A comparison of serial computed tomography and functional change in bronchiectasis

Sheehan, Ramon E.; Wells, Adrian; Copley, Susan J.; Desai, Sujal R.; Howling, S.J.; Cole, P J; Wilson, Robert; Hansell, David M.

doi:10.1183/09031936.02.00284602

Cited by 128 publications

(85 citation statements)

References 27 publications

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“…The limited correlations with lung function are in keeping with the work of CHANG et al [15], but are in contrast to other work utilising the modified Bhalla score [16,[19][20][21]. There are a number of possible explanations for this.…”

Section: Discussioncontrasting

confidence: 47%

“…This has lead to the suggestion that HRCT is useful to grade disease severity. A more recent longitudinal adult study demonstrated that the severity of bronchial wall thickness was the primary determinant of functional decline, implying that HRCT scans may be useful to monitor disease progression [21]. Nevertheless, it is unclear how complete a description of the status of a patient with bronchiectasis is provided by a HRCT scan.…”

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confidence: 99%

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HRCT lung abnormalities are not a surrogate for exercise limitation in bronchiectasis

Edwards

Narang²,

Li³

et al. 2004

European Respiratory Journal

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In paediatric bronchiectasis, there has been limited work on the relationship between disease severity as assessed by exercise limitation and high resolution computed tomography (HRCT).An observational study was performed on 36 children who completed a questionnaire, physical examination, spirometry and sputum analysis, followed by a low dose of radiation protocol chest computed tomography (CT) scan and cycle ergometry incremental exercise test. A modified Bhalla score was used to score the HRCT abnormalities. The exercise variables used to assess functional status were heart rate, oxygen consumption, oxygen saturations and time of exercise. The results were compared with established normal paediatric values.The median (range) age of the children was 13 yrs (10.6-17.1). Age, sex, height, weight or pubertal status were equally distributed between the children with cystic fibrosis (CF) or non-CF bronchiectasis. The children with non-CF bronchiectasis had a lower median forced expiratory volume in one second % predicted than the children with CF (69% versus 76%, respectively). The distribution of lung disease differed between the two groups. The children with CF bronchiectasis had predominantly right upper lobe disease, and scored higher for the presence and extent of bronchiectasis. Otherwise, there was no statistical difference in the overall CT score or the individual CT parameters between the groups. There was evidence of exercise limitation in both CF and non-CF bronchiectasis compared to normal children. No consistent relationships were identified between the lung function parameters, HRCT findings or exercise parameters in either disease group.In this study, high resolution computed tomography features were not found to be markers of exercise capacity. As spirometry, high resolution computed tomography features and exercise testing give different information in children with cystic fibrosis and non-cystic fibrosis bronchiectasis, the current authors suggest all three may be required for the comprehensive assessment of respiratory status.

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Section: Discussioncontrasting

confidence: 47%

mentioning

confidence: 99%

HRCT lung abnormalities are not a surrogate for exercise limitation in bronchiectasis

Edwards

Narang²,

Li³

et al. 2004

European Respiratory Journal

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“…Serial observation of pulmonary function indices and CT scans in 48 adult patients with bronchiectasis also have found that variations in mucous plugging on CT correlate with minor fluctuations in pulmonary function tests in bronchiectasis, although the severity of bronchial wall thickness is the primary determinant of subsequent major functional decline. 13 In addition, clearance of secretions by rigorous postural drainage has been associated with significant increases in pulmonary function indices in a small cohort of patients with bronchiectasis.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary function abnormalities in adult patients with acute exacerbation of bronchiectasis

Niu

Tian³

et al. 2015

Chron Respir Dis

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Lung function impairments, especially airflow obstruction, are important features during acute exacerbation in patients with bronchiectasis. Recognition of the risk factors associated with airflow obstruction is important in the management of these exacerbations. The medical records of adult patients admitted to the Peking University People's Hospital, Beijing, China, from 2004 to 2011 with a diagnosis of bronchiectasis were reviewed retrospectively. Univariate and multivariate analyses were used to evaluate the risk factors associated with airflow obstruction. Airflow obstruction was found in 55.6% of 156 patients hospitalized with acute exacerbation of bronchiectasis, and the risk factors associated with airflow obstruction included young age (14 years old) at diagnosis (odds ratio (OR) ¼ 3.454, 95% confidence interval (CI) 1.709-6.982, p ¼ 0.001) as well as the presence of chronic obstructive pulmonary disease (COPD; OR ¼ 14.677, 95% CI 5.696-37.819, p ¼ 0.001), asthma (OR ¼ 3.063, 95% CI 1.403-6.690, p ¼ 0.005), and wheezing on auscultation (OR ¼ 3.279, 95% CI 1. 495-7.194, p ¼ 0.003). The C-reactive protein (13.9 mg/dl vs. 6.89 mg/ dl, p ¼ 0.005), partial pressure of arterial oxygen (66.7 + 8.57 mmHg vs. 89.56 + 12.80 mmHg, p < 0.001), and partial pressure of arterial carbon dioxide (40.52 + 2.77 mmHg vs. 42.87 + 5.39 mmHg, p ¼ 0.02) profiles were different between patients with or without airflow obstruction. In addition, patients colonized with potential pathogenic microorganisms had a decreased diffusing capacity (56.0% vs. 64.7%, p ¼ 0.04). Abnormal pulmonary function was common in hospitalized patients with bronchiectasis exacerbations. Airflow obstruction was correlated with the patient's age at diagnosis, as well as the presence of combined COPD and asthma, and wheezing on auscultation, which also resulted in more severe systemic inflammation and hypoxemia.

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“…This choice is supported by authors who have found a clear dissociation between the radiological extension of bronchiectasis and its clinical and functional aspects [25], on account of the low correlation between these different variables. Other radiological variables that are more difficult to obtain and interpret, such as the characteristics of the bronchial wall, were not included, even though some studies have found them to be very important in the follow-up of these patients [27,28]. Lastly, one key characteristic of patients with non-CF bronchiectasis is the microbiological profile.…”

Section: Discussionmentioning

confidence: 99%

“…The high colinearity between FEV1 and forced vital capacity made it possible to choose FEV1 to represent the patient's functional state, as this is the variable most commonly used in the evaluation of airflow obstruction, the most common functional pattern in patients with bronchiectasis [24][25][26]. Although it is possible that other functional variables, such as those related to exercise tests [27], could have a greater predictive value than FEV1, they were not taken into account for the construction of this score as they are not generally applied.…”

Section: Discussionmentioning

confidence: 99%

Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score

Martínez‐García

Gracia

Relat

et al. 2013

European Respiratory Journal

393

255

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Bronchiectasis is a multidimensional disease and, therefore, its severity or prognosis cannot be adequately quantified by analysing one single variable. The objective of the present study was to develop a multidimensional score that classifies the severity of bronchiectasis according to its prognosis. This is an observational multicentre study including 819 patients diagnosed with non-cystic fibrosis bronchiectasis using high-resolution computed tomography. 397 subjects were selected at random to construct the score while the remaining 422 were used for its validation. The outcome was 5-year all-cause mortality after radiological diagnosis. A logistic regression analysis was used to select the variables included in the final score.The final seven-point score incorporated five dichotomised variables: forced expiratory volume in 1 s % predicted (F, cut-off 50%, maximum value 2 points); age (A, cut-off 70 years, maximum value 2 points); presence of chronic colonisation by Pseudomonas aeruginosa (C, dichotomic, maximum value 1 point); radiological extension (E, number of lobes affected, cut-off two lobes, maximum value 1 point); and dyspnoea (D, cut-off grade II on the Medical Research Council scale, maximum value 1 point) to construct the FACED score. The validation cohort confirmed the score's validity.We conclude that this easy-to-use multidimensional grading system proved capable of accurately classifying the severity of bronchiectasis according to its prognosis. @ERSpublications An easy-to-use multidimensional grading system accurately classifies bronchiectasis severity according to prognosis

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A comparison of serial computed tomography and functional change in bronchiectasis

Cited by 128 publications

References 27 publications

HRCT lung abnormalities are not a surrogate for exercise limitation in bronchiectasis

HRCT lung abnormalities are not a surrogate for exercise limitation in bronchiectasis

Pulmonary function abnormalities in adult patients with acute exacerbation of bronchiectasis

Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score

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