Woo Jin Kim1, Edwin K Silverman2, Eric Hoffman3, Gerard J Criner4, Zab Mosenifar5, Frank C Sciurba6, Barry J Make7, Vincent Carey8, Raúl San José Estépar9, Alejandro Diaz10, John J Reilly6, Fernando J Martinez11, George R Washko12. 1. Department of Internal Medicine, Kangwon National University, Chuncheon, South Korea. 2. Channing Laboratory, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA. 3. Department of Radiology, University of Iowa, Iowa City, IA. 4. Division of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, PA. 5. Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. 6. Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 7. Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Medical & Research Center, Denver, CO. 8. Channing Laboratory, Brigham and Women's Hospital, Boston, MA. 9. Department of Radiology, Brigham and Women's Hospital, Boston, MA. 10. Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA. 11. Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, MI. 12. Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: GWashko@Partners.org.
Abstract
BACKGROUND: CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. METHODS: Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of -950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV(1) and percent predicted value of FEV(1) with CT scan measures of emphysema and airway disease. RESULTS: In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT (r = -0.28, p = 0.0001) and SRWA (r = -0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV(1)% predicted (R = -0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (beta = -5.2, p = 0.009; beta = -2.6, p = 0.008, respectively) and %LAA-950 (beta = -10.6, p = 0.03) with the postbronchodilator FEV(1)% predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). CONCLUSIONS: Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.
BACKGROUND: CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. METHODS: Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of -950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV(1) and percent predicted value of FEV(1) with CT scan measures of emphysema and airway disease. RESULTS: In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT (r = -0.28, p = 0.0001) and SRWA (r = -0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV(1)% predicted (R = -0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (beta = -5.2, p = 0.009; beta = -2.6, p = 0.008, respectively) and %LAA-950 (beta = -10.6, p = 0.03) with the postbronchodilator FEV(1)% predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). CONCLUSIONS: Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.
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