Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening

Sverzellati, Nicola; Rastelli, A.; Chetta, Alfredo; Schembri, Valentina; Fasano, Luca; Pacilli, Angela Maria Grazia; Scioscio, Valerio Di; Bartalena, Tommaso; Filippo, Massimo De; Zompatori, Maurizio

doi:10.1007/s00330-009-1306-9

Cited by 54 publications

(64 citation statements)

References 29 publications

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“…These fi ndings have potential relevance to the increasingly common application of multidetector CT scan to assess forced expiratory tracheal collapse in patients at risk for tracheomalacia. 23,24 Just as sex and age infl uence the interpretation of pulmonary function tests, our results suggest that these same characteristics should be considered when assessing forced expiratory airway collapse for suspected tracheomalacia.…”

Section: Tracheal Measurementsmentioning

confidence: 75%

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

O’Donnell

Litmanovich

Loring

et al. 2012

Chest

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A lthough much is known about changes in lung dimensions during various respiratory maneuvers, there is relatively little data regarding the normal range of forced expiratory airway collapse. 1,2 With growing interest in the use of CT scanning to evaluate forced expiratory collapse of the trachea in patients with suspected tracheomalacia, 3 there is a need to determine whether a single threshold of percentage forced expiratory collapse (%collapse) can be applied in the diagnostic evaluation of this disorder.Stern et al, 1 in a study of 10 healthy young men aged 24 to 31 years, reported a mean 35% forced expiratory collapse of the intrathoracic trachea. In contrast, we recently reported on a sample of 51 healthy men and women aged 25 to 75 years with an approximate 55% average forced expiratory collapse of the intrathoracic trachea. 2 We wondered whether this Background: A recent estimate for the normal range of forced expiratory tracheal collapse differs substantially from that in an earlier study performed with comparable measurement methods. Given differences in subject characteristics between the two samples, we hypothesized that these discrepant fi ndings may refl ect a heretofore unrecognized association between forced expiratory tracheal collapse and age or sex. Methods: We enrolled 40 female and 41 male healthy volunteers between 25 and 75 years of age who were without respiratory symptoms or known risk factors for tracheomalacia. Subjects underwent low-dose CT scanning at total lung capacity (TLC) and during forced exhalation (Expdyn) with spirometric monitoring and coaching. Percentage forced expiratory collapse was regressed on age for the total sample and separately within sex. Results: Mean tracheal cross-sectional area (CSA) was 2.54 cm 2 Ϯ 0.57 cm 2 at TLC and 1.15 cm 2 Ϯ 0.53 cm 2 at Expdyn. Mean percentage forced expiratory collapse (%collapse) was 54% Ϯ 20%. Men aged 24 to 31 years (n 5 12) had mean %collapse of 36% Ϯ 19%, comparable to results previously reported for similarly aged men (35% Ϯ 18%). Men, but not women, showed a signifi cant positive correlation ( R 2 5 0.40, P , .001) between %collapse and age. Older men had both greater CSA at TLC ( P 5 .02) and smaller CSA at Expdyn ( P 5 .001) than younger men. Conclusions: Men exhibit positive age dependence of forced expiratory tracheal collapse. The infl uence of age and sex on forced expiratory tracheal collapse should be considered in the diagnostic evaluation of expiratory dynamic airway collapse and/or tracheomalacia.CHEST 2012; 142(1):168-174

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Section: Tracheal Measurementsmentioning

confidence: 75%

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

O’Donnell

Litmanovich

Loring

et al. 2012

Chest

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“…On the one hand, airway walls thickened by reticular basement membrane deposition of extracellular matrix, smooth muscle hyperplasia, and/or hypertrophy and extracellular edema would be stiffer, as has been demonstrated by several studies indicating reduced airway distensibility in asthma (1)(2)(3)(4). Conversely, the altered extracellular composition and architecture, cartilage degradation, and widespread elastolysis (5) seen in asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis could reduce airway wall elastance resulting in increased airway flaccidity and malacia (6)(7)(8). In addition to these intrinsic airway wall influences, airway caliber may be affected by changes in the radial traction exerted on the airway by the lung parenchyma (airway-parenchymal interdependence).…”

mentioning

confidence: 95%

Elastic Properties of the Central Airways in Obstructive Lung Diseases Measured Using Anatomical Optical Coherence Tomography

Williamson¹,

McLaughlin²,

Noffsinger³

et al. 2011

Am J Respir Crit Care Med

102

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Rationale: Our understanding of how airway remodeling affects regional airway elastic properties is limited due to technical difficulties in quantitatively measuring dynamic, in vivo airway dimensions. Such knowledge could help elucidate mechanisms of excessive airway narrowing. Objectives: To use anatomical optical coherence tomography (aOCT) to compare central airway elastic properties in control subjects and those with obstructive lung diseases. Methods: After bronchodilation, airway lumen area (Ai) was measured using aOCT during bronchoscopy in control subjects (n 5 10) and those with asthma (n 5 16), chronic obstructive pulmonary disease (COPD) (n 5 9), and bronchiectasis (n 5 8). Ai was measured in each of generations 0 to 5 while airway pressure was increased from 210 to 20 cm H 2 O. Airway compliance (Caw) and specific compliance (sCaw) were derived from the transpulmonary pressure (PL) versus Ai curves. Measurements and Main Results: Caw decreased progressively as airway generation increased, but sCaw did not differ appreciably across the generations. In subjects with asthma and bronchiectasis, Caw and sCaw were similar to control subjects and the PL-Ai curves were left-shifted. No significant differences were observed between control and COPD groups. Conclusions: Proximal airway elastic properties are altered in obstructive lung diseases. Although central airway compliance does not differ from control subjects in asthma, bronchiectasis, or COPD, Ai is lower in asthma and the PL-Ai relationship is left-shifted in both asthma and bronchiectasis, suggesting that airways are maximally distended at lower inflating pressures. Such changes reflect alteration in the balance between airway wall distensibility and radial traction exerted on airways by surrounding lung parenchyma favoring airway narrowing. Clinical trial registered with Australian New Zealand Clinical Trials Registry (ACTRN12607000624482).

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“…Different attempts have been made to measure the lumen in the large airways as a quantification estimate for airway obstruction and small airway remodelling (7)(8)(9). Up to date, only the crosssectional area of the trachea and the main bronchi were successfully analysed in humans with regard to luminal calibre changes induced by physiological breathing, in the end-inspiratory and end-expiratory phases in both healthy volunteers and patients with bronchial asthma and COPD (10)(11)(12). Whereas changes in the luminal area of the large airways are known to vary considerably even in healthy people between forced inspiration and forced expiration, corresponding changes of bronchial crosssectional area below e.g., in segmental (the 3 rd generation) bronchi have not yet been intensively studied.…”

Section: Introductionmentioning

confidence: 99%

“…Other variables like e.g., the magnitude of collateral ventilation are also known to affect the balance of intrapulmonary pressure and bronchial collapsibility in this clinical setting. Notably, airway malacia that was described as >50% expiratory reduction of the airway lumen in the trachea of COPD patients seems to spare the 3 rd generation bronchi (11).…”

mentioning

confidence: 99%

Segmental bronchi collapsibility: computed tomography-based quantification in patients with chronic obstructive pulmonary disease and correlation with emphysema phenotype, corresponding lung volume changes and clinical parameters

et al. 2016

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Background: Global pulmonary function tests lack region specific differentiation that might influence therapy in severe chronic obstructive pulmonary disease (COPD) patients. Therefore, the aim of this work was to assess the degree of expiratory 3 rd generation bronchial lumen collapsibility in patients with severe COPD using chest-computed tomography (CT), to evaluate emphysema-phenotype, lobar volumes and correlate results with pulmonary function tests.Methods: Thin-slice chest-CTs acquired at end-inspiration & end-expiration in 42 COPD GOLD IV patients (19 females, median-age: 65.9 y) from November 2011 to July 2014 were re-evaluated. The crosssectional area of all segmental bronchi was measured 5 mm below the bronchial origin in both examinations.Lung lobes were semi-automatically segmented, volumes calculated at end-inspiratory and end-expiratory phase and visually defined emphysema-phenotypes defined. Results of CT densitometry were compared with lung functional tests including forced expiratory volume at 1 s (FEV 1 ), total lung capacity (TLC), vital capacity (VC), residual volume (RV), diffusion capacity parameters and the maximal expiratory flow rates (MEFs).Results: Mean expiratory bronchial collapse was 31%, stronger in lobes with homogenous (38.5%) vs.heterogeneous emphysema-phenotype (27.8%, P=0.014). The mean lobar expiratory volume reduction was comparable in both emphysema-phenotypes (volume reduction 18.6%±8.3% in homogenous vs.17.6%±16.5% in heterogeneous phenotype). The degree of bronchial lumen collapsibility, did not correlate with expiratory volume reduction. MEF 25 correlated weakly with 3 rd generation airway collapsibility (r=0.339, P=0.03). All patients showed a concentric expiratory reduction of bronchial cross-sectional area.Conclusions: Changes in collapsibility of 3 rd generation bronchi in COPD grade IV patients is significantly lower than that in the trachea and the main bronchi. Collapsibility did not correlate with the reduction in lung volume but was significantly higher in lobes with homogeneous vs. heterogeneous emphysema phenotype. Changes in the 3 rd generation bronchial calibres between inspiration and expiration are not predictive for the degree of small airway collapsibility and related airflow limitation.

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Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening

Cited by 54 publications

References 29 publications

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

Age and Sex Dependence of Forced Expiratory Central Airway Collapse in Healthy Volunteers

Elastic Properties of the Central Airways in Obstructive Lung Diseases Measured Using Anatomical Optical Coherence Tomography

Segmental bronchi collapsibility: computed tomography-based quantification in patients with chronic obstructive pulmonary disease and correlation with emphysema phenotype, corresponding lung volume changes and clinical parameters

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