Prevalence Of Emphysema Research Articles

Оценка влияния пандемии COVID‑19 на распространённость эмфиземы по данным компьютерной томографии с применением технологии искусственного интеллекта

Respiratory diseases represent the most prevalent class of diseases in the Russian Federation, accounting for up to 25.0% of the total morbidity structure according to various authors. Several authors suggest that the proportion of patients with chronic obstructive pulmonary disease (COPD) with emphysema has increased in recent years. One of the reasons for the rising prevalence of emphysema is the aftermath of COVID‑19. The aim of this study is to analyze the changes in the incidence of emphysema before, during, and after the COVID‑19 pandemic. Materials and methods. The study included the results of chest computed tomography (CT) scans processed using artificial intelligencebased software, enabling the assessment of the volume of emphysematous lung tissue damage. Patient samples were divided into four periods: the «pre-COVID period» (625 studies), the «COVID period» (6,809 studies), the «post-COVID2023» period (101,872 studies), and the «post-COVID2024» period (78,539 studies). Results. The proportion of studies indicating emphysema in the pre-COVID period was 5.60%, increasing to 9.37% during the COVID period, and then decreasing to 6.63% in the first post-COVID year (2023), with a subsequent increase to 7.67% in the second post-COVID year (2024). Statistically significant differences in the percentage of emphysema were found in 2022, 2023, and 2024 when analyzed pairwise. Notably, when categorized by the severity of the disease, significant emphysema (>6% lung involvement) was more prevalent in 2024, with an average percentage of 25.79% in this group. Conclusion. Our study confirms a significant increase in cases of emphysema in the population in recent years, which may be associated with the impact of the COVID‑19 pandemic. The proportion of patients with signs of emphysema in 2024 was 7.67%, which is 1% higher than in 2023.

Occurrence of Emphysema in Individuals With Williams-Beuren Syndrome: A Narrative Review

BackgroundWilliams-Beuren syndrome (WBS) is a multisystem genetic condition characterized by a submicroscopic deletion on the 7th chromosome (7q11.23), which usually includes the elastin gene. Research QuestionThough the elastin deficiency in WBS can predispose to emphysema, the prevalence of emphysema in WBS is unknown. This narrative review aims to address this gap by estimating the frequency of emphysema (or suggestive features thereof) in patients with WBS, with a special focus on concomitant alpha-1 antitrypsin deficiency. MethodsLiterature was reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ResultsOf 419 studies identified by the search strategy, 19 eligible studies reported 393 adult patients with WBS. The criteria by which emphysema was assessed varied greatly among the relatively few reports addressing this issue. Chest CT evidence of emphysema was reported in 3 of 26 (11.5%) patients. Physiologic evidence of airflow obstruction, though not definitive for emphysema (i.e., with asthma not excluded) was present in as many as 38.6%. Considering studies that reported multi-organ clinical manifestations of WBS, irrespective of whether chest CT imaging and/or pulmonary function testing was reported, the frequency of spirometric and imaging signs suggestive of emphysema was 4.3%. Emphysema was not reported in any of the 11 patients with concomitant PI*MZ heterozygous alpha-1 antitrypsin deficiency. InterpretationIn the context that only few adults with WBS have been fully characterized regarding the occurrence of emphysema, confidently estimating the prevalence of emphysema is difficult. This review shows that the frequency of imaging and PFT abnormalities suggestive of emphysema seems relatively low in the context that the elastin deficiency of WBS clearly can predispose to emphysema, and that other manifestations of elastin deficiency are present early in life. Acknowledging the challenges of studying uncommon diseases or syndromes, more systematic study of adults with WBS is needed.

Alpha-1 deficiency in severe asthma patients.

<sec id="st1"><title>INTRODUCTION</title>Alpha-1 antitrypsin (AAT) deficiency, an autosomal co-dominant condition, decreases protein concentration and activity at both serum and tissue levels. Few studies investigated whether the type of SERPINA1 gene phenotype in patients with severe asthma can influence symptoms and disease control during follow-up.</sec><sec id="st2"><title>OBJECTIVE</title>To assess whether the presence of a non-MM genotype of SERPINA1 in patients with severe asthma is associated with disease control, systemic and airway inflammation, lung function and comorbidities prevalence compared to severe asthma patients with a homozygous genotype (MM).</sec><sec id="st3"><title>METHODS</title>Asthmatic patients belonging to Global Initiative for Asthma (GINA) step 5 were retrospectively analysed in an Italian reference asthma clinic. We collected clinical, biological and functional variables at baseline and for the three following years.</sec><sec id="st4"><title>RESULTS</title>Out of 73 patients enrolled, 14 (19.18%) were non-MM and 59 (80.8%) were MM. Asthmatics with non-MM genotype had lower serum AAT concentration (P = 0.004) and higher emphysema prevalence than the MM group (P = 0.003) at baseline. During follow up, only MM patients showed a significant improvement of both ACQ-6 score (P < 0.0001) and eosinophilic systemic inflammation (P < 0.0001).</sec><sec id="st5"><title>CONCLUSIONS</title>Our findings emphasise the importance of a screening for AAT deficiency in severe asthma, as alleles mutation may influence patient's follow-up.</sec>.

A Plant-Centered Diet is Inversely Associated With Radiographic Emphysema: Findings from the CARDIA Lung Study.

Chronic obstructive pulmonary disease (COPD) is a significant public health concern and intercepting the development of emphysema is vital for COPD prevention. Smokers are a high-risk population for emphysema with limited prevention strategies. We aimed to determine if adherence to a nutritionally rich, plant-centered diet among young ever-smokers is associated with reduced risk of future radiographic emphysema. We studied participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Lung Prospective Cohort Study who were 18-30 years old at enrollment and followed for 30 years. We analyzed 1706 adults who reported current or former smoking by year 20. Repeated measures of diet history were used to calculate A Priori Diet Quality Scores (APDQSs), and categorized into quintiles, with higher quintiles representing higher nutritionally rich plant-centered food intake. Emphysema was assessed at year 25 (n=1351) by computed tomography (CT). Critical covariates were selected, acknowledging potential residual confounding. Emphysema was observed in 13.0% of the cohort, with a mean age of 50.4 ± 3.5 years. The prevalence of emphysema was 4.5% in the highest APDQS quintile (nutritionally rich), compared with 25.4% in the lowest quintile. After adjustment for multiple covariates, including smoking, greater adherence to a plant-centered diet was inversely associated with emphysema (highest versus lowest quintile odds ratio: 0.44, 95% CI 0.19-0.99, ptrend=0.008). Longitudinal adherence to a nutritionally rich, plant-centered diet was associated with a decreased risk of emphysema development in middle adulthood, warranting further examination of diet as a strategy for emphysema prevention in a high-risk smoking population.

Association between dietary antioxidant intakes and chronic respiratory diseases in adults

BackgroundChronic respiratory diseases (CRDs) pose a significant global health burden. Antioxidant-rich diets have been associated with improved lung health, but the specific relationship with CRDs remains unclear. MethodsThis study examined the relationship between dietary antioxidant intakes and CRDs using data from the 2001–2018 National Health and Nutrition Examination Survey (NHANES). Information on dietary antioxidant intakes, including vitamins A, C, and E, zinc, selenium, and carotenoid, were collected from the 2 24-h recall interviews to calculate composite dietary antioxidant index (CDAI). CRDs were determined based on self-reported physician diagnoses. To examine the relationship between CDAI and CRDs, multivariate logistic regression was used. To study potential non-linear correlations within these associations, restricted cubic spline (RCS) regression was performed. ResultsThe study involved 40 557 individuals. The median CDAI was −0.09 (−2.05, 2.25). We discovered those who were in the fourth quartile of CDAI scores had a 19% lower prevalence than those in the first quartile (OR = 0.81 [0.72–0.91], Ptrend < 0.01) after adjusting for all relevant covariates. The fourth quartile of CDAI was linked with a lower prevalence of emphysema (OR = 0.57 [0.40–0.81], Ptrend < 0.01) and chronic bronchitis (OR = 0.74 [0.62–0.88], Ptrend < 0.01). RCS regression showed that CDAI was non-linearly related to the prevalence of CRDs, with inflection points of 3.20 (P for non-linearity <0.01). The stratified analysis did not identify variables that significantly affected the results. ConclusionHigher dietary antioxidant intakes were related with a lower prevalence of CRDs (particularly emphysema and chronic bronchitis) in general adults.

Популяционное исследование эмфизематозных изменений легких у населения г. Москвы методом автоматизированного анализа результатов лучевых исследований.

Background. Emphysema, commonly seen in patients with chronic obstructive pulmonary disease (COPD), worsens the course of chronic cardiovascular and endocrine diseases and is also associated with an increased risk of lung cancer. Although the evaluation of COPD incidence is applied systematically, the prevalence of emphysema is often not known. One of the ways to offset that is automated analysis of chest CT scans using artificial intelligence technologies. Goal. To study the prevalence of emphysema in the population of Moscow using automated analysis of radiological examinations. Methods. The results of the chest CT scan of 116,216 patients were analyzed. All studies were performed between October 2022 and June 2023 in Moscow medical facilities. The Emphysema-IRA AI service (Intelligent Radiology Assistance Laboratories (AIRA Labs) LLC) used an automated mode to determine the presence of emphysematous changes in the lungs (binary classification – yes/no) and the percentage of emphysematous lesions in both lungs and each lung separately. Results. The prevalence of pulmonary emphysema among the Moscow population was 0.614 per 1,000 people; the prevalence of clinically significant emphysema was 0.173 per 1,000 people. The majority of individuals presented with either pulmonary or clinically significant emphysema in CT belong to the elderly group (47.0% and 55.0%, respectively); the proportion of young people is also significant (9.0% and 5.0%). Men of all age groups have a significantly higher chance to get diagnosed with emphysema which suggests a higher incidence compared to the female population (Chi-square = 1000.0; p&lt;0.001). Regardless of gender, a 5-year increase in age elevates the likelihood of both emphysema and clinically significant emphysema by 1.1 times. Conclusions. Automated detection of signs of pulmonary emphysema on CT allows for a quick, population-wide, and objective assessment of the COPD prevalence. Thanks to the development of AI-based medical software, it has become possible to develop and implement ground-breaking digital technologies for healthcare management and public health studies.

Reliability of Total Serum IgE Levels to Define Type 2 High and Low Asthma Phenotypes.

Background: High total IgE levels are weak predictors of T2High and have been reported in nonallergic asthma. Therefore, the role of total serum IgE (IgE) in the T2High phenotype is still debated. Objective: This study investigated the reliability of stratifying asthmatics into IgEHigh and IgELow within the T2High and T2Low phenotypes. Methods: This cross-sectional single-center study investigated the association of clinical, functional, and bio-humoral parameters in a large asthmatic population stratified by IgE ≥ 100 kU/L, allergen sensitization, B-EOS ≥ 300/µL, and FENO ≥ 30 ppb. Results: Combining T2 biomarkers and IgE identifies (1) T2Low-IgELow (15.5%); (2) T2Low-IgEHigh (5.1%); (3) T2High-IgELow (33.6%); and T2High-IgEHigh (45.7%). T2Low-IgELow patients have more frequent cardiovascular and metabolic comorbidities, a higher prevalence of emphysema, and higher LAMA use than the two T2High subgroups. Higher exacerbation rates, rhinitis, and anxiety/depression syndrome characterize the T2Low-IgEHigh phenotype vs. the T2Low-IgELow phenotype. Within the T2High, low IgE was associated with female sex, obesity, and anxiety/depression. Conclusions: High IgE in T2Low patients is associated with a peculiar clinical phenotype, similar to T2High in terms of disease severity and nasal comorbidities, while retaining the T2Low features. IgE may represent an additional biomarker for clustering asthma in both T2High and T2Low phenotypes rather than a predictor of T2High asthma "per se".

Inverse correlations between serum carotenoids and respiratory morbidity and mortality: the Third National Health and Nutrition Examination Survey.

The objective was to evaluate the association between serum carotenoid levels and respiratory morbidity and mortality in a nationally representative sample of US adults. We assessed the association of serum carotenoid levels with respiratory morbidity and mortality using logistic regression and proportional hazards regression models. Meanwhile, a series of confounders were controlled in regression models and restricted cubic spline, which included age, sex, race, marriage, education, income, drinking, smoking, regular exercise, BMI, daily energy intake, vitamin E, vitamin C, fruit intake, vegetable intake, diabetes, hypertension, asthma, emphysema and chronic bronchitis. Compared with participants in the lowest tertiles, participants in the highest tertiles of serum total carotenoids, β-cryptoxanthin and lutein/zeaxanthin levels had a significantly lower prevalence of emphysema (ORtotal carotenoids = 0·61, 95% CI: 0·41-0·89, ORβ-cryptoxanthin = 0·67, 95% CI: 0·49-0·92), chronic bronchitis (ORβ-cryptoxanthin = 0·66, 95% CI: 0·50-0·87) and asthma (Q2: ORlutein/zeaxanthin = 0·78, 95% CI: 0·62-0·97); participants in the highest tertiles of total carotenoids, α-carotene, lutein/zeaxanthin and lycopene had a lower risk of respiratory mortality (hazard ratio (HR)total carotenoids = 0·62, 95% CI: 0·42-0·90, HRα-carotene = 0·54, 95% CI: 0·36-0·82, HRlutein/zeaxanthin = 0·48, 95% CI: 0·33-0·71, HRlycopene = 0·66, 95% CI: 0·45-0·96) than those in the lowest tertiles. Higher serum total carotenoids and β-cryptoxanthin levels is associated with decreased prevalence of emphysema and chronic bronchitis, and higher serum total carotenoids, α-carotene, lutein/zeaxanthin and lycopene levels had a lower mortality of respiratory disease.

Association of rest-activity circadian rhythm with chronic respiratory diseases, a cross-section survey from NHANES 2011–2014

ObjectiveA growing number of studies have examined the 24-h rest-activity characteristics in relation to health outcomes. Up to now, few studies have paid attention to the role of rest-activity circadian rhythm in chronic respiratory diseases (CRDs); therefore, to fill this gap, our study innovatively explored the association of rest-activity circadian rhythm indices with CRDs. MethodsA total of 7412 participants from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were included in this study. The rest-activity circadian rhythm indices were calculated using accelerometer data and were divided into quartiles to perform logistic regression. ResultsParticipants in the highest quartile of Relative amplitude (RA) had a lower prevalence of emphysema, chronic bronchitis and asthma, compared to those in the lowest quartile. Participants in the highest quartile of Intradaily variability (IV) was associated with a higher prevalence of emphysema relative to those in the lowest quartile. Compared to those in the lowest quartile, participants in the highest quartile of the average activity of the most active continuous 10-h period (M10) had a lower prevalence of emphysema. Additionally, compared to those in the lowest quartile of the average activity of the least active continuous 5-h period (L5) and L5 start time, participants in the highest quartile had a higher prevalence of asthma. ConclusionsThis study demonstrated that in general US adult population, disrupted rest-activity circadian rhythm was associated with a higher prevalence of CRDs.

1450. Trends in hospitalizations and outpatient visits with early or delayed antibiotic treatment initiation in nontuberculous mycobacterial lung disease

Abstract Background The 2020 treatment guidelines for patients diagnosed with nontuberculous mycobacterial lung disease (NTMLD) recommend antibiotic treatment initiation rather than “watchful waiting” for most patients. Little is known regarding how delayed treatment (DT) may impact healthcare resource utilization (HRU). The goal of this study was to assess HRU with early antibiotic treatment (ET) or DT in NTMLD. Methods We conducted a retrospective observational cohort study using MarketScan claims from July 2014 to June 2020. Inclusion criteria were: ≥ 2 NTMLD medical claims (with date of first NTMLD claim as index date); continuous enrollment spanning 12 months pre–index date (baseline) to ≥ 24 months post–index date; concomitant treatment with antibiotics used in NTMLD, ie, from ≥ 2 drug classes within 28 days of each other; and no tuberculosis diagnosis. Mean time to antibiotic initiation (TT) from index date was used to define ET (TT ≤ 3 months) and DT (TT &amp;gt; 3 months) groups. Trends in hospitalizations (any, respiratory-related) and any outpatient visits at baseline, year 1 (Y1), and year 2 (Y2) post–index date were described. Results A total of 518 patients with NTMLD were included: 395 (76%) ET and 123 (24%) DT patients. ET patients tended to be younger and male; DT patients had a higher prevalence of emphysema, asthma, and bronchiectasis. ET patients had a decrease from baseline in the proportion of patients hospitalized and the mean number of hospitalizations at Y1 and Y2 (Figure 1A and 1B). DT patients had an increase from baseline in the proportion of patients hospitalized and the mean number of hospitalizations at Y1, followed by a decrease in Y2, although the mean number of hospitalizations at Y2 remained higher than at baseline. Similar trends in respiratory-related hospitalizations were observed per patient group (Figure 1C and 1D). ET patients had a decrease from baseline in the proportion of patients and the mean number of emergency room visits at Y1 and Y2, whereas DT patients showed little to no improvement (Figure 2A and 2B). Figure 1.Proportion of patients with (A) any hospitalization and (C) respiratory disease–related hospitalizations with early or delayed treatment for NTMLD. Mean number of (B) any hospitalizations and (D) respiratory disease–related hospitalizations per patient with early or delayed treatment for NTMLDFigure 2.(A) Proportion of patients with any ER visits with early or delayed treatment for NTMLD. (B) Number of ER visits per patient with early or delayed treatment for NTMLD Conclusion During the first 2 years after diagnosis, improvements in hospitalizations and ER visits were observed in patients who received ET, whereas patients who received DT showed little to no improvement from baseline. Disclosures Kevin L. Winthrop, MD, MPH, AN2: Advisor/Consultant|AN2: Grant/Research Support|Insmed: Advisor/Consultant|Insmed: Grant/Research Support|Paratek: Advisor/Consultant|Paratek: Grant/Research Support|Red Hill Biopharma: Advisor/Consultant|Red Hill Biopharma: Grant/Research Support|Spero Therapeutics: Advisor/Consultant Catherine Waweru, PhD, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds Mariam Hassan, PhD, B. Pharm, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds Sara Burns, MS, Panalgo: Employee Anjan Chatterjee, MD, MPH, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds.

Lung Cancer in the Course of COPD-Emerging Problems Today

Simple SummaryChronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer independent of the influence of tobacco smoke. There are some similarities in immunopathogenesis of both diseases. The participation of inflammatory cells: macrophages, neutrophils and lymphocytes T with CD8 population was presented in both diseases. The emphysematous phenotype of COPD seems to be most often complicated by lung cancer. Some elements of autoimmunity could be involved in the development of emphysema, and its relation with malignant transformation requires further studies. COPD complicates lung cancer diagnosis and treatment, and the patients with coexistence of these both serious diseases need special care.Tobacco smoking remains the main cause of tobacco-dependent diseases like lung cancer, chronic obstructive pulmonary disease (COPD), in addition to cardiovascular diseases and other cancers. Whilst the majority of smokers will not develop either COPD or lung cancer, they are closely related diseases, occurring as co-morbidities at a higher rate than if they were independently triggered by smoking. A patient with COPD has a four- to six-fold greater risk of developing lung cancer independent of smoking exposure, when compared to matched smokers with normal lung function. The 10 year risk is about 8.8% in the COPD group and only 2% in patients with normal lung function. COPD is not a uniform disorder: there are different phenotypes. One of them is manifested by the prevalence of emphysema and this is complicated by malignant processes most often. Here, we present and discuss the clinical problems of COPD in patients with lung cancer and against lung cancer in the course of COPD. There are common pathological pathways in both diseases. These are inflammation with participation of macrophages and neutrophils and proteases. It is known that anticancer immune regulation is distorted towards immunosuppression, while in COPD the elements of autoimmunity are described. Cytotoxic T cells, lymphocytes B and regulatory T cells with the important role of check point molecules are involved in both processes. A growing number of lung cancer patients are treated with immune check point inhibitors (ICIs), and it was found that COPD patients may have benefits from this treatment. Altogether, the data point to the necessity for deeper analysis and intensive research studies to limit the burden of these serious diseases by prevention and by elaboration of specific therapeutic options.

Small‐cell lung cancer from the peripheral lung is frequently accompanied by emphysema and interstitial lung disease in the background

BackgroundIt has long been thought that small‐cell lung cancer (SCLC) is a central type of tumor that is located in the proximal bronchi and the mediastinum. However, several studies reported that SCLC exhibited several types of spread pattern on computed tomography (CT). The aim of this study is to investigate the relationship between CT images and clinical characteristics in patients with SCLC.MethodsWe retrospectively reviewed the CT images of 92 SCLC patients and classified them into six types of spreading patterns: central, peripheral, lymphangitic spread (LYM), pleural dissemination (PLE), lobar replacement (LOB), and air‐space consolidation (AC). We also evaluated the correlation between primary tumor location and the clinical characteristics of patients.ResultsThe most common type of imaging pattern was peripheral (n = 40, 44%), with the next most common type being central (n = 27, 29%). Atypical types of SCLC, such as LYM (n = 2, 2%), PLE (n = 4, 4%), LOB (n = 8, 9%), and AC (n = 11, 12%), were also recognized in our study. The prevalence of emphysema and interstitial lung disease (ILD) was significantly higher in the peripheral type than in the central type (p = 0.0056 and p = 0.0403, respectively). Meanwhile, no survival difference was seen between the central type and the peripheral type (median months 17.9 vs. 21.9, respectively, p = 0.720).ConclusionsThe peripheral type of tumor was correlated with higher prevalence of emphysema and ILD in SCLC. Our result suggests different mechanisms of development and tumor characteristics according to tumor location.

Comparing Racial Differences in Emphysema Prevalence Among Adults With Normal Spirometry: A Secondary Data Analysis of the CARDIA Lung Study.

Computed tomography (CT) imaging complements spirometry and may provide insight into racial disparities in respiratory health. To determine the difference in emphysema prevalence between Black and White adults with different measures of normal spirometry results. Observational study using clinical data and spirometry from the CARDIA (Coronary Artery Risk Development in Young Adults) study obtained in 2015 to 2016 and CT scans done in 2010 to 2011. 4 U.S. centers. Population-based sample of Black and White adults. Self-identified race and visually identified emphysema on CT in participants with different measures of "normal" spirometry results, calculated using standard race-specific and race-neutral reference equations. A total of 2674 participants (485 Black men, 762 Black women, 659 White men, and 768 White women) had both a CT scan and spirometry available for analysis. Among participants with a race-specific FEV1 between 80% and 99% of predicted, 6.5% had emphysema. In this group, emphysema prevalence was 3.9-fold (95% CI, 2.1- to 7.1-fold; 15.5% vs. 4.0%) higher among Black men than White men and 1.9-fold (CI, 1.0- to 3.8-fold; 6.6% vs. 3.4%) higher among Black women than White women. Among participants with a race-specific FEV1 between 100% and 120% of predicted, 4.0% had emphysema. In this category, Black men had a 6.4-fold (CI, 2.2- to 18.7-fold; 13.9% vs. 2.2%) higher prevalence of emphysema than White men, whereas Black and White women had a similar prevalence of emphysema (2.6% and 2.0%, respectively). The use of race-neutral equations to identify participants with an FEV1 percent predicted between 80% and 120% attenuated racial differences in emphysema prevalence among men and eliminated racial differences among women. No CT scans were obtained during the most recent study visit (2015 to 2016) when spirometry was done. Emphysema is often present before spirometry findings become abnormal, particularly among Black men. Reliance on spirometry alone to differentiate lung health from lung disease may result in the underrecognition of impaired respiratory health and exacerbate racial disparities. National Institutes of Health.

The detrimental effect of quantity of smoking on survival in progressive fibrosing ILD

Background and objectivePatients with progressive fibrosing interstitial lung disease (PF-ILD) are prone to early mortality compared with other phenotypes of ILD. The possible effect of smoking on survival has not been investigated yet. Furthermore, it is unknown what the effect of quantity of smoking is in PF-ILD. In this study, it was determined if quantity of smoking is associated with worse survival in patients with PF-ILD. MethodsPatients meeting the INBUILD trial-criteria for PF-ILD were included in this retrospective cohort study. Pack year (py) was tested as a prognostic variable with a multivariable Cox proportional hazard model. Also, median transplant-free survival was compared between heavy (≥20 pys) and mild-moderate smokers (0.1–19.9 pys). ResultsIn PF-ILD (N = 377), the unadjusted and adjusted hazard ratio for py were significant, (1.014, 95% confidence interval (CI): 1.006–1.022, P < 0.001; 1.011, CI:1.002–1.021, P = 0.022 respectively). This translates to an 11%, 22%, or 44% higher risk for mortality for patients accumulating 10, 20 or 40 pys, respectively. Heavy smokers demonstrated a median transplant-free survival of 3.0 years, which was significantly reduced compared with mild-moderate smokers (3.8 years, P = 0.035). Additionally, more patients with emphysema were heavy smokers (N = 68) than never (N = 5, P < 0.001) or mild-moderate smokers (n = 21, p < 0.001). ConclusionIn PF-ILD, a pack year is associated with an increased risk of mortality. Furthermore, quantity of smoking is associated with worse survival and higher prevalence of emphysema. Our data indicates that limiting amount of pys will provide a survival benefit in patients developing PF-ILD.

Research on the application of uniportal video-assisted thoracoscopic segmental resection of the lung in elderly patients with non-small cell lung cancer aged over 65 years.

IntroductionThe literature regarding the application of uniportal video-assisted thoracoscopic segmental resection of the lung in patients aged over 65 years with non-small cell lung cancer (NSCLC) is sparse. This paper reports 175 cases of uniportal video-assisted thoracoscopic segmental resection of the lung performed at one center, of which 63 patients were over 65 years old.AimTo investigate the safety and feasibility of uniportal video-assisted thoracoscopic segmental resection of the lung in elderly patients aged over 65 years with NSCLC.Material and methodsA retrospective analysis of 175 NSCLC patients who underwent uniport video-assisted thoracoscopic segmental resection of the lung in the center from August 2018 to August 2020 was conducted, and based on the age of 65 years, patients were divided into elderly and non-elderly groups. The general data and perioperative indicators of the two groups were compared.ResultsThe procedures were completed in all patients without death or conversion to open surgery. In the general data of the two groups of patients, the prevalence of emphysema in the elderly group was significantly higher than that in the non-elderly group (p = 0.001). However, there was no statistically significant difference between the two groups in surgery time, intraoperative blood loss, thoracic drainage tube retention time, postoperative hospital stay, incision satisfaction, or postoperative complications (p > 0.05).ConclusionsUniportal video-assisted thoracoscopic segmental resection of the lung is feasible and safe in elderly patients with NSCLC aged over 65 years.

The Correlation Between Air Pollution Exposure Duration and Occurence of Emphysema Based on Chest CT Scan in Public Transportation Drivers

Background: Emphysema is included in chronic obstructive pulmonary disease (COPD) whose prevalence tends to increase in Indonesia. Air pollution is one of risk factor for emphysema. Public transportation drivers are one of the most vulnerable occupation exposed to air pollution. This study aimed to determine the correlation between air pollution exposure duration and occurence of emphysema in public transportation drivers. Methods: This was an analytic observational study using a cross-sectional approach. Samples of this study (n=32) were public transportation drivers in North Jakarta. Data were collected during August – October 2019 at Atma Jaya Hospital, North Jakarta. The study datawere secondary data obtained through interviews and chest CT scan. Data analysis was performed using Fisher’s exact method. Results: The prevalence of emphysema was 46,9% with 9 respondents (60%) had mixed type emphysema and 13 respondents (87,7%) had mild degrees. The prevalence of public transportation drivers exposed to air pollution for more than or equal to 8 hours a day was 87,5%. There was a significant correlation between air pollution exposure duration and occurence of emphysema (P=0,038). Conclusion: There was a statistically significant correlation between air pollution exposure duration and occurence of emphysema. As many as 11 respondents (39,3%) exposed to air pollution for more than or equal to 8 hours a day exposure were found to have emphysema. However, all respondents in this study were smokers, which was also a risk factor for emphysema and could be considered as severe air pollution.

The importance of low-dose CT screening to identify emphysema in asymptomatic participants with and without a prior diagnosis of COPD

PurposeChronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. MethodsWe reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. ResultsOf 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (ORage10 = 0.72, p < 0.0001), lower pack-years of smoking (OR10pack-years = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was ORmoderate = 0.58(p = 0.0007) and for severe emphysema, it was ORsevere = 0.23(p < 0.0001). ConclusionEmphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation.

Amfizemli Hastalarda Amfizem Yaygınlığının Arter Kan Gazı, Solunum Fonksiyon Testi ve Hastaların Performanslarıyla Olan İlişkisi: Tanımlayıcı Klinik Araştırma

Objective: In emphysema, changes such as decrease in the maximum expiratory air flow, excessive ventilation and air trapping occur. These changes affect the patients' exercise tolerance and effort capacities in the later period. Our purpose was to determine the relation between the prevalence of emphysema and patients' performance, the level of obstruction in the patients, the changes occurring in patients' artery blood gas (ABG) and other emphysema parameters. Material and Methods: A total of 55 consecutive patients with definite emphysema were included in the study. Patients' demographic and clinical characteristics were recorded. High resolution computed tomography (HRCT), pulmonary function tests, ABG measurement, patient performance evaluation and lung quantitative perfusion scintigraphy were performed to all patients. HRCT and visual emphysema score were used to determine the distribution and prevalence of emphysema. Results: Negative correlation coefficients were found between the emphysema scores and forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, diffusing capacity of the lung for carbon monoxide, oxygen saturation percentage and 6 minutes walking test (6MWT) and positive correlation coefficients were found residual volume (RV), total lung capacity, partial carbon monoxide tension, Global Obstructive Lung Disease stage and Modified Medical Research Council (p<0.05). Conclusion: It was determined that among all the parameters, the strongest negative correlation was with the 6MWT, and the strongest positive correlation was with the RV. It was seen that in terms of the zones, the percentage of perfusion decreased as the emphysema scores increased.

Asthma with Irreversible Airway Obstruction in Smokers and Nonsmokers: Links between Airway Inflammation and Structural Changes

Background: The development of irreversible airway obstruction (IRAO) in asthma is related to lung/airway inflammatory and structural changes whose characteristics are likely influenced by exposure to tobacco smoke. Objective: To investigate the interplay between airway and lung structural changes, airway inflammation, and smoking exposure in asthmatics with IRAO. Methods: We studied asthmatics with IRAO who were further classified according to their smoking history, those with ≥20 pack-years of tobacco exposure (asthmatics with smoking-related IRAO [AwS-IRAO]) and those with <5 pack-years of tobacco exposure (asthmatics with nonsmoking-related IRAO [AwNS-IRAO]). In addition to recording baseline clinical and lung function features, all patients had a chest computed tomography (CT) from which airway wall thickness was measured and quantitative and qualitative assessment of emphysema was performed. The airway inflammatory profile was documented from differential inflammatory cell counts on induced sputum. Results: Ninety patients were recruited (57 AwS-IRAO and 33 AwNS-IRAO). There were no statistically significant differences in the extent of emphysema and gas trapping between groups on quantitative chest CT analysis, although Pi10, a marker of airway wall thickness, was significantly higher in AwS-IRAO (p = 0.0242). Visual analysis showed a higher prevalence of emphysema (p = 0.0001) and higher emphysema score (p < 0.0001) in AwS-IRAO compared to AwNS-IRAO and distribution of emphysema was different between groups. Correlations between radiological features and lung function were stronger in AwS-IRAO. In a subgroup analysis, we found a correlation between airway neutrophilia and emphysematous features in AwS-IRAO and between eosinophilia and both airway wall thickness and emphysematous changes in AwNS-IRAO. Conclusions: Although bronchial structural changes were relatively similar in smoking and nonsmoking patients with asthma and IRAO, emphysematous changes were more predominant in smokers. However, neutrophils in AwS-IRAO and eosinophils in AwNS-IRAO were associated with lung and airway structural changes.

Prevalence, Symptom Burden, and Underdiagnosis of Chronic Obstructive Pulmonary Disease in a Lung Cancer Screening Cohort.

Rationale: Individuals eligible for lung cancer screening (LCS) by low-dose computed tomography (LDCT) are also at risk of chronic obstructive pulmonary disease (COPD) due to age and smoking exposure. Whether the LCS episode is useful for early detection of COPD is not well established.Objectives: To explore associations between symptoms, comorbidities, spirometry, and emphysema in participants enrolled in the Lung Screen Uptake Trial.Methods: This cross-sectional study was a prespecified analysis nested within Lung Screen Uptake Trial, which was a randomized study testing the impact of differing invitation materials on attendance of 60- to 75-year-old smokers and ex-smokers to a “lung health check” between November 2015 and July 2017. Participants with a smoking history ≥30 pack-years and who quit ≤15 years ago, or meeting a lung cancer risk of ≥1.51% via the Prostate Lung Colorectal Ovarian model or ≥2.5% via the Liverpool Lung Project model, were offered LDCT. COPD was defined and classified according to the GOLD (Global Initiative for Obstructive Lung Disease) criteria using prebronchodilator spirometry. Analyses included the use of descriptive statistics, chi-square tests to examine group differences, and univariable and multivariable logistic regression to explore associations between symptom prevalence, airflow limitation, and visually graded emphysema.Results: A total of 560 of 986 individuals included in the analysis (57%) had prebronchodilator spirometry consistent with COPD; 67% did not have a prior history of COPD and were termed “undiagnosed.” Emphysema prevalence in those with known and “undiagnosed” COPD was 73% and 68%, respectively. A total of 32% of those with “undiagnosed COPD” had no emphysema on LDCT. Inhaler use and symptoms were more common in the “known” than the “undiagnosed” COPD group (63% vs. 33% with persistent cough [P < 0.001]; 73% vs. 33% with dyspnea [P < 0.001]). Comorbidities were common in all groups. Adjusted odds ratio (aOR) of respiratory symptoms were more significant for airflow obstruction (aOR GOLD 1 and 2, 1.57; confidence interval [CI], 1.14–2.17; aOR GOLD 3 and 4, 4.6; CI, 2.17–9.77) than emphysema (aOR mild, 1.12; CI, 0.81–1.55; aOR moderate, 1.33; CI, 0.85–2.09; aOR severe, 4.00; CI, 1.57–10.2).Conclusions: There is high burden of “undiagnosed COPD” and emphysema in LCS participants. Adding spirometry findings to the LDCT enhances identification of individuals with COPD.Clinical trial registered with www.clinicaltrials.gov (NCT02558101).