Association of the transfer coefficient of the lung for carbon monoxide with emphysema progression in male smokers

Hoesein, Firdaus A. A. Mohamed; Zanen, Pieter; Ginneken, Bram van; Klaveren, Rob J. van; Lammers, Jan Willem J.

doi:10.1183/09031936.00050711

Cited by 22 publications

(9 citation statements)

References 33 publications

(29 reference statements)

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“…In particular, we observed that CT emphysema measurements correlated significantly with the diffusing lung capacity of carbon monoxide (DLco) at levels of both individual lobes and the entire lung. Our results are in consistence with those in [10, 27, 28], suggesting that DLco might be a useful measurement for emphysema diagnosis.…”

Section: Discussionsupporting

confidence: 88%

Optimal threshold in CT quantification of emphysema

et al. 2012

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Objectives To determine the optimal threshold by quantitatively assessing the extent of emphysema at the level of the entire lung and at the level of individual lobes using a large, diverse dataset of CT examinations. Methods This study comprises 573 chest CT examinations acquired from different subjects (222 none, 83 mild, 141 moderate, 63 severe, and 64 very severe obstruction). The extent of emphysema was quantified using the percentage of the low attenuation area (LAA%) divided by the total lung or lobe volume(s). The correlations between the extent of emphysema, and pulmonary functions and the five-category classification were assessed using Pearson and Spearman’s correlation coefficients, respectively. When quantifying emphysema using a density mask, a wide range of thresholds from −850 to −1000 HU were used. Results The highest correlations of LAA% with the five-category classification and PFT measures ranged from −925 to −965 HU for each individual lobe and the entire lung. However, the differences between the highest r and those obtained at −950 HU are relatively small. Conclusion Although there are variations in the optimal cut-off thresholds for individual lobes, the single threshold of −950 HU is still an acceptable threshold for density-based emphysema quantification.

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Section: Discussionsupporting

confidence: 88%

Optimal threshold in CT quantification of emphysema

et al. 2012

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“…A low baseline carbon monoxide transfer coefficient is independently associated with more rapid progression of emphysema and airflow limitation in heavy smokers. 141 TL CO measurement can provide additional prognostic information in COPD patients on follow-up. 142 Low DL CO is a predictor of future airflow obstruction in smokers with normal spirometry.…”

Section: Pulmonary Function Testsmentioning

confidence: 99%

Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research – a consensus document from six scientific societies

Rossi

Butorac-Petanjek

Chilosi

et al. 2017

COPD

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Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 ≥80% predicted. In recent years, an elegant series of studies has shown that “exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment”. In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient’s physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of “mild COPD”. To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with “mild” airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind “mild” COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both.

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“…K CO measurement might therefore be valuable as a screening tool among smokers with normal spirometry, to identify individuals with early age-related systemic abnormalities. Low K CO may reflect early lung destruction before COPD onset, as lower baseline K CO is independently associated with worse symptoms and more rapid progression of emphysema and airflow limitation in heavy smokers [ 18 , 25 , 26 ]. However, further longitudinal studies are needed to determine whether smokers without airflow obstruction but with low K CO are at high risk for developing accelerated aging, COPD, and systemic manifestations.…”

Section: Discussionmentioning

confidence: 99%

Aging-Related Systemic Manifestations in COPD Patients and Cigarette Smokers

et al. 2015

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RationaleChronic obstructive pulmonary disease (COPD) is often associated with age-related systemic abnormalities that adversely affect the prognosis. Whether these manifestations are linked to the lung alterations or are independent complications of smoking remains unclear.ObjectivesTo look for aging-related systemic manifestations and telomere shortening in COPD patients and smokers with minor lung destruction responsible for a decline in the diffusing capacity for carbon monoxide (DLCO) corrected for alveolar volume (KCO).MethodsCross-sectional study in 301 individuals (100 with COPD, 100 smokers without COPD, and 101 nonsmokers without COPD).Measurements and Main ResultsCompared to control smokers, patients with COPD had higher aortic pulse-wave velocity (PWV), lower bone mineral density (BMD) and appendicular skeletal muscle mass index (ASMMI), and shorter telomere length (TL). Insulin resistance (HOMA-IR) and glomerular filtration rate (GFR) were similar between control smokers and COPD patients. Smokers did not differ from nonsmokers for any of these parameters. However, smokers with normal spirometry but low KCO had lower ASMMI values compared to those with normal KCO. Moreover, female smokers with low KCO, had lower BMD and shorter TL compared to those with normal KCO.ConclusionsAging-related abnormalities in patients with COPD are also found in smokers with minor lung dysfunction manifesting as a KCO decrease. Decreased KCO might be useful, particularly among women, for identifying smokers at high risk for aging-related systemic manifestations and telomere shortening.

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Association of the transfer coefficient of the lung for carbon monoxide with emphysema progression in male smokers

Cited by 22 publications

References 33 publications

Optimal threshold in CT quantification of emphysema

Optimal threshold in CT quantification of emphysema

Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research – a consensus document from six scientific societies

Aging-Related Systemic Manifestations in COPD Patients and Cigarette Smokers

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Association of the transfer coefficient of the lung for carbon monoxide with emphysema progression in male smokers

Cited by 22 publications

References 33 publications

Optimal threshold in CT quantification of emphysema

Optimal threshold in CT quantification of emphysema

Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research &ndash; a consensus document from six scientific societies

Aging-Related Systemic Manifestations in COPD Patients and Cigarette Smokers

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Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research – a consensus document from six scientific societies