Alejandro A Diaz1, Carolyn E Come2, James C Ross3, Raúl San José Estépar3, MeiLan K Han4, Stephen H Loring5, Edwin K Silverman6, George R Washko2. 1. Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Pulmonary Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile. Electronic address: adiaz6@partners.org. 2. Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 3. Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA. 4. Pulmonary and Critical Care, University of Michigan School of Medicine, Ann Arbor, MI. 5. Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 6. Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Channing Laboratory, Brigham and Women's Hospital, Boston, MA.
Abstract
BACKGROUND: An increase in airway caliber (airway distensibility) with lung inflation is attenuated in COPD. Furthermore, some subjects have a decrease in airway caliber with lung inflation. We aimed to test the hypothesis that airway caliber increases are lower in subjects with emphysema-predominant (EP) compared with airway-predominant (AP) CT scan subtypes. Additionally, we compared clinical and CT scan features of subjects with (airway constrictors) and without a decrease in airway caliber. METHODS: Based on GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages and CT scan subtypes, we created a control group (n = 46) and the following matched COPD groups (n = 23 each): GOLD-2-AP, GOLD-2-EP, GOLD-4-AP, and GOLD-4-EP. From the CT scans of all 138 subjects, we measured emphysema, lung volumes, and caliber changes in the third and fourth airway generations of two bronchi. We expressed airway distensibility (ratio of airway lumen diameter change to lung volume change from end tidal breathing to full inspiration) as a global or lobar measure based on normalization by whole-lung or lobar volume changes. RESULTS: Global distensibility in the third and fourth airway generations was significantly lower in the GOLD-2-EP and GOLD-4-EP groups than in control subjects. In GOLD-2 subjects, lobar distensibility of the right-upper-lobe fourth airway generation was significantly lower in those with EP than in those with AP. In multivariate analysis, emphysema was an independent determinant of global and lobar airway distensibility. Compared with nonconstrictors, airway constrictors experienced more dyspnea, were more hyperinflated, and had a higher percentage of emphysema. CONCLUSIONS: Distensibility of large- to medium-sized airways is reduced in subjects with an EP CT scan subtype. Emphysema seems to alter airway-parenchyma interdependence. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
BACKGROUND: An increase in airway caliber (airway distensibility) with lung inflation is attenuated in COPD. Furthermore, some subjects have a decrease in airway caliber with lung inflation. We aimed to test the hypothesis that airway caliber increases are lower in subjects with emphysema-predominant (EP) compared with airway-predominant (AP) CT scan subtypes. Additionally, we compared clinical and CT scan features of subjects with (airway constrictors) and without a decrease in airway caliber. METHODS: Based on GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages and CT scan subtypes, we created a control group (n = 46) and the following matched COPD groups (n = 23 each): GOLD-2-AP, GOLD-2-EP, GOLD-4-AP, and GOLD-4-EP. From the CT scans of all 138 subjects, we measured emphysema, lung volumes, and caliber changes in the third and fourth airway generations of two bronchi. We expressed airway distensibility (ratio of airway lumen diameter change to lung volume change from end tidal breathing to full inspiration) as a global or lobar measure based on normalization by whole-lung or lobar volume changes. RESULTS: Global distensibility in the third and fourth airway generations was significantly lower in the GOLD-2-EP and GOLD-4-EP groups than in control subjects. In GOLD-2 subjects, lobar distensibility of the right-upper-lobe fourth airway generation was significantly lower in those with EP than in those with AP. In multivariate analysis, emphysema was an independent determinant of global and lobar airway distensibility. Compared with nonconstrictors, airway constrictors experienced more dyspnea, were more hyperinflated, and had a higher percentage of emphysema. CONCLUSIONS: Distensibility of large- to medium-sized airways is reduced in subjects with an EP CT scan subtype. Emphysema seems to alter airway-parenchyma interdependence. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
Authors: Alejandro A Diaz; Brian Bartholmai; Raúl San José Estépar; James Ross; Shin Matsuoka; Tsuneo Yamashiro; Hiroto Hatabu; John J Reilly; Edwin K Silverman; George R Washko Journal: Respir Med Date: 2010-04-10 Impact factor: 3.415
Authors: Elizabeth A Regan; John E Hokanson; James R Murphy; Barry Make; David A Lynch; Terri H Beaty; Douglas Curran-Everett; Edwin K Silverman; James D Crapo Journal: COPD Date: 2010-02 Impact factor: 2.409
Authors: M Mishima; T Hirai; H Itoh; Y Nakano; H Sakai; S Muro; K Nishimura; Y Oku; K Chin; M Ohi; T Nakamura; J H Bates; A M Alencar; B Suki Journal: Proc Natl Acad Sci U S A Date: 1999-08-03 Impact factor: 11.205
Authors: Harvey O Coxson; John Mayo; Stephen Lam; Giles Santyr; Grace Parraga; Don D Sin Journal: Am J Respir Crit Care Med Date: 2009-07-16 Impact factor: 21.405
Authors: M K Han; R Wise; J Mumford; F Sciurba; G J Criner; J L Curtis; S Murray; A Sternberg; G Weinman; E Kazerooni; A P Fishman; B Make; E A Hoffman; Z Mosenifar; F J Martinez Journal: Eur Respir J Date: 2009-11-19 Impact factor: 16.671
Authors: Klaus F Rabe; Suzanne Hurd; Antonio Anzueto; Peter J Barnes; Sonia A Buist; Peter Calverley; Yoshinosuke Fukuchi; Christine Jenkins; Roberto Rodriguez-Roisin; Chris van Weel; Jan Zielinski Journal: Am J Respir Crit Care Med Date: 2007-05-16 Impact factor: 21.405
Authors: Michael H Cho; Peter J Castaldi; Craig P Hersh; Brian D Hobbs; R Graham Barr; Ruth Tal-Singer; Per Bakke; Amund Gulsvik; Raúl San José Estépar; Edwin J R Van Beek; Harvey O Coxson; David A Lynch; George R Washko; Nan M Laird; James D Crapo; Terri H Beaty; Edwin K Silverman Journal: Am J Respir Crit Care Med Date: 2015-09-01 Impact factor: 21.405
Authors: Alejandro A Diaz; MeiLan K Han; Carolyn E Come; Raúl San José Estépar; James C Ross; Victor Kim; Mark T Dransfield; Douglas Curran-Everett; Joyce D Schroeder; David A Lynch; Juerg Tschirren; Edwin K Silverman; George R Washko Journal: Chest Date: 2013-03 Impact factor: 9.410
Authors: Jens Petersen; Mathilde M W Wille; Lars Lau Rakêt; Aasa Feragen; Jesper H Pedersen; Mads Nielsen; Asger Dirksen; Marleen de Bruijne Journal: Eur Radiol Date: 2014-06-06 Impact factor: 5.315
Authors: C Matthew Kinsey; Raul San José Estépar; Jos van der Velden; Bernard F Cole; David C Christiani; George R Washko Journal: Cancer Epidemiol Biomarkers Prev Date: 2016-05-19 Impact factor: 4.254
Authors: C Matthew Kinsey; Raul San Jose Estepar; Yang Zhao; Xiaojin Yu; Nancy Diao; Rebecca Suk Heist; John C Wain; Eugene J Mark; George Washko; David C Christiani Journal: Lung Cancer Date: 2014-02-11 Impact factor: 5.705
Authors: Gregory L Kinney; Stephanie A Santorico; Kendra A Young; Michael H Cho; Peter J Castaldi; Raul San José Estépar; James C Ross; Jennifer G Dy; Barry J Make; Elizabeth A Regan; David A Lynch; Douglas C Everett; Sharon M Lutz; Edwin K Silverman; George R Washko; James D Crapo; John E Hokanson Journal: Am J Epidemiol Date: 2018-10-01 Impact factor: 4.897