Emphysema distribution and annual changes in pulmonary function in male patients with chronic obstructive pulmonary disease

Respiratory Research

Michiaki Mishima¹  Toyohiro Hirai¹  Emiko Ogawa¹  Takeshi Kubo³  Yuma Hoshino¹  Daisuke Kinose¹  Tamaki Takahashi¹  Hirofumi Kiyokawa¹  Tsuyoshi Oguma¹  Susumu Sato¹  Shiro Tanaka²  Shigeo Muro¹  Naoya Tanabe¹ 

[1] Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan;Division of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan;Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan

关键词: Heterogeneity;    Lung function;    Emphysema;    CT;    COPD;    Chronic obstructive pulmonary diseases;   

Others  :  796732
DOI  :  10.1186/1465-9921-13-31

 received in 2012-01-25, accepted in 2012-04-18,  发布年份 2012

【 摘 要 】

Background

The progression of chronic obstructive pulmonary disease (COPD) considerably varies among patients. Those with emphysema identified by quantitative computed tomography (CT) are associated with the rapid progression assessed by forced expiratory volume in one second (FEV₁). However, whether the rate of the decline in lung function is independently affected by the regional distribution or the severity of emphysema in the whole lung is unclear.

Methods

We followed up 131 male patients with COPD for a median of 3.7 years. We measured wall area percent (WA%) in right apical segmental bronchus, total lung volume, percent low attenuation volume (LAV%), and the standard deviation (SD) of LAV% values from CT images of 10 isovolumetric partitions (SD-LAV) as an index of cranial-caudal emphysema heterogeneity. Annual changes in FEV₁ were then determined using a random coefficient model and relative contribution of baseline clinical parameters, pulmonary function, and CT indexes including LAV%, SD-LAV, and WA% to annual changes in FEV₁ were examined.

Results

The mean (SD) annual change in FEV₁ was −44.4 (10.8) mL. Multivariate random coefficient model showed that higher baseline FEV₁, higher LAV%, current smoking, and lower SD-LAV independently contributed to an excessive decline in FEV₁, whereas ratio of residual volume to total lung capacity, ratio of diffusing capacity to alveolar ventilation, and WA% did not, after adjusting for age, height, weight, and ratio of CT-measured total lung volume to physiologically-measured total lung capacity.

Conclusions

A more homogeneous distribution of emphysema contributed to an accelerated decline in FEV₁ independently of baseline pulmonary function, whole-lung emphysema severity, and smoking status. In addition to whole-lung analysis of emphysema, CT assessment of the cranial-caudal distribution of emphysema might be useful for predicting rapid, progressive disease and for developing a targeted strategy with which to prevent disease progression.

【 授权许可】

   
2012 Tanabe et al.; licensee BioMed Central Ltd.

【 图 表 】

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