Abstract
Background and Objectives: In clinical practice, spirometry plays a key role in the diagnosis of chronic obstructive pulmonary disease (COPD), however, it provides no information about structural pulmonary abnormality. The aim of this study was to evaluate whether there is a relation between the clinical criteria and chest radiography or CT studies in differentiating chronic bronchitis from emphysema in COPD. Patients and methods: In a prospective study, data analysis on 165 COPD subjects who were enrolled between September, 2011 and December 2012 was completed. Data were collected including clinical characteristics of stable COPD, pulmonary function tests, chest X-ray and multidetector computerized tomography (MDCT) findings. Results: Emphysema was diagnosed in 90 (55%) of 165 CT scans. The median emphysema score was 58 (range 48 - 72) and significantly correlated with lower FEV1 values (r = 0.542, p = 0.003). In chronic bronchitis, bronchial wall thickening was diagnosed approximately as often in chest radiography (56%) as in CT (64%) as a major finding. Body mass index (BMI), forced expiratory volume in the first second (FEV1), and diffusion capacity of the lung for carbon monoxide (DL,CO) were significantly lower, whereas total lung capacity (TLC) was higher in patients with emphysema. Cardiovascular diseases and obstructive sleep apnea syndrome (OSAS) were more common in chronic bronchitis group. Conclusions: Chest radiography is a valuable, inexpensive means of diagnosing emphysema or bronchial wall thickening in chronic bronchitis. Emphysematous patients show a worse pulmonary function and a greater dyspnea. Greater comorbidity in chronic bronchitis may require specific treatment strategies in this subgroup.
Highlights
Chronic airflow limitation is thought to be resulted from the combination of two mechanisms: increased airway resistance due to narrowing of the small airways, and loss of lung elastic recoil due to emphysema
The phenotypic expression of these different subtypes of chronic obstructive pulmonary disease (COPD) is vital because a therapy designed to modulate the inflammation in airways in chronic bronchitis may be contraindicated in subjects with the emphysema phenotype and vice versa
The aim of this study was to evaluate whether there is a relation between the clinical criteria and chest radiography findings or computed tomography (CT) studies in differentiating emphysema from chronic bronchitis COPD phenotypes
Summary
Chronic airflow limitation is thought to be resulted from the combination of two mechanisms: increased airway resistance due to narrowing of the small airways, and loss of lung elastic recoil due to emphysema. The advent and proliferation of computed tomography initially allowed investigators to quantify changes in lung parenchymal structure in subjects with emphysema, and more recently attention has turned to the measurement of airway wall dimensions [4]. The phenotypic expression of these different subtypes of COPD is vital because a therapy designed to modulate the inflammation in airways in chronic bronchitis may be contraindicated in subjects with the emphysema phenotype and vice versa These new imaging techniques are very likely to play a front-line role in the study of COPD and will, hopefully, allow clinicians to phenotype individuals, thereby personalizing their treatment [6]. Spirometry plays a key role in the diagnosis of chronic obstructive pulmonary disease (COPD), it provides no information about structural pulmonary abnormality. Greater comorbidity in chronic bronchitis may require specific treatment strategies in this subgroup
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