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Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
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Rudnyk V, Chaplynska N, Skrypnyk L. BRONCHIECTASIS IN ADULT PATIENTS: CLINICAL PECULIARITIES AND APPROACHES TO THE TREATMENT. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1406-1412. [PMID: 37463375 DOI: 10.36740/wlek202306112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim: To perform a clinical analysis of bronchiectasis in adults, to analyze the effectiveness of nebulizer therapy with hypertonic NaCl solution with hyaluronic acid. PATIENTS AND METHODS Materials and methods: All patients were performed clinical-functional examination (MRC dyspnea index, Sp O2, 6-minute walking test, external respiration function); calculated the index BODE, analyzed the SGRQ, studied the results of sputum. Statistical data analysis was performed using the Microsoft Excel for Microsoft 365 MSO 16.0.13530.2040418 package of statistical functions. RESULTS Results: The main symptom in 100% of cases was chronic cough with production of sputum. Patients were concerned about shortness of breath (91.7%), episodic hemoptysis (29.2%), systemic symptoms (fatigue, weight loss). Hypertonic NaCl solution has a direct mucolytic effect, osmotic and anti-edematous effect. Protection of the mucous membrane of the respiratory tract makes hyaluronic acid an ideal additional component of hypertonic saline solution. All patients showed a positive effect of treatment immediately. After 2 weeks, the respiratory rate decreased, the FEV1 index increased at 8.6 (p<0.05), SpO2 increased up to 93.75 ± 7.13%, the number of points according to the SGRQ decreased, BODE index also decreased. CONCLUSION Conclusions: Leading clinical signs of bronchiectasis were: a chronic cough with daily sputum production (100% of patients), shortness of breath (91.7%). The use of nebulizer inhalations decreased shortness of breath at 17.6% (р<0.05), improved external respiratory function indices (FVCL increased at 9.7% (р<0.01), FEV1 at 8.6% (р<0.01)) and blood oxygen saturation increased at 4.9% (р<0.05)). The offered complex increased tolerance to physical exertion (the 6-minute walk test and 4-year survival (BODE prognostic index).
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Affiliation(s)
- Viktoriia Rudnyk
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | | | - Liubov Skrypnyk
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
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Lee HJ, Kim SK, Lee JW, Im SA, Chung NG, Cho B. Quantitative CT lung densitometry as an obstructive marker for the diagnosis of bronchiolitis obliterans in children. PLoS One 2022; 17:e0271135. [PMID: 35797398 PMCID: PMC9262182 DOI: 10.1371/journal.pone.0271135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to evaluate the quantitative diagnostic performance of computed tomography (CT) densitometry in pediatric patients with bronchiolitis obliterans (BO). We measured the mean lung density (MLD) and represented the difference of MLD in inspiratory and expiratory phases (MLDD), the ratio of the MLD (E/I MLD), and the relative volume percentage of lung density at 50-Hounsfield unit (HU) interval threshold (E600 to E950). We calculated the sensitivity, specificity, and diagnostic accuracy of the lung density indices for the diagnosis of BO. A total of 81 patients, including 51 patients with BO and 30 controls, were included in this study. In the BO patients, expiratory (EXP) MLD and MLDD were significantly lower, and E/I MLD and expiratory low attenuation areas below the threshold of −850 HU to −950 HU (E850, E900, and E950) were statistically significantly higher than controls. Multivariate logistic regression analysis showed that MLDD (odds ratio [OR] = 0.98, p < .001), E/I MLD (OR = 1.39, p < .001), and E850 to E950 were significant densitometry parameters for BO diagnosis. In a receiver-operating characteristic analysis, E900 (cutoff, 1.4%; AUC = 0.920), E/I MLD (cutoff, 0.87; AUC = 0.887), and MLDD (cutoff, 109 HU; AUC = 0.867) showed high accuracy for the diagnosis of BO. In conclusion, the lung CT densitometry can serve as a quantitative marker providing additional indications of expiratory airflow limitation in pediatric patients with BO.
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Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Koo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Ah Im
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Nagpal P, Guo J, Shin KM, Lim JK, Kim KB, Comellas AP, Kaczka DW, Peterson S, Lee CH, Hoffman EA. Quantitative CT imaging and advanced visualization methods: potential application in novel coronavirus disease 2019 (COVID-19) pneumonia. BJR Open 2021; 3:20200043. [PMID: 33718766 PMCID: PMC7931412 DOI: 10.1259/bjro.20200043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Increasingly, quantitative lung computed tomography (qCT)-derived metrics are providing novel insights into chronic inflammatory lung diseases, including chronic obstructive pulmonary disease, asthma, interstitial lung disease, and more. Metrics related to parenchymal, airway, and vascular anatomy together with various measures associated with lung function including regional parenchymal mechanics, air trapping associated with functional small airways disease, and dual-energy derived measures of perfused blood volume are offering the ability to characterize disease phenotypes associated with the chronic inflammatory pulmonary diseases. With the emergence of COVID-19, together with its widely varying degrees of severity, its rapid progression in some cases, and the potential for lengthy post-COVID-19 morbidity, there is a new role in applying well-established qCT-based metrics. Based on the utility of qCT tools in other lung diseases, previously validated supervised classical machine learning methods, and emerging unsupervised machine learning and deep-learning approaches, we are now able to provide desperately needed insight into the acute and the chronic phases of this inflammatory lung disease. The potential areas in which qCT imaging can be beneficial include improved accuracy of diagnosis, identification of clinically distinct phenotypes, improvement of disease prognosis, stratification of care, and early objective evaluation of intervention response. There is also a potential role for qCT in evaluating an increasing population of post-COVID-19 lung parenchymal changes such as fibrosis. In this work, we discuss the basis of various lung qCT methods, using case-examples to highlight their potential application as a tool for the exploration and characterization of COVID-19, and offer scanning protocols to serve as templates for imaging the lung such that these established qCT analyses have the best chance at yielding the much needed new insights.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | | | | | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ki Beom Kim
- Department of Radiology, Daegu Fatima Hospital, Daegu, South Korea
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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Huang Y, Jiang B, Miao X, Ma J, Wang J, Ding K, Chen X, Hu Q, Fu F, Zeng T, Hu J, Hu B, Yang D, Zhang X. The Relationship of Lymphocyte to High-Density Lipoprotein Ratio with Pulmonary Function in COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:3159-3169. [PMID: 33293805 PMCID: PMC7718883 DOI: 10.2147/copd.s276372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This study aimed to explore the relation between lymphocyte to high-density lipoprotein ratio (LHR) and pulmonary function of chronic obstructive pulmonary disease (COPD) patients compared with neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR). Patients and Methods In total, 154 participants (n = 77 with COPD and n = 77 without COPD) were recruited. LHR, NLR, PLR, lung function and other data were collected and compared. Pearson’s correlation test and the receiver operating characteristics curves were used to compare the utility of LHR, NLR and PLR. Besides, univariate and multivariate logistic regression analyses were conducted. Results COPD patients with poorer lung function had a lower LHR level (P < 0.001). In low LHR group, more patients underwent greater airflow limitation than the other group (P = 0.006). LHR positively correlated with forced expiratory volume in 1 second in percent of the predicted value (FEV1%) (r = 0.333, P = 0.003). At a cut-off value of 2.08, the sensitivity and specificity of LHR in predicting FEV1% < 50 were 93.2% and 55.6%, respectively, with an AUC of 0.770 (P = 0.001) better than NLR and PLR. Based on logistic regression analyses, it was proved that LHR was associated with decreased risk of FEV1 <50% predicted in COPD patients (odds ratio = 0.198, 95% CI: 0.048–0.811, P = 0.024). Conclusion In contrast with NLR and PLR, LHR has higher accuracy for predicting pulmonary function in COPD; lower LHR level is independently associated with poorer pulmonary function.
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Affiliation(s)
- Yiben Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Bingqian Jiang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaqi Miao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiedong Ma
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jianing Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Keke Ding
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xianjing Chen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Qiaoming Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Fangyi Fu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Tian Zeng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jingyu Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Binbin Hu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xiaodiao Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Xu L, Ye T, Li J, Hu Y, Xu W, Wang K, Ou C, Chen X. Identification of relevant variables and construction of a multidimensional index for predicting mortality in COPD patients. Int J Chron Obstruct Pulmon Dis 2019; 14:1703-1711. [PMID: 31534324 PMCID: PMC6682173 DOI: 10.2147/copd.s215219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background and objective The Body mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index is a well-known metric for chronic obstructive pulmonary disease (COPD), but it is inadequate for predicting mortality. This study proposed a new index that combines inspiratory muscle training with the BODE index and verified its ability to predict mortality in patients with COPD. Methods Cox regression identified predictors of mortality, which were then included in the new index. The receiver operating characteristic (ROC) curve verified the ability of the new index to predict mortality. The Kaplan-Meier curves compared the survival rates of patients with different scores on the new index. Results Among the 326 patients, 48 died during follow-up (1–59 months). Cox regression showed that the fat-free mass index (FFMI), forced expiratory volume in one second/the predicted value (FEV1%), modified Medical Research Council (mMRC) score, six-minute–walk test (6MWT) distance, and maximal inspiratory pressure were predictors of mortality (P<0.05); these variables were included in the FODEP index. The AUC of the FODEP index (0.860, 95% CI: 95% CI: 0.817–0.896) was greater than that of the BODE index (0.778, 95% CI: 0.729–0.822). The Kaplan-Meier curves suggested that as the FODEP score increased, so did the risk of morality in patients with COPD. The cumulative survival in the group with the highest FODEP-value was significantly lower than that in the other groups (P<0.01). Conclusion The FODEP index was more effective than the BODE index at predicting the risk of mortality in patients with COPD.
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Affiliation(s)
- Limei Xu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Tiaofei Ye
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiahui Li
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yuhe Hu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Wenhui Xu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Kai Wang
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Chunquan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People's Republic of China
| | - Xin Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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7
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Gonçalves I, Guimarães M, van Zeller M, Menezes F, Moita J, Simão P. Clinical and molecular markers in COPD. Pulmonology 2018; 24:250-259. [DOI: 10.1016/j.pulmoe.2018.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 02/09/2018] [Indexed: 11/15/2022] Open
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Lim JU, Lee JH, Kim TH, Lee JS, Lee SD, Oh YM, Rhee CK. Alternative definitions of chronic bronchitis and their correlation with CT parameters. Int J Chron Obstruct Pulmon Dis 2018; 13:1893-1899. [PMID: 29942122 PMCID: PMC6005312 DOI: 10.2147/copd.s164055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Phenotyping of chronic bronchitis (CB) using COPD assessment tool (CAT) scores and St George's Respiratory Questionnaire (SGRQ) has rarely been attempted. The present study defined CB using CAT 1 and 2 scores and the questions on the severity of cough and sputum from the SGRQ. Furthermore, the predictability of CT parameters was also assessed for each CB definition. Materials and methods Patients enrolled in the Korean Obstructive Lung Disease study from June 2005 to October 2015 were evaluated for this study. The patients were spirometrically diagnosed with COPD and had a smoking history of >10 pack-years. Volumetric CT scans were performed for each patient upon enrollment in the cohort. Two definitions of CB using CAT 1/2 scores and SGRQ questions were used to phenotype CB among the study patients. Receiver operating characteristic curve analysis was performed to estimate the predictability of CT parameters for the CB phenotypes. Results Using CAT 1/2 scores, 57 of 279 (20.4%) patients had CB, and 178 of 573 (31.1%) had CB when the SGRQ questions were used to phenotype it. Total CAT and SGRQ scores were significantly higher in the CB group than those in the non-CB group for both definitions of CB. Forced expiratory volume in 1 second was lower for both CAT-defined and SGRQ-defined CB than that in the non-CB group. Mean wall thickness was significantly higher for both CB groups than in the non-CB group. Expiratory lung volume was higher and mean lung density was significantly lower for the SGRQ-defined CB group than non-CB group. Conclusion The 2 CB definitions using CAT scores and the SGRQ questions correlated with associated CT airway parameters. SGRQ-defined CB better reflected the accompaniment of small airway obstruction when compared with CAT-defined CB.
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Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Tae-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ostridge K, Williams NP, Kim V, Harden S, Bourne S, Clarke SC, Aris E, Mesia-Vela S, Devaster JM, Tuck A, Williams A, Wootton S, Staples KJ, Wilkinson TMA. Relationship of CT-quantified emphysema, small airways disease and bronchial wall dimensions with physiological, inflammatory and infective measures in COPD. Respir Res 2018; 19:31. [PMID: 29458372 PMCID: PMC5819274 DOI: 10.1186/s12931-018-0734-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/01/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND COPD is a complex, heterogeneous disease characterised by progressive development of airflow limitation. Spirometry provides little information about key aspects of pathology and is poorly related to clinical outcome, so other tools are required to investigate the disease. We sought to explore the relationships between quantitative CT analysis with functional, inflammatory and infective assessments of disease to identify the utility of imaging to stratify disease to better predict outcomes and disease response. METHODS Patients from the AERIS study with moderate-very severe COPD underwent HRCT, with image analysis determining the quantity of emphysema (%LAA<- 950), small airways disease (E/I MLD) and bronchial wall thickening (Pi10). At enrolment subjects underwent lung function testing, six-minute walk testing (6MWT), blood sampling for inflammatory markers and sputum sampling for white cell differential and microbiological culture and PCR. RESULTS 122 subjects were included in this analysis. Emphysema and small airways disease had independent associations with airflow obstruction (β = - 0.34, p < 0.001 and β = - 0.56, p < 0.001). %LAA<- 950 had independent associations with gas transfer (β = - 0.37, p < 0.001) and E/I MLD with RV/TLC (β = 0.30, p =0.003). The distance walked during the 6MWT was not associated with CT parameters, but exertional desaturation was independently associated with emphysema (β = 0.73, p < 0.001). Pi10 did not show any independent associations with lung function or functional parameters. No CT parameters had any associations with sputum inflammatory cells. Greater emphysema was associated with lower levels of systemic inflammation (CRP β = - 0.34, p < 0.001 and fibrinogen β = - 0.28, p =0.003). There was no significant difference in any of the CT parameters between subjects where potentially pathogenic bacteria were detected in sputum and those where it was not. CONCLUSIONS This study provides further validation for the use of quantitative CT measures of emphysema and small airways disease in COPD as they showed strong associations with pulmonary physiology and functional status. In contrast to this quantitative CT measures showed few convincing associations with biological measures of disease, suggesting it is not an effective tool at measuring disease activity.
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Affiliation(s)
- Kristoffer Ostridge
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. .,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Nicholas P Williams
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Viktoriya Kim
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Harden
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Simon Bourne
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth, UK
| | - Stuart C Clarke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | | | | | | | - Andrew Tuck
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Anthony Williams
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Stephen Wootton
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Karl J Staples
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Tom M A Wilkinson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
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10
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Crossley D, Renton M, Khan M, Low EV, Turner AM. CT densitometry in emphysema: a systematic review of its clinical utility. Int J Chron Obstruct Pulmon Dis 2018; 13:547-563. [PMID: 29445272 PMCID: PMC5808715 DOI: 10.2147/copd.s143066] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the study was to assess the relationship between computed tomography (CT) densitometry and routine clinical markers in patients with chronic obstructive pulmonary disease (COPD) and alpha-1 anti-trypsin deficiency (AATD). METHODS Multiple databases were searched using a combination of pertinent terms and those articles relating quantitatively measured CT densitometry to clinical outcomes. Studies that used visual scoring only were excluded, as were those measured in expiration only. A thorough review of abstracts and full manuscripts was conducted by 2 reviewers; data extraction and assessment of bias was conducted by 1 reviewer and the 4 reviewers independently assessed for quality. Pooled correlation coefficients were calculated, and heterogeneity was explored. RESULTS A total of 112 studies were identified, 82 being suitable for meta-analysis. The most commonly used density threshold was -950 HU, and a significant association between CT density and all included clinical parameters was demonstrated. There was marked heterogeneity between studies secondary to large variety of disease severity within commonly included cohorts and differences in CT acquisition parameters. CONCLUSION CT density shows a good relationship to clinically relevant parameters; however, study heterogeneity and lack of longitudinal data mean that it is difficult to compare studies or derive a minimal clinically important difference. We recommend that international consensus is reached to standardize CT conduct and analysis in future COPD and AATD studies.
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Affiliation(s)
- Diana Crossley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Correspondence: Diana Crossley, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK, Tel +44 121 371 3885, Fax +44 121 371 3203, Email
| | - Mary Renton
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Khan
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Emma V Low
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
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Cui L, Ji X, Xie M, Dou S, Wang W, Xiao W. Role of inspiratory capacity on dyspnea evaluation in COPD with or without emphysematous lesions: a pilot study. Int J Chron Obstruct Pulmon Dis 2017; 12:2823-2830. [PMID: 29033563 PMCID: PMC5628691 DOI: 10.2147/copd.s142016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Since forced expiratory volume in 1 second (FEV1) shows a weak correlation with patients’ symptoms in COPD, some volume parameters may better reflect the change in dyspnea symptoms after treatment. In this article, we investigated the role of inspiratory capacity (IC) on dyspnea evaluation among COPD patients with or without emphysematous lesions. Methods In this prospective study, 124 patients with stable COPD were recruited. During the baseline visit, patients performed pulmonary function tests and dyspnea evaluation using the modified Medical Research Council (mMRC) scale. Partial patients underwent quantitative computerized tomography scans under physicians’ recommendations, and emphysematous changes were assessed using the emphysema index (EI; low attenuation area [LAA]% −950). These subjects were then divided into the emphysema-predominant group (LAA% −950≥9.9%) and the non-emphysema-predominant group (LAA% −950<9.9%). After treatment for ~1 month, subjects returned for reevaluation of both pulmonary function parameters and dyspnea severity. Correlation analysis between the change in IC (ΔIC) and dyspnea (ΔmMRC) was performed. Results Correlation analysis revealed that ΔIC was negatively correlated with ΔmMRC (correlation coefficient [cc], −0.490, P<0.001) in the total study population, which was stronger than that between ΔFEV1 and ΔmMRC (cc, −0.305, P=0.001). Patients with absolute ΔmMRC >1 were more likely to exhibit a marked increase in IC (≥300 mL) than those with absolute ΔmMRC ≤1 (74.36% versus 35.29%; odds ratio [OR], 5.317; P<0.001). In the emphysema-predominant group, only ΔIC strongly correlated with ΔmMRC (cc, −0.459, P=0.005), while ΔFEV1 did not (P>0.05). Conclusion IC could serve as an effective complement to FEV1 in COPD patients undergoing dyspnea evaluation after treatment. For COPD patients with predominant emphysematous lesions, an increase in IC is particularly more suitable for explaining dyspnea relief than FEV1.
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Affiliation(s)
- Liwei Cui
- Department of Respiratory Disease, Qilu Hospital, Shandong University
| | - Xiuli Ji
- Department of Pulmonary Disease, Jinan Traditional Chinese Medicine Hospital, Jinan, People's Republic of China
| | - Mengshuang Xie
- Department of Respiratory Disease, Qilu Hospital, Shandong University
| | - Shuang Dou
- Department of Respiratory Disease, Qilu Hospital, Shandong University
| | - Wei Wang
- Department of Respiratory Disease, Qilu Hospital, Shandong University
| | - Wei Xiao
- Department of Respiratory Disease, Qilu Hospital, Shandong University
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12
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Abstract
Lung densitometry assesses with computed tomography (CT) the X-ray attenuation of the pulmonary tissue which reflects both the degree of inflation and the structural lung abnormalities implying decreased attenuation, as in emphysema and cystic diseases, or increased attenuation, as in fibrosis. Five reasons justify replacement with lung densitometry of semi-quantitative visual scales used to measure extent and severity of diffuse lung diseases: (I) improved reproducibility; (II) complete vs. discrete assessment of the lung tissue; (III) shorter computation times; (IV) better correlation with pathology quantification of pulmonary emphysema; (V) better or equal correlation with pulmonary function tests (PFT). Commercially and open platform software are available for lung densitometry. It requires attention to technical and methodological issues including CT scanner calibration, radiation dose, and selection of thickness and filter to be applied to sections reconstructed from whole-lung CT acquisition. Critical is also the lung volume reached by the subject at scanning that can be measured in post-processing and represent valuable information per se. The measurements of lung density include mean and standard deviation, relative area (RA) at -970, -960 or -950 Hounsfield units (HU) and 1st and 15th percentile for emphysema in inspiratory scans, and RA at -856 HU for air trapping in expiratory scans. Kurtosis and skewness are used for evaluating pulmonary fibrosis in inspiratory scans. The main indication for lung densitometry is assessment of emphysema component in the single patient with chronic obstructive pulmonary diseases (COPD). Additional emerging applications include the evaluation of air trapping in COPD patients and in subjects at risk of emphysema and the staging in patients with lymphangioleiomyomatosis (LAM) and with pulmonary fibrosis. It has also been applied to assess prevalence of smoking-related emphysema and to monitor progression of smoking-related emphysema, alpha1 antitrypsin deficiency emphysema, and pulmonary fibrosis. Finally, it is recommended as end-point in pharmacological trials of emphysema and lung fibrosis.
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Affiliation(s)
- Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences
| | - Gianna Camiciottoli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences.,Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
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13
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Ostridge K, Wilkinson TMA. Present and future utility of computed tomography scanning in the assessment and management of COPD. Eur Respir J 2016; 48:216-28. [PMID: 27230448 DOI: 10.1183/13993003.00041-2016] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/21/2016] [Indexed: 01/08/2023]
Abstract
Computed tomography (CT) is the modality of choice for imaging the thorax and lung structure. In chronic obstructive pulmonary disease (COPD), it used to recognise the key morphological features of emphysema, bronchial wall thickening and gas trapping. Despite this, its place in the investigation and management of COPD is yet to be determined, and it is not routinely recommended. However, lung CT already has important clinical applications where it can be used to diagnose concomitant pathology and determine which patients with severe emphysema are appropriate for lung volume reduction procedures. Furthermore, novel quantitative analysis techniques permit objective measurements of pulmonary and extrapulmonary manifestations of the disease. These techniques can give important insights into COPD, and help explore the heterogeneity and underlying mechanisms of the condition. In time, it is hoped that these techniques can be used in clinical trials to help develop disease-specific therapy and, ultimately, as a clinical tool in identifying patients who would benefit most from new and existing treatments. This review discusses the current clinical applications for CT imaging in COPD and quantification techniques, and its potential future role in stratifying disease for optimal outcome.
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Affiliation(s)
- Kristoffer Ostridge
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - Tom M A Wilkinson
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, UK Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
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14
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Boeck L, Soriano JB, Brusse-Keizer M, Blasi F, Kostikas K, Boersma W, Milenkovic B, Louis R, Lacoma A, Djamin R, Aerts J, Torres A, Rohde G, Welte T, Martinez-Camblor P, Rakic J, Scherr A, Koller M, van der Palen J, Marin JM, Alfageme I, Almagro P, Casanova C, Esteban C, Soler-Cataluña JJ, de-Torres JP, Miravitlles M, Celli BR, Tamm M, Stolz D. Prognostic assessment in COPD without lung function: the B-AE-D indices. Eur Respir J 2016; 47:1635-44. [PMID: 27103389 PMCID: PMC5394475 DOI: 10.1183/13993003.01485-2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/18/2016] [Indexed: 02/02/2023]
Abstract
Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function.The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988).Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05).The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk.
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Affiliation(s)
- Lucas Boeck
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
| | | | - Wim Boersma
- Dept of Pneumology, Medisch Centrum, Alkmaar, The Netherlands
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Renaud Louis
- Dept of Pneumology, University of Liege, Liege, Belgium
| | - Alicia Lacoma
- Dept of Microbiology, Hospital Universitari Germans Trias i Pujol, CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Remco Djamin
- Dept of Pneumology, Amphia Hospital, Breda, The Netherlands
| | - Joachim Aerts
- Dept of Pneumology, Amphia Hospital, Breda, The Netherlands
| | - Antoni Torres
- Dept of Pneumology, Hospital Clinic, Barcelona, Spain
| | - Gernot Rohde
- Dept of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tobias Welte
- Dept of Pneumology, Medizinische Hochschule, Hannover, Germany
| | | | - Janko Rakic
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Andreas Scherr
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Michael Koller
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jose M Marin
- Respiratory Dept, Hospital Universitario Miguel Servet, Zaragoza, CIBER Enfermedades Respiratoria, Madrid, Spain
| | | | - Pere Almagro
- Internal Medicine Unit, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Ciro Casanova
- Respiratory Dept, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Juan P de-Torres
- Respiratory Dept, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bartolome R Celli
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Michael Tamm
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital, Basel, Switzerland
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15
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Fragoso E, André S, Boleo-Tomé JP, Areias V, Munhá J, Cardoso J. Understanding COPD: A vision on phenotypes, comorbidities and treatment approach. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:101-11. [PMID: 26827246 DOI: 10.1016/j.rppnen.2015.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 01/31/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) phenotypes have become increasingly recognized as important for grouping patients with similar presentation and/or behavior, within the heterogeneity of the disease. The primary aim of identifying phenotypes is to provide patients with the best health care possible, tailoring the therapeutic approach to each patient. However, the identification of specific phenotypes has been hindered by several factors such as which specific attributes are relevant, which discriminant features should be used for assigning patients to specific phenotypes, and how relevant are they to the therapeutic approach, prognostic and clinical outcome. Moreover, the definition of phenotype is still not consensual. Comorbidities, risk factors, modifiable risk factors and disease severity, although not phenotypes, have impact across all COPD phenotypes. Although there are some identified phenotypes that are fairly consensual, many others have been proposed, but currently lack validation. The on-going debate about which instruments and tests should be used in the identification and definition of phenotypes has contributed to this uncertainty. In this paper, the authors review present knowledge regarding COPD phenotyping, discuss the role of phenotypes and comorbidities on the severity of COPD, propose new phenotypes and suggest a phenotype-based pharmacological therapeutic approach. The authors conclude that a patient-tailored treatment approach, which takes into account each patient's specific attributes and specificities, should be pursued.
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Affiliation(s)
- E Fragoso
- Pulmonology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE (CHLN), Lisbon, Portugal.
| | - S André
- Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, EPE(CHLO), Lisbon, Portugal.
| | - J P Boleo-Tomé
- Pulmonology Department, Hospital Prof. Doutor Fernando da Fonseca, EPE, Amadora, Portugal.
| | - V Areias
- Pulmonology Department, Hospital de Faro, Centro Hospitalar do Algarve, EPE, Faro, Portugal; Department of Biomedical Sciences and Medicine, Algarve University, Portugal.
| | - J Munhá
- Pulmonology Department, Centro Hospitalar do Barlavento Algarvio, EPE, Portimão, Portugal.
| | - J Cardoso
- Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE (CHLC), Lisbon, Portugal; Nova Medical School, Nova University, Lisbon, Portugal.
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16
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Dijkstra AE, Postma DS, ten Hacken N, Vonk JM, Oudkerk M, van Ooijen PMA, Zanen P, Mohamed Hoesein FA, van Ginneken B, Schmidt M, Groen HJM. Low-dose CT measurements of airway dimensions and emphysema associated with airflow limitation in heavy smokers: a cross sectional study. Respir Res 2013; 14:11. [PMID: 23356533 PMCID: PMC3570364 DOI: 10.1186/1465-9921-14-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/17/2013] [Indexed: 11/13/2022] Open
Abstract
Background Increased airway wall thickness (AWT) and parenchymal lung destruction both contribute to airflow limitation. Advances in computed tomography (CT) post-processing imaging allow to quantify these features. The aim of this Dutch population study is to assess the relationships between AWT, lung function, emphysema and respiratory symptoms. Methods AWT and emphysema were assessed by low-dose CT in 500 male heavy smokers, randomly selected from a lung cancer screening population. AWT was measured in each lung lobe in cross-sectionally reformatted images with an automated imaging program at locations with an internal diameter of 3.5 mm, and validated in smaller cohorts of patients. The 15th percentile method (Perc15) was used to assess the severity of emphysema. Information about respiratory symptoms and smoking behavior was collected by questionnaires and lung function by spirometry. Results Median AWT in airways with an internal diameter of 3.5 mm (AWT3.5) was 0.57 (0.44 - 0.74) mm. Median AWT in subjects without symptoms was 0.52 (0.41-0.66) and in those with dyspnea and/or wheezing 0.65 (0.52-0.81) mm (p<0.001). In the multivariate analysis only AWT3.5 and emphysema independently explained 31.1%and 9.5%of the variance in FEV1%predicted, respectively, after adjustment for smoking behavior. Conclusions Post processing standardization of airway wall measurements provides a reliable and useful method to assess airway wall thickness. Increased airway wall thickness contributes more to airflow limitation than emphysema in a smoking male population even after adjustment for smoking behavior.
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Affiliation(s)
- Akkelies E Dijkstra
- University of Groningen, Department of Pulmonary Diseases, University Medical Center Groningen, GRIAC research institute, Groningen, the Netherlands.
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