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Armandi A, Merizian T, Werner MM, Coxson HO, Sanavia T, Birolo G, Gashaw I, Ertle J, Michel M, Galle PR, Labenz C, Emrich T, Schattenberg JM. Variability of transient elastography-based spleen stiffness performed at 100 Hz. Eur Radiol Exp 2023; 7:79. [PMID: 38087079 PMCID: PMC10716091 DOI: 10.1186/s41747-023-00393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Spleen stiffness measurement (SSM) performed by transient elastography at 100 Hz is a novel technology for the evaluation of portal hypertension in advanced chronic liver disease, but technical aspects are lacking. We aimed to evaluate the intraexamination variability of SSM and to determine the best transient elastography protocol for obtaining robust measurements to be used in clinical practice. METHODS We analyzed 253 SSM exams with up to 20 scans for each examination, performed between April 2021 and June 2022. All SSM results were evaluated according to different protocols by dividing data into groups of n measurements (from 2 to 19). Considering as reference the median SSM values across all the 20 measurements, we calculated the distribution of the absolute deviations of each protocol from the reference median. This analysis was repeated 1,000 times by resampling the data. Distributions were also stratified by etiology (chronic liver disease versus clinically significant portal hypertension) and different SSM ranges: < 25 kPa, 25-75, and > 75 kPa. RESULTS Overall, we observed that the spleen stiffness exam had less variability if it exceeded 12 measurements, i.e., absolute deviations ≤ 5 kPa at 95% confidence. For exams with higher SSM values (> 75 kPa), as seen in clinically significant portal hypertension, at least 15 measurements are highly recommendable. CONCLUSIONS Fifteen scans per examination should be considered for each SSM exam performed at 100 Hz to achieve a low intraexamination variability within a reasonable time in clinical practice. RELEVANCE STATEMENT Performing at least 15 scans per examination is recommended for 100 Hz SSM in order to achieve a low intraexamination variability, in particular for values > 75 kPa compatible with clinically significant portal hypertension. KEY POINTS • Spleen stiffness measurement by transient elastography is used for stratification in patients with portal hypertension. • At 100 Hz, this method may have intraexamination variability. • A minimum of 15 scans per examination achieves a low intraexamination variability.
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Affiliation(s)
- Angelo Armandi
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Talal Merizian
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Merle Marie Werner
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Harvey O Coxson
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach & Ingelheim, Germany
| | - Tiziana Sanavia
- Computational Biomedicine Unit, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - Giovanni Birolo
- Computational Biomedicine Unit, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Turin, 10126, Italy
| | - Isabella Gashaw
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach & Ingelheim, Germany
| | - Judith Ertle
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Maurice Michel
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Peter R Galle
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Christian Labenz
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Tilman Emrich
- Department of Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany
| | - Jörn M Schattenberg
- Metabolic Liver Disease Research Program, I. Department of Medicine, University Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, 55131, Germany.
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Lawitz EJ, Reiberger T, Schattenberg JM, Schoelch C, Coxson HO, Wong D, Ertle J. Safety and pharmacokinetics of BI 685509, a soluble guanylyl cyclase activator, in patients with cirrhosis: A randomized Phase Ib study. Hepatol Commun 2023; 7:e0276. [PMID: 37889522 PMCID: PMC10615399 DOI: 10.1097/hc9.0000000000000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/29/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Portal hypertension is a severe complication of cirrhosis. This Phase Ib study (NCT03842761) assessed the safety, tolerability, and pharmacokinetics of soluble guanylyl cyclase activator BI 685509 in patients with mild or moderate hepatic impairment (Child-Pugh [CP] A or B cirrhosis) and healthy volunteers (HVs). METHODS In this single-center, randomized, placebo-controlled study, patients received BI 685509 (maximum doses: 1, 2, or 3 mg, twice daily [BID]) or placebo for 28 days. HVs received one 0.5 mg dose of BI 685509 or placebo. RESULTS In total, 64 participants (CP-A, n=24; CP-B, n=25; HVs, n=15) were included; most commonly with NAFLD (36.7%), alcohol-associated (30.6%), or chronic viral hepatitis-related cirrhosis (28.6%). In patients with CP-A cirrhosis, drug-related adverse events (AEs) occurred in 5.6% of BI 685509-treated patients and 16.7% of placebo recipients. In patients with CP-B cirrhosis, drug-related AEs occurred in 26.3% of BI 685509-treated patients only. No serious AEs occurred in patients with CP-A cirrhosis; in patients with CP-B cirrhosis, serious AEs (not drug-related) occurred in 10.5% of BI 685509-treated patients and 16.7% of patients receiving placebo. BI 685509 was rapidly absorbed; exposure increased with dosage and was similar between etiologies and between patients with CP-A cirrhosis and patients with CP-A cirrhosis but lower in HVs. The mean percentage portal-systemic shunt fraction was measured in patients with CP-A cirrhosis and decreased at the end of treatment in the 2 mg BID (-11.2 ± 11.9%) and 3 mg BID (-14.0 ± 8.4%) BI 685509 dose groups, but not in the placebo group (+1.0 ± 27.3%). CONCLUSION BI 685509 was generally well tolerated, with 3 serious, not drug-related AEs reported in patients with CP-B cirrhosis. In patients with CP-A cirrhosis, portal-systemic shunt fraction in the exploratory efficacy analysis was reduced by 2 mg BID and 3 mg BID BI 685509.
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Affiliation(s)
- Eric J. Lawitz
- The Texas Liver Institute, University of Texas Health, San Antonio, Texas, USA
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Jörn M. Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Mainz, Rhineland Palatinate, Germany
| | | | | | - Diane Wong
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | - Judith Ertle
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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Pavlides M, Mózes FE, Akhtar S, Wonders K, Cobbold J, Tunnicliffe EM, Allison M, Godfrey EM, Aithal GP, Francis S, Romero-Gomez M, Castell J, Fernandez-Lizaranzu I, Aller R, González RS, Agustin S, Pericàs JM, Boursier J, Aube C, Ratziu V, Wagner M, Petta S, Antonucci M, Bugianesi E, Faletti R, Miele L, Geier A, Schattenberg JM, Tilman E, Ekstedt M, Lundberg P, Berzigotti A, Huber AT, Papatheodoridis G, Yki-Järvinen H, Porthan K, Schneider MJ, Hockings P, Shumbayawonda E, Banerjee R, Pepin K, Kalutkiewicz M, Ehman RL, Trylesinksi A, Coxson HO, Martic M, Yunis C, Tuthill T, Bossuyt PM, Anstee QM, Neubauer S, Harrison S. Liver Investigation: Testing Marker Utility in Steatohepatitis (LITMUS): Assessment & validation of imaging modality performance across the NAFLD spectrum in a prospectively recruited cohort study (the LITMUS imaging study): Study protocol. Contemp Clin Trials 2023; 134:107352. [PMID: 37802221 DOI: 10.1016/j.cct.2023.107352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the liver manifestation of the metabolic syndrome with global prevalence reaching epidemic levels. Despite the high disease burden in the population only a small proportion of those with NAFLD will develop progressive liver disease, for which there is currently no approved pharmacotherapy. Identifying those who are at risk of progressive NAFLD currently requires a liver biopsy which is problematic. Firstly, liver biopsy is invasive and therefore not appropriate for use in a condition like NAFLD that affects a large proportion of the population. Secondly, biopsy is limited by sampling and observer dependent variability which can lead to misclassification of disease severity. Non-invasive biomarkers are therefore needed to replace liver biopsy in the assessment of NAFLD. Our study addresses this unmet need. The LITMUS Imaging Study is a prospectively recruited multi-centre cohort study evaluating magnetic resonance imaging and elastography, and ultrasound elastography against liver histology as the reference standard. Imaging biomarkers and biopsy are acquired within a 100-day window. The study employs standardised processes for imaging data collection and analysis as well as a real time central monitoring and quality control process for all the data submitted for analysis. It is anticipated that the high-quality data generated from this study will underpin changes in clinical practice for the benefit of people with NAFLD. Study Registration: clinicaltrials.gov: NCT05479721.
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Affiliation(s)
- Michael Pavlides
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK.
| | - Ferenc E Mózes
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Salma Akhtar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Kristy Wonders
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jeremy Cobbold
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Elizabeth M Tunnicliffe
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Michael Allison
- Liver Unit, Department of Medicine, Cambridge NIHR Biomedical Research Centre, Cambridge University NHS Foundation Trust, UK
| | - Edmund M Godfrey
- Department of Radiology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Susan Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Manuel Romero-Gomez
- Digestive Diseases Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Javier Castell
- Radiodiagnosis Clinical Management Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Rocio Aller
- Department of Gastroenterology, Clinic University Hospital, Medical School, University of Valladolid, CIBERINFEC, Valladolid, Spain
| | - Rebeca Sigüenza González
- Department of Radiology, Clinic University Hospital, Medical School, University of Valladolid, Valladolid, Spain
| | - Salvador Agustin
- Liver Unit, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital, Centros de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital, Centros de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Jerome Boursier
- Centre Hospitalier Universitaire d'Angers, Angers, France; & Laboratoire HIFIH UPRES EA3859, Université d'Angers, Angers, France
| | - Christophe Aube
- Department of Radiology, Centre Hospitalier Universitaire d'Angers, Angers, France; & Laboratoire HIFIH UPRES EA3859, Université d'Angers, Angers, France
| | - Vlad Ratziu
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathilde Wagner
- Radiology department, AP-HP.6, GH Pitié Salpêtrière - Charles Foix Sorbonne Université, Paris, France
| | - Salvatore Petta
- Section of Gastroenterology, PROMISE, University of Palermo, Italy
| | - Michela Antonucci
- Section of Radiology - Di.Bi.Me.F., University of Palermo, Palermo, Italy
| | - Elisabetta Bugianesi
- Division of Gastroenterology, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Riccardo Faletti
- Department of Diagnostic and Interventional Radiology, University of Turin, Turin, Italy
| | - Luca Miele
- Department of Translational Medicine and Surgery, Medical School, Università Cattolica del S. Cuore and Fondazione Pol. Gemelli IRCCS Hospital, Rome, Italy
| | - Andreas Geier
- Department of Hepatology, University of Würzburg, Würzburg, Germany
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Centre, Mainz, Germany
| | - Emrich Tilman
- Department of Diagnostic and Interventional Radiology, University Medical Center of Johannes-Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Mattias Ekstedt
- Department of Health, Medicine and Caring Sciences, and Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Department of Radiation Physics, and Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Paediatric Radiology (DIPR), Bern University Hospital, University of Bern, Bern, Switzerland
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Hannele Yki-Järvinen
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Porthan
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | | | | | | | - Aldo Trylesinksi
- ADVANZPHARMA, Capital House, 1st Floor, 85 King William Street, London EC4N 7BL, United Kingdom
| | | | - Miljen Martic
- Novartis AG, Translational Medicine, Clinical and Precision Medicine Imaging, Basel, Switzerland
| | - Carla Yunis
- Clinical Development and Operations, Pfizer Inc., Lake Mary, FL, USA
| | - Theresa Tuthill
- Clinical Development and Operations, Pfizer Inc., Lake Mary, FL, USA
| | - Patrick M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Centres, University of Amsterdam, the Netherlands
| | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK
| | - Stephen Harrison
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Moslemi A, Makimoto K, Tan WC, Bourbeau J, Hogg JC, Coxson HO, Kirby M. Quantitative CT Lung Imaging and Machine Learning Improves Prediction of Emergency Room Visits and Hospitalizations in COPD. Acad Radiol 2022; 30:707-716. [PMID: 35690537 DOI: 10.1016/j.acra.2022.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE Predicting increased risk of future healthcare utilization in chronic obstructive pulmonary disease (COPD) patients is an important goal for improving patient management. OBJECTIVE Our objective was to determine the importance of computed tomography (CT) lung imaging measurements relative to other demographic and clinical measurements for predicting future health services use with machine learning in COPD. MATERIALS AND METHODS In this retrospective study, lung function measurements and chest CT images were acquired from Canadian Cohort of Obstructive Lung Disease study participants from 2010 to 2017 (https://clinicaltrials.gov, NCT00920348). Up to two follow-up visits (1.5- and 3-year follow-up) were performed and participants were asked for details related to healthcare utilization. Healthcare utilization was defined as any COPD hospitalization or emergency room visit due to respiratory problems in the 12 months prior to the follow-up visits. CT analysis was performed (VIDA Diagnostics Inc.); a total of 108 CT quantitative emphysema, airway and vascular measurements were investigated. A hybrid feature selection method with support vector machine classifier was used to predict healthcare utilization. Performance was determined using accuracy, F1-measure and area under the receiver operating characteristic curve (AUC) and Matthews's correlation coefficient (MC). RESULTS Of the 527 COPD participants evaluated, 179 (35%) used healthcare services at follow-up. There were no significant differences between the participants with or without healthcare utilization at follow-up for age (p = 0.50), sex (p = 0.44), BMI (p = 0.05) or pack-years (p = 0.76). The accuracy for predicting subsequent healthcare utilization was 80% ± 3% (F1-measure = 74%, AUC = 0.80, MC = 0.6) when all measurements were considered, 76% ± 6% (F1-measure = 72%, AUC = 0.77, MC = 0.55) for CT measurements alone and 65% ± 5% (F1-measure = 60%, AUC = 0.67, MC = 0.34) for demographic and lung function measurements alone. CONCLUSION The combination of CT lung imaging and conventional measurements leads to greater prediction accuracy of subsequent health services use than conventional measurements alone, and may provide needed prognostic information for patients suffering from COPD.
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Affiliation(s)
- Amir Moslemi
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Kalysta Makimoto
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
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Xu F, Vasilescu DM, Kinose D, Tanabe N, Ng KW, Coxson HO, Cooper JD, Hackett TL, Verleden SE, Vanaudenaerde BM, Stevenson CS, Lenburg ME, Spira A, Tan WC, Sin DD, Ng RT, Hogg JC. The molecular and cellular mechanisms associated with the destruction of terminal bronchioles in COPD. Eur Respir J 2022; 59:2101411. [PMID: 34675046 DOI: 10.1183/13993003.01411-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/27/2021] [Indexed: 11/05/2022]
Abstract
RATIONALE Peripheral airway obstruction is a key feature of chronic obstructive pulmonary disease (COPD), but the mechanisms of airway loss are unknown. This study aims to identify the molecular and cellular mechanisms associated with peripheral airway obstruction in COPD. METHODS Ten explanted lung specimens donated by patients with very severe COPD treated by lung transplantation and five unused donor control lungs were sampled using systematic uniform random sampling (SURS), resulting in 240 samples. These samples were further examined by micro-computed tomography (CT), quantitative histology and gene expression profiling. RESULTS Micro-CT analysis showed that the loss of terminal bronchioles in COPD occurs in regions of microscopic emphysematous destruction with an average airspace size of ≥500 and <1000 µm, which we have termed a "hot spot". Based on microarray gene expression profiling, the hot spot was associated with an 11-gene signature, with upregulation of pro-inflammatory genes and downregulation of inhibitory immune checkpoint genes, indicating immune response activation. Results from both quantitative histology and the bioinformatics computational tool CIBERSORT, which predicts the percentage of immune cells in tissues from transcriptomic data, showed that the hot spot regions were associated with increased infiltration of CD4 and CD8 T-cell and B-cell lymphocytes. INTERPRETATION The reduction in terminal bronchioles observed in lungs from patients with COPD occurs in a hot spot of microscopic emphysema, where there is upregulation of IFNG signalling, co-stimulatory immune checkpoint genes and genes related to the inflammasome pathway, and increased infiltration of immune cells. These could be potential targets for therapeutic interventions in COPD.
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Affiliation(s)
- Feng Xu
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Dragoş M Vasilescu
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Daisuke Kinose
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Naoya Tanabe
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Harvey O Coxson
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Joel D Cooper
- Division of Thoracic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Tillie-Louise Hackett
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Stijn E Verleden
- Laboratory of Respiratory Diseases, BREATHE, Dept of CHROMETA, KU Leuven, Leuven, Belgium
| | | | | | - Marc E Lenburg
- Division of Computational Biomedicine, Dept of Medicine, Boston University, Boston, MA, USA
| | - Avrum Spira
- Division of Computational Biomedicine, Dept of Medicine, Boston University, Boston, MA, USA
| | - Wan C Tan
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
| | - Raymond T Ng
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
- Dept of Computer Science, The University of British Columbia, Vancouver, BC, Canada
| | - James C Hogg
- The Centre for Heart Lung Innovation, The University of British Columbia, located at St Paul's Hospital, Vancouver, BC, Canada
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6
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Dong S, Wang L, Chitano P, Coxson HO, Vasilescu DM, Paré PD, Seow CY. Lung resistance and elastance are different in ex vivo sheep lungs ventilated by positive and negative pressures. Am J Physiol Lung Cell Mol Physiol 2022; 322:L673-L682. [PMID: 35272489 DOI: 10.1152/ajplung.00464.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lung resistance (RL) and elastance (EL) can be measured during positive or negative pressure ventilation. Whether the different modes of ventilation produce different RL and EL is still being debated. Although negative pressure ventilation (NPV) is more physiological, positive pressure ventilation (PPV) is more commonly used for treating respiratory failure. In the present study we measured lung volume, airway diameter and airway volume, as well as RL and EL with PPV and NPV in explanted sheep lungs. We found that lung volume under a static pressure, either positive or negative, was not different. However, RL and EL were significantly higher in NPV at high inflation pressures. Interestingly, diameters of smaller airways (diameters < 3.5 mm) and total airway volume were significantly greater at high negative inflation pressures compared with those at high positive inflation pressures. This suggests that NPV is more effective in distending the peripheral airways, likely due to the fact that negative pressure is applied through the pleural membrane and reaches the central airways via the peripheral airways, whereas positive pressure is applied in the opposite direction. More distension of lung periphery could explain why RL is higher in NPV (vs. PPV), because the peripheral parenchyma is a major source of tissue resistance, which is a part of the RL that increases with pressure. This explanation is consistent with the finding that during high frequency ventilation (>1 Hz, where RL reflects airway resistance more than tissue resistance), the difference in RL between NPV and PPV disappeared.
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Affiliation(s)
- Shoujin Dong
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.,Respiratory Department, Chengdu First People's Hospital, Chengdu, China
| | - Lu Wang
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Pasquale Chitano
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Harvey O Coxson
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | | | - Peter D Paré
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chun Y Seow
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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Kirby M, Smith BM, Tanabe N, Hogg JC, Coxson HO, Sin DD, Bourbeau J, Tan WC. Computed tomography total airway count predicts progression to COPD in at-risk smokers. ERJ Open Res 2021; 7:00307-2021. [PMID: 34708120 PMCID: PMC8542990 DOI: 10.1183/23120541.00307-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited understanding of how to identify people at high risk of developing COPD. Our objective was to investigate the association between computed tomography (CT) total airway count (TAC) and incident COPD over 3 years among ever-smokers from the population-based Canadian Cohort Obstructive Lung Disease (CanCOLD) study. CT and spirometry were acquired in ever-smokers at baseline; spirometry was repeated at 3-year follow-up. CT TAC was generated by summing all airway segments in the segmented airway tree (VIDA Diagnostics, Inc.). CT airway wall area, wall thickness for a theoretical airway with 10 mm perimeter (Pi10), and low attenuation areas below −856 HU (LAA856) were also measured. Logistic and mixed effects regression models were constructed to determine the association for CT measurements with development of COPD and forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) decline, respectively. Among 316 at-risk participants evaluated at baseline (65±9 years, 40% female, 18±19 pack-years), incident COPD was detected in 56 participants (18%) over a median 3.1±0.6 years of follow-up. Among CT measurements, only TAC was associated with incident COPD (p=0.03), where a 1-sd decrement in TAC increased the odds ratio for incident COPD by a factor of two. In a multivariable linear regression model, reduced TAC was significantly associated with greater longitudinal FEV1/FVC decline (p=0.03), but no other measurements were significant. CT TAC predicts incident COPD in at-risk smokers, indicating that smokers exhibit early structural changes associated with COPD prior to abnormal spirometry. Computed tomography (CT) total airway count (TAC) predicts incident COPD in at-risk smokers, indicating that smokers exhibit early airway remodelling prior to abnormal spirometry and that CT TAC is a potential tool to help identify smokers at increased risk of COPDhttps://bit.ly/2UTw3I4
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Affiliation(s)
- Miranda Kirby
- Dept of Physics, Ryerson University, Toronto, ON, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Benjamin M Smith
- Dept of Medicine, McGill University, Montreal, QC, Canada.,Dept of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Dept of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Naoya Tanabe
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - James C Hogg
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Harvey O Coxson
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Wan C Tan
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
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8
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Ikezoe K, Hackett TL, Peterson S, Prins D, Hague CJ, Murphy D, LeDoux S, Chu F, Xu F, Cooper JD, Tanabe N, Ryerson CJ, Paré PD, Coxson HO, Colby TV, Hogg JC, Vasilescu DM. Small Airway Reduction and Fibrosis is an Early Pathologic Feature of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2021; 204:1048-1059. [PMID: 34343057 DOI: 10.1164/rccm.202103-0585oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE To improve disease outcomes in idiopathic pulmonary fibrosis (IPF) it is essential to understand its early pathophysiology so that it can be targeted therapeutically. OBJECTIVES Perform three-dimensional (3D) assessment of the IPF lung micro-structure using stereology and multi-resolution computed tomography (CT) imaging. METHODS Explanted lungs from IPF patients (n=8) and donor controls (n=8) were inflated with air and frozen. CT scans were used to assess large airways. Unbiased, systematic uniform random (SUR) samples (n=8/lung) were scanned with microCT for stereological assessment of small airways (number, airway wall and lumen area) and parenchymal fibrosis (volume fraction of tissue, alveolar surface area, and septal wall thickness). RESULTS The total number of airways on clinical CT was greater in IPF lungs than control lungs (p<0.01), due to an increase in the wall (p<0.05) and lumen area (p<0.05) resulting in more visible airways with a lumen larger than 2 mm. In IPF tissue samples without microscopic fibrosis, assessed by the volume fraction of tissue using microCT, there was a reduction in the number of the terminal (p<0.01) and transitional (p<0.001) bronchioles, and an increase in terminal bronchiole wall area (p<0.001) compared to control lungs. In IPF tissue samples with microscopic parenchymal fibrosis, terminal bronchioles had increased airway wall thickness (p<0.05), and dilated airway lumens (p<0.001) leading to honeycomb cyst formations. CONCLUSION This study has important implications for the current thinking on how the lung tissue is remodeled in IPF, and highlights small airways as a potential target to modify IPF outcomes.
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Affiliation(s)
- Kohei Ikezoe
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Tillie-Louise Hackett
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | | | - Dante Prins
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Cameron J Hague
- The University of British Columbia Department of Radiology, 478400, Vancouver, British Columbia, Canada
| | - Darra Murphy
- The University of British Columbia Department of Radiology, 478400, Vancouver, British Columbia, Canada
| | - Stacey LeDoux
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Fanny Chu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Feng Xu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Pathology and Lab Medicine, Vancouver, British Columbia, Canada
| | - Joel D Cooper
- University of Pennsylvania, 6572, Thoracic surgery, Philadelphia, Pennsylvania, United States
| | - Naoya Tanabe
- Kyoto University Graduate School of Medicine Department of Respiratory Medicine, 215651, Kyoto, Japan
| | - Christopher J Ryerson
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Medicine, Vancouver, British Columbia, Canada
| | - Peter D Paré
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Harvey O Coxson
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Thomas V Colby
- Mayo Clinic Department of Laboratory Medicine and Pathology, 195112, Rochester, Minnesota, United States
| | - James C Hogg
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada
| | - Dragoş M Vasilescu
- The University of British Columbia Centre for Heart Lung Innovation, 539747, Vancouver, British Columbia, Canada;
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9
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Dong SJ, Wang L, Chitano P, Coxson HO, Paré PD, Seow CY. Airway diameter at different transpulmonary pressures in ex vivo sheep lungs: Implications for deep-inspiration-induced bronchodilation and bronchoprotection. Am J Physiol Lung Cell Mol Physiol 2021; 321:L663-L674. [PMID: 34287071 DOI: 10.1152/ajplung.00208.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep inspiration (DI)-induced bronchodilation is the first line of defense against bronchoconstriction in healthy subjects. A hallmark of asthma is the lack of this beneficial effect of DI. The mechanism underlying the bronchodilatory effect of DI is not clear. Understanding the mechanism will help us unravel the mystery of asthma pathophysiology. It has been postulated that straining airway smooth muscle (ASM) during a DI could lead to bronchodilation and bronchoprotection. The hypothesis is currently under debate, and a central question is whether ASM is sufficiently stretched during a DI for its contractility to be compromised. Besides bronchoconstriction, another contributor to lung resistance is airway heterogeneity. The present study examines changes in airway diameter and heterogeneity at different lung volumes. Freshly explanted sheep lungs were used in plethysmographic measurements of lung resistance and elastance at different lung volumes while the airway dimensions were measured by computed tomography (CT). The change in airway diameter informed by CT measurements was applied to isolated airway ring preparations to determine the strain-induced loss of ASM contractility. We found that changing the transpulmonary pressure from 5 to 30 cmH2O led to a 51%-increase in lung volume, accompanied by a 46%-increase in the airway diameter with no change in airway heterogeneity. When comparable airway strains measured in the whole lung were applied to isolated airway rings in either relaxed or contracted state, a significant loss of ASM contractility was observed, suggesting that DI-induced bronchodilation and bronchoprotection can result from strain-induced loss of ASM contractility.
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Affiliation(s)
- Shou-Jin Dong
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.,Respiratory Department, Chengdu First People's Hospital, Chengdu, China
| | - Lu Wang
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Pasquale Chitano
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Harvey O Coxson
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Peter D Paré
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chun Y Seow
- The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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10
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Molgat-Seon Y, Guler SA, Peters CM, Vasilescu DM, Puyat JH, Coxson HO, Ryerson CJ, Guenette JA. Pectoralis muscle area and its association with indices of disease severity in interstitial lung disease. Respir Med 2021; 186:106539. [PMID: 34271524 DOI: 10.1016/j.rmed.2021.106539] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 01/31/2023]
Abstract
RATIONALE The pathophysiology of interstitial lung disease (ILD) impacts body composition, whereby ILD severity is linked to lower lean mass. OBJECTIVES To determine i) if pectoralis muscle area (PMA) is a surrogate for whole-body lean mass in ILD, ii) whether PMA is associated with ILD severity, and iii) if the longitudinal change in PMA is associated with pulmonary function and mortality in ILD. METHODS Patients with ILD (n = 164) were analyzed retrospectively. PMA was quantified from a chest computed tomography scan. Peripheral oxygen saturation (SpO2), 6-min walk distance (6MWD), and pulmonary function were obtained as part of routine clinical care. Dyspnea and quality of life were assessed using the UCSD Shortness of Breath Questionnaire and European Quality of Life 5 Dimensions questionnaire, respectively. RESULTS PMA was associated with whole-body lean mass (p < 0.001). After adjusting for age, sex, height, body mass, and prednisone status, PMA was associated with %-predicted forced vital capacity (FVC), %-predicted diffusion capacity (DLCO), resting and exertional SpO2, and dyspnea (all p < 0.05), but not forced expiratory volume in 1 s (FEV1), FEV1/FVC, 6MWD, or quality of life (all p > 0.05). The annual negative PMA slope was associated with annual negative slopes in FVC, FEV1, and DLCO (all p < 0.05), but not FEV1/FVC (p = 0.46). Annual slope in PMA was associated with all-cause mortality (hazard ratio = -0.80, 95% CI:0.889-0.959; p < 0.001). CONCLUSION In patients with ILD, PMA is a suitable surrogate for whole-body lean mass. A lower PMA is associated with indices of ILD severity, which supports the notion that ILD progression may involve sarcopenia.
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Affiliation(s)
- Yannick Molgat-Seon
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Sabina A Guler
- Department of Pulmonary Medicine, University Hospital and University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland
| | - Carli M Peters
- School of Kinesiology, Faculty of Education, The University of British Columbia, 6081 University Boulevard, Vancouver, British Columbia, V6T 1Z1, Canada
| | - Dragoş M Vasilescu
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Joseph H Puyat
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, St. Paul's Hospital, 166-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada; School of Kinesiology, Faculty of Education, The University of British Columbia, 6081 University Boulevard, Vancouver, British Columbia, V6T 1Z1, Canada; Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
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11
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Xu F, Tanabe N, Vasilescu DM, McDonough JE, Coxson HO, Ikezoe K, Kinose D, Ng KW, Verleden SE, Wuyts WA, Vanaudenaerde BM, Verschakelen J, Cooper JD, Lenburg ME, Morshead KB, Abbas AR, Arron JR, Spira A, Hackett TL, Colby TV, Ryerson CJ, Ng RT, Hogg JC. The transition from normal lung anatomy to minimal and established fibrosis in idiopathic pulmonary fibrosis (IPF). EBioMedicine 2021; 66:103325. [PMID: 33862585 PMCID: PMC8054143 DOI: 10.1016/j.ebiom.2021.103325] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The transition from normal lung anatomy to minimal and established fibrosis is an important feature of the pathology of idiopathic pulmonary fibrosis (IPF). The purpose of this report is to examine the molecular and cellular mechanisms associated with this transition. METHODS Pre-operative thoracic Multidetector Computed Tomography (MDCT) scans of patients with severe IPF (n = 9) were used to identify regions of minimal(n = 27) and established fibrosis(n = 27). MDCT, Micro-CT, quantitative histology, and next-generation sequencing were used to compare 24 samples from donor controls (n = 4) to minimal and established fibrosis samples. FINDINGS The present results extended earlier reports about the transition from normal lung anatomy to minimal and established fibrosis by showing that there are activations of TGFBI, T cell co-stimulatory genes, and the down-regulation of inhibitory immune-checkpoint genes compared to controls. The expression patterns of these genes indicated activation of a field immune response, which is further supported by the increased infiltration of inflammatory immune cells dominated by lymphocytes that are capable of forming lymphoid follicles. Moreover, fibrosis pathways, mucin secretion, surfactant, TLRs, and cytokine storm-related genes also participate in the transitions from normal lung anatomy to minimal and established fibrosis. INTERPRETATION The transition from normal lung anatomy to minimal and established fibrosis is associated with genes that are involved in the tissue repair processes, the activation of immune responses as well as the increased infiltration of CD4, CD8, B cell lymphocytes, and macrophages. These molecular and cellular events correlate with the development of structural abnormality of IPF and probably contribute to its pathogenesis.
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Affiliation(s)
- Feng Xu
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Naoya Tanabe
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Dragos M Vasilescu
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - John E McDonough
- Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium
| | - Harvey O Coxson
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Kohei Ikezoe
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Daisuke Kinose
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Division of Respiratory Medicine, Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | | | - Stijn E Verleden
- Laboratory of Respiratory Diseases, BREATHE, Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium
| | | | - Johny Verschakelen
- Leuven Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium
| | - Joel D Cooper
- Division of Thoracic Surgery, University of Pennsylvania, USA
| | | | | | | | | | - Avrum Spira
- Boston University Medical Center, Boston, MA, USA
| | - Tillie-Louise Hackett
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
| | - Thomas V Colby
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, USA
| | - Christopher J Ryerson
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Raymond T Ng
- Department of Computer Science, The University of British Columbia, Vancouver, Canada
| | - James C Hogg
- Center for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada
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12
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Celli B, Locantore N, Yates JC, Bakke P, Calverley PMA, Crim C, Coxson HO, Lomas DA, MacNee W, Miller BE, Mullerova H, Rennard SI, Silverman EK, Wouters E, Tal-Singer R, Agusti A, Vestbo J. Markers of disease activity in COPD: an 8-year mortality study in the ECLIPSE cohort. Eur Respir J 2021; 57:13993003.01339-2020. [PMID: 33303557 PMCID: PMC7991608 DOI: 10.1183/13993003.01339-2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/20/2020] [Indexed: 01/22/2023]
Abstract
Rationale There are no validated measures of disease activity in COPD. Since “active” disease is expected to have worse outcomes (e.g. mortality), we explored potential markers of disease activity in patients enrolled in the ECLIPSE cohort in relation to 8-year all-cause mortality. Methods We investigated 1) how changes in relevant clinical variables over time (1 or 3 years) relate to 8-year mortality; 2) whether these variables inter-relate; and 3) if any clinical, imaging and/or biological marker measured cross-sectionally at baseline relates to any activity component. Results Results showed that 1) after 1 year, hospitalisation for COPD, exacerbation frequency, worsening of body mass index, airflow obstruction, dyspnoea and exercise (BODE) index or health status (St George's Respiratory Questionnaire (SGRQ)) and persistence of systemic inflammation were significantly associated with 8-year mortality; 2) at 3 years, the same markers, plus forced expiratory volume in 1 s (FEV1) decline and to a lesser degree computed tomography (CT) emphysema, showed association, thus qualifying as markers of disease activity; 3) changes in FEV1, inflammatory cytokines and CT emphysema were not inter-related, while the multidimensional indices (BODE and SGRQ) showed modest correlations; and 4) changes in these markers could not be predicted by any baseline cross-sectional measure. Conclusions In COPD, 1- and 3-year changes in exacerbation frequency, systemic inflammation, BODE and SGRQ scores and FEV1 decline are independent markers of disease activity associated with 8-year all-cause mortality. These disease activity markers are generally independent and not predictable from baseline measurements. In patients with COPD, 1- and 3-year changes in exacerbation frequency, systemic inflammation, BODE and SGRQ scores, and FEV1 decline, are independent markers of disease activity associated with 8-year all-cause mortalityhttps://bit.ly/2CyifcN
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Affiliation(s)
- Bartolome Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Joint first authors
| | | | | | - Per Bakke
- Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Peter M A Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | - Harvey O Coxson
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - David A Lomas
- UCL Respiratory, Rayne Institute, University College London, London, UK
| | | | | | | | | | - Edwin K Silverman
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emiel Wouters
- University of Maastricht, Maastricht, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | | | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Joint senior authors
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK.,Joint senior authors
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13
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Boulet LP, Boulay ME, Coxson HO, Hague CJ, Milot J, Lepage J, Maltais F. Asthma with Irreversible Airway Obstruction in Smokers and Nonsmokers: Links between Airway Inflammation and Structural Changes. Respiration 2020; 99:1-11. [PMID: 33291112 DOI: 10.1159/000508163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of irreversible airway obstruction (IRAO) in asthma is related to lung/airway inflammatory and structural changes whose characteristics are likely influenced by exposure to tobacco smoke. OBJECTIVE To investigate the interplay between airway and lung structural changes, airway inflammation, and smoking exposure in asthmatics with IRAO. METHODS We studied asthmatics with IRAO who were further classified according to their smoking history, those with ≥20 pack-years of tobacco exposure (asthmatics with smoking-related IRAO [AwS-IRAO]) and those with <5 pack-years of tobacco exposure (asthmatics with nonsmoking-related IRAO [AwNS-IRAO]). In addition to recording baseline clinical and lung function features, all patients had a chest computed tomography (CT) from which airway wall thickness was measured and quantitative and qualitative assessment of emphysema was performed. The airway inflammatory profile was documented from differential inflammatory cell counts on induced sputum. RESULTS Ninety patients were recruited (57 AwS-IRAO and 33 AwNS-IRAO). There were no statistically significant differences in the extent of emphysema and gas trapping between groups on quantitative chest CT analysis, although Pi10, a marker of airway wall thickness, was significantly higher in AwS-IRAO (p = 0.0242). Visual analysis showed a higher prevalence of emphysema (p = 0.0001) and higher emphysema score (p < 0.0001) in AwS-IRAO compared to AwNS-IRAO and distribution of emphysema was different between groups. Correlations between radiological features and lung function were stronger in AwS-IRAO. In a subgroup analysis, we found a correlation between airway neutrophilia and emphysematous features in AwS-IRAO and between eosinophilia and both airway wall thickness and emphysematous changes in AwNS-IRAO. CONCLUSIONS Although bronchial structural changes were relatively similar in smoking and nonsmoking patients with asthma and IRAO, emphysematous changes were more predominant in smokers. However, neutrophils in AwS-IRAO and eosinophils in AwNS-IRAO were associated with lung and airway structural changes.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada,
| | - Marie-Eve Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron J Hague
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Milot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Johane Lepage
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
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14
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Tanabe N, Vasilescu DM, Hague CJ, Ikezoe K, Murphy DT, Kirby M, Stevenson CS, Verleden SE, Vanaudenaerde BM, Gayan-Ramirez G, Janssens W, Coxson HO, Paré PD, Hogg JC. Pathological Comparisons of Paraseptal and Centrilobular Emphysema in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2020; 202:803-811. [PMID: 32485111 DOI: 10.1164/rccm.201912-2327oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Although centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are commonly identified on multidetector computed tomography (MDCT), little is known about the pathology associated with PSE compared with that of CLE.Objectives: To assess the pathological differences between PSE and CLE in chronic obstructive pulmonary disease (COPD).Methods: Air-inflated frozen lung specimens (n = 6) obtained from patients with severe COPD treated by lung transplantation were scanned with MDCT. Frozen tissue cores were taken from central (n = 8) and peripheral (n = 8) regions of each lung, scanned with micro-computed tomography (microCT), and processed for histology. The core locations were registered to the MDCT, and a percentage of PSE or CLE was assigned by radiologists to each of the regions. MicroCT scans were used to measure number and structural change of terminal bronchioles. Furthermore, microCT-based volume fractions of CLE and PSE allowed classifying cores into mild emphysema, CLE-dominant, and PSE-dominant.Measurements and Main Results: The percentages of PSE measured on MDCT and microCT were positively associated (P = 0.015). The number of terminal bronchioles per milliliter of lung and cross-sectional lumen area were significantly lower and wall area percentage was significantly higher in CLE-dominant regions compared with mild emphysema and PSE-dominant regions (all P < 0.05), whereas no difference was found between PSE-dominant and mild emphysema samples (all P > 0.5). Immunohistochemistry showed significantly higher infiltration of neutrophils (P = 0.002), but not of macrophages, CD4, CD8, or B cells, in PSE compared with CLE regions.Conclusions: The terminal bronchioles are relatively preserved, whereas neutrophilic inflammation is increased in PSE-dominant regions compared with CLE-dominant regions in patients with COPD.
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Affiliation(s)
- Naoya Tanabe
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and.,Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Cameron J Hague
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kohei Ikezoe
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - Darra T Murphy
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Miranda Kirby
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and.,Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Christopher S Stevenson
- Janssen Disease Interception Accelerator, Janssen Pharmaceutical Companies of Johnson and Johnson, Beerse, Belgium; and
| | - Stijn E Verleden
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Department of Chronic Disease, Metabolism and Aging, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium
| | - Harvey O Coxson
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - Peter D Paré
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
| | - James C Hogg
- Centre for Heart and Lung Innovation, St. Paul's Hospital, and
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15
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Moslemi A, Tan WC, Bourbeau J, Hogg JC, Coxson HO, Kirby M. Machine Learning for Predicting Health Care Utilization in COPD using Quantitative CT Imaging. Imaging 2020. [DOI: 10.1183/13993003.congress-2020.2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Smith BM, Kirby M, Hoffman EA, Kronmal RA, Aaron SD, Allen NB, Bertoni A, Coxson HO, Cooper C, Couper DJ, Criner G, Dransfield MT, Han MK, Hansel NN, Jacobs DR, Kaufman JD, Lin CL, Manichaikul A, Martinez FJ, Michos ED, Oelsner EC, Paine R, Watson KE, Benedetti A, Tan WC, Bourbeau J, Woodruff PG, Barr RG. Association of Dysanapsis With Chronic Obstructive Pulmonary Disease Among Older Adults. JAMA 2020; 323:2268-2280. [PMID: 32515814 PMCID: PMC7284296 DOI: 10.1001/jama.2020.6918] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/15/2020] [Indexed: 12/23/2022]
Abstract
Importance Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD), yet much of COPD risk remains unexplained. Objective To determine whether dysanapsis, a mismatch of airway tree caliber to lung size, assessed by computed tomography (CT), is associated with incident COPD among older adults and lung function decline in COPD. Design, Setting, and Participants A retrospective cohort study of 2 community-based samples: the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study, which involved 2531 participants (6 US sites, 2010-2018) and the Canadian Cohort of Obstructive Lung Disease (CanCOLD), which involved 1272 participants (9 Canadian sites, 2010-2018), and a case-control study of COPD: the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), which involved 2726 participants (12 US sites, 2011-2016). Exposures Dysanapsis was quantified on CT as the geometric mean of airway lumen diameters measured at 19 standard anatomic locations divided by the cube root of lung volume (airway to lung ratio). Main Outcomes and Measures Primary outcome was COPD defined by postbronchodilator ratio of forced expired volume in the first second to vital capacity (FEV1:FVC) less than 0.70 with respiratory symptoms. Secondary outcome was longitudinal lung function. All analyses were adjusted for demographics and standard COPD risk factors (primary and secondhand tobacco smoke exposures, occupational and environmental pollutants, and asthma). Results In the MESA Lung sample (mean [SD] age, 69 years [9 years]; 1334 women [52.7%]), 237 of 2531 participants (9.4%) had prevalent COPD, the mean (SD) airway to lung ratio was 0.033 (0.004), and the mean (SD) FEV1 decline was -33 mL/y (31 mL/y). Of 2294 MESA Lung participants without prevalent COPD, 98 (4.3%) had incident COPD at a median of 6.2 years. Compared with participants in the highest quartile of airway to lung ratio, those in the lowest had a significantly higher COPD incidence (9.8 vs 1.2 cases per 1000 person-years; rate ratio [RR], 8.12; 95% CI, 3.81 to 17.27; rate difference, 8.6 cases per 1000 person-years; 95% CI, 7.1 to 9.2; P < .001) but no significant difference in FEV1 decline (-31 vs -33 mL/y; difference, 2 mL/y; 95% CI, -2 to 5; P = .30). Among CanCOLD participants (mean [SD] age, 67 years [10 years]; 564 women [44.3%]), 113 of 752 (15.0%) had incident COPD at a median of 3.1 years and the mean (SD) FEV1 decline was -36 mL/y (75 mL/y). The COPD incidence in the lowest airway to lung quartile was significantly higher than in the highest quartile (80.6 vs 24.2 cases per 1000 person-years; RR, 3.33; 95% CI, 1.89 to 5.85; rate difference, 56.4 cases per 1000 person-years; 95% CI, 38.0 to 66.8; P<.001), but the FEV1 decline did not differ significantly (-34 vs -36 mL/y; difference, 1 mL/y; 95% CI, -15 to 16; P=.97). Among 1206 SPIROMICS participants (mean [SD] age, 65 years [8 years]; 542 women [44.9%]) with COPD who were followed up for a median 2.1 years, those in the lowest airway to lung ratio quartile had a mean FEV1 decline of -37 mL/y (15 mL/y), which did not differ significantly from the decline in MESA Lung participants (P = .98), whereas those in highest quartile had significantly faster decline than participants in MESA Lung (-55 mL/y [16 mL/y ]; difference, -17 mL/y; 95% CI, -32 to -3; P = .004). Conclusions and Relevance Among older adults, dysanapsis was significantly associated with COPD, with lower airway tree caliber relative to lung size associated with greater COPD risk. Dysanapsis appears to be a risk factor associated with COPD.
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Affiliation(s)
- Benjamin M. Smith
- Department of Medicine, Columbia University Medical Center, New York, New York
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City
- Department of Biomedical Engineering, University of Iowa, Iowa City
- Department of Internal Medicine, University of Iowa, Iowa City
| | | | - Shawn D. Aaron
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Norrina B. Allen
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Alain Bertoni
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Harvey O. Coxson
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Chris Cooper
- Department of Medicine, University of California, Los Angeles
| | - David J. Couper
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gerard Criner
- Department of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | - MeiLan K. Han
- Department of Medicine, University of Michigan, Ann Arbor
| | - Nadia N. Hansel
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David R. Jacobs
- Division of Epidemiology and Community Health School of Public Health, University of Minnesota, Minneapolis
| | - Joel D. Kaufman
- Department of Epidemiology, University of Washington, Seattle
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle
| | - Ching-Long Lin
- Department of Mechanical Engineering, University of Iowa, Iowa City
| | - Ani Manichaikul
- Department of Public Health Sciences, University of Virginia, Charlottesville
| | | | - Erin D. Michos
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City
| | - Karol E. Watson
- Department of Medicine, University of California, Los Angeles
| | - Andrea Benedetti
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Wan C. Tan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - R. Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York
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17
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Kirby M, Tanabe N, Vasilescu DM, Cooper JD, McDonough JE, Verleden SE, Vanaudenaerde BM, Sin DD, Tan WC, Coxson HO, Hogg JC. Computed Tomography Total Airway Count Is Associated with the Number of Micro-Computed Tomography Terminal Bronchioles. Am J Respir Crit Care Med 2020; 201:613-615. [PMID: 31697561 DOI: 10.1164/rccm.201910-1948le] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Miranda Kirby
- Ryerson UniversityToronto, Canada.,St. Paul's HospitalVancouver, Canada
| | | | | | - Joel D Cooper
- University of PennsylvaniaPhiladelphia, Pennsylvaniaand
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18
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Tang LYW, Coxson HO, Lam S, Leipsic J, Tam RC, Sin DD. Towards large-scale case-finding: training and validation of residual networks for detection of chronic obstructive pulmonary disease using low-dose CT. Lancet Digit Health 2020; 2:e259-e267. [PMID: 33328058 DOI: 10.1016/s2589-7500(20)30064-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/21/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is underdiagnosed in the community. Thoracic CT scans are widely used for diagnostic and screening purposes for lung cancer. In this proof-of-concept study, we aimed to evaluate a software pipeline for the automated detection of COPD, based on deep learning and a dataset of low-dose CTs that were performed for early detection of lung cancer. METHODS We examined the use of deep residual networks, a type of artificial residual network, for the automated detection of COPD. Three versions of the residual networks were independently trained to perform COPD diagnosis using random subsets of CT scans collected from the PanCan study, which enrolled ex-smokers and current smokers at high risk of lung cancer, and evaluated the networks using three-fold cross-validation experiments. External validation was performed using 2153 CT scans acquired from a separate cohort of individuals with COPD in the ECLIPSE study. Spirometric data were used to define COPD, with stages defined according to the GOLD criteria. FINDINGS The best performing networks achieved an area under the receiver operating characteristic curve (AUC) of 0·889 (SD 0·017) in three-fold cross-validation experiments. When the same set of networks was applied to the ECLIPSE cohort without any modifications to the trained models, they achieved an AUC of 0·886 (0·017), a positive predictive value of 0·847 (0·056), and a negative predictive value of 0·755 (0·097), which is a greater performance than the best quantitative CT measure, the percentage of lung volumes of less than or equal to -950 Hounsfield units (AUC 0·742). INTERPRETATION Our proposed approach could identify patients with COPD among ex-smokers and current smokers without a previous diagnosis of COPD, with clinically acceptable performance. The use of deep residual networks on chest CT scans could be an effective case-finding tool for COPD detection and diagnosis, particularly in ex-smokers and current smokers who are being screened for lung cancer. FUNDING Data Science Institute, University of British Columbia; Canadian Institutes of Health Research.
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Affiliation(s)
- Lisa Y W Tang
- Data Science Institute, University of British Columbia, Vancouver, BC, Canada; Department of Radiology, University of British Columbia, Vancouver, BC, Canada; University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada.
| | - Harvey O Coxson
- University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Stephen Lam
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Imaging Unit, Integrative Oncology Department, British Columbia Cancer Agency Research Centre, Vancouver, BC, Canada
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Roger C Tam
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Don D Sin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
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19
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Viglino D, Martin M, Almeras N, Després JP, Coxson HO, Pépin JL, Vivodtzev I, Maltais F. Low Liver Density Is Linked to Cardiovascular Comorbidity in COPD: An ECLIPSE Cohort Analysis. Int J Chron Obstruct Pulmon Dis 2019; 14:3053-3061. [PMID: 32099343 PMCID: PMC6997198 DOI: 10.2147/copd.s233834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Fatty liver disease is associated with cardiometabolic disorders and represents a potential key comorbidity in Chronic Obstructive Pulmonary Disease (COPD). Some intermediary mechanisms of fatty liver disease (including its histological component steatosis) include tissue hypoxia, low-grade inflammation and oxidative stress that are key features of COPD. Despite these shared physiological pathways, the effect of COPD on the prevalence of hepatic steatosis, and the association between hepatic steatosis and comorbidities in this population remain unclear. Liver density measured by computed tomography (CT)-scan is a non-invasive surrogate of fat infiltration, with lower liver densities reflecting more fat infiltration and a liver density of 40 Hounsfield Units (HU) corresponding to a severe 30% fat infiltration. Patients and Methods We took advantage of the international cohort ECLIPSE in which non-enhanced chest CT-scans were obtained in 1554 patients with COPD and 387 healthy controls to analyse the liver density at T12-L1. Results The distribution of liver density was similar and the prevalence of severe steatosis (density<40 HU) was not different (4.7% vs 5.2%, p=0.7) between COPD and controls. In patients with COPD, the lowest liver density quartile was associated, after age and sex adjustment, with coronary artery disease (ORa=1.59, 95% CI 1.12 to 2.24) and stroke (ORa=2.20, 95% CI 1.07 to 4.50), in comparison with the highest liver density quartile. Conclusion The present data indicate that a low liver density emerged as a predictor of cardiovascular comorbidities in the COPD population. However, the distribution of liver density and the prevalence of severe steatosis were similar in patients with COPD and control subjects.
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Affiliation(s)
- Damien Viglino
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Hypoxia Pathophysiology Laboratory INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France
| | - Mickaël Martin
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Natalie Almeras
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Jean-Pierre Després
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - Harvey O Coxson
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean-Louis Pépin
- Hypoxia Pathophysiology Laboratory INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France
| | - Isabelle Vivodtzev
- Hypoxia Pathophysiology Laboratory INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
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20
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Chen YW, Ramsook AH, Coxson HO, Bon J, Reid WD. Prevalence and Risk Factors for Osteoporosis in Individuals With COPD: A Systematic Review and Meta-analysis. Chest 2019; 156:1092-1110. [PMID: 31352034 DOI: 10.1016/j.chest.2019.06.036] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/10/2019] [Accepted: 06/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteoporosis is prevalent in individuals with COPD. Updated evidence is required to complement the previous systematic review on this topic to provide best practice. The aim of this systematic review and meta-analysis was to quantitatively synthesize data from studies with respect to the prevalence and risk factors for osteoporosis among individuals with COPD. METHODS EMBASE, CINAHL, MEDLINE, and PubMed databases were searched for articles containing the key words "COPD," "osteoporosis," "prevalence," and "risk factor." Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine osteoporosis prevalence and risk factors in individuals with COPD. Meta-regression analyses were conducted to explore the sources of heterogeneity. RESULTS The pooled global prevalence from 58 studies was 38% (95% CI, 34-43). The presence of COPD increased the likelihood of having osteoporosis (OR, 2.83). Other significant risk factors for osteoporosis in COPD patients were BMI < 18.5 kg/m2 (OR, 4.26) and the presence of sarcopenia (OR, 3.65). CONCLUSIONS Osteoporosis is prevalent in individuals with COPD, and the prevalence seems to be high and similar in many countries. Patients with COPD should be screened for osteoporosis and contributing risk factors.
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Affiliation(s)
- Yi-Wen Chen
- Department of Sports Medicine, China Medical University, Taichung, Taiwan.
| | - Andrew H Ramsook
- Department of Physical Therapy, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Harvey O Coxson
- Department of Radiology, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Bon
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - W Darlene Reid
- Department of Physical Therapy, Faculty of Medicine, Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; KITE - Toronto Rehab-University Health Network, Toronto, ON, Canada
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21
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Kim W, Cho MH, Sakornsakolpat P, Lynch DA, Coxson HO, Tal-Singer R, Silverman EK, Beaty TH. DSP variants may be associated with longitudinal change in quantitative emphysema. Respir Res 2019; 20:160. [PMID: 31324189 PMCID: PMC6642569 DOI: 10.1186/s12931-019-1097-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Background Emphysema, characterized by lung destruction, is a key component of Chronic Obstructive Pulmonary Disease (COPD) and is associated with increased morbidity and mortality. Genome-wide association studies (GWAS) have identified multiple genetic factors associated with cross-sectional measures of quantitative emphysema, but the genetic determinants of longitudinal change in quantitative measures of emphysema remain largely unknown. Our study aims to identify genetic variants associated with longitudinal change in quantitative emphysema measured by computed tomography (CT) imaging. Methods We included current and ex-smokers from two longitudinal cohorts: COPDGene, a study of Non-Hispanic Whites (NHW) and African Americans (AA), and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE). We calculated annual change in two quantitative measures of emphysema based on chest CT imaging: percent low attenuation area (≤ − 950HU) (%LAA-950) and adjusted lung density (ALD). We conducted GWAS, separately in 3030 NHW and 1158 AA from COPDGene and 1397 Whites from ECLIPSE. We further explored effects of 360 previously reported variants and a lung function based polygenic risk score on annual change in quantitative emphysema. Results In the genome-wide association analysis, no variants achieved genome-wide significance (P < 5e-08). However, in the candidate region analysis, rs2076295 in the DSP gene, previously associated with COPD, lung function and idiopathic pulmonary fibrosis, was associated with change in %LAA-950 (β (SE) = 0.09 (0.02), P = 3.79e-05) and in ALD (β (SE) = − 0.06 (0.02), P = 2.88e-03). A lung function based polygenic risk score was associated with annual change in %LAA-950 (P = 4.03e-02) and with baseline measures of quantitative emphysema (P < 1e-03) and showed a trend toward association with annual change in ALD (P = 7.31e-02). Conclusions DSP variants may be associated with longitudinal change in quantitative emphysema. Additional investigation of the DSP gene are likely to provide further insights into the disease progression in emphysema and COPD. Trial registration Clinicaltrials.gov Identifier: NCT00608764, NCT00292552. Electronic supplementary material The online version of this article (10.1186/s12931-019-1097-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Woori Kim
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.,Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael H Cho
- Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Phuwanat Sakornsakolpat
- Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, British Columbia, Canada
| | | | - Edwin K Silverman
- Channing Division of Network Medicine Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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22
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Kirby M, Tanabe N, Tan WC, Zhou G, Obeidat M, Hague CJ, Leipsic J, Bourbeau J, Sin DD, Hogg JC, Coxson HO. Total Airway Count on Computed Tomography and the Risk of Chronic Obstructive Pulmonary Disease Progression. Findings from a Population-based Study. Am J Respir Crit Care Med 2019; 197:56-65. [PMID: 28886252 DOI: 10.1164/rccm.201704-0692oc] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Studies of excised lungs show that significant airway attrition in the "quiet" zone occurs early in chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine if the total number of airways quantified in vivo using computed tomography (CT) reflects early airway-related disease changes and is associated with lung function decline independent of emphysema in COPD. METHODS Participants in the multicenter, population-based, longitudinal CanCOLD (Canadian Chronic Obstructive Lung Disease) study underwent inspiratory/expiratory CT at visit 1; spirometry was performed at four visits over 6 years. Emphysema was quantified as the CT inspiratory low-attenuation areas below -950 Hounsfield units. CT total airway count (TAC) was measured as well as airway inner diameter and wall area using anatomically equivalent airways. MEASUREMENTS AND MAIN RESULTS Participants included never-smokers (n = 286), smokers with normal spirometry at risk for COPD (n = 298), Global Initiative for Chronic Obstructive Lung Disease (GOLD) I COPD (n = 361), and GOLD II COPD (n = 239). TAC was significantly reduced by 19% in both GOLD I and GOLD II compared with never-smokers (P < 0.0001) and by 17% in both GOLD I and GOLD II compared with at-risk participants (P < 0.0001) after adjusting for low-attenuation areas below -950 Hounsfield units. Further analysis revealed parent airways with missing daughter branches had reduced inner diameters (P < 0.0001) and thinner walls (P < 0.0001) compared with those without missing daughter branches. Among all CT measures, TAC had the greatest influence on FEV1 (P < 0.0001), FEV1/FVC (P < 0.0001), and bronchodilator responsiveness (P < 0.0001). TAC was independently associated with lung function decline (FEV1, P = 0.02; FEV1/FVC, P = 0.01). CONCLUSIONS TAC may reflect the airway-related disease changes that accumulate in the "quiet" zone in early/mild COPD, indicating that TAC acquired with commercially available software across various CT platforms may be a biomarker to predict accelerated COPD progression.
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Affiliation(s)
- Miranda Kirby
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naoya Tanabe
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Wan C Tan
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Guohai Zhou
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ma'en Obeidat
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Cameron J Hague
- 2 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- 2 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- 3 The Montreal Chest Institute, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada; and.,4 Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, Quebec, Canada
| | - Don D Sin
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - James C Hogg
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Harvey O Coxson
- 1 The University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,2 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Kirby M, Tan WC, Hogg JC, Coxson HO. Reply to Hu et al.: How to Determine the Patient’s Head and Neck Posture during Computed Tomography Scanning? Am J Respir Crit Care Med 2018; 198:1238-1239. [DOI: 10.1164/rccm.201806-1154le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Miranda Kirby
- Centre for Heart Lung Innovation, St. Paul’s HospitalVancouver, British Columbia, Canadaand
- University of British ColumbiaVancouver, British Columbia, Canada
| | - Wan C. Tan
- Centre for Heart Lung Innovation, St. Paul’s HospitalVancouver, British Columbia, Canadaand
| | - James C. Hogg
- Centre for Heart Lung Innovation, St. Paul’s HospitalVancouver, British Columbia, Canadaand
| | - Harvey O. Coxson
- Centre for Heart Lung Innovation, St. Paul’s HospitalVancouver, British Columbia, Canadaand
- University of British ColumbiaVancouver, British Columbia, Canada
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24
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Koo HK, Vasilescu DM, Booth S, Hsieh A, Katsamenis OL, Fishbane N, Elliott WM, Kirby M, Lackie P, Sinclair I, Warner JA, Cooper JD, Coxson HO, Paré PD, Hogg JC, Hackett TL. Small airways disease in mild and moderate chronic obstructive pulmonary disease: a cross-sectional study. Lancet Respir Med 2018; 6:591-602. [PMID: 30072106 DOI: 10.1016/s2213-2600(18)30196-6] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/18/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The concept that small conducting airways less than 2 mm in diameter become the major site of airflow obstruction in chronic obstructive pulmonary disease (COPD) is well established in the scientific literature, and the last generation of small conducting airways, terminal bronchioles, are known to be destroyed in patients with very severe COPD. We aimed to determine whether destruction of the terminal and transitional bronchioles (the first generation of respiratory airways) occurs before, or in parallel with, emphysematous tissue destruction. METHODS In this cross-sectional analysis, we applied a novel multiresolution CT imaging protocol to tissue samples obtained using a systematic uniform sampling method to obtain representative unbiased samples of the whole lung or lobe of smokers with normal lung function (controls) and patients with mild COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1), moderate COPD (GOLD 2), or very severe COPD (GOLD 4). Patients with GOLD 1 or GOLD 2 COPD and smokers with normal lung function had undergone lobectomy and pneumonectomy, and patients with GOLD 4 COPD had undergone lung transplantation. Lung tissue samples were used for stereological assessment of the number and morphology of terminal and transitional bronchioles, airspace size (mean linear intercept), and alveolar surface area. FINDINGS Of the 34 patients included in this study, ten were controls (smokers with normal lung function), ten patients had GOLD 1 COPD, eight had GOLD 2 COPD, and six had GOLD 4 COPD with centrilobular emphysema. The 34 lung specimens provided 262 lung samples. Compared with control smokers, the number of terminal bronchioles decreased by 40% in patients with GOLD 1 COPD (p=0·014) and 43% in patients with GOLD 2 COPD (p=0·036), the number of transitional bronchioles decreased by 56% in patients with GOLD 1 COPD (p=0·0001) and 59% in patients with GOLD 2 COPD (p=0·0001), and alveolar surface area decreased by 33% in patients with GOLD 1 COPD (p=0·019) and 45% in patients with GOLD 2 COPD (p=0·0021). These pathological changes were found to correlate with lung function decline. We also showed significant loss of terminal and transitional bronchioles in lung samples from patients with GOLD 1 or GOLD 2 COPD that had a normal alveolar surface area. Remaining small airways were found to have thickened walls and narrowed lumens, which become more obstructed with increasing COPD GOLD stage. INTERPRETATION These data show that small airways disease is a pathological feature in mild and moderate COPD. Importantly, this study emphasises that early intervention for disease modification might be required by patients with mild or moderate COPD. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Hyun-Kyoung Koo
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Dragoş M Vasilescu
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Steven Booth
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Aileen Hsieh
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Orestis L Katsamenis
- μ-VIS X-ray Imaging Centre, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - Nick Fishbane
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - W Mark Elliott
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Miranda Kirby
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Peter Lackie
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ian Sinclair
- μ-VIS X-ray Imaging Centre, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - Jane A Warner
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joel D Cooper
- Division of Thoracic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Peter D Paré
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada; Department of Pathology, University of British Columbia, Vancouver, BC, Canada
| | - Tillie-Louise Hackett
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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25
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Chen YW, HajGhanbari B, Road JD, Coxson HO, Camp PG, Reid WD. Reliability and validity of the Brief Pain Inventory in individuals with chronic obstructive pulmonary disease. Eur J Pain 2018; 22:1718-1726. [PMID: 29883526 DOI: 10.1002/ejp.1258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pain is prevalent in chronic obstructive pulmonary disease (COPD) and the Brief Pain Inventory (BPI) appears to be a feasible questionnaire to assess this symptom. However, the reliability and validity of the BPI have not been determined in individuals with COPD. This study aimed to determine the internal consistency, test-retest reliability and validity (construct, convergent, divergent and discriminant) of the BPI in individuals with COPD. METHODS In order to examine the test-retest reliability, individuals with COPD were recruited from pulmonary rehabilitation programmes to complete the BPI twice 1 week apart. In order to investigate validity, de-identified data was retrieved from two previous studies, including forced expiratory volume in 1-s, age, sex and data from four questionnaires: the BPI, short-form McGill Pain Questionnaire (SF-MPQ), 36-Item Short Form Survey (SF-36) and Community Health Activities Model Program for Seniors (CHAMPS) questionnaire. RESULTS In total, 123 participants were included in the analyses (eligible data were retrieved from 86 participants and additional 37 participants were recruited). The BPI demonstrated excellent internal consistency and test-retest reliability. It also showed convergent validity with the SF-MPQ and divergent validity with the SF-36. The factor analysis yielded two factors of the BPI, which demonstrated that the two domains of the BPI measure the intended constructs. The BPI can also discriminate pain levels among COPD patients with varied levels of quality of life (SF-36) and physical activity (CHAMPS). CONCLUSION The BPI is a reliable and valid pain questionnaire that can be used to evaluate pain in COPD. SIGNIFICANCE This study formally established the reliability and validity of the BPI in individuals with COPD, which have not been determined in this patient group. The results of this study provide strong evidence that assessment results from this pain questionnaire are reliable and valid.
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Affiliation(s)
- Y-W Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - B HajGhanbari
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - J D Road
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H O Coxson
- Department of Radiology, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - P G Camp
- Department of Physical Therapy, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - W D Reid
- Department of Physical Therapy, University of Toronto, ON, Canada.,Interdivisional Department of Critical Care Medicine, University of Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
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26
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Chen YW, Coxson HO, Coupal TM, Lam S, Munk PL, Leipsic J, Reid WD. The contribution of thoracic vertebral deformity and arthropathy to trunk pain in patients with chronic obstructive pulmonary disease (COPD). Respir Med 2018; 137:115-122. [PMID: 29605193 DOI: 10.1016/j.rmed.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to trunk pain in COPD patients compared to people with a significant smoking history. METHOD Participants completed the Brief Pain Inventory (BPI) on the same day as chest CT scans and spirometry. Current and ex-smokers were separated into COPD (n = 91) or non-COPD (n = 80) groups based on spirometry. Subsequently, CT images were assessed for thoracic vertebral deformity, bone attenuation values, and arthropathy of thoracic vertebral joints. RESULTS The trunk area was the most common pain location in both COPD and non-COPD groups. Thoracic vertebral deformity and costotransverse joint arthropathy were independent contributors to trunk pain in COPD patients (adjusted OR = 3.55 and 1.30, respectively) whereas alcohol consumption contributed to trunk pain in the non-COPD group (adjusted OR = 0.35 in occasional alcohol drinkers; 0.08 in non-alcohol drinkers). The spinal deformity index and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients. CONCLUSION Trunk pain, at least in part, is caused by thoracic vertebral deformity, and costotransverse and intervertebral arthropathy in patients living with COPD. The results of this study provided the foundation for the management of pain, which requires further exploration.
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Affiliation(s)
- Yi-Wen Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| | - Harvey O Coxson
- Department of Radiology, and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Tyler M Coupal
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Stephen Lam
- Respiratory Division, Department of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology and Department of Medicine, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto Rehabilitation Institute, Interdivisional Department of Critical Care Medicine, Toronto, Canada
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27
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Tanabe N, Vasilescu DM, Kirby M, Coxson HO, Verleden SE, Vanaudenaerde BM, Kinose D, Nakano Y, Paré PD, Hogg JC. Analysis of airway pathology in COPD using a combination of computed tomography, micro-computed tomography and histology. Eur Respir J 2018; 51:51/2/1701245. [PMID: 29444912 DOI: 10.1183/13993003.01245-2017] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/30/2017] [Indexed: 01/01/2023]
Abstract
The small conducting airways are the major site of obstruction in chronic obstructive pulmonary disease (COPD). This study examined small airway pathology using a novel combination of multidetector row computed tomography (MDCT), micro-computed tomography (microCT) and histology.Airway branches visible on specimen MDCT were counted and the dimensions of the third- to fifth-generation airways were computed, while the terminal bronchioles (designated TB), preterminal bronchioles (TB-1) and pre-preterminal bronchioles (TB-2) were examined with microCT and histology in eight explanted lungs with end-stage COPD and seven unused donor lungs that served as controls.On MDCT, COPD lungs showed a decrease in the number of 2-2.5 mm diameter airways and the lumen area of fifth-generation airways, while on microCT there was a reduction in the number of terminal bronchioles as well as a decrease in the luminal areas, wall volumes and alveolar attachments to the walls of TB, TB-1 and TB-2 bronchioles. The combination of microCT and histology showed increased B-cell infiltration into the walls of TB-1 and TB-2 bronchioles, and this change was correlated with a reduced number of alveolar attachments in COPD.Small airways disease extends from 2 mm diameter airways to the terminal bronchioles in COPD. Destruction of alveolar attachments may be driven by a B-cell-mediated immune response in the preterminal bronchioles.
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Affiliation(s)
- Naoya Tanabe
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada .,Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Dragoş M Vasilescu
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Miranda Kirby
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Harvey O Coxson
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stijn E Verleden
- KU Leuven - University of Leuven, Dept of Clinical and Experimental Medicine, Division of Respiratory diseases, Leuven, Belgium
| | - Bart M Vanaudenaerde
- KU Leuven - University of Leuven, Dept of Clinical and Experimental Medicine, Division of Respiratory diseases, Leuven, Belgium
| | - Daisuke Kinose
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Division of Respiratory Medicine, Dept of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Dept of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Peter D Paré
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James C Hogg
- Centre for Heart and Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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28
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Labaki WW, Martinez CH, Martinez FJ, Galbán CJ, Ross BD, Washko GR, Barr RG, Regan EA, Coxson HO, Hoffman EA, Newell JD, Curran-Everett D, Hogg JC, Crapo JD, Lynch DA, Kazerooni EA, Han MK. The Role of Chest Computed Tomography in the Evaluation and Management of the Patient with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 196:1372-1379. [PMID: 28661698 DOI: 10.1164/rccm.201703-0451pp] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | - Fernando J Martinez
- 2 New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | | | | | - George R Washko
- 3 Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Graham Barr
- 4 New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | | | - Harvey O Coxson
- 6 University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | | | | | - James C Hogg
- 6 University of British Columbia, Vancouver, British Columbia, Canada; and
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29
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Chen YW, Camp PG, Coxson HO, Road JD, Guenette JA, Hunt MA, Reid WD. A Comparison of Pain, Fatigue, Dyspnea and their Impact on Quality of Life in Pulmonary Rehabilitation Participants with Chronic Obstructive Pulmonary Disease. COPD 2017; 15:65-72. [PMID: 29227712 DOI: 10.1080/15412555.2017.1401990] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In addition to dyspnea and fatigue, pain is a prevalent symptom in chronic obstructive pulmonary disease (COPD). Understanding the relative prevalence, magnitude, and interference with aspects of daily living of these symptoms can improve COPD management. Therefore, the purposes of this study were to: (1) compare the prevalence and magnitude of dyspnea, fatigue, and pain and how each limits aspects of daily living; (2) determine the association between pain and the other two symptoms; and (3) assess the impact of these symptoms on quality of life in COPD. Participants were recruited from pulmonary rehabilitation programs. Pain, dyspnea, and fatigue were measured using the Brief Pain Inventory (BPI), Brief Fatigue Inventory (BFI), and Dyspnea Inventory (DI), respectively. Quality of life was measured using the Clinical COPD Questionnaire (CCQ). The prevalence of dyspnea, fatigue, and pain were 93%, 77%, and 74%, respectively. Individuals with COPD reported similar severity scores of the three symptoms. Dyspnea interfered with general activity more than pain (F1.7,79.9 = 3.1, p < 0.05), whilst pain interfered with mood (F1.8, 82.7 = 3.6, p < 0.05) and sleep (F1,46 = 7.4, p < 0.01) more than dyspnea and fatigue. These three symptoms were moderately-to-highly correlated with each other (ρ = 0.49-0.78, p < 0.01) and all individually impacted quality of life. In summary, pain is a common symptom in addition to dyspnea and fatigue in COPD; all three interfere similarly among aspects of daily living with some exceptions. Accordingly, management of COPD should include a multifaceted approach that addresses pain as well as dyspnea and fatigue.
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Affiliation(s)
- Yi-Wen Chen
- a Department of Physical Therapy , University of British Columbia , Vancouver , BC Canada
| | - Pat G Camp
- b Department of Physical Therapy, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Harvey O Coxson
- c Department of Radiology, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Jeremy D Road
- d Division of Respiratory Medicine, Department of Medicine , University of British Columbia , Vancouver , BC Canada
| | - Jordan A Guenette
- b Department of Physical Therapy, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Michael A Hunt
- a Department of Physical Therapy , University of British Columbia , Vancouver , BC Canada
| | - W Darlene Reid
- e Department of Physical Therapy , University of Toronto , Toronto , ON Canada
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30
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Washko GR, Coxson HO, O'Donnell DE, Aaron SD. CT imaging of chronic obstructive pulmonary disease: insights, disappointments, and promise. Lancet Respir Med 2017; 5:903-908. [PMID: 28965820 DOI: 10.1016/s2213-2600(17)30345-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 11/26/2022]
Abstract
CT imaging is a readily quantifiable tool that can provide in-vivo assessments of lung structure in conditions such as chronic obstructive pulmonary disease (COPD). The information extracted from these data has been used in many clinical, epidemiological, and genetic investigations for patient stratification and prognostication, and to determine intermediate endpoints for clinical trials. Although these efforts have informed our understanding of the heterogeneity of pulmonary disease in smokers, they have not yet translated into new treatments for COPD or the personalisation of patient care. There are a multitude of potential reasons for this, including the lack of insight that static imaging provides for lung function and dysfunction, the limited resolution of clinical CT scanning for microscopic changes to the lung architecture, and the challenges that the biomedical community faces when trying to translate discovery to therapy. Such limitations might be addressed through novel image analysis techniques, up-and-coming CT-based and MRI-based technologies, closer ties between academia and industry, and an expanded endeavour to share data across the biomedical community.
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Affiliation(s)
- George R Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Denis E O'Donnell
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Shawn D Aaron
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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31
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Kirby M, Yin Y, Tschirren J, Tan WC, Leipsic J, Hague CJ, Bourbeau J, Sin DD, Hogg JC, Coxson HO. A Novel Method of Estimating Small Airway Disease Using Inspiratory-to-Expiratory Computed Tomography. Respiration 2017; 94:336-345. [PMID: 28848199 DOI: 10.1159/000478865] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/19/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Disease accumulates in the small airways without being detected by conventional measurements. OBJECTIVES To quantify small airway disease using a novel computed tomography (CT) inspiratory-to-expiratory approach called the disease probability measure (DPM) and to investigate the association with pulmonary function measurements. METHODS Participants from the population-based CanCOLD study were evaluated using full-inspiration/full-expiration CT and pulmonary function measurements. Full-inspiration and full-expiration CT images were registered, and each voxel was classified as emphysema, gas trapping (GasTrap) related to functional small airway disease, or normal using two classification approaches: parametric response map (PRM) and DPM (VIDA Diagnostics, Inc., Coralville, IA, USA). RESULTS The participants included never-smokers (n = 135), at risk (n = 97), Global Initiative for Chronic Obstructive Lung Disease I (GOLD I) (n = 140), and GOLD II chronic obstructive pulmonary disease (n = 96). PRMGasTrap and DPMGasTrap measurements were significantly elevated in GOLD II compared to never-smokers (p < 0.01) and at risk (p < 0.01), and for GOLD I compared to at risk (p < 0.05). Gas trapping measurements were significantly elevated in GOLD II compared to GOLD I (p < 0.0001) using the DPM classification only. Overall, DPM classified significantly more voxels as gas trapping than PRM (p < 0.0001); a spatial comparison revealed that the expiratory CT Hounsfield units (HU) for voxels classified as DPMGasTrap but PRMNormal (PRMNormal- DPMGasTrap = -785 ± 72 HU) were significantly reduced compared to voxels classified normal by both approaches (PRMNormal-DPMNormal = -722 ± 89 HU; p < 0.0001). DPM and PRMGasTrap measurements showed similar, significantly associations with forced expiratory volume in 1 s (FEV1) (p < 0.01), FEV1/forced vital capacity (p < 0.0001), residual volume/total lung capacity (p < 0.0001), bronchodilator response (p < 0.0001), and dyspnea (p < 0.05). CONCLUSION CT inspiratory-to-expiratory gas trapping measurements are significantly associated with pulmonary function and symptoms. There are quantitative and spatial differences between PRM and DPM classification that need pathological investigation.
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Affiliation(s)
- Miranda Kirby
- UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
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32
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Boueiz A, Lutz SM, Cho MH, Hersh CP, Bowler RP, Washko GR, Halper-Stromberg E, Bakke P, Gulsvik A, Laird NM, Beaty TH, Coxson HO, Crapo JD, Silverman EK, Castaldi PJ, DeMeo DL. Genome-Wide Association Study of the Genetic Determinants of Emphysema Distribution. Am J Respir Crit Care Med 2017; 195:757-771. [PMID: 27669027 DOI: 10.1164/rccm.201605-0997oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Emphysema has considerable variability in the severity and distribution of parenchymal destruction throughout the lungs. Upper lobe-predominant emphysema has emerged as an important predictor of response to lung volume reduction surgery. Yet, aside from alpha-1 antitrypsin deficiency, the genetic determinants of emphysema distribution remain largely unknown. OBJECTIVES To identify the genetic influences of emphysema distribution in non-alpha-1 antitrypsin-deficient smokers. METHODS A total of 11,532 subjects with complete genotype and computed tomography densitometry data in the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease [COPD]; non-Hispanic white and African American), ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints), and GenKOLS (Genetics of Chronic Obstructive Lung Disease) studies were analyzed. Two computed tomography scan emphysema distribution measures (difference between upper-third and lower-third emphysema; ratio of upper-third to lower-third emphysema) were tested for genetic associations in all study subjects. Separate analyses in each study population were followed by a fixed effect metaanalysis. Single-nucleotide polymorphism-, gene-, and pathway-based approaches were used. In silico functional evaluation was also performed. MEASUREMENTS AND MAIN RESULTS We identified five loci associated with emphysema distribution at genome-wide significance. These loci included two previously reported associations with COPD susceptibility (4q31 near HHIP and 15q25 near CHRNA5) and three new associations near SOWAHB, TRAPPC9, and KIAA1462. Gene set analysis and in silico functional evaluation revealed pathways and cell types that may potentially contribute to the pathogenesis of emphysema distribution. CONCLUSIONS This multicohort genome-wide association study identified new genomic loci associated with differential emphysematous destruction throughout the lungs. These findings may point to new biologic pathways on which to expand diagnostic and therapeutic approaches in chronic obstructive pulmonary disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00608764).
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Affiliation(s)
- Adel Boueiz
- 1 Channing Division of Network Medicine.,2 Pulmonary and Critical Care Division, Department of Medicine, and
| | - Sharon M Lutz
- 3 Department of Biostatistics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Michael H Cho
- 1 Channing Division of Network Medicine.,2 Pulmonary and Critical Care Division, Department of Medicine, and
| | - Craig P Hersh
- 1 Channing Division of Network Medicine.,2 Pulmonary and Critical Care Division, Department of Medicine, and
| | - Russell P Bowler
- 4 Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - George R Washko
- 2 Pulmonary and Critical Care Division, Department of Medicine, and
| | - Eitan Halper-Stromberg
- 4 Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Per Bakke
- 5 Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- 5 Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nan M Laird
- 6 Harvard School of Public Health, Boston, Massachusetts
| | - Terri H Beaty
- 7 Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and
| | - Harvey O Coxson
- 8 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - James D Crapo
- 4 Division of Pulmonary Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Edwin K Silverman
- 1 Channing Division of Network Medicine.,2 Pulmonary and Critical Care Division, Department of Medicine, and
| | - Peter J Castaldi
- 1 Channing Division of Network Medicine.,9 Division of General Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dawn L DeMeo
- 1 Channing Division of Network Medicine.,2 Pulmonary and Critical Care Division, Department of Medicine, and
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33
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Beiko T, Janech MG, Alekseyenko AV, Atkinson C, Coxson HO, Barth JL, Stephenson SE, Wilson CL, Schnapp LM, Barker A, Brantly M, Sandhaus RA, Silverman EK, Stoller JK, Trapnell B, Charlie S. Serum Proteins Associated with Emphysema Progression in Severe Alpha-1 Antitrypsin Deficiency. Chronic Obstr Pulm Dis 2017; 4:204-216. [PMID: 28848932 DOI: 10.15326/jcopdf.4.3.2016.0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Computed tomography (CT) lung density is an accepted biomarker for emphysema in alpha-1 antitrypsin deficiency (AATD), although concerns for radiation exposure limit its longitudinal use. Serum proteins associated with emphysema, particularly in early disease, may provide additional pathogenic insights. We investigated whether distinct proteomic signatures characterize the presence and progression of emphysema in individuals with severe AATD and normal forced expiratory volume in 1 second (FEV1). QUANTitative lung CT UnMasking emphysema progression in AATD (QUANTUM-1) is a multicenter, prospective 3-year study of 49 adults with severe AATD and FEV1 post-bronchodilator values (Post-BD) ≥ 80% predicted. All participants received chest CT, serial spirometry, and contributed to the serum biobank. Volumetric imaging display and analysis (VIDA) software defined the baseline 15th percentile density (PD15) which was indexed to CT-derived total lung capacity (TLC). We measured 317 proteins using a multiplexed immunoassay (Myriad Discovery MAP® panel) in 31 individuals with a complete dataset. We analyzed associations between initial PD15/TLC, PD15/TLC annual decline, body mass index (BMI), and protein levels using Pearson's product moment correlation. C-reactive protein (CRP), adipocyte fatty acid-binding protein (AFBP), leptin, and tissue plasminogen activator (tPA) were found to be associated with baseline emphysema and all but leptin were associated with emphysema progression after adjustments were made for age and sex. All 4 proteins were associated with BMI after further adjustment for multiple comparisons was made. The relationship between these proteins and BMI, and further validation of these findings in replicative cohorts require additional studies.
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Affiliation(s)
- Tatsiana Beiko
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Michael G Janech
- Division of Nephrology, Medical University of South Carolina, Charleston
| | - Alexander V Alekseyenko
- Biomedical Informatics Center, Departments of Public Health Sciences and Oral Health Sciences, Medical University of South Carolina, Charleston
| | - Carl Atkinson
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston
| | - Harvey O Coxson
- Centre for Heart Lung Innovation and Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Jeremy L Barth
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston
| | - Sarah E Stephenson
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Carole L Wilson
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Lynn M Schnapp
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Alan Barker
- Oregon Health and Science University, Portland
| | - Mark Brantly
- University of Florida Health Science Center, Gainesville
| | | | - Edwin K Silverman
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Bruce Trapnell
- University of Cincinnati/Cincinnati Children's Hospital Medical Center, Ohio
| | - Strange Charlie
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston
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Aamli Gagnat A, Gjerdevik M, Gallefoss F, Coxson HO, Gulsvik A, Bakke P. Incidence of non-pulmonary cancer and lung cancer by amount of emphysema and airway wall thickness: a community-based cohort. Eur Respir J 2017; 49:49/5/1601162. [PMID: 28495686 DOI: 10.1183/13993003.01162-2016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/28/2017] [Indexed: 11/05/2022]
Abstract
There is limited knowledge about the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness in cancer.The aim of this study was to investigate if using CT to quantitatively assess the amount of emphysema and airway wall thickness independently predicts the subsequent incidence of non-pulmonary cancer and lung cancer.In the GenKOLS study of 2003-2005, 947 ever-smokers performed spirometry and underwent CT examination. The main predictors were the amount of emphysema measured by the percentage of low attenuation areas (%LAA) on CT and standardised measures of airway wall thickness (AWT-PI10). Cancer data from 2003-2013 were obtained from the Norwegian Cancer Register. The hazard ratio associated with emphysema and airway wall thickness was assessed using Cox proportional hazards regression for cancer diagnoses.During 10 years of follow-up, non-pulmonary cancer was diagnosed in 11% of the subjects with LAA <3%, in 19% of subjects with LAA 3-10%, and in 17% of subjects with LAA ≥10%. Corresponding numbers for lung cancer were 2%, 3% and 11%, respectively. After adjustment, the baseline amount of emphysema remained a significant predictor of the incidence of non-pulmonary cancer and lung cancer. Airway wall thickness did not predict cancer independently.This study offers a strong argument that emphysema is an independent risk factor for both non-pulmonary cancer and lung cancer.
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Affiliation(s)
| | - Miriam Gjerdevik
- Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Dept of Thoracic Medicine, Norwegian Registry for Chronic Obstructive Pulmonary Disease and Norwegian Registry for Long-Term Mechanical Ventilation, Haukeland University Hospital, Bergen, Norway
| | - Frode Gallefoss
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Harvey O Coxson
- Dept of Radiology and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Amund Gulsvik
- Dept of Clinical Science, University of Bergen, Bergen, Norway
| | - Per Bakke
- Dept of Clinical Science, University of Bergen, Bergen, Norway
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Kirby M, Eddy RL, Pike D, Svenningsen S, Coxson HO, Sin DD, McCormack DG, Parraga G. MRI ventilation abnormalities predict quality-of-life and lung function changes in mild-to-moderate COPD: longitudinal TINCan study. Thorax 2017; 72:475-477. [DOI: 10.1136/thoraxjnl-2016-209770] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/04/2022]
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Martin M, Almeras N, Després JP, Coxson HO, Washko GR, Vivodtzev I, Wouters EF, Rutten E, Williams MC, Murchison JT, MacNee W, Sin DD, Maltais F. Ectopic fat accumulation in patients with COPD: an ECLIPSE substudy. Int J Chron Obstruct Pulmon Dis 2017; 12:451-460. [PMID: 28203068 PMCID: PMC5293362 DOI: 10.2147/copd.s124750] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obesity is increasingly associated with COPD, but little is known about the prevalence of ectopic fat accumulation in COPD and whether this can possibly be associated with poor clinical outcomes and comorbidities. The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) substudy tested the hypothesis that COPD is associated with increased ectopic fat accumulation and that this would be associated with COPD-related outcomes and comorbidities. METHODS Computed tomography (CT) images of the thorax obtained in ECLIPSE were used to quantify ectopic fat accumulation at L2-L3 (eg, cross-sectional area [CSA] of visceral adipose tissue [VAT] and muscle tissue [MT] attenuation, a reflection of muscle fat infiltration) and CSA of MT. A dose-response relationship between CSA of VAT, MT attenuation and CSA of MT and COPD-related outcomes (6-minute walking distance [6MWD], exacerbation rate, quality of life, and forced expiratory volume in 1 second [FEV1] decline) was addressed with the Cochran-Armitage trend test. Regression models were used to investigate possible relationships between CT body composition indices and comorbidities. RESULTS From the entire ECLIPSE cohort, we identified 585 subjects with valid CT images at L2-L3 to assess body composition. CSA of VAT was increased (P<0.0001) and MT attenuation was reduced (indicating more muscle fat accumulation) in patients with COPD (P<0.002). Progressively increasing CSA of VAT was not associated with adverse clinical outcomes. The probability of exhibiting low 6MWD and accelerated FEV1 decline increased with progressively decreasing MT attenuation and CSA of MT. In COPD, the probability of having diabetes (P=0.024) and gastroesophageal reflux (P=0.0048) at baseline increased in parallel with VAT accumulation, while the predicted MT attenuation increased the probability of cardiovascular comorbidities (P=0.042). Body composition parameters did not correlate with coronary artery scores or with survival. CONCLUSION Ectopic fat accumulation is increased in COPD, and this was associated with relevant clinical outcomes and comorbidities.
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Affiliation(s)
- Mickaël Martin
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Natalie Almeras
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Jean-Pierre Després
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - George R Washko
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabelle Vivodtzev
- Hypoxia Pathophysiology Laboratory, Grenoble University Hospital, Grenoble, France
| | - Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht
| | - Erica Rutten
- Research and Development, CIRO, Horn, the Netherlands
| | | | - John T Murchison
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William MacNee
- Department of Respiratory Medicine, University of Edinburgh
| | - Don D Sin
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - François Maltais
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
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Henderson WR, Molgat-Seon Y, Vos W, Lipson R, Ferreira F, Kirby M, Holsbeke CV, Dominelli PB, Griesdale DEG, Sekhon M, Coxson HO, Mayo J, Sheel AW. Functional respiratory imaging, regional strain, and expiratory time constants at three levels of positive end expiratory pressure in an ex vivo pig model. Physiol Rep 2016; 4:e13059. [PMID: 27923979 PMCID: PMC5357821 DOI: 10.14814/phy2.13059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/28/2016] [Accepted: 11/05/2016] [Indexed: 12/24/2022] Open
Abstract
Heterogeneity in regional end expiratory lung volume (EELV) may lead to variations in regional strain (ε). High ε levels have been associated with ventilator-associated lung injury (VALI). While both whole lung and regional EELV may be affected by changes in positive end-expiratory pressure (PEEP), regional variations are not revealed by conventional respiratory system measurements. Differential rates of deflation of adjacent lung units due to regional variation in expiratory time constants (τE) may create localized regions of ε that are significantly greater than implied by whole lung measures. We used functional respiratory imaging (FRI) in an ex vivo porcine lung model to: (i) demonstrate that computed tomography (CT)-based imaging studies can be used to assess global and regional values of ε and τE and, (ii) demonstrate that the manipulation of PEEP will cause measurable changes in total and regional ε and τE values. Our study provides three insights into lung mechanics. First, image-based measurements reveal egional variation that cannot be detected by traditional methods such as spirometry. Second, the manipulation of PEEP causes global and regional changes in R, E, ε and τE values. Finally, regional ε and τE were correlated in several lobes, suggesting the possibility that regional τE could be used as a surrogate marker for regional ε.
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Affiliation(s)
- William R Henderson
- Division of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | - Miranda Kirby
- Radiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Paolo B Dominelli
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald E G Griesdale
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mypinder Sekhon
- Division of Critical Care Medicine Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation St Paul's Hospital University of British Columbia, Vancouver, British Columbia, Canada
| | - John Mayo
- Department of Radiology Vancouver General Hospital University of British Columbia, Vancouver, British Columbia, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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Tan WC, Hague CJ, Leipsic J, Bourbeau J, Zheng L, Li PZ, Sin DD, Coxson HO, Kirby M, Hogg JC, Raju R, Road J, O’Donnell DE, Maltais F, Hernandez P, Cowie R, Chapman KR, Marciniuk DD, FitzGerald JM, Aaron SD. Findings on Thoracic Computed Tomography Scans and Respiratory Outcomes in Persons with and without Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study. PLoS One 2016; 11:e0166745. [PMID: 27861566 PMCID: PMC5115801 DOI: 10.1371/journal.pone.0166745] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/02/2016] [Indexed: 01/31/2023] Open
Abstract
Background Thoracic computed tomography (CT) scans are widely performed in clinical practice, often leading to detection of airway or parenchymal abnormalities in asymptomatic or minimally symptomatic individuals. However, clinical relevance of CT abnormalities is uncertain in the general population. Methods We evaluated data from 1361 participants aged ≥40 years from a Canadian prospective cohort comprising 408 healthy never-smokers, 502 healthy ever-smokers, and 451 individuals with spirometric evidence of chronic obstructive pulmonary disease (COPD) who had thoracic CT scans. CT images of subjects were visually scored for respiratory bronchiolitis(RB), emphysema(E), bronchial-wall thickening(BWT), expiratory air-trapping(AT), and bronchiectasis(B). Multivariable logistic regression models were used to assess associations of CT features with respiratory symptoms, dyspnea, health status as determined by COPD assessment test, and risk of clinically significant exacerbations during 12 months follow-up. Results About 11% of life-time never-smokers demonstrated emphysema on CT scans. Prevalence increased to 30% among smokers with normal lung function and 36%, 50%, and 57% among individuals with mild, moderate or severe/very severe COPD, respectively. Presence of emphysema on CT was associated with chronic cough (OR,2.11; 95%CI,1.4–3.18); chronic phlegm production (OR,1.87; 95% CI,1.27–2.76); wheeze (OR,1.61; 95% CI,1.05–2.48); dyspnoea (OR,2.90; 95% CI,1.41–5.98); CAT score≥10(OR,2.17; 95%CI,1.42–3.30) and risk of ≥2 exacerbations over 12 months (OR,2.17; 95% CI, 1.42–3.0). Conclusions Burden of thoracic CT abnormalities is high among Canadians ≥40 years of age, including never-smokers and smokers with normal lung function. Detection of emphysema on CT scans is associated with pulmonary symptoms and increased risk of exacerbations, independent of smoking or lung function.
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Affiliation(s)
- Wan C. Tan
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Cameron J. Hague
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Leipsic
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montréal, QC, Canada
| | - Liyun Zheng
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Pei Z. Li
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montréal, QC, Canada
| | - Don D. Sin
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Harvey O. Coxson
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Miranda Kirby
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James C. Hogg
- Center for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Rekha Raju
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jeremy Road
- University of British Columbia, Vancouver General Hospital, Institute for Heart and Lung Health, Vancouver, BC, Canada
| | - Denis E. O’Donnell
- Division of Respiratory & Critical Care Medicine, Queen’s University, Kingston, ON, Canada
| | - Francois Maltais
- Hospital Laval, Centre de Pneumologie, Institute Universitaire de Cardiologie et de Pneumologie de Quebec, Universite Laval, Quebec, QC, Canada
| | - Paul Hernandez
- Division of Respirology, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Cowie
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Darcy D. Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, and Airway research Group, University of Saskatchewan, Saskatoon, SK, Canada
| | - J. Mark FitzGerald
- University of British Columbia, Vancouver General Hospital, Institute for Heart and Lung Health, Vancouver, BC, Canada
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Chen YW, Camp PG, Coxson HO, Road JD, Guenette JA, Hunt MA, Reid WD. Comorbidities That Cause Pain and the Contributors to Pain in Individuals With Chronic Obstructive Pulmonary Disease. Arch Phys Med Rehabil 2016; 98:1535-1543. [PMID: 27866992 DOI: 10.1016/j.apmr.2016.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine comorbidities that cause pain and the potential contributors to pain in individuals with chronic obstructive pulmonary disease (COPD). DESIGN Prospective cross-sectional survey study. SETTING Pulmonary rehabilitation programs of 6 centers. PARTICIPANTS A convenience sample of individuals with COPD (N=137) who attended pulmonary rehabilitation programs. In total, 100 (73%) returned the survey packages. Of those responders, 96 participants (70%) were included in the analyses. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain was measured using the Brief Pain Inventory. The questionnaire used to obtain information about health conditions that might contribute to pain and a medication record asked, in lay terms, about comorbidities that cause pain. The health conditions that cause pain were then validated by health professionals. Demographics, fatigue, dyspnea, quality of life, and self-efficacy were also measured using questionnaires. RESULTS Pain was reported in 71% (68/96) of participants. Low back pain was the most common location (41%). Arthritis (75%), back problems (47%), and muscle cramps (46%) were the most common comorbidities that caused pain. Lower self-efficacy, and renting rather than home ownership increased the likelihood of pain (P<.05). Pain severity and Brief Fatigue Inventory scores contributed to pain interference scores (P<.05). CONCLUSIONS Pain was highly prevalent in pulmonary rehabilitation program participants with COPD. The most common causes of pain were musculoskeletal conditions. Pain severity and higher levels of fatigue contributed to how pain interfered with daily aspects of living. The assessment and management of pain need to be addressed within the overall care of individuals with COPD.
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Affiliation(s)
- Yi-Wen Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeremy D Road
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan A Guenette
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Tam A, Churg A, Wright JL, Zhou S, Kirby M, Coxson HO, Lam S, Man SFP, Sin DD. Sex Differences in Airway Remodeling in a Mouse Model of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2016; 193:825-34. [PMID: 26599602 DOI: 10.1164/rccm.201503-0487oc] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE After adjustment for the amount of smoking, women have a 50% increased risk of chronic obstructive pulmonary disease (COPD) compared with men. The anatomic basis and/or mechanism(s) of these sex-related differences in COPD are unknown. OBJECTIVES To characterize the impact of female sex hormones on chronic cigarette smoke-induced airway remodeling and emphysema in a mouse model of COPD. METHODS Airway remodeling and emphysema were determined morphometrically in male, female, and ovariectomized mice exposed to 6 months of cigarette smoke. Antioxidant- and transforming growth factor (TGF)-β-related genes were profiled in airway tissues. The selective estrogen receptor modulator tamoxifen was also administered during smoke exposure in a short-term model. Airway wall thickness of male and female human smokers at risk of or with mild COPD was measured using optical coherence tomography. MEASUREMENTS AND MAIN RESULTS Small airway wall remodeling was increased in female but not male or ovariectomized mice and was associated with increased distal airway resistance, down-regulation of antioxidant genes, increased oxidative stress, and activation of TGF-β1. These effects were prevented by ovariectomy. Use of tamoxifen as a therapeutic intervention mitigated smoke-induced increase in oxidative stress in female mice. Compared with male human smokers, female human smokers had significantly thicker airway walls. CONCLUSIONS The excess risk of small airway disease in female mice after chronic smoke exposure was associated with increased oxidative stress and TGF-β1 signaling and also was related to the effects of female sex hormones. Estrogen receptor antagonism might be of value in reducing oxidative stress in female smokers.
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Affiliation(s)
- Anthony Tam
- 1 Centre for Heart Lung Innovation, St. Paul's Hospital.,2 Department of Medicine, and
| | - Andrew Churg
- 3 Department of Pathology, University of British Columbia, Vancouver, BC, Canada; and
| | - Joanne L Wright
- 3 Department of Pathology, University of British Columbia, Vancouver, BC, Canada; and
| | - Steven Zhou
- 3 Department of Pathology, University of British Columbia, Vancouver, BC, Canada; and
| | - Miranda Kirby
- 1 Centre for Heart Lung Innovation, St. Paul's Hospital.,2 Department of Medicine, and
| | - Harvey O Coxson
- 1 Centre for Heart Lung Innovation, St. Paul's Hospital.,2 Department of Medicine, and
| | - Stephen Lam
- 4 British Columbia Cancer Agency, Vancouver, BC, Canada
| | - S F Paul Man
- 1 Centre for Heart Lung Innovation, St. Paul's Hospital.,2 Department of Medicine, and
| | - Don D Sin
- 1 Centre for Heart Lung Innovation, St. Paul's Hospital.,2 Department of Medicine, and
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Kirby M, van Beek EJR, Seo JB, Biederer J, Nakano Y, Coxson HO, Parraga G. Management of COPD: Is there a role for quantitative imaging? Eur J Radiol 2016; 86:335-342. [PMID: 27592252 DOI: 10.1016/j.ejrad.2016.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/26/2016] [Indexed: 11/19/2022]
Abstract
While the recent development of quantitative imaging methods have led to their increased use in the diagnosis and management of many chronic diseases, medical imaging still plays a limited role in the management of chronic obstructive pulmonary disease (COPD). In this review we highlight three pulmonary imaging modalities: computed tomography (CT), magnetic resonance imaging (MRI) and optical coherence tomography (OCT) imaging and the COPD biomarkers that may be helpful for managing COPD patients. We discussed the current role imaging plays in COPD management as well as the potential role quantitative imaging will play by identifying imaging phenotypes to enable more effective COPD management and improved outcomes.
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Affiliation(s)
- Miranda Kirby
- Department of Radiology, University of British Columbia, Vancouver, Canada; UBC James Hogg Research Center & The Institute of Heart and Lung Health, St. Paul's Hospital, Vancouver, Canada
| | - Edwin J R van Beek
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Joon Beom Seo
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Juergen Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Germany; Radiologie Darmstadt, Gross-Gerau County Hospital, Germany
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, Vancouver, Canada; UBC James Hogg Research Center & The Institute of Heart and Lung Health, St. Paul's Hospital, Vancouver, Canada
| | - Grace Parraga
- Robarts Research Institute, The University of Western Ontario, London, Canada; Department of Medical Biophysics, The University of Western Ontario, London, Canada.
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Leung JM, Chen V, Hollander Z, Dai D, Tebbutt SJ, Aaron SD, Vandemheen KL, Rennard SI, FitzGerald JM, Woodruff PG, Lazarus SC, Connett JE, Coxson HO, Miller B, Borchers C, McManus BM, Ng RT, Sin DD. COPD Exacerbation Biomarkers Validated Using Multiple Reaction Monitoring Mass Spectrometry. PLoS One 2016; 11:e0161129. [PMID: 27525416 PMCID: PMC4985129 DOI: 10.1371/journal.pone.0161129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/30/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in considerable morbidity and mortality. However, there are no objective biomarkers to diagnose AECOPD. METHODS We used multiple reaction monitoring mass spectrometry to quantify 129 distinct proteins in plasma samples from patients with COPD. This analytical approach was first performed in a biomarker cohort of patients hospitalized with AECOPD (Cohort A, n = 72). Proteins differentially expressed between AECOPD and convalescent states were chosen using a false discovery rate <0.01 and fold change >1.2. Protein selection and classifier building were performed using an elastic net logistic regression model. The performance of the biomarker panel was then tested in two independent AECOPD cohorts (Cohort B, n = 37, and Cohort C, n = 109) using leave-pair-out cross-validation methods. RESULTS Five proteins were identified distinguishing AECOPD and convalescent states in Cohort A. Biomarker scores derived from this model were significantly higher during AECOPD than in the convalescent state in the discovery cohort (p<0.001). The receiver operating characteristic cross-validation area under the curve (CV-AUC) statistic was 0.73 in Cohort A, while in the replication cohorts the CV-AUC was 0.77 for Cohort B and 0.79 for Cohort C. CONCLUSIONS A panel of five biomarkers shows promise in distinguishing AECOPD from convalescence and may provide the basis for a clinical blood test to diagnose AECOPD. Further validation in larger cohorts is necessary for future clinical translation.
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Affiliation(s)
- Janice M. Leung
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Virginia Chen
- PROOF Center of Excellence, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Zsuzsanna Hollander
- PROOF Center of Excellence, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Darlene Dai
- PROOF Center of Excellence, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Scott J. Tebbutt
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- PROOF Center of Excellence, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy L. Vandemheen
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen I. Rennard
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- AstraZeneca, Cambridge, United Kingdom
| | - J. Mark FitzGerald
- Division of Respiratory Medicine, Department of Medicine, Vancouver General Hospital and the Institute for Heart and Lung Health, Vancouver, British Columbia, Canada
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, United States of America
| | - Stephen C. Lazarus
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, United States of America
| | - John E. Connett
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Harvey O. Coxson
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Bruce Miller
- GlaxoSmithKline Research and Development, King of Prussia, Pennsylvania, United States of America
| | - Christoph Borchers
- University of Victoria-Genome British Columbia Proteomics Centre, Department of Biochemistry and Microbiology, University of Victoria, Victoria, British Columbia, Canada
| | - Bruce M. McManus
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- PROOF Center of Excellence, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Raymond T. Ng
- PROOF Center of Excellence, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Don D. Sin
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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Llapur CJ, Martínez MR, Grassino PT, Stok A, Altieri HH, Bonilla F, Caram MM, Krowchuk NM, Kirby M, Coxson HO, Tepper RS. Chronic Hypoxia Accentuates Dysanaptic Lung Growth. Am J Respir Crit Care Med 2016; 194:327-32. [DOI: 10.1164/rccm.201509-1851oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chen YW, Coxson HO, Reid WD. Reliability and Validity of the Brief Fatigue Inventory and Dyspnea Inventory in People With Chronic Obstructive Pulmonary Disease. J Pain Symptom Manage 2016; 52:298-304. [PMID: 27233134 DOI: 10.1016/j.jpainsymman.2016.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 02/02/2016] [Accepted: 02/26/2016] [Indexed: 11/28/2022]
Abstract
CONTEXT Dyspnea, fatigue, and pain are common in individuals with chronic obstructive pulmonary disease (COPD). However, questionnaires with a similar format are not available to assess their relative severity and interference. OBJECTIVES To determine the reliability and validity of the Brief Fatigue Inventory (BFI) and Dyspnea Inventory (DI) in COPD patients who attend pulmonary rehabilitation programs. METHODS Participants were recruited from four pulmonary rehabilitation programs to complete a survey package containing: the Chronic Respiratory Questionnaire (CRQ), BFI, and DI; and one week later, to complete the BFI and DI. Retrospective data of the CRQ, BFI, and DI were retrieved from one of the programs. RESULTS For the prospective component, there was an 85% response rate (n = 91) for the first package and 83.5% response rate (n = 76) for the second package. Retrospectively, CRQ, BFI, and DI data were retrieved from 48 charts. The BFI and DI demonstrated excellent internal consistency (Cronbach alpha = 0.96 both), and high test-retest reliability (intraclass correlation3,1 = 0.86 and 0.91, respectively). By comparison to the fatigue and dyspnea domains of the CRQ, the BFI showed high concurrent validity (ρ = -0.83), whereas the DI showed moderate (ρ = -0.57) to high (ρ = -0.78) concurrent validity. Factor analysis provided evidence that the items in the BFI and DI measured the intended constructs. CONCLUSION The BFI and DI are valid and reliable measures to evaluate fatigue and dyspnea in COPD patients and could be used concurrently with the Brief Pain Inventory to inform the relative severity and interference of these common symptoms in COPD.
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Affiliation(s)
- Yi-Wen Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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45
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí AA, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EFM, ZuWallack RL. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD. Eur Respir Rev 2016; 24:159-72. [PMID: 26028628 PMCID: PMC9487818 DOI: 10.1183/16000617.00000315] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. Clinicians, researchers and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified. Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers and patient advocates believe will have the greatest impact on patient-centred outcomes. ATS/ERS statement highlighting research areas that will have the greatest impact on patient-centred outcomes in COPDhttp://ow.ly/LXW2J
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46
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Kirby M, Lane P, Coxson HO. Measurement of pulmonary structure and function. Imaging 2016. [DOI: 10.1183/2312508x.10003415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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47
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Putman RK, Hatabu H, Araki T, Gudmundsson G, Gao W, Nishino M, Okajima Y, Dupuis J, Latourelle JC, Cho MH, El-Chemaly S, Coxson HO, Celli BR, Fernandez IE, Zazueta OE, Ross JC, Harmouche R, Estépar RSJ, Diaz AA, Sigurdsson S, Gudmundsson EF, Eiríksdottír G, Aspelund T, Budoff MJ, Kinney GL, Hokanson JE, Williams MC, Murchison JT, MacNee W, Hoffmann U, O’Donnell CJ, Launer LJ, Harrris TB, Gudnason V, Silverman EK, O’Connor GT, Washko GR, Rosas IO, Hunninghake GM. Association Between Interstitial Lung Abnormalities and All-Cause Mortality. JAMA 2016; 315:672-81. [PMID: 26881370 PMCID: PMC4828973 DOI: 10.1001/jama.2016.0518] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Interstitial lung abnormalities have been associated with lower 6-minute walk distance, diffusion capacity for carbon monoxide, and total lung capacity. However, to our knowledge, an association with mortality has not been previously investigated. OBJECTIVE To investigate whether interstitial lung abnormalities are associated with increased mortality. DESIGN, SETTING, AND POPULATION Prospective cohort studies of 2633 participants from the FHS (Framingham Heart Study; computed tomographic [CT] scans obtained September 2008-March 2011), 5320 from the AGES-Reykjavik Study (Age Gene/Environment Susceptibility; recruited January 2002-February 2006), 2068 from the COPDGene Study (Chronic Obstructive Pulmonary Disease; recruited November 2007-April 2010), and 1670 from ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints; between December 2005-December 2006). EXPOSURES Interstitial lung abnormality status as determined by chest CT evaluation. MAIN OUTCOMES AND MEASURES All-cause mortality over an approximate 3- to 9-year median follow-up time. Cause-of-death information was also examined in the AGES-Reykjavik cohort. RESULTS Interstitial lung abnormalities were present in 177 (7%) of the 2633 participants from FHS, 378 (7%) of 5320 from AGES-Reykjavik, 156 (8%) of 2068 from COPDGene, and in 157 (9%) of 1670 from ECLIPSE. Over median follow-up times of approximately 3 to 9 years, there were more deaths (and a greater absolute rate of mortality) among participants with interstitial lung abnormalities when compared with those who did not have interstitial lung abnormalities in the following cohorts: 7% vs 1% in FHS (6% difference [95% CI, 2% to 10%]), 56% vs 33% in AGES-Reykjavik (23% difference [95% CI, 18% to 28%]), and 11% vs 5% in ECLIPSE (6% difference [95% CI, 1% to 11%]). After adjustment for covariates, interstitial lung abnormalities were associated with a higher risk of death in the FHS (hazard ratio [HR], 2.7 [95% CI, 1.1 to 6.5]; P = .03), AGES-Reykjavik (HR, 1.3 [95% CI, 1.2 to 1.4]; P < .001), COPDGene (HR, 1.8 [95% CI, 1.1 to 2.8]; P = .01), and ECLIPSE (HR, 1.4 [95% CI, 1.1 to 2.0]; P = .02) cohorts. In the AGES-Reykjavik cohort, the higher rate of mortality could be explained by a higher rate of death due to respiratory disease, specifically pulmonary fibrosis. CONCLUSIONS AND RELEVANCE In 4 separate research cohorts, interstitial lung abnormalities were associated with a greater risk of all-cause mortality. The clinical implications of this association require further investigation.
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Affiliation(s)
- Rachel K. Putman
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Tetsuro Araki
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Gunnar Gudmundsson
- Department of Respiratory Medicine and Sleep, Landspital University Hospital, University of Iceland, Faculty of Medicine
| | - Wei Gao
- Department of Biostatistics, Boston University School of Public Health
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Yuka Okajima
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, St. Luke’s International Hospital, Tokyo, Japan
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health
- National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham MA
| | - Jeanne C. Latourelle
- Pulmonary Center, Department of Medicine, Boston University, Boston, MA
- Department of Neurology, Boston University, Boston, MA
| | - Michael H. Cho
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- The Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Souheil El-Chemaly
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Harvey O. Coxson
- Department of Radiology, University of British Columbia, Vancouver, B.C., Canada
| | - Bartolome R. Celli
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Isis E. Fernandez
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Comprehensive Pneumology Center, Ludwig-Maximilians-University, University Hospital Grosshadern, and Helmholtz Zentrum München; Member of the German Center for Lung Research, Munich, Germany
| | - Oscar E. Zazueta
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - James C. Ross
- The Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, Boston MA
| | - Rola Harmouche
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, Boston MA
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women’s Hospital, Boston MA
| | - Alejandro A. Diaz
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Matthew J. Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
| | - Gregory L. Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado
| | - John E. Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado
| | - Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, Scotland
| | - John T. Murchison
- Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, Scotland
| | - William MacNee
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christopher J. O’Donnell
- National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham MA
- Cardiovascular Epidemiology and Human Genomics Branch, NHLBI Division of Intramural Research, Bethesda, MD
| | - Lenore J. Launer
- Intramural Research Program, National Institute of Aging, NIH, Bethesda, MD
| | - Tamara B. Harrris
- Intramural Research Program, National Institute of Aging, NIH, Bethesda, MD
| | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Edwin K. Silverman
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- The Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - George T. O’Connor
- National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham MA
- Pulmonary Center, Department of Medicine, Boston University, Boston, MA
| | - George R. Washko
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Ivan O. Rosas
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Gary M. Hunninghake
- Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Kirby M, Ohtani K, Nickens T, Lisbona RML, Lee AMD, Shaipanich T, Lane P, MacAulay C, Lam S, Coxson HO. Reproducibility of optical coherence tomography airway imaging. Biomed Opt Express 2015; 6:4365-77. [PMID: 26601002 PMCID: PMC4646546 DOI: 10.1364/boe.6.004365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 09/23/2015] [Accepted: 09/30/2015] [Indexed: 05/23/2023]
Abstract
Optical coherence tomography (OCT) is a promising imaging technique to evaluate small airway remodeling. However, the short-term insertion-reinsertion reproducibility of OCT for evaluating the same bronchial pathway has yet to be established. We evaluated 74 OCT data sets from 38 current or former smokers twice within a single imaging session. Although the overall insertion-reinsertion airway wall thickness (WT) measurement coefficient of variation (CV) was moderate at 12%, much of the variability between repeat imaging was attributed to the observer; CV for repeated measurements of the same airway (intra-observer CV) was 9%. Therefore, reproducibility may be improved by introduction of automated analysis approaches suggesting that OCT has potential to be an in-vivo method for evaluating airway remodeling in future longitudinal and intervention studies.
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Affiliation(s)
- Miranda Kirby
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keishi Ohtani
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Taylor Nickens
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Rosa Maria Lopez Lisbona
- Department of Respirology, Bellvitge University Hospital, l’Hospitalet de Llobregat, Barcelona, Spain
| | - Anthony M. D. Lee
- Imaging Unit, Integrative Oncology Department, British Columbia Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Tawimas Shaipanich
- Imaging Unit, Integrative Oncology Department, British Columbia Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Pierre Lane
- Imaging Unit, Integrative Oncology Department, British Columbia Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Calum MacAulay
- Imaging Unit, Integrative Oncology Department, British Columbia Cancer Agency Research Centre, Vancouver, British Columbia, Canada
| | - Stephen Lam
- Imaging Unit, Integrative Oncology Department, British Columbia Cancer Agency Research Centre, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harvey O. Coxson
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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49
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Cho MH, Castaldi PJ, Hersh CP, Hobbs BD, Barr RG, Tal-Singer R, Bakke P, Gulsvik A, San José Estépar R, Van Beek EJR, Coxson HO, Lynch DA, Washko GR, Laird NM, Crapo JD, Beaty TH, Silverman EK. A Genome-Wide Association Study of Emphysema and Airway Quantitative Imaging Phenotypes. Am J Respir Crit Care Med 2015; 192:559-69. [PMID: 26030696 PMCID: PMC4595690 DOI: 10.1164/rccm.201501-0148oc] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 05/28/2015] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) is defined by the presence of airflow limitation on spirometry, yet subjects with COPD can have marked differences in computed tomography imaging. These differences may be driven by genetic factors. We hypothesized that a genome-wide association study (GWAS) of quantitative imaging would identify loci not previously identified in analyses of COPD or spirometry. In addition, we sought to determine whether previously described genome-wide significant COPD and spirometric loci were associated with emphysema or airway phenotypes. OBJECTIVES To identify genetic determinants of quantitative imaging phenotypes. METHODS We performed a GWAS on two quantitative emphysema and two quantitative airway imaging phenotypes in the COPDGene (non-Hispanic white and African American), ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints), NETT (National Emphysema Treatment Trial), and GenKOLS (Genetics of COPD, Norway) studies and on percentage gas trapping in COPDGene. We also examined specific loci reported as genome-wide significant for spirometric phenotypes related to airflow limitation or COPD. MEASUREMENTS AND MAIN RESULTS The total sample size across all cohorts was 12,031, of whom 9,338 were from COPDGene. We identified five loci associated with emphysema-related phenotypes, one with airway-related phenotypes, and two with gas trapping. These loci included previously reported associations, including the HHIP, 15q25, and AGER loci, as well as novel associations near SERPINA10 and DLC1. All previously reported COPD and a significant number of spirometric GWAS loci were at least nominally (P < 0.05) associated with either emphysema or airway phenotypes. CONCLUSIONS Genome-wide analysis may identify novel risk factors for quantitative imaging characteristics in COPD and also identify imaging features associated with previously identified lung function loci.
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Affiliation(s)
- Michael H. Cho
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | | | - Craig P. Hersh
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Brian D. Hobbs
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - R. Graham Barr
- Department of Medicine, College of Physicians and Surgeons, and
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ruth Tal-Singer
- GlaxoSmithKline Research and Development, King of Prussia, Pennsylvania
| | - Per Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Raúl San José Estépar
- Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Edwin J. R. Van Beek
- Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Department of Radiology and
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Harvey O. Coxson
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A. Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
| | - Nan M. Laird
- Harvard School of Public Health, Boston, Massachusetts; and
| | - James D. Crapo
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Terri H. Beaty
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Edwin K. Silverman
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
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50
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Sheikh K, Coxson HO, Parraga G. This
is what
COPD
looks like. Respirology 2015; 21:224-36. [DOI: 10.1111/resp.12611] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Khadija Sheikh
- Robarts Research Institute London Canada
- Department of Medical BiophysicsThe University of Western Ontario London Canada
| | - Harvey O Coxson
- UBC Centre for Heart Lung InnovationSt. Paul's Hospital Vancouver Canada
- Department of RadiologyUniversity of British Columbia Vancouver Canada
| | - Grace Parraga
- Robarts Research Institute London Canada
- Department of Medical BiophysicsThe University of Western Ontario London Canada
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