A comparison of three multidimensional indices of COPD severity as predictors of future exacerbations

Motegi, Takashi; Jones, Rupert; Ishii, Takeo; Hattori, Kumiko; Kusunoki, Yuji; Furutate, Ryuko; Yamada, Kouich; Gemma, Akihiko; Kida, Kenji

doi:10.2147/copd.s42769

Cited by 57 publications

(60 citation statements)

References 37 publications

(39 reference statements)

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“…It has been hypothesised that increased bronchial wall thickness is a marker of airway inflammation and therefore would be associated with symptoms of chronic bronchitis or frequent exacerbations. Han [57] confirmed this by showing that markers of airway wall thickness were increased in frequent exacerbators, although another study failed to find this association [58]. These measures also show associations with symptoms of chronic bronchitis [84,85].…”

Section: Page 34 Of 52 European Respiratory Journalmentioning

confidence: 98%

“…CT densitometry has been found to correlate with mortality in patients with COPD [55] and analysis from the GENKOLs trial [56] found that LAA% had a better predictive value for respiratory and cardiac mortality than GOLD staging. Emphysematous change on CT has also been associated with higher exacerbation rate [57][58][59] and increased mortality from exacerbations [59].…”

Section: Emphysemamentioning

confidence: 99%

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Present and future utility of computed tomography scanning in the assessment and management of COPD

Ostridge

Wilkinson

2016

Eur Respir J

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likely to have important implications for understanding disease progression and the future management of this condition [2]. There are currently no significant diseasemodifying medications for COPD and there have not been the improvements in outcome seen in other chronic diseases. Other tools are required in addition to spirometry to help explain the heterogeneity and provide further insights into approaches to study and treat COPD. CT has current practical applications in the routine management and investigation of the disease and with the development of novel analysis techniques has the potential to provide further details about the pulmonary and extra-pulmonary manifestations of COPD. Computed Tomography in Current Clinical PractisePrior to the 1970s histological and post mortem studies were required to study structural changes of the lung. The introduction of CT made it possible to visualise the thorax and assess lung structure non-invasively. In COPD CT can identify key morphological features, including emphysema, bronchial wall thickening and gas trapping. These pathologies contribute directly to airflow obstruction and therefore CT has the potential to provide vital insights into the underlying pathophysiological changes of COPD. Despite this, routine CT imaging has not necessarily been widely adopted in clinical practise and its place in the management and investigation of COPD has not been firmly established. The GOLD guidelines do not routinely recommend CT scanning in COPD and only advise that it may be helpful in differential diagnosis or when surgical options are being considered [3]. This general ambivalence is highlighted by a study of attitudes in respiratory physicians and surgeons in the UK where only 32% thought it necessary for patients with severe COPD to have a CT scan [4].There are a number of reasons why the use of CT has not become routine in COPD. One of the most important is the perceived notion that using CT does not alter management, although this is not strictly true. The National Emphysema Treatment Trial (NETT) demonstrated that patients with advanced upper lobe emphysema and limited exercise ability improved after lung volume reduction surgery [5]. There has also been considerable progress and experience in using endobronchial treatments for severe emphysema including coils, valves, sealant and airway bypass. In the correct patients with severe heterogeneous emphysema these treatments can lead to significant improvement in pulmonary physiology and functional capacity [6, 7]. CT imaging can also identify bullous disease, which may be amenable to surgery and bullectomy can lead to improved health status [8]. It therefore seems clear that patients with severe COPD require CT imaging to determine which patients are appropriate for these techniques.CT imaging can also detect concomitant pulmonary pathology in COPD. Bronchiectasis is particularly prevalent, with studies demonstrating 50% of COPD patients having CT evidence of the disease [9][10][11]. When present bronchiectasis is asso...

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Section: Page 34 Of 52 European Respiratory Journalmentioning

confidence: 98%

Section: Emphysemamentioning

confidence: 99%

Present and future utility of computed tomography scanning in the assessment and management of COPD

Ostridge

Wilkinson

2016

Eur Respir J

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“…The date of onset and sputum amount or purulence was determined once a month according to an interview (diary and self-assessment) during the patient's visit to our clinic (21). A stable state was defined as no symptoms of exacerbation and no use of systemic corticosteroids and/or antibiotics for the preceding 8 weeks.…”

Section: Exacerbationsmentioning

confidence: 99%

The Neutrophil to Lymphocyte Ratio Is Related to Disease Severity and Exacerbation in Patients with Chronic Obstructive Pulmonary Disease

et al. 2016

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Objective Although chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation, the association between the neutrophil to lymphocyte ratio (NLR; an indicator of inflammation) and the clinical status of COPD has not been well studied. We hypothesized that the NLR is associated with disease severity and exacerbation in COPD patients. Methods We performed blood testing, pulmonary function testing, chest computed tomography, a body composition analysis, and a 6-minute walk test and applied the modified Medical Research Council (MMRC) dyspnea scale for 141 stable COPD patients. In addition, we calculated the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index to evaluate the disease severity. Finally, we examined the association between the NLR and clinical parameters in stable COPD patients, and we further investigated changes in the NLR between exacerbation and the stable state. Results The NLR was positively correlated with the BODE index, extent of emphysema, and MMRC score (p<0.001 for all), while inversely correlated with airflow obstruction (p<0.001), body mass index (p<0.001), fat-free mass index (p=0.001), and the 6-minute walk distance (p<0.001). We obtained the NLR during exacerbation from 49 patients. The NLR was significantly higher at exacerbation compared to the stable state (p< 0.001). Conclusion The NLR was associated with disease severity and exacerbation in COPD patients. Therefore, the usefulness of the NLR in COPD patients should be elucidated in clinical settings in future investigations.

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“…The multiplication of these tools was the consequence of a search for the best possible discriminative properties, combining high accuracy and generalisability. Indeed, comparisons of these multidimensional indices gave somewhat variable results in various populations [13][14][15]. Altogether, the BODE index has certainly gained the wider recognition.…”

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confidence: 99%

Adding biological markers to COPD categorisation schemes: a way towards more personalised care?

Roche

2016

Eur Respir J

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A comparison of three multidimensional indices of COPD severity as predictors of future exacerbations

Cited by 57 publications

References 37 publications

Present and future utility of computed tomography scanning in the assessment and management of COPD

Present and future utility of computed tomography scanning in the assessment and management of COPD

The Neutrophil to Lymphocyte Ratio Is Related to Disease Severity and Exacerbation in Patients with Chronic Obstructive Pulmonary Disease

Adding biological markers to COPD categorisation schemes: a way towards more personalised care?

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