High-Resolution Computed Tomography Quantitation of Emphysema Is Correlated with Selected Lung Function Values in Stable COPD

D’Anna, Silvestro Ennio; Asnaghi, Roberto; Caramori, Gaetano; Appendini, Lorenzo; Rizzo, Manfredi; Cavallaro, Carmelo; Marino, Giorgio; Cappello, Francesco; Balbi, Bruno; Stefano, Antonino Di

doi:10.1159/000329871

Cited by 24 publications

(29 citation statements)

References 65 publications

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“…As such, a significant association between emphysema grade and both IC/TLC and DLCO was found in the total study population. This is consistent with previous studies, which have shown associations between emphysema and hyperinflation, as well as DLCO 17,39. Furthermore, a significant association between emphysema grade and FEV 1 was seen in both the total study population and the 0–1 comorbidity subgroup, which is consistent with previous studies, although these have been of variable strength 39,40.…”

Section: Discussionsupporting

confidence: 92%

“…This is consistent with previous studies, which have shown associations between emphysema and hyperinflation, as well as DLCO 17,39. Furthermore, a significant association between emphysema grade and FEV 1 was seen in both the total study population and the 0–1 comorbidity subgroup, which is consistent with previous studies, although these have been of variable strength 39,40. Moreover, no association was found between TLC and emphysema grade, which is supported by previous findings 41.…”

Section: Discussionsupporting

confidence: 92%

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The effect of comorbidities on COPD assessment: a pilot study

Weinreich

Thomsen

Bielaska

et al. 2015

COPD

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IntroductionPatients with chronic obstructive pulmonary disease (COPD) frequently suffer from comorbidities. COPD severity may be evaluated by the Global initiative for chronic Obstructive Lung Disease (GOLD) combined risk assessment score (GOLD score). Spirometry, body plethysmography, diffusing capacity of the lung for carbon monoxide (DLCO), and high-resolution computed tomography (HR-CT) measure lung function and elucidate pulmonary pathology. This study assesses associations between GOLD score and measurements of lung function in COPD patients with and without (≤1) comorbidities. It evaluates whether the presence of comorbidities influences evaluation by GOLD score of COPD severity, and questions whether GOLD score describes morbidity rather than COPD severity.MethodsIn this prospective study, 106 patients with stable COPD were included. Patients treated for lung cancer were excluded. Demographics, oxygen saturation (SpO2), modified Medical Research Council Dyspnea Scale, COPD exacerbations, and comorbidities were recorded. Body plethysmography and DLCO were measured, and HR-CT performed and evaluated for emphysema and airways disease. COPD severity was stratified by the GOLD score. Correlation analyses: 1) GOLD score, 2) emphysema grade, and 3) airways disease and lung function parameters, described by: forced expiratory volume in the first second in percent of expected value (FEV1%), inspiratory capacity (IC%), total lung volume (TLC%), IC/TLC, and SpO2. Correlation analyses between subgroups and hierarchical cluster analysis were performed.ResultsSignificant associations were found between GOLD score and both emphysema grade (correlation coefficients [cc]: −0.2, P=0.03) and lung function parameters (cc: −0.5 to −0.7, P-values all <0.001) weakened in patients with >1 comorbidity (cc: −0.4 to −0.5, P-values all 0.001). Significant differences between subgroups were found in GOLD score and both FEV1% (cc: −0.2, P=0.02) and IC/TLC (cc: −0.2, P=0.02). Comorbidities were associated with GOLD score and composite measures in hierarchical cluster analysis.ConclusionThe presence of comorbidities influences the relationship between GOLD score and lung function measurements. GOLD score may be more representative of morbidity than of COPD severity.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

The effect of comorbidities on COPD assessment: a pilot study

Weinreich

Thomsen

Bielaska

et al. 2015

COPD

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“…Prior literature has indicated that emphysema – particularly panlobular emphysema – is only modestly associated with smoking, as shown on autopsy (13), on CT scan in COPD patients (17, 56), and in the current cohort (57). Nonetheless, compared to strong and consistent associations observed among smokers, findings among never-smokers were modest and did not attain statistical significance, although neither did the statistical test for effect modification by smoking history.…”

Section: Discussionmentioning

confidence: 75%

Association Between Emphysema-like Lung on Cardiac Computed Tomography and Mortality in Persons Without Airflow Obstruction

Oelsner¹,

Hoffman²,

Folsom

et al. 2014

Ann Intern Med

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Background Whereas low lung function is known to predict mortality in the general population, the prognostic significance of emphysema on computed tomography (CT) in persons without chronic obstructive pulmonary disease (COPD) remains uncertain. Objective To determine whether greater emphysema-like lung on CT is associated with all-cause mortality among persons without airflow obstruction or COPD in the general population. Design Prospective cohort study. Setting Population-based, multiethnic sample from 6 US communities. Participants 2965 participants ages 45-84 years without airflow obstruction on spirometry. Measurements Emphysema-like lung was defined on cardiac CT as the number of lung voxels less than -950 Hounsfield Units, and was adjusted for the number of total imaged lung voxels. Results Among 2965 participants, 50.9% of whom never smoked, there were 186 deaths over a median of 6.2 years. Greater emphysema-like lung was independently associated with increased mortality (adjusted hazard ratio [HR]1.14 per one-half of the interquartile range, 95% CI 1.04-1.24, P=0.004), adjusting for potential confounders including cardiovascular risk factors and the forced expiratory volume in one second. Generalized additive models supported a linear association between emphysema-like lung and mortality without evidence for a threshold. The association was of greatest magnitude among smokers, although multiplicative interaction terms did not support effect modification by smoking status. Limitations Cardiac CT scans did not include lung apices. The number of deaths was limited among subgroup analyses. Conclusions Emphysema-like lung on CT was associated with all-cause mortality among persons without airflow obstruction or COPD in a general population sample, particularly among smokers. Recognition of the independent prognostic significance of emphysema on CT among patients without COPD on spirometry is warranted. Primary Funding Source NIH/NHLBI.

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“…69 Regardless, given that lung cancer screening is now recommended in smokers, 70 emphysema on CT may be increasingly available for clinical decision-making. We did not evaluate DLCO, which associates with dyspnea 71 and correlates modestly with emphysema on CT. 72 Bronchoprovocation, exercise testing and plethysmography were not performed. A measure of anemia was not available, however due to physiologic adaptations, anemia must be severe in order to cause dyspnea in otherwise healthy adults, such as those enrolled in MESA.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Tests for the Diagnostic Evaluation of Dyspnea Among Outpatients: The Multi-Ethnic Study of Atherosclerosis Lung Study

Oelsner

Lima

Kawut

et al. 2015

The American Journal of Medicine

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Background Dyspnea on exertion is a common and debilitating complaint, yet evidence for the relative value of cardiac and pulmonary tests for the evaluation of chronic dyspnea among adults without known cardiac or pulmonary disease is limited. Methods The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants ages 45-84 years who were free of clinical cardiovascular disease from six communities; participants with clinical pulmonary disease were excluded from this report. Dyspnea on exertion was assessed via structured interview. Tests included electrocardiograms, cardiac computed tomography (CT) for coronary artery calcium, cardiac magnetic resonance imaging, spirometry, percent emphysema (percent of lung regions < -950 Hounsfield Units) on CT, inflammatory biomarkers and N-terminal pro-Brain Natriuretic Peptide (NT-proBNP). Logistic regression was used to identify independent correlates of dyspnea after adjustment for age, sex, body mass index, physical activity, anxiety, and leg pain. Results Among 1,969 participants without known cardiopulmonary disease, 9% had dyspnea. The forced expiratory volume in one second (FEV1) (p <0.001), NT-proBNP (p=0.004), and percent emphysema on CT (p=0.004) provided independent information on the probability of self-reported dyspnea. Associations with the FEV1 were stronger among smokers and participants with other recent respiratory symptoms or seasonal allergies; associations with NT-proBNP were present only among participants with coexisting symptoms of lower extremity edema. Only the FEV1 provided a significant improvement in the receiver operating curve. Conclusions Among adults without known cardiac or pulmonary disease reporting dyspnea on exertion, spirometry, NT-proBNP, and CT imaging for pulmonary parenchymal disease were the most informative tests.

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High-Resolution Computed Tomography Quantitation of Emphysema Is Correlated with Selected Lung Function Values in Stable COPD

Cited by 24 publications

References 65 publications

The effect of comorbidities on COPD assessment: a pilot study

The effect of comorbidities on COPD assessment: a pilot study

Association Between Emphysema-like Lung on Cardiac Computed Tomography and Mortality in Persons Without Airflow Obstruction

Noninvasive Tests for the Diagnostic Evaluation of Dyspnea Among Outpatients: The Multi-Ethnic Study of Atherosclerosis Lung Study

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