Chronic Obstructive Pulmonary Disease: More Imaging, More Phenotyping...Better Care?

Damien Pike,Grace Parraga

doi:10.1155/2013/375298

Abstract

Chronic Obstructive Pulmonary Disease: More Imaging, More Phenotyping...Better Care?

Highlights

COPD is recognized as a regionally heterogeneous disease with underlying contributions from airway abnormalities (5) or, perhaps, airway obliteration (6) and emphysematous destruction
Exacerbation frequency was shown to be related to both emphysema and airway disease-dominant phenotypes and, in the case of mixed emphysemaairways disease phenotypes, exacerbation frequency was decreased but quality of life was much worse. How can this information be used in the future? Do the risks and resources inherent in acquiring CT data outweigh the important information content and the potential to alter therapy decisions in COPD? In a resource-limited setting, outside of a major clinical trial, a careful clinical study involving a small group of smokers with COPD, such as presented by Tulek et al (1), provides intriguing evidence that CT phenotypes may help explain exacerbation risk, predict underlying inflammation and, perhaps, stratify patients
Future steps necessarily include automated image analysis tools to reduce the time and variability inherent in manual analyses and a randomized controlled trial to evaluate COPD outcomes based on therapy decisions made with and without imaging phenotype information

Summary

Introduction

COPD is recognized as a regionally heterogeneous disease with underlying contributions from airway abnormalities (5) or, perhaps, airway obliteration (6) and emphysematous destruction. High-resolution CT images of airway morphology, parenchyma density and gross anatomy have been analyzed to determine phenotypes of COPD and classify patients into disease severity subgroups. Using COPDGene data, Galban et al (8) developed an elegant approach to derive parametric response maps and identify CT phenotypes.

Results

Conclusion