereology. The application of stereology to volumetric CT imaging enabled comprehensive quantification of total lung volume, volume fractions of alveolar, alveolar duct, and tissue, mean linear intercept, alveolar surface area, alveolar surface area density, septal wall thickness, alveolar number, number-weighted mean alveolar volume, and the number and morphometry of terminal and transitional bronchioles. With the use of this data set, we found that women and men have the same number of terminal bronchioles (last generation of conducting airways), but men have longer terminal bronchioles, a smaller wall area percentage, and larger lungs due to a greater number of alveoli per acinus. The application of stereology to multiresolution CT imaging enables comprehensive analysis of the human lung parenchyma that identifies differences between men and women. The reported data set of normal donor lungs aged 25-77 yr provides reference data for future studies of chronic lung disease to determine exact changes in tissue pathology.NEW & NOTEWORTHY Stereology has been the gold standard to quantify the three-dimensional lung anatomy using two-dimensional microscopy images. However, such techniques are labor intensive. This study provides a method that applies stereology to volumetric computed tomography images of frozen whole human lungs and systematic uniform random samples. The method yielded a comprehensive data set on the small airways and parenchymal lung structures, highlighting morphometric sex differences and providing a reference data set for future pathological studies.
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Affiliation(s)
- Dragoş M Vasilescu
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - André B Phillion
- Department of Materials Science and Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Daisuke Kinose
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stijn E Verleden
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | - Geert M Verleden
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | - Dirk Van Raemdonck
- Leuven Lung Transplant Unit, Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven-Gasthuisberg, Leuven, Belgium
| | | | - Cameron J Hague
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Joel D Cooper
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tillie-Louise Hackett
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Bhatt SP, Washko GR, Hoffman EA, Newell JD, Bodduluri S, Diaz AA, Galban CJ, Silverman EK, San José Estépar R, Lynch DA. 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 DOI: 10.1164/rccm.201807-1351so] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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
- 1 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
- 3 Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - John D Newell
- 3 Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Sandeep Bodduluri
- 1 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
- 4 Department of Radiology and Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan; and
| | | | - Raúl San José Estépar
- 6 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David A Lynch
- 7 Department of Radiology, National Jewish Health, Denver, Colorado
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19
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Maselli DJ, Bhatt SP, Anzueto A, Bowler RP, DeMeo DL, Diaz AA, Dransfield MT, Fawzy A, Foreman MG, Hanania NA, Hersh CP, Kim V, Kinney GL, Putcha N, Wan ES, Wells JM, Westney GE, Young KA, Silverman EK, Han MK, Make BJ. Clinical Epidemiology of COPD: Insights From 10 Years of the COPDGene Study. Chest 2019; 156:228-238. [PMID: 31154041 PMCID: PMC7198872 DOI: 10.1016/j.chest.2019.04.135] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/08/2019] [Accepted: 04/28/2019] [Indexed: 12/16/2022] Open
Abstract
The Genetic Epidemiology of COPD (COPDGene) study is a noninterventional, multicenter, longitudinal analysis of > 10,000 subjects, including smokers with a ≥ 10 pack-year history with and without COPD and healthy never smokers. The goal was to characterize disease-related phenotypes and explore associations with susceptibility genes. The subjects were extensively phenotyped with the use of comprehensive symptom and comorbidity questionnaires, spirometry, CT scans of the chest, and genetic and biomarker profiling. The objective of this review was to summarize the major advances in the clinical epidemiology of COPD from the first 10 years of the COPDGene study. We highlight the influence of age, sex, and race on the natural history of COPD, and the impact of comorbid conditions, chronic bronchitis, exacerbations, and asthma/COPD overlap.
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Affiliation(s)
- Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, UT Health San Antonio, and South Texas Veterans Health System, San Antonio, TX
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Antonio Anzueto
- Division of Pulmonary Diseases and Critical Care, UT Health San Antonio, and South Texas Veterans Health System, San Antonio, TX
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilyn G Foreman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor Kim
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily S Wan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; VA Boston Healthcare System, Jamaica Plain, MA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gloria E Westney
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.
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20
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Engle ML, Monk JN, Jania CM, Martin JR, Gomez JC, Dang H, Parker JS, Doerschuk CM. Dynamic changes in lung responses after single and repeated exposures to cigarette smoke in mice. PLoS One 2019; 14:e0212866. [PMID: 30818335 PMCID: PMC6395068 DOI: 10.1371/journal.pone.0212866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Cigarette smoke is well recognized to cause injury to the airways and the alveolar walls over time. This injury usually requires many years of exposure, suggesting that the lungs may rapidly develop responses that initially protect it from this repetitive injury. Our studies tested the hypotheses that smoke induces an inflammatory response and changes in mRNA profiles that are dependent on sex and the health status of the lung, and that the response of the lungs to smoke differs after 1 day compared to 5 days of exposure. Male and female wildtype (WT) and Scnn1b-transgenic (βENaC) mice, which have chronic bronchitis and emphysematous changes due to dehydrated mucus, were exposed to cigarette smoke or sham air conditions for 1 or 5 days. The inflammatory response and gene expression profiles were analyzed in lung tissue. Overall, the inflammatory response to cigarette smoke was mild, and changes in mediators were more numerous after 1 than 5 days. βENaC mice had more airspace leukocytes than WT mice, and smoke exposure resulted in additional significant alterations. Many genes and gene sets responded similarly at 1 and 5 days: genes involved in oxidative stress responses were upregulated while immune response genes were downregulated. However, certain genes and biological processes were regulated differently after 1 compared to 5 days. Extracellular matrix biology genes and gene sets were upregulated after 1 day but downregulated by 5 days of smoke compared to sham exposure. There was no difference in the transcriptional response to smoke between WT and βENaC mice or between male and female mice at either 1 or 5 days. Taken together, these studies suggest that the lungs rapidly alter gene expression after only one exposure to cigarette smoke, with few additional changes after four additional days of repeated exposure. These changes may contribute to preventing lung damage.
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Affiliation(s)
- Michelle L. Engle
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Curriculum in Genetics and Molecular Biology, University of North Carolina, Chapel Hill, NC, United States of America
| | - Justine N. Monk
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Pathobiology and Translational Science Graduate Program, University of North Carolina, Chapel Hill, NC, United States of America
| | - Corey M. Jania
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States of America
| | - Jessica R. Martin
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
| | - John C. Gomez
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
| | - Joel S. Parker
- Department of Genetics, University of North Carolina, Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Claire M. Doerschuk
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC, United States of America
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States of America
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21
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Abstract
BACKGROUND Smoking for a long period is known to cause several harms to the human body, chiefly associated with serious pulmonary damage. OBJECTIVE The purpose of this study was to evaluate the difference in the pulmonary damage between current smokers and ex-smokers, through measuring the bronchial parameters and the extent of emphysema, in order to further illustrate the harm of smoking and the need to stop smoking. METHODS Using the FACT-Digital lung TM software quantitatively analysis of CT images, including the WT, WA%, LD, LV, PD, and %LAA-950 was performed. The percentage of low attenuation areas less than -950 Hounsfield units (%LAA-950) was defined as the extent of emphysema. The longitudinal data in the two consecutive years of these current smoker group and ex-smoker group were compared by paired t-test. RESULTS The LV, %LAA-950, WT and WA% of current smokers increased more rapidly each year than that of ex-smokers. The PD and LD of current smokers declined more rapidly each year than that of ex-smokers. CONCLUSIONS This study shows that pulmonary damage caused by smoking related to the smoking status, can be measured. Smoking cessation has a positive role in alleviating the progress of pulmonary damage.
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Affiliation(s)
- Yan Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi, China
| | - Yongliang Dai
- Department of Radiology, The Weapons Industry of 521 Hospital, Xi'an, Shannxi, China
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi, China
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22
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Li Y, Dai YL, Yu N, Guo YM. Sex-related differences in bronchial parameters and pulmonary function test results in patients with chronic obstructive pulmonary disease based on three-dimensional quantitative computed tomography. J Int Med Res 2017; 46:135-142. [PMID: 28758847 PMCID: PMC6011288 DOI: 10.1177/0300060517721309] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study was performed to evaluate the effect of sex on bronchial parameters and the predicted forced expiratory volume in 1 s expressed as a percentage of the forced vital capacity (FEV1% pred) on pulmonary function testing. Methods The data of 359 patients with chronic obstructive pulmonary disease (COPD) with available FEV1% pred and computed tomography (CT) images were retrospectively reviewed. FACT-Digital lung TM software (DeXin, Xi’an, China) was used to perform fully automated three-dimensional CT quantitative measurements of the bronchi. Generation 5 to 7 bronchi were measured, and the parameters analyzed were the lumen diameter (LD), wall thickness (WT), lumen area (LA), and WA% [WA / (WA + LA) × 100%]. Results In the smoking, smoking cessation, and nonsmoking groups, women had a significantly larger WA% and smaller LD, WT, and LA than men. The FEV1% pred was significantly lower in women than men in the smoking and smoking cessation groups. The FEV1% pred was significantly higher in women than men in the nonsmoking group. Conclusion Sex-related differences may partially explain why smoking women experience more severe pulmonary function impairment than men among patients with COPD.
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Affiliation(s)
- Yan Li
- 1 Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yong-Liang Dai
- 2 Department of Radiology, Weapons Industry of 521 Hospital, Xi'an, China
| | - Nan Yu
- 3 Department of Radiology, First Affiliated Hospital of Shaanxi Chinese Medicine University, Xi'an, China
| | - You-Min Guo
- 1 Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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23
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Hong Y, Ji W, An S, Han SS, Lee SJ, Kim WJ. Sex differences of COPD phenotypes in nonsmoking patients. Int J Chron Obstruct Pulmon Dis 2016; 11:1657-62. [PMID: 27524891 PMCID: PMC4965225 DOI: 10.2147/copd.s108343] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is growing evidence about sex-related phenotypes of COPD. However, the sex differences in COPD mainly result from smokers. This study evaluated the sex differences in nonsmoking patients with COPD, focusing on structural changes in the lungs in airway diseases and emphysema. METHODS Ninety-seven nonsmoking patients, defined as having <1 pack-year of lifetime cigarette smoking, diagnosed with COPD were selected from a Korean COPD cohort. Emphysema extent and mean wall area percentage (WA%) on computed tomography were compared between the male and female groups. RESULTS The 97 patients with COPD included 62 females and 35 males. Emphysema index was significantly lower (3.5±4.2 vs 6.2±5.7, P<0.01) and mean WA% on computed tomography was significantly higher (71.8%±5% vs 69.4%±5%, P<0.01) in females than in males, after adjusting for age, body mass index, history of biomass exposure, and postbronchodilator forced expiratory volume in 1 second (% of predicted). CONCLUSION WA% was higher and emphysema extent was lower in nonsmoking females with COPD than in nonsmoking males with COPD. These findings suggest that males may be predisposed to an emphysema phenotype and females may be predisposed to an airway phenotype of COPD.
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Affiliation(s)
- Yoonki Hong
- Department of Internal Medicine, Environmental Health Center, Kangwon National University Hospital, Chuncheon, South Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soojeong An
- Department of Statistics, Kangwon National University, Chuncheon, South Korea
| | - Seon-Sook Han
- Department of Internal Medicine, Environmental Health Center, Kangwon National University Hospital, Chuncheon, South Korea
| | - Seung-Joon Lee
- Department of Internal Medicine, Environmental Health Center, Kangwon National University Hospital, Chuncheon, South Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Environmental Health Center, Kangwon National University Hospital, Chuncheon, South Korea
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24
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Park H, Jung SY, Lee K, Bae WK, Lee K, Han JS, Kim S, Choo S, Jeong JM, Kim HR, Ro HJ, Jeong H. Prevalence of chronic obstructive lung disease in Korea using data from the fifth Korea national health and nutrition examination survey. Korean J Fam Med 2015; 36:128-34. [PMID: 26019762 PMCID: PMC4445052 DOI: 10.4082/kjfm.2015.36.3.128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/05/2015] [Indexed: 11/21/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of death worldwide. The awareness and treatment rate of the disease are low despite its relatively high prevalence. With the added data, this study aimed to identify changes in prevalence and risk factors of COPD using the data from the 5th KNHNES. Methods The subjects of this study were 8,969 individuals aged 40 and older who satisfied suitability and reproducibility for pulmonary function tests. The prevalence, awareness and risk factors of COPD were predicted based on the questionnaires on gender, age, educational level, income level, smoking history, body mass index (BMI) and other COPD related questions. Results Diagnosis of COPD was based on the airflow limitation (forced expiratory volume in one second/forced vital capacity <0.7) of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The prevalence of COPD from 2010 to 2012 was 13.7%, of which 23.3% was men and 6.5% women. The prevalence was on the rise, with 12.2% in 2010, 13.2% in 2011, and 15.5% in 2012. In GOLD stage 1, the percentages of those who had cough or sputum and smoking history were 12.1% and 75.5%, respectively, but only 0.1% was diagnosed with COPD. Even after adjusting for asthma and tuberculosis, men, old age, larger amount of smoking were linked with a higher prevalence of COPD, and obese and higher educational level were associated with a lower prevalence of COPD. Conclusion The prevalence of COPD in Korea has been increasing every year, and a higher prevalence was associated with male, older age, more amount of smoking, lower educational level and lower BMI.
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Affiliation(s)
- Hwayeon Park
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Young Jung
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Kyung Bae
- Department of Family Medicine, Health Promotion Center, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keehyuck Lee
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Soo Han
- Department of Family Medicine, Health Promotion Center, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sarah Kim
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seryung Choo
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Mook Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Ray Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun Jung Ro
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hansol Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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Camiciottoli G, Diciotti S, Bigazzi F, Lombardo S, Bartolucci M, Paoletti M, Mascalchi M, Pistolesi M. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD? Int J Chron Obstruct Pulmon Dis 2015; 10:843-52. [PMID: 25960647 PMCID: PMC4423505 DOI: 10.2147/copd.s80558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A substantial proportion of patients with chronic obstructive pulmonary disease (COPD) develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory-expiratory low dose computed tomography (CT) and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28) and in females (n=27). Women with a predominant conductive airway phenotype (n=10) showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001). Intrathoracic tracheal collapsibility was directly correlated with inspiratory-expiratory volume variation at CT and with forced expiratory volume (1 second), and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD are closely correlated. In patients with a predominant emphysematous phenotype, a reduced collapsibility may reflect the mechanical properties of the stiff hyperinflated emphysematous lung. The high collapsibility in patients with predominant airway disease, mild airway obstruction, and in women with this phenotype may reflect chronic airway inflammation. The lack of relationship with such symptoms as wheezing, cough, and dyspnea could indicate that intrathoracic tracheal collapsibility itself should be considered neither an abnormal feature of COPD nor a relevant clinical finding.
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Affiliation(s)
- Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, Cesena, Italy
| | - Francesca Bigazzi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Simone Lombardo
- Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Maurizio Bartolucci
- Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy
| | - Matteo Paoletti
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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26
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Chronic respiratory symptoms associated with airway wall thickening measured by thin-slice low-dose CT. AJR Am J Roentgenol 2014; 203:W383-90. [PMID: 25247967 DOI: 10.2214/ajr.13.11536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In lung cancer screening, the prevalence of chronic respiratory symptoms is high among heavy smokers. The purpose of this study was to compare CT-derived airway wall measurements between male smokers with and those without chronic respiratory symptoms. MATERIALS AND METHODS Fifty male heavy smokers with chronic respiratory symptoms (cough, excessive mucus secretion, dyspnea, and wheezing) and 50 without any respiratory symptom were randomly selected from the Dutch-Belgian Randomized Lung Cancer Screening Trial. Thin-slice low-dose CT images were evaluated with dedicated software for airway measurements. Wall area percentage and airway wall thickness were measured from trachea to bronchi in five different pulmonary lobes of airways with a luminal diameter of 5 mm or greater. Association between airway wall measurements and respiratory symptoms was analyzed by multiple linear regression adjusted for age, body mass index, smoking status, emphysema, and pulmonary function. RESULTS After adjustment for relevant factors, a significant positive association between airway wall measurements and respiratory symptoms was found in airways with a luminal diameter between 5 to 10 mm (p < 0.01), but not in airways measuring 10 mm or greater (p > 0.05). At the airway level between 5 to 10 mm, the mean wall area percentages were 51.5% ± 7.9%. Airway wall thicknesses were 1.54 ± 0.39 mm and 1.37 ± 0.35 mm (p < 0.001). CONCLUSION Male heavy smokers with chronic respiratory symptoms in lung cancer screening, who are at high-risk of chronic bronchitis, have bronchial wall thickening in airways with a luminal diameter of 5-10 mm but not in larger airways.
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Bowler RP, Kim V, Regan E, Williams AAA, Santorico SA, Make BJ, Lynch DA, Hokanson JE, Washko GR, Bercz P, Soler X, Marchetti N, Criner GJ, Ramsdell J, Han MK, Demeo D, Anzueto A, Comellas A, Crapo JD, Dransfield M, Wells JM, Hersh CP, MacIntyre N, Martinez F, Nath HP, Niewoehner D, Sciurba F, Sharafkhaneh A, Silverman EK, van Beek EJR, Wilson C, Wendt C, Wise RA. Prediction of acute respiratory disease in current and former smokers with and without COPD. Chest 2014; 146:941-950. [PMID: 24945159 PMCID: PMC4188150 DOI: 10.1378/chest.13-2946] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/21/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The risk factors for acute episodes of respiratory disease in current and former smokers who do not have COPD are unknown. METHODS Eight thousand two hundred forty-six non-Hispanic white and black current and former smokers in the Genetic Epidemiology of COPD (COPDGene) cohort had longitudinal follow-up (LFU) every 6 months to determine acute respiratory episodes requiring antibiotics or systemic corticosteroids, an ED visit, or hospitalization. Negative binomial regression was used to determine the factors associated with acute respiratory episodes. A Cox proportional hazards model was used to determine adjusted hazard ratios (HRs) for time to first episode and an acute episode of respiratory disease risk score. RESULTS At enrollment, 4,442 subjects did not have COPD, 658 had mild COPD, and 3,146 had moderate or worse COPD. Nine thousand three hundred three acute episodes of respiratory disease and 2,707 hospitalizations were reported in LFU (3,044 acute episodes of respiratory disease and 827 hospitalizations in those without COPD). Major predictors included acute episodes of respiratory disease in year prior to enrollment (HR, 1.20; 95% CI, 1.15-1.24 per exacerbation), airflow obstruction (HR, 0.94; 95% CI, 0.91-0.96 per 10% change in % predicted FEV1), and poor health-related quality of life (HR, 1.07; 95% CI, 1.06-1.08 for each 4-unit increase in St. George's Respiratory Questionnaire score). Risks were similar for those with and without COPD. CONCLUSIONS Although acute episode of respiratory disease rates are higher in subjects with COPD, risk factors are similar, and at a population level, there are more episodes in smokers without COPD.
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Affiliation(s)
| | - Victor Kim
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA
| | | | | | - Stephanie A Santorico
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO
| | - Barry J Make
- Department of Medicine, National Jewish Health, Denver, CO
| | - David A Lynch
- Department of Medicine, National Jewish Health, Denver, CO
| | - John E Hokanson
- Department of Medicine and the Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - George R Washko
- Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Peter Bercz
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA
| | - Xavier Soler
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California at San Diego, La Jolla, CA
| | - Nathaniel Marchetti
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA
| | - Gerard J Criner
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Temple University, Philadelphia PA
| | - Joe Ramsdell
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California at San Diego, La Jolla, CA
| | - MeiLan K Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Dawn Demeo
- Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Antonio Anzueto
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, TX
| | | | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO
| | | | | | - Craig P Hersh
- Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Fernando Martinez
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | | | - Frank Sciurba
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Edwin K Silverman
- Channing Division of Network Medicine, Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Edwin J R van Beek
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, Scotland
| | - Carla Wilson
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO
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Ratios of peripheral-to-central airway lumen area and percentage wall area as predictors of severity of chronic obstructive pulmonary disease. AJR Am J Roentgenol 2014; 203:78-84. [PMID: 24951198 DOI: 10.2214/ajr.13.11748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the ability of the ratios of peripheral-to-central airway lumen area (hereafter referred to as LA) and percentage wall area (hereafter referred to as %WA) to predict the severity of chronic obstructive pulmonary disease (COPD) according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. SUBJECTS AND METHODS We examined 32 patients (27 men and five women; mean age ± SD, 70.0 ± 6.8 years; seven GOLD stage 0 [at risk for COPD], 19 GOLD stage 1-2 [mild to moderate airflow limitation], and six GOLD stage 3-4 [severe to very severe airflow limitation]) using inspiratory CT. Mean LA and %WA were measured for the first (main bronchi), third, and fifth generations of five bronchi in each lobe and the ratios of peripheral to central airways were calculated (third to first, fifth to first, and fifth to third) and statistically compared. RESULTS The fifth-generation LA, LA fifth to first, and LA fifth to third significantly decreased and fifth %WA, %WA fifth to first, and %WA fifth to third also increased with progression of GOLD stage (p < 0.05), but central measurements, including first and third generations, did not. There were significant differences between GOLD 0 and GOLD 1-2 for %WA fifth to third and LA fifth to third and between GOLD 0 and GOLD 3-4 for all six parameters (p < 0.05); %WA fifth to third had the best cutoff value of 1.02 (sensitivity, 92%; specificity, 86%) for diagnosis of COPD (GOLD 1-4). The %WA fifth to first of 1.51 (sensitivity, 83%; specificity, 89%) was best for diagnosis of GOLD 3-4. CONCLUSION Ratios of peripheral-to-central airway LA and %WA show improved correlation with COPD severity.
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Hardin M, Cho M, McDonald ML, Beaty T, Ramsdell J, Bhatt S, van Beek EJR, Make BJ, Crapo JD, Silverman EK, Hersh CP. The clinical and genetic features of COPD-asthma overlap syndrome. Eur Respir J 2014; 44:341-50. [PMID: 24876173 DOI: 10.1183/09031936.00216013] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Individuals with chronic obstructive pulmonary disease (COPD) and asthma are an important but poorly characterised group. The genetic determinants of COPD and asthma overlap have not been studied. The aim of this study was to identify clinical features and genetic risk factors for COPD and asthma overlap. Subjects were current or former smoking non-Hispanic whites or African-Americans with COPD. Overlap subjects reported a history of physician-diagnosed asthma before the age of 40 years. We compared clinical and radiographic features between COPD and overlap subjects. We performed genome-wide association studies (GWAS) in the non-Hispanic whites and African-American populations, and combined these results in a meta-analysis. More females and African-Americans reported a history of asthma. Overlap subjects had more severe and more frequent respiratory exacerbations, less emphysema and greater airway wall thickness compared to subjects with COPD alone. The non-Hispanic white GWAS identified single nucleotide polymorphisms in the genes CSMD1 (rs11779254, p=1.57 × 10(-6)) and SOX5 (rs59569785, p=1.61 × 10(-6)) and the meta-analysis identified single nucleotide polymorphisms in the gene GPR65 (rs6574978, p=1.18 × 10(-7)) associated with COPD and asthma overlap. Overlap subjects have more exacerbations, less emphysema and more airway disease for any degree of lung function impairment compared to COPD alone. We identified novel genetic variants associated with this syndrome. COPD and asthma overlap is an important syndrome and may require distinct clinical management.
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Affiliation(s)
- Megan Hardin
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Merry-Lynn McDonald
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Terri Beaty
- Dept of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Joe Ramsdell
- Dept of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Surya Bhatt
- Dept of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, AL, USA
| | - Edwin J R van Beek
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Barry J Make
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - James D Crapo
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Tam A, Sin DD. Why are women more vulnerable to chronic obstructive pulmonary disease? Expert Rev Respir Med 2014; 7:197-9. [PMID: 23734641 DOI: 10.1586/ers.13.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Janssen WJ, Yunt ZX, Muldrow A, Kearns MT, Kloepfer A, Barthel L, Bratton DL, Bowler RP, Henson PM. Circulating hematopoietic progenitor cells are decreased in COPD. COPD 2013; 11:277-89. [PMID: 24182349 DOI: 10.3109/15412555.2013.841668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
RATIONALE Bone marrow derived progenitor cells participate in the repair of injured vessels. The lungs of individuals with emphysema have reduced alveolar capillary density and increased endothelial apoptosis. We hypothesized that circulating levels of endothelial and hematopoietic progenitor cells would be reduced in this group of patients. OBJECTIVES The goal of this study was to measure circulating levels of endothelial progenitor cells (EPCs) and hematopoietic progenitor cells (HPCs) in subjects with COPD and to determine if progenitor levels correlated with disease severity and the presence of emphysema. METHODS Peripheral blood mononuclear cells were isolated from 61 patients with COPD and 32 control subjects. Levels of EPCs (CD45(dim) CD34+) and HPCs (CD45(+) CD34(+) VEGF-R2(+)) were quantified using multi-parameter flow cytometry. Progenitor cell function was assessed using cell culture assays. All subjects were evaluated with spirometry and CT scanning. MEASUREMENTS AND MAIN RESULTS HPC levels were reduced in subjects with COPD compared to controls, whereas circulating EPC levels were similar between the two groups. HPC levels correlated with severity of obstruction and were lowest in subjects with severe emphysema. These associations remained after correction for factors known to affect progenitor cell levels including age, smoking status, the use of statin medications and the presence of coronary artery disease. The ability of mononuclear cells to form endothelial cell colony forming units (EC-CFU) was also reduced in subjects with COPD. CONCLUSIONS HPC levels are reduced in subjects with COPD and correlate with emphysema phenotype and severity of obstruction. Reduction of HPCs may disrupt maintenance of the capillary endothelium, thereby contributing to the pathogenesis of COPD.
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Affiliation(s)
- William J Janssen
- 1Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
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Bowler RP, Bahr TM, Hughes G, Lutz S, Kim YI, Coldren CD, Reisdorph N, Kechris KJ. Integrative omics approach identifies interleukin-16 as a biomarker of emphysema. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2013; 17:619-26. [PMID: 24138069 DOI: 10.1089/omi.2013.0038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Interleukin-16 (IL-16) is a multifunctional cytokine that has been associated with autoimmune and allergic diseases. To investigate comprehensively whether IL-16 is also associated with chronic obstructive pulmonary disease (COPD) and emphysema, we performed an integrated analysis of multiple "omics" data. Over 500 subjects participating in the COPDGene® study donated blood and were clinically characterized and genetically profiled. IL-16 mRNA levels were measured in peripheral blood mononuclear cells (PBMC), and protein levels were measured in fresh frozen plasma. A multivariate analysis found plasma IL-16 positively associated with age and body mass index, and negatively associated with current smoking and emphysema in the upper lobes. PBMC IL-16 expression was positively associated with gender and a composite score for airflow obstruction, emphysema, and gas trapping. Whole-genome expression quantitative trait locus (eQTL) analysis identified a novel IL-16 missense SNP (rs11556218) associated with lower IL-16 in plasma. In summary, an integrated "omics" analysis in a very large cohort identified an association between decreased IL-16 and emphysema and discovered a novel IL-16 cis-eQTL. Thus IL-16 plasma levels and IL-16 genotyping may be useful in a personalized medicine approach for lung disease.
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Affiliation(s)
- Russell P Bowler
- 1 Department of Medicine, National Jewish Health , Denver, Colorado
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Diaz AA, Han MK, Come CE, San José Estépar R, Ross JC, Kim V, Dransfield MT, Curran-Everett D, Schroeder JD, Lynch DA, Tschirren J, Silverman EK, Washko GR. Effect of emphysema on CT scan measures of airway dimensions in smokers. Chest 2013; 143:687-693. [PMID: 23460155 DOI: 10.1378/chest.12-0039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In CT scans of smokers with COPD, the subsegmental airway wall area percent (WA%) is greater and more strongly correlated with FEV1 % predicted than WA% obtained in the segmental airways. Because emphysema is linked to loss of airway tethering and may limit airway expansion, increases in WA% may be related to emphysema and not solely to remodeling. We aimed to first determine whether the stronger association of subsegmental vs segmental WA% with FEV1 % predicted is mitigated by emphysema and, second, to assess the relationships among emphysema, WA%, and total bronchial area (TBA). METHODS We analyzed CT scan segmental and subsegmental WA% (WA% = 100 × wall area/TBA) of six bronchial paths and corresponding lobar emphysema, lung function, and clinical data in 983 smokers with COPD. RESULTS Compared with segmental WA%, the subsegmental WA% had a greater effect on FEV1% predicted (-0.8% to -1.7% vs -1.9% to -2.6% per 1-unit increase in WA%, respectively; P < .05 for most bronchial paths). After adjusting for emphysema, the association between subsegmental WA% and FEV1 % predicted was weakened in two bronchial paths. Increases in WA% between bronchial segments correlated directly with emphysema in all bronchial paths (P < .05). In multivariate regression models, emphysema was directly related to subsegmental WA% in most bronchial paths and inversely related to subsegmental TBA in all bronchial paths. CONCLUSION The greater effect of subsegmental WA% on airflow obstruction is mitigated by emphysema. Part of the emphysema effect might be due to loss of airway tethering, leading to a reduction in TBA and an increase in WA%.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Pulmonary Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - MeiLan K Han
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Carolyn E Come
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Raúl San José Estépar
- Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Victor Kim
- School of Medicine, Temple University, Philadelphia, PA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Denver, CO
| | - Joyce D Schroeder
- Division of Radiology, National Jewish Health, University of Colorado, School of Medicine, Denver, CO
| | - David A Lynch
- Division of Radiology, National Jewish Health, University of Colorado, School of Medicine, Denver, CO
| | | | - Edwin K Silverman
- Channing Laboratory (Dr Silverman), Brigham and Women's Hospital, Boston, MA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Abstract
OBJECTIVES The purposes of this study were to evaluate the reference range of quantitative computed tomography (QCT) measures of lung attenuation and airway parameter measurements in healthy nonsmoking adults and to identify sources of variation in those measures and possible means to adjust for them. MATERIALS AND METHODS Within the COPDGene study, 92 healthy non-Hispanic white nonsmokers (29 men, 63 women; mean [SD] age, 62.7 [9.0] years; mean [SD] body mass index [BMI], 28.1 [5.1] kg/m(2)) underwent volumetric computed tomography (CT) at full inspiration and at the end of a normal expiration. On QCT analysis (Pulmonary Workstation 2, VIDA Diagnostics), inspiratory low-attenuation areas were defined as lung tissue with attenuation values -950 Hounsfield units or less on inspiratory CT (LAA(I-950)). Expiratory low-attenuation areas were defined as lung tissue -856 Hounsfield units or less on expiratory CT (LAA(E-856)). We used simple linear regression to determine the impact of age and sex on QCT parameters and multiple regression to assess the additional impact of total lung capacity and functional residual capacity measured by CT (TLC(CT) and FRC(CT)), scanner type, and mean tracheal air attenuation. Airways were evaluated using measures of airway wall thickness, inner luminal area, wall area percentage (WA%), and standardized thickness of an airway with inner perimeter of 10 mm (Pi10). RESULTS Mean (SD) %LAA(I-950) was 2.0% (2.7%), and mean (SD) %LAA(E-856) was 9.2% (6.8%). Mean (SD) %LAA(I-950) was 3.6% (3.2%) in men, compared with 1.3% (2.0%) in women (P < 0.001). The %LAA(I-950) did not change significantly with age (P = 0.08) or BMI (P = 0.52). %LAA(E-856) did not show any independent relationship with age (P = 0.33), sex (P = 0.70), or BMI (P = 0.32). On multivariate analysis, %LAA(I-950) showed a direct relationship to TLC(CT) (P = 0.002) and an inverse relationship to mean tracheal air attenuation (P = 0.003), and %LAA(E-856) was related to age (P = 0.001), FRC(CT) (P = 0.007), and scanner type (P < 0.001). Multivariate analysis of segmental airways showed that inner luminal area and WA% were significantly related to TLC(CT) (P < 0.001) and age (0.006). Moreover, WA% was associated with sex (P = 0.05), axial pixel size (P = 0.03), and slice interval (P = 0.04). Lastly, airway wall thickness was strongly influenced by axial pixel size (P < 0.001). CONCLUSIONS Although the attenuation characteristics of normal lung differ by age and sex, these differences do not persist on multivariate analysis. Potential sources of variation in measurement of attenuation-based QCT parameters include depth of inspiration/expiration and scanner type. Tracheal air attenuation may partially correct variation because of scanner type. Sources of variation in QCT airway measurements may include age, sex, BMI, depth of inspiration, and spatial resolution.
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