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Mettler SK, Nath HP, Grumley S, Orejas JL, Dolliver WR, Nardelli P, Yen AC, Kligerman SJ, Jacobs K, Manapragada PP, Abozeed M, Aziz MU, Zahid M, Ahmed AN, Terry NL, Elalami R, Estépar RSJ, Sonavane S, Billatos E, Wang W, Estépar RSJ, Richards JB, Cho MH, Diaz AA. Silent Airway Mucus Plugs in COPD and Clinical Implications. Chest 2023:S0012-3692(23)05825-7. [PMID: 38013161 DOI: 10.1016/j.chest.2023.11.033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Airway mucus plugs are frequently identified on CT scans of patients with COPD with a smoking history without mucus-related symptoms (ie, cough, phlegm [silent mucus plugs]). RESEARCH QUESTION In patients with COPD, what are the risk and protective factors associated with silent airway mucus plugs? Are silent mucus plugs associated with functional, structural, and clinical measures of disease? STUDY DESIGN AND METHODS We identified mucus plugs on chest CT scans of participants with COPD from the COPDGene study. The mucus plug score was defined as the number of pulmonary segments with mucus plugs, ranging from 0 to 18, and categorized into three groups (0, 1-2, and ≥ 3). We determined risk and protective factors for silent mucus plugs and the associations of silent mucus plugs with measures of disease severity using multivariable linear and logistic regression models. RESULTS Of 4,363 participants with COPD, 1,739 had no cough or phlegm. Among the 1,739 participants, 627 (36%) had airway mucus plugs identified on CT scan. Risk factors of silent mucus plugs (compared with symptomatic mucus plugs) were older age (OR, 1.02), female sex (OR, 1.40), and Black race (OR, 1.93) (all P values < .01). Among those without cough or phlegm, silent mucus plugs (vs absence of mucus plugs) were associated with worse 6-min walk distance, worse resting arterial oxygen saturation, worse FEV1 % predicted, greater emphysema, thicker airway walls, and higher odds of severe exacerbation in the past year in adjusted models. INTERPRETATION Mucus plugs are common in patients with COPD without mucus-related symptoms. Silent mucus plugs are associated with worse functional, structural, and clinical measures of disease. CT scan-identified mucus plugs can complement the evaluation of patients with COPD.
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Affiliation(s)
- Sofia K Mettler
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Hrudaya P Nath
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Scott Grumley
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - José L Orejas
- Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Pietro Nardelli
- Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Andrew C Yen
- Department of Radiology, University of California San Diego, San Diego, CA
| | | | - Kathleen Jacobs
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Padma P Manapragada
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Mostafa Abozeed
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Muhammad Usman Aziz
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Mohd Zahid
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Asmaa N Ahmed
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Nina L Terry
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Rim Elalami
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ruben San José Estépar
- Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | | | - Ehab Billatos
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, MA
| | - Raúl San José Estépar
- Harvard Medical School, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Jeremy B Richards
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Alejandro A Diaz
- Harvard Medical School, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
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Diaz AA, Wang W, Orejas JL, Elalami R, Dolliver WR, Nardelli P, San José Estépar R, Choi B, Pistenmaa CL, Ross JC, Maselli DJ, Yen A, Young KA, Kinney GL, Cho MH, San José Estépar R. Suspected Bronchiectasis and Mortality in Adults With a History of Smoking Who Have Normal and Impaired Lung Function : A Cohort Study. Ann Intern Med 2023; 176:1340-1348. [PMID: 37782931 PMCID: PMC10809158 DOI: 10.7326/m23-1125] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Bronchiectasis in adults with chronic obstructive pulmonary disease (COPD) is associated with greater mortality. However, whether suspected bronchiectasis-defined as incidental bronchiectasis on computed tomography (CT) images plus clinical manifestation-is associated with increased mortality in adults with a history of smoking with normal spirometry and preserved ratio impaired spirometry (PRISm) is unknown. OBJECTIVE To determine the association between suspected bronchiectasis and mortality in adults with normal spirometry, PRISm, and obstructive spirometry. DESIGN Prospective, observational cohort. SETTING The COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) study. PARTICIPANTS 7662 non-Hispanic Black or White adults, aged 45 to 80 years, with 10 or more pack-years of smoking history. Participants who were former and current smokers were stratified into normal spirometry (n = 3277), PRISm (n = 986), and obstructive spirometry (n = 3399). MEASUREMENTS Bronchiectasis identified by CT was ascertained using artificial intelligence-based measurements of an airway-to-artery ratio (AAR) greater than 1 (AAR >1), a measure of bronchial dilatation. The primary outcome of "suspected bronchiectasis" was defined as an AAR >1 of greater than 1% plus 2 of the following: cough, phlegm, dyspnea, and history of 2 or more exacerbations. RESULTS Among the 7662 participants (mean age, 60 years; 52% women), 1352 (17.6%) had suspected bronchiectasis. During a median follow-up of 11 years, 2095 (27.3%) died. Ten-year mortality risk was higher in participants with suspected bronchiectasis, compared with those without suspected bronchiectasis (normal spirometry: difference in mortality probability [Pr], 0.15 [95% CI, 0.09 to 0.21]; PRISm: Pr, 0.07 [CI, -0.003 to 0.15]; obstructive spirometry: Pr, 0.06 [CI, 0.03 to 0.09]). When only CT was used to identify bronchiectasis, the differences were attenuated in the normal spirometry (Pr, 0.04 [CI, -0.001 to 0.08]). LIMITATIONS Only 2 racial groups were studied. Only 1 measurement was used to define bronchiectasis on CT. Symptoms of suspected bronchiectasis were nonspecific. CONCLUSION Suspected bronchiectasis was associated with a heightened risk for mortality in adults with normal and obstructive spirometry. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts (W.W.)
| | - Jose L Orejas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Rim Elalami
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
| | - Ruben San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
| | - Bina Choi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - Carrie L Pistenmaa
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts (A.A.D., J.L.O., R.E., W.R.D., B.C., C.L.P.)
| | - James C Ross
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
| | - Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, The University of Texas at San Antonio, San Antonio, Texas (D.J.M.)
| | - Andrew Yen
- Department of Radiology, University of California San Diego, San Diego, California (A.Y.)
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado (K.A.Y., G.L.K.)
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado (K.A.Y., G.L.K.)
| | - Michael H Cho
- Division of Pulmonary and Critical Care Medicine, and Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.H.C.)
| | - Raul San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts (P.N., RubenS.J.E., J.C.R., RaulS.J.E.)
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Diaz AA, Orejas JL, Grumley S, Nath HP, Wang W, Dolliver WR, Yen A, Kligerman SJ, Jacobs K, Manapragada PP, Abozeed M, Aziz MU, Zahid M, Ahmed AN, Terry NL, San José Estépar R, Kim V, Make BJ, Han MK, Sonavane S, Washko GR, Cho M, San José Estépar R. Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease. JAMA 2023; 329:1832-1839. [PMID: 37210745 PMCID: PMC10201404 DOI: 10.1001/jama.2023.2065] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 11/17/2022] [Accepted: 02/07/2023] [Indexed: 05/23/2023]
Abstract
Importance Airway mucus plugs are common in patients with chronic obstructive pulmonary disease (COPD); however, the association of airway mucus plugging and mortality in patients with COPD is unknown. Objective To determine whether airway mucus plugs identified on chest computed tomography (CT) were associated with increased all-cause mortality. Design, Setting, and Participants Observational retrospective analysis of prospectively collected data of patients with a diagnosis of COPD in the Genetic Epidemiology of COPD cohort. Participants were non-Hispanic Black or White individuals, aged 45 to 80 years, who smoked at least 10 pack-years. Participants were enrolled at 21 centers across the US between November 2007 and April 2011 and were followed up through August 31, 2022. Exposures Mucus plugs that completely occluded airways on chest CT scans, identified in medium- to large-sized airways (ie, approximately 2- to 10-mm lumen diameter) and categorized as affecting 0, 1 to 2, or 3 or more lung segments. Main Outcomes and Measures The primary outcome was all-cause mortality, assessed with proportional hazard regression analysis. Models were adjusted for age, sex, race and ethnicity, body mass index, pack-years smoked, current smoking status, forced expiratory volume in the first second of expiration, and CT measures of emphysema and airway disease. Results Among the 4483 participants with COPD, 4363 were included in the primary analysis (median age, 63 years [IQR, 57-70 years]; 44% were women). A total of 2585 (59.3%), 953 (21.8%), and 825 (18.9%) participants had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. During a median 9.5-year follow-up, 1769 participants (40.6%) died. The mortality rates were 34.0% (95% CI, 32.2%-35.8%), 46.7% (95% CI, 43.5%-49.9%), and 54.1% (95% CI, 50.7%-57.4%) in participants who had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. The presence of mucus plugs in 1 to 2 vs 0 and 3 or more vs 0 lung segments was associated with an adjusted hazard ratio of death of 1.15 (95% CI, 1.02-1.29) and 1.24 (95% CI, 1.10-1.41), respectively. Conclusions and Relevance In participants with COPD, the presence of mucus plugs that obstructed medium- to large-sized airways was associated with higher all-cause mortality compared with patients without mucus plugging on chest CT scans.
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Affiliation(s)
- Alejandro A. Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - José L. Orejas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Scott Grumley
- Department of Radiology, University of Alabama at Birmingham
| | - Hrudaya P. Nath
- Department of Radiology, University of Alabama at Birmingham
| | - Wei Wang
- Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Wojciech R. Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Andrew Yen
- Department of Radiology, University of California, San Diego
| | - Seth J. Kligerman
- Department of Radiology, University of California, San Diego
- now with Department of Radiology, National Jewish Health, Denver, Colorado
| | - Kathleen Jacobs
- Department of Radiology, University of California, San Diego
| | | | - Mostafa Abozeed
- Department of Radiology, University of Alabama at Birmingham
| | | | - Mohd Zahid
- Department of Radiology, University of Alabama at Birmingham
| | - Asmaa N. Ahmed
- Department of Radiology, University of Alabama at Birmingham
| | - Nina L. Terry
- Department of Radiology, University of Alabama at Birmingham
| | - Ruben San José Estépar
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Victor Kim
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Barry J. Make
- Division of Pulmonary, Critical Care and Sleep Medicine at National Jewish Health, Denver, Colorado
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care at the University of Michigan, Ann Arbor
| | | | - George R. Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Michael Cho
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raúl San José Estépar
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
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4
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Díaz AA, Nardelli P, Wang W, San José Estépar R, Yen A, Kligerman S, Maselli DJ, Dolliver WR, Tsao A, Orejas JL, Aliberti S, Aksamit TR, Young KA, Kinney GL, Washko GR, Silverman EK, San José Estépar R. Artificial Intelligence-based CT Assessment of Bronchiectasis: The COPDGene Study. Radiology 2023; 307:e221109. [PMID: 36511808 PMCID: PMC10068886 DOI: 10.1148/radiol.221109] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/04/2022] [Revised: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
Background CT is the standard method used to assess bronchiectasis. A higher airway-to-artery diameter ratio (AAR) is typically used to identify enlarged bronchi and bronchiectasis; however, current imaging methods are limited in assessing the extent of this metric in CT scans. Purpose To determine the extent of AARs using an artificial intelligence-based chest CT and assess the association of AARs with exacerbations over time. Materials and Methods In a secondary analysis of ever-smokers from the prospective, observational, multicenter COPDGene study, AARs were quantified using an artificial intelligence tool. The percentage of airways with AAR greater than 1 (a measure of airway dilatation) in each participant on chest CT scans was determined. Pulmonary exacerbations were prospectively determined through biannual follow-up (from July 2009 to September 2021). Multivariable zero-inflated regression models were used to assess the association between the percentage of airways with AAR greater than 1 and the total number of pulmonary exacerbations over follow-up. Covariates included demographics, lung function, and conventional CT parameters. Results Among 4192 participants (median age, 59 years; IQR, 52-67 years; 1878 men [45%]), 1834 had chronic obstructive pulmonary disease (COPD). During a 10-year follow-up and in adjusted models, the percentage of airways with AARs greater than 1 (quartile 4 vs 1) was associated with a higher total number of exacerbations (risk ratio [RR], 1.08; 95% CI: 1.02, 1.15; P = .01). In participants meeting clinical and imaging criteria of bronchiectasis (ie, clinical manifestations with ≥3% of AARs >1) versus those who did not, the RR was 1.37 (95% CI: 1.31, 1.43; P < .001). Among participants with COPD, the corresponding RRs were 1.10 (95% CI: 1.02, 1.18; P = .02) and 1.32 (95% CI: 1.26, 1.39; P < .001), respectively. Conclusion In ever-smokers with chronic obstructive pulmonary disease, artificial intelligence-based CT measures of bronchiectasis were associated with more exacerbations over time. Clinical trial registration no. NCT00608764 © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Schiebler and Seo in this issue.
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Affiliation(s)
- Alejandro A. Díaz
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Pietro Nardelli
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Wei Wang
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Rubén San José Estépar
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Andrew Yen
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Seth Kligerman
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Diego J. Maselli
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Wojciech R. Dolliver
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Andrew Tsao
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - José L. Orejas
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Stefano Aliberti
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Timothy R. Aksamit
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Kendra A. Young
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Gregory L. Kinney
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - George R. Washko
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Edwin K. Silverman
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
| | - Raúl San José Estépar
- From the Division of Pulmonary and Critical Care Medicine (A.A.D.,
W.R.D., A.T., J.L.O., G.R.W.), Department of Radiology (P.N., Rubén San
José Estépar, Raúl San José Estépar),
Division of Sleep Medicine and Circadian Disorders (W.W.), and Channing Division
of Network Medicine (E.K.S.), Brigham and Women’s Hospital, Harvard
Medical School, 15 Francis St, Boston, MA 02115; Department of Radiology,
University of California–San Diego, San Diego, Calif (A.Y., S.K.);
Division of Pulmonary Diseases and Critical Care, University of Texas–San
Antonio, San Antonio, Tex (D.J.M.); Department of Biomedical Sciences, Humanitas
University, Milan, Italy (S.A.); Respiratory Unit, IRCCS Humanitas Research
Hospital, Milan, Italy (S.A.); Department of Pulmonary Disease and Critical Care
Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); and Department of Epidemiology,
Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y.,
G.L.K.)
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5
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Dolliver WR, Wang W, Nardelli P, Rahaghi FN, Orejas JL, Maselli DJ, Yen A, Young K, Kinney G, Estépar RSJ, Diaz AA. Pulmonary arterial pruning is associated with CT-derived bronchiectasis progression in smokers. Respir Med 2022; 202:106971. [PMID: 36116143 DOI: 10.1016/j.rmed.2022.106971] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
Loss of small pulmonary arteries measured as the ratio of blood vessel volume in arteries <5 mm2 in cross-section to total arterial blood vessel volume (BV5a/TBVa), with lower values indicating more pruning, was associated with 5-yr progressing CT-derived bronchiectasis in smokers (Odds Ratio (OR) [95% Confidence interval], 1.28 [1.07-1.53] per 5% lower BV5a/TBVa, P = 0.007). Corresponding results in smokers with COPD were: OR 1.45 [1.11-1.89] per 5% lower BV5a/TBVa, P = 0.007. The results support a vascular factor for structural progression of bronchiectasis.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Wei Wang
- Division of Sleep Medicine and Circadian Disorders, Brigham and Women's Hospital, Boston, USA
| | - Pietro Nardelli
- Department of Radiology, Brigham and Women's Hospital, Boston, USA
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Jose L Orejas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA
| | - Diego J Maselli
- Division of Pulmonary Diseases and Critical Care, University of Texas, San Antonio, USA
| | - Andrew Yen
- Department of Radiology, University of California, San Diego, USA
| | - Kendra Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, USA
| | - Gregory Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, USA
| | | | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, USA.
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6
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Maselli DJ, Yen A, Wang W, Okajima Y, Dolliver WR, Mercugliano C, Anzueto A, Restrepo MI, Aksamit TR, Basavaraj A, Aliberti S, Young KA, Kinney GL, Wells JM, San José Estépar R, Lynch DA, Diaz AA. Small Airway Disease and Emphysema Are Associated with Future Exacerbations in Smokers with CT-derived Bronchiectasis and COPD: Results from the COPDGene Cohort. Radiology 2021; 300:706-714. [PMID: 34156303 DOI: 10.1148/radiol.2021204052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) and bronchiectasis can overlap and share pathologic features, such as small airway disease (SAD). Whether the presence of SAD and emphysema in smokers with CT-derived bronchiectasis is associated with exacerbations is unknown. Purpose To assess whether SAD and emphysema in smokers with CT-derived bronchiectasis are associated with future exacerbations. Materials and Methods SAD and emphysema were quantified using the parametric response map method in former and current heavy smokers with and without bronchiectasis at CT from the COPDGene Study (from July 2009 to July 2018). Exacerbations were prospectively assessed through biannual follow-up. An exacerbation was defined as an increase in or new onset of respiratory symptoms treated with antibiotics and/or corticosteroids. Severe exacerbations were defined as those that required hospitalization. The association of a high burden of SAD (≥15.6%) and high burden of emphysema (≥5%) at CT with exacerbations was assessed with generalized linear mixed models. Results Of 737 participants, 387 (median age, 64 years [interquartile range, 58-71 years]; 223 women) had CT-derived bronchiectasis. During a 9-year follow-up, after adjustment for age, sex, race, body mass index, current smoking status, pack-years, exacerbations before study entry, forced expiratory volume in 1 second, or FEV1, and bronchiectasis severity CT score, high burden of SAD and high burden of emphysema were associated with a higher number of exacerbations per year (relative risk [RR], 1.89 [95% CI: 1.54, 2.33] and 1.37 [95% CI: 1.13, 1.66], respectively; P ≤ .001 for both). Results were comparable among participants with bronchiectasis meeting criteria for COPD (n = 197) (RR, 1.67 [95% CI: 1.23, 2.27] for high burden of SAD and 1.51 [95% CI: 1.20, 1.91] for high burden of emphysema; P ≤ .001 for both). Conclusion In smokers with CT-derived bronchiectasis and chronic obstructive pulmonary disease, structural damage to lung parenchyma and small airways was associated with a higher number of exacerbations per year. Clinical trial registration no. NCT00608764 © RSNA, 2021.
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Affiliation(s)
- Diego Jose Maselli
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Andrew Yen
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Wei Wang
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Yuka Okajima
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Wojciech R Dolliver
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Christina Mercugliano
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Antonio Anzueto
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Marcos I Restrepo
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Timothy R Aksamit
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Ashwin Basavaraj
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Stefano Aliberti
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Kendra A Young
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Gregory L Kinney
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - J Michael Wells
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Raúl San José Estépar
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - David A Lynch
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
| | - Alejandro A Diaz
- From the Division of Pulmonary Diseases and Critical Care, the University of Texas Health Science Center at San Antonio, San Antonio, Tex (D.J.M., A.A., M.I.R.); Department of Radiology, University of California, San Diego, Calif (A.Y.); Division of Sleep Medicine and Circadian Disorders (W.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine (W.R.D., A.A.D.), and Department of Radiology (R.S.J.E.), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan (Y.O.); Quinnipiac University School of Medicine, Hamden, Conn (C.M.); South Texas Veterans Health Care System, San Antonio, Tex (A.A., M.I.R.); Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, Minn (T.R.A.); Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine, New York, NY (A.B.); Department of Pathophysiology and Transplantation, University of Milan Internal Medicine, and Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy (S.A.); Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colo (K.A.Y., G.L.K.); Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Ala (J.M.W.); and Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.)
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Kim V, Dolliver WR, Nath HP, Grumley SA, Terry N, Ahmed A, Yen A, Jacobs K, Kligerman S, Diaz AA. Mucus plugging on computed tomography and chronic bronchitis in chronic obstructive pulmonary disease. Respir Res 2021; 22:110. [PMID: 33865371 PMCID: PMC8053272 DOI: 10.1186/s12931-021-01712-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/11/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Victor Kim
- Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, 785 Parkinson Pavilion, Philadelphia, PA, 19140, USA.
| | - Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Hrudaya P Nath
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Scott A Grumley
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nina Terry
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Asmaa Ahmed
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew Yen
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Kathleen Jacobs
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Seth Kligerman
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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8
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Dolliver WR, Diaz AA. Advances in Chronic Obstructive Pulmonary Disease Imaging. ACTA ACUST UNITED AC 2020; 6:128-143. [PMID: 33758787 DOI: 10.23866/brnrev:2019-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chest computed tomography (CT) imaging is a useful tool that provides in vivo information regarding lung structure. Imaging has contributed to a better understanding of COPD, allowing for the detection of early structural changes and the quantification of extra-pulmonary structures. Novel CT imaging techniques have provided insight into the progression of the main COPD subtypes, such as emphysema and small airway disease. This article serves as a review of new information relevant to COPD imaging. CT abnormalities, such as emphysema and loss of airways, are present even in smokers who do not meet the criteria for COPD and in those with mild-to-moderate disease. Subjects with mild-to-moderate COPD, with the highest loss of airways, also experience the highest decline in lung function. Extra-pulmonary manifestations of COPD, such as right ventricle enlargement and low muscle mass measured on CT, are associated with increased risk for all-cause mortality. CT longitudinal data has also given insight into the progression of COPD. Mechanically affected areas of lung parenchyma adjacent to emphysematous areas are associated with a greater decline in FEV1. Subjects with the greatest percentage of small airway disease, as measured on matched inspiratory-expiratory CT scan, also present with the greatest decline in lung function.
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Affiliation(s)
- Wojciech R Dolliver
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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