Phenotyping COPD Patients with Emphysema Distribution Using Quantitative CT Measurement; More Severe Airway Involvement in Lower Dominant Emphysema.

Content Provider	Europe PMC
Author	Park, Jisoo Kim, Eun-Kyung Lee, Se Hee Kim, Mi-Ae Kim, Jung-Hyun Lee, Sang Min Lee, Jae Seung Oh, Yeon-Mok Lee, Sang-Do Lee, Ji-Hyun
Copyright Year	2022
Abstract	PurposeWe explored the differences in clinical manifestations of COPD patients regarding emphysema distribution along with evidence of airway involvement in chest computed tomography (CT) scans.Patients and MethodsThe patients were divided into three groups according to the emphysema distribution: the upper dominant (UD), lower dominant (LD), and homogeneous (HD) groups. Airway wall thickness was quantitatively measured and the presence of bronchiectasis and/or bronchial wall thickening (BE/BWT) was visually assessed. Baseline characteristics including the evidence of airway involvement and long-term outcomes were compared among the three groups. Non-severe patients of each group were first treated with 3 months of ICS/LABA combination after 2 weeks of wash-out period and lung functions before and after the treatment were compared.ResultsOf the 425 patients, 141 were in the UD, 107 in LD, and 177 in HD. The LD had more severe airway obstruction with lower emphysema index (EI) than the UD (LD vs UD; FEV1, 49.5–14.9 vs 54.6–16.5; EI, 21.0 [IQR: 14.0–33.1] vs 26.3 [IQR: 15.8–39.0]). The LD showed thicker airways (higher WA% and Pi10) and more severe air trapping (higher RV and RV/TLC) than UD. A larger proportion of patients in LD had BE/BWT (35.5% in LD vs 11.3% in UD). In LD, more patients experienced acute exacerbations and the time to first exacerbation was shorter than UD. Non-severe patients in LD treated with 3 months of ICS/LABA combined inhalers showed a notable reduction of RV than UD (LD vs UD; −531.1–936.5 vs −86.5–623.5).ConclusionThe LD showed a more prominent airway involvement than UD, which may cause more frequent exacerbations and a marked reduction of RV after the ICS/LABA combination treatment in LD. Phenotyping of the COPD patients using quantitatively measured emphysema distribution would be useful for predicting treatment response and exacerbation.
Page Count	13
ISSN	11769106
Volume Number	17
PubMed Central reference number	PMC9441583
PubMed reference number	36072609
Journal	International Journal of Chronic Obstructive Pulmonary Disease [Int J Chron Obstruct Pulmon Dis]
e-ISSN	11782005
DOI	10.2147/COPD.S362906
Language	English
Publisher	Dove
Publisher Date	2022-08-31
Access Restriction	Open
Rights License	This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). © 2022 Park et al.
Subject Keyword	pulmonary disease chronic obstructive computed tomography emphysema
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Public Health, Environmental and Occupational Health Health Policy