Abstract
BackgroundThoracic computed tomography (CT) scans are widely performed in clinical practice, often leading to detection of airway or parenchymal abnormalities in asymptomatic or minimally symptomatic individuals. However, clinical relevance of CT abnormalities is uncertain in the general population.MethodsWe evaluated data from 1361 participants aged ≥40 years from a Canadian prospective cohort comprising 408 healthy never-smokers, 502 healthy ever-smokers, and 451 individuals with spirometric evidence of chronic obstructive pulmonary disease (COPD) who had thoracic CT scans. CT images of subjects were visually scored for respiratory bronchiolitis(RB), emphysema(E), bronchial-wall thickening(BWT), expiratory air-trapping(AT), and bronchiectasis(B). Multivariable logistic regression models were used to assess associations of CT features with respiratory symptoms, dyspnea, health status as determined by COPD assessment test, and risk of clinically significant exacerbations during 12 months follow-up.ResultsAbout 11% of life-time never-smokers demonstrated emphysema on CT scans. Prevalence increased to 30% among smokers with normal lung function and 36%, 50%, and 57% among individuals with mild, moderate or severe/very severe COPD, respectively. Presence of emphysema on CT was associated with chronic cough (OR,2.11; 95%CI,1.4–3.18); chronic phlegm production (OR,1.87; 95% CI,1.27–2.76); wheeze (OR,1.61; 95% CI,1.05–2.48); dyspnoea (OR,2.90; 95% CI,1.41–5.98); CAT score≥10(OR,2.17; 95%CI,1.42–3.30) and risk of ≥2 exacerbations over 12 months (OR,2.17; 95% CI, 1.42–3.0).ConclusionsBurden of thoracic CT abnormalities is high among Canadians ≥40 years of age, including never-smokers and smokers with normal lung function. Detection of emphysema on CT scans is associated with pulmonary symptoms and increased risk of exacerbations, independent of smoking or lung function.
Highlights
Chronic obstructive pulmonary disease (COPD) is a complex heterogeneous disease with a spectrum of overlapping clinical subtypes leading to chronic airflow limitation[1]
Prevalence increased to 30% among smokers with normal lung function and 36%, 50%, and 57% among individuals with mild, moderate or severe/very severe COPD, respectively
Presence of emphysema on computed tomography (CT) was associated with chronic cough (OR,2.11; 95%CI,1.4–3.18); chronic phlegm production (OR,1.87; 95% CI,1.27–2.76); wheeze (OR,1.61; 95% CI,1.05– 2.48); dyspnoea (OR,2.90; 95% CI,1.41–5.98); CAT score!10(OR,2.17; 95%CI,1.42–3.30) and risk of !2 exacerbations over 12 months (OR,2.17; 95% CI, 1.42–3.0)
Summary
Chronic obstructive pulmonary disease (COPD) is a complex heterogeneous disease with a spectrum of overlapping clinical subtypes leading to chronic airflow limitation[1]. Clinical relevance of these abnormalities, especially in never-smokers and those with normal lung function, is unknown. The primary aim of this study was to: 1) ascertain the prevalence of emphysema and airway abnormalities (e.g. bronchiolitis, bronchiectasis, etc) in the general Canadian population !40 years of age, including never-smokers and those with normal lung function; 2) determine the relationship of detected CT abnormalities with pulmonary symptoms, health status, and clinical outcomes, such as risk of exacerbations in the general population. Thoracic computed tomography (CT) scans are widely performed in clinical practice, often leading to detection of airway or parenchymal abnormalities in asymptomatic or minimally symptomatic individuals. Clinical relevance of CT abnormalities is uncertain in the general population
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