Discriminating dominant computed tomography phenotypes in smokers without or with mild COPD

Hoesein, Firdaus A. A. Mohamed; Schmidt, Michael A.; Mets, Onno M.; Gietema, Hester A.; Lammers, Jan‐Willem J.; Zanen, Pieter; Koning, Harry J. de; Aalst, Carlijn van der; Oudkerk, Matthijs; Vliegenthart, Rozemarijn; Išgum, Ivana; Prokop, Mathias; Ginneken, Bram van; Rikxoort, Eva M. van; Jong, Pim A. de

doi:10.1016/j.rmed.2013.08.014

Cited by 28 publications

(12 citation statements)

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“…In the GOLD 0 group, we found that 10.4% (428 of 4110) of the individuals had emphysema exceeding that level. A recent study by Mohamed Hoesein et al 27 using CT scans from the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON) instead selected the 75th percentile (1.2% for current smokers and 1.7% for former smokers). Using those criteria, we would have identified more CT emphysema and matched our visual scoring of emphysema more closely.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiologic Disease in Smokers With Normal Spirometry

et al. 2015

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IMPORTANCE Airflow obstruction on spirometry is universally used to define chronic obstructive pulmonary disease (COPD), and current or former smokers without airflow obstruction may assume that they are disease free.OBJECTIVE To identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for COPD, for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0. DESIGN, SETTING, AND PARTICIPANTS Individuals from the Genetic Epidemiology of COPD (COPDGene) cross-sectional observational study completed spirometry, chest computed tomography (CT) scans, a 6-minute walk, and questionnaires. Participants were recruited from local communities at 21 sites across the United States. The GOLD 0 group (n = 4388) (ratio of forced expiratory volume in the first second of expiration [FEV 1 ] to forced vital capacity >0.7 and FEV 1 Ն80% predicted) from the COPDGene study was compared with a GOLD 1 group (n = 794), COPD groups (n = 3690), and a group of never smokers (n = 108). Recruitment began in January 2008 and ended in July 2011. MAIN OUTCOMES AND MEASURESPhysical function impairments, respiratory symptoms, CT abnormalities, use of respiratory medications, and reduced respiratory-specific quality of life.RESULTS One or more respiratory-related impairments were found in 54.1% (2375 of 4388) of the GOLD 0 group. The GOLD 0 group had worse quality of life (mean [SD] St George's Respiratory Questionnaire total score, 17.0 [18.0] vs 3.8 [6.8] for the never smokers; P < .001) and a lower 6-minute walk distance, and 42.3% (127 of 300) of the GOLD 0 group had CT evidence of emphysema or airway thickening. The FEV 1 percent predicted distribution and mean for the GOLD 0 group were lower but still within the normal range for the population. Current smoking was associated with more respiratory symptoms, but former smokers had greater emphysema and gas trapping. Advancing age was associated with smoking cessation and with more CT findings of disease. Individuals with respiratory impairments were more likely to use respiratory medications, and the use of these medications was associated with worse disease. CONCLUSIONS AND RELEVANCELung disease and impairments were common in smokers without spirometric COPD. Based on these results, we project that there are 35 million current and former smokers older than 55 years in the United States who may have unrecognized disease or impairment. The effect of chronic smoking on the lungs and the individual is substantially underestimated when using spirometry alone.

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Section: Discussionmentioning

confidence: 99%

Clinical and Radiologic Disease in Smokers With Normal Spirometry

et al. 2015

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“…ECLIPSE[13] COPDgene[14] and SPIROMICS[24] studies), by demonstrating the added value of this approach in the general population[14, 25–28]. Additionally, data could be employed to strengthen anti-smoking efforts as it added population-specific evidence to previous studies of convenient samples of selected smokers[29, 30] Another application was that radiological markers could be used to define individuals for future early interventional trials, reemphasizing the continued relevance of traditional, population-based epidemiological studies in an era of ‘mega-cohorts’ comprising administrative databases, selected participants, and consortia of cohorts[31]. …”

Section: Discussionmentioning

confidence: 99%

Findings on Thoracic Computed Tomography Scans and Respiratory Outcomes in Persons with and without Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study

et al. 2016

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BackgroundThoracic computed tomography (CT) scans are widely performed in clinical practice, often leading to detection of airway or parenchymal abnormalities in asymptomatic or minimally symptomatic individuals. However, clinical relevance of CT abnormalities is uncertain in the general population.MethodsWe evaluated data from 1361 participants aged ≥40 years from a Canadian prospective cohort comprising 408 healthy never-smokers, 502 healthy ever-smokers, and 451 individuals with spirometric evidence of chronic obstructive pulmonary disease (COPD) who had thoracic CT scans. CT images of subjects were visually scored for respiratory bronchiolitis(RB), emphysema(E), bronchial-wall thickening(BWT), expiratory air-trapping(AT), and bronchiectasis(B). Multivariable logistic regression models were used to assess associations of CT features with respiratory symptoms, dyspnea, health status as determined by COPD assessment test, and risk of clinically significant exacerbations during 12 months follow-up.ResultsAbout 11% of life-time never-smokers demonstrated emphysema on CT scans. Prevalence increased to 30% among smokers with normal lung function and 36%, 50%, and 57% among individuals with mild, moderate or severe/very severe COPD, respectively. Presence of emphysema on CT was associated with chronic cough (OR,2.11; 95%CI,1.4–3.18); chronic phlegm production (OR,1.87; 95% CI,1.27–2.76); wheeze (OR,1.61; 95% CI,1.05–2.48); dyspnoea (OR,2.90; 95% CI,1.41–5.98); CAT score≥10(OR,2.17; 95%CI,1.42–3.30) and risk of ≥2 exacerbations over 12 months (OR,2.17; 95% CI, 1.42–3.0).ConclusionsBurden of thoracic CT abnormalities is high among Canadians ≥40 years of age, including never-smokers and smokers with normal lung function. Detection of emphysema on CT scans is associated with pulmonary symptoms and increased risk of exacerbations, independent of smoking or lung function.

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“…The quantitative assessment is automatically performed and can identify EMP, air trapping, and abnormal airways. 6 , 31 , 33 , 34 There are evidences that CT measurements of EMP or peripheral airways are significantly related to airflow obstruction in COPD patients. 5 …”

Section: Discussionmentioning

confidence: 99%

COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients

Silva¹,

Paschoal²,

Capitani³

et al. 2016

COPD

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BackgroundComputed tomography (CT) phenotypic characterization helps in understanding the clinical diversity of chronic obstructive pulmonary disease (COPD) patients, but its clinical relevance and its relationship with functional features are not clarified. Volumetric capnography (VC) uses the principle of gas washout and analyzes the pattern of CO2 elimination as a function of expired volume. The main variables analyzed were end-tidal concentration of carbon dioxide (ETCO2), Slope of phase 2 (Slp2), and Slope of phase 3 (Slp3) of capnogram, the curve which represents the total amount of CO2 eliminated by the lungs during each breath.ObjectiveTo investigate, in a group of patients with severe COPD, if the phenotypic analysis by CT could identify different subsets of patients, and if there was an association of CT findings and functional variables.Subjects and methodsSixty-five patients with COPD Gold III–IV were admitted for clinical evaluation, high-resolution CT, and functional evaluation (spirometry, 6-minute walk test [6MWT], and VC). The presence and profusion of tomography findings were evaluated, and later, the patients were identified as having emphysema (EMP) or airway disease (AWD) phenotype. EMP and AWD groups were compared; tomography findings scores were evaluated versus spirometric, 6MWT, and VC variables.ResultsBronchiectasis was found in 33.8% and peribronchial thickening in 69.2% of the 65 patients. Structural findings of airways had no significant correlation with spirometric variables. Air trapping and EMP were strongly correlated with VC variables, but in opposite directions. There was some overlap between the EMP and AWD groups, but EMP patients had signicantly lower body mass index, worse obstruction, and shorter walked distance on 6MWT. Concerning VC, EMP patients had signicantly lower ETCO2, Slp2 and Slp3. Increases in Slp3 characterize heterogeneous involvement of the distal air spaces, as in AWD.ConclusionVisual assessment and phenotyping of CT in COPD patients is feasible and may help identify functional and clinically different subsets of patients. VC may provide useful information about the heterogeneous involvement of lung structures in COPD.

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Discriminating dominant computed tomography phenotypes in smokers without or with mild COPD

Abstract: ISRCTN63545820, registered at www.trialregister.nl.

Cited by 28 publications

References 36 publications

Clinical and Radiologic Disease in Smokers With Normal Spirometry

Clinical and Radiologic Disease in Smokers With Normal Spirometry

Findings on Thoracic Computed Tomography Scans and Respiratory Outcomes in Persons with and without Chronic Obstructive Pulmonary Disease: A Population-Based Cohort Study

COPD phenotypes on computed tomography and its correlation with selected lung function variables in severe patients

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