Abstract
BackgroundThe clinical and radiological presentation of chronic obstructive pulmonary disease (COPD) is heterogenous depending on the characterized sources of inflammation. This study aimed to evaluate COPD phenotypes associated with specific dust exposure.MethodsThis study was designed to compare the characteristics, clinical outcomes and radiological findings between two prospective COPD cohorts representing two distinguishing regions in the Republic of Korea; COPD in Dusty Area (CODA) and the Korean Obstructive Lung Disease (KOLD) cohort. A total of 733 participants (n = 186 for CODA, and n = 547 for KOLD) were included finally. A multivariate analysis to compare lung function and computed tomography (CT) measurements of both cohort studies after adjusting for age, sex, education, body mass index, smoking status, and pack-year, Charlson comorbidity index, and frequency of exacerbation were performed by entering the level of FEV1(%), biomass exposure and COPD medication into the model in stepwise.ResultsThe mean wall area (MWA, %) became significantly lower in COPD patients in KOLD from urban and metropolitan area than those in CODA cohort from cement dust area (mean ± standard deviation [SD]; 70.2 ± 1.21% in CODA vs. 66.8 ± 0.88% in KOLD, p = 0.028) after including FEV1 in the model. COPD subjects in KOLD cohort had higher CT-emphysema index (EI, 6.07 ± 3.06 in CODA vs. 20.0 ± 2.21 in KOLD, p < 0.001, respectively). The difference in the EI (%) was consistently significant even after further adjustment of FEV1 (6.12 ± 2.88% in CODA vs. 17.3 ± 2.10% in KOLD, p = 0.002, respectively). However, there was no difference in the ratio of mean lung density (MLD) between the two cohorts (p = 0.077). Additional adjustment for biomass parameters and medication for COPD did not alter the statistical significance after entering into the analysis with COPD medication.ConclusionsHigher MWA and lower EI were observed in COPD patients from the region with dust exposure. These results suggest that the imaging phenotype of COPD is influenced by specific environmental exposure.
Highlights
Chronic obstructive pulmonary disease (COPD) is defined as progressive airway obstruction with parenchymal lung destruction and airway inflammation
We investigated whether there is a difference in structural findings in computed tomography (CT) by evaluating the characteristic of patients with chronic obstructive pulmonary disease (COPD) who lived in two functional areas; urban areas where mainly composed of metropolitan regions with residential areas, without large industrial emissions and rural areas, where large cement plants are located nearby expecting exposure to different composition of dust
COPD subjects in both cohorts were recruited for medical examination which consisted of a questionnaire regarding environmental exposure, health-related symptoms and behaviors, and laboratory findings with a pulmonary function test (PFT) with postbronchodilator use and CT
Summary
Chronic obstructive pulmonary disease (COPD) is defined as progressive airway obstruction with parenchymal lung destruction and airway inflammation. Inflammation, characterized by COPD, can differ by smoking, air pollutants, biomass, or genetic factors leading to diverse clinical or radiological findings. Heterogeneity of COPD on computed tomography (CT) findings have been broadly characterized as either; emphysema-predominant or airway-predominant type [3, 4]. Bronchial parameters such as bronchial lumen area (LA) and bronchial wall area (WA) represented bronchial wall thickness and have been shown to correlate with spirometric parameters [5,6,7]. The clinical and radiological presentation of chronic obstructive pulmonary disease (COPD) is heter‐ ogenous depending on the characterized sources of inflammation. This study aimed to evaluate COPD phenotypes associated with specific dust exposure
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