CT in COPD: To be or not to be

Abstract

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition, with varied structural and functional alterations, both inside and outside the lungs. 1 In the lungs, COPD can be associated with airway disease (bronchitis, bronchiolitis, bronchiectasis), alveolar abnormalities (emphysema) and/or vascular alterations (pulmonary hypertension); occasionally, it can also be

Treatable traits in pre‐COPD: Time to extend the treatable traits paradigm beyond established disease

“…95 The identification of nodules (potential lung cancer) or pulmonary artery dilation (potential indicator of pulmonary hypertension) deserves specific work-up and treatment, but its discussion is beyond the scope of this review. Clearly, chest CT offers a new and wide variety of possibilities to detect TTs in those with COPD and, most likely in pre-COPD too, 96 albeit this deserves prospective, well-designed studies. 90…”

COPD: Providing the right treatment for the right patient at the right time

“…Common comorbidities should be considered within the context of a broad-based patient assessment [92]. Computerized tomography of the thorax is helpful to characterize the intrathoracic features of COPD, as well as to identify comorbidities such as cancer, coronary artery disease, osteoporosis, body composition abnormalities and pulmonary vascular disease [118][119][120][121][122], and to exclude other conditions. Other testing to assess for systemic manifestations of COPD, including blood work, electrocardiogram echocardiogram, and/or body composition/nutritional assessment among others, depends on each patient's symptoms, medical history, radiologic and physiologic findings, physical and functional limitations, disease stability as well as shared decision making between patients and their health care providers regarding potential benefits vs. risks and associated costs of testing.…”

GOLD 2023 Executive Summary: responses from the GOLD Scientific Committee

“…As far as the second question, which was whether bronchiectasis with airflow obstruction can be regarded as a new etiotype of COPD, the response is a little bit more complex. There is no question that a large proportion of patients with bronchiectasis have airflow obstruction and that a sizable proportion of patients with COPD have bronchiectasis when a computed tomography scan or chest radiograph is obtained [ 14 , 15 ]. What comes first is not clear and calling bronchiectasis an “etiotype” (in contrast to the infectious agents) is not right, because bronchiectasis itself has several causative agents and constitutes a specific recognised nosological entity.…”