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Song Soo Kim, MD,1,2 Kunihiro Yagihashi, MD,1 Douglas S. Stinson, MS,1 Jordan A. Zach, BA,1 Alexander S. McKenzie, BA,1 Douglas Curran-Everett, PhD,3 Emily S.Wan, MD,4 Edwin K. Silverman, MD, PhD,4 James D. Crapo, MD,5 David A. Lynch, MB1
Author Affiliations
- Department of Radiology, National Jewish Health, Denver, CO
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Division of Biostatistics and Bioinformatics, National Jewish Health, and Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, CO
- Channing Division of Network Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
Address correspondence to:
A Song Soo Kim, MD
Department of Radiology, National Jewish Health, Denver, CO
and Department of Radiology, Chungnam National University
Hospital, Chungnam National University School of Medicine,
301-721, Daesadong, Jung-gu, Daejeon, Republic of Korea
Tel. 82-42-280-7333, Fax. 82-42-253-0061
E-mail: haneul88@hanmail.net
Abstract
Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p< 0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD- nonobstructed status.
Citation
Citation: Kim SS, Yagihashi U, Stinson D, et al. Visual assessment of CT findings in smokers with nonobstructed spirometric abnormalities in the COPDGene® study. J COPD F. 2014; 1(1): 88-96. doi: http://dx.doi.org/10.15326/jcopdf.1.1.2013.0001
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Krishna S. Iyer, BS,1,2 Randall W. Grout, BS,1 Gideon K. Zamba, PhD,3 Eric A. Hoffman, PhD1,2
Author Affiliations
1. Department of Radiology, University of Iowa, College of Medicine, Iowa City
2. Department of Biomedical Engineering, University of Iowa, Iowa City
3. Department of Biostatistics, University of Iowa, Iowa City
Address correspondence to:
Eric A. Hoffman, PhD
Division of Physiological Imaging
Dept. of Radiology
University of Iowa Hospitals & Clinics
200 Hawkins Drive
CC 701 GH
Iowa City, IA 52242
eric-hoffman@uiowa.edu
Tel: 319-356-1381
Abstract
Rationale and Objectives: Density-based metrics assess severity of lung disease but vary with lung inflation and method of scanning. The aim of this study was to evaluate the repeatability of single center, computed tomography (CT)-based density metrics of the lung in a normal population and assess study sample sizes needed to detect meaningful changes in lung density metrics when scan parameters and volumes are tightly controlled.
Materials and Methods: Thirty-seven participants (normal smokers and non-smokers) gave consent to have randomly assigned repeated, breath-held scans at either inspiration (90% vital capacity: total lung capacity [TLC]) or expiration (20% vital capacity: functional residual capacity [FRC]). Repeated scans were analyzed for: mean lung density (MLD), 15th percentile point of the density histogram (P15), low attenuation areas (LAA) and alpha (fractal measure of hole size distribution). Using inter-participant differences and previously reported bias, sample size was estimated from change in density metrics obtained from published literature (i.e. meaningful change).
Results: Inter-scan difference measurements were small for density metrics (ICC > 0.80) and average intra-class correlation coefficients (ICC)for whole lung alpha-910 and alpha-950 were 0.57 and 0.64, respectively. Power analyses demonstrated that, under the control conditions with minimal extrinsic variation, population sizes needed to detect meaningful changes in density measures for TLC or FRC repeated scans ranged from a few (20-40) to a few hundred participants, respectively.
Conclusion: A meaningful sample size was predicted from this study using volume-controlled normal participants in a controlled imaging environment. Under proper breath-hold conditions, high repeatability was obtained in cohorts of normal smokers and non-smokers.
Citation
Citation: Iyer KS, Grout RW, Zamba GK, Hoffman EA. Repeatability and sample size assessment associated with computed tomography-based lung density metrics. 2014. J COPD F. 2014; 1(1): 97-104. doi: http://dx.doi.org/10.15326/jcopdf.1.1.2014.0111
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Nirupama Putcha, MD,1 Meilan K. Han, MD,2 Carlos H. Martinez, MD,2 Marilyn G. Foreman, MD,3 Antonio R. Anzueto, MD,4 Richard Casaburi, MD,5 Michael H. Cho, MD,6 Nicola A. Hanania, MD,7 Craig P. Hersh, MD,6 Gregory L. Kinney, PhD,8 Barry J. Make, MD,9 Robert M. Steiner, MD,10 Sharon M. Lutz, PhD,8 Byron M. Thomashow, MD,11 Andre A. Williams , PhD,12 Surya P. Bhatt, MD,13 Terri H. Beaty, PhD,14 Russell P. Bowler, MD,9 Joe W. Ramsdell, MD,15 Jeffrey L. Curtis, MD,2 Douglas Everett, PhD,12 John E. Hokanson, PhD,8 David A. Lynch, MB,16 E. Rand Sutherland, MD,9 Edwin K. Silverman, MD,6 James D. Crapo, MD,9 Robert A. Wise, MD,1 Elizabeth A. Regan, MD,*17 Nadia N. Hansel, MD*1 and the COPDGene® Investigators
*indicates two senior authors for this manuscript
Author Affiliations
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD;
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor;
- Divison of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, GA;
- Pulmonary Section, Department of Medicine, University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio;
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA;
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA;
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX;
- Colorado School of Public Health, Aurora;
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO;
- Department of Radiology, Temple University School of Medicine, Philadelphia, PA;
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, NY;
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO;
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham;
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
- Department of Medicine, University of California, San Diego;
- Division of Radiology, National Jewish Health, Denver, CO;
- Department of Medicine, National Jewish Health, Denver, CO
Address correspondence to:
Nirupama Putcha, MD, MHS
5501 Hopkins Bayview Circle
JHAAC 4B.74
Baltimore, MD 21224
nputcha1@jhmi.edu
410-550-0545
Abstract
Background
COPD patients have a great burden of comorbidity. However, it is not well established whether this is due to shared risk factors such as smoking, if the comorbidities impact patients’ exercise capacity and quality of life, or whether there are racial disparities in their impact on COPD.
Methods
We analyzed data from 10,192 current and ex-smokers with (cases) and without COPD (controls) from the Genetic Epidemiology of COPD (COPDGene®) study cohort to establish risk for COPD comorbidities adjusted for pertinent covariates. In adjusted models, we examined comorbidity prevalence and impact in African-Americans (AA) and non-Hispanic whites (NHW).
Results
Comorbidities are more common in individuals with COPD compared to those with normal spirometry (controls), and the risk persists after adjustments for covariates including pack-years smoked. After adjustment for confounders, 8 conditions were independently associated with worse exercise capacity, quality of life and dyspnea. There were racial disparities in the impact of comorbidities on exercise capacity, dyspnea and quality of life, with the presence of osteoarthritis and gastroesophageal reflux disease having a greater negative impact on all three outcomes in AAs than NHWs (p<0.05 for all interaction terms).
Conclusions
Individuals with COPD have a higher risk for comorbidities than controls, an important finding shown for the first time comprehensively after accounting for confounders. Individual comorbidities are associated with worse exercise capacity, quality of life, and dyspnea, in AAs compared with NHWs.
Note: The abstract of a previous version of this work was presented at the American Thoracic Society Conference in Philadelphia, PA on May 21, 2013.
Citation
Citation: Putcha N, Han MK, Martinez CH, et al. Comorbidities of COPD have a major impact on clinical outcomes, particularly in African Americans. J COPD F. 2014; 1(1): 105-114. doi: http://dx.doi.org/10.15326/jcopdf.1.1.2014.0112
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Corrine Hanson, PhD, RD,1 Harlan Sayles,2 Erica E.P.A. Rutten, PhD,3 E.F.M. Wouters, MD,4 William MacNee, MD,5 Peter Calverley, MD,6 Jane L. Meza, PhD,2 Stephen Rennard, MD7
Author Affiliations
- University of Nebraska Medical Center, School of Allied Health Professions, Medical Nutrition Education, Omaha
- University of Nebraska Medical Center, College of Public Health, Omaha
- Program Development Centre, Centre of Expertise for Chronic Organ Failure,The Horn, Netherlands
- Department of Pulmonary Diseases, University of Maastricht, Maastrict, Netherlands
- University of Edinburgh, Scotland, UK
- Department of Medicine, Clinical Sciences Centre, University of Liverpool, UK
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
Address correspondence to:
Corrine Hanson, PhD, RD
University of Nebraska Medical Center, School of Allied Health Professionals
Medical Nutrition Education
984045 Nebraska Medical Center, Omaha, NE 68198-4045
ckhanson@unmc.edu
Phone: 402-559-3658 Fax: 402-559-7565
Abstract
Background: Diet is a potentially modifiable risk factor in the development and progression of many diseases, and there is evidence that diet plays a role in COPD.
Objective: Evaluate the relationship between dietary intake and clinical characteristics of COPD in a large and well-characterized population of COPD patients and controls who were part of the ECLIPSE study.
Methods: Limited diet records were available from 2,167 participants at 8 time points over a 3-year period. Participants reported the amount they had consumed over the last 24 hours for 8 food categories. Intake of each food group was handled as a dichotomous variable (Yes/last 24 hours at any of the 8 follow-up points vs. No at all 8 points). These 2 groups were then compared using clinical outcome measures at the last available follow-up that included lung function, emphysema, 6-minute walk, St. George’s Respiratory Questionaire (SGRQ) scores, the change in these scores over a 3-year period, and inflammatory biomarkers. Multivariate models for each food group and each outcome measure were run to adjust for confounding factors of age, sex, body mass index (BMI), and smoking.
Results: Participants who demonstrated recent consumption of foods associated with a healthful diet, including fish, fruit, tea, and dairy products, had greater lung function measures and less decline over time, less emphysema and emphysema progression, greater 6-minute walk and SGRQ scores, and lower levels of certain inflammatory markers. Increasing the number of diet record time points that were included in the analysis improved ability to detect significant associations.
Conclusion: Diet as a possible modifiable risk factor in COPD continues to warrant investigation.
Citation
Citation: Hanson C, Sayles H, Rutten EEPA, et al. The association between dietary intake and phenotypical characteristics of COPD in the ECLIPSE cohort. J COPD F. 2014; 1(1): 115-124. doi: http://dx.doi.org/10.15326/jcopdf.1.1.2014.0113
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Nicola Sverzellati, MD, PhD,1 David A. Lynch, MB2 Massimo Pistolesi, MD,3 Hans-Ulrich Kauczor, MD,4 Phillippe A. Grenier, MD,5 Carla Wilson,6 James D, Crapo, MD7; on behalf of the COPDGeneCT workshop group.
Author Affiliations
- Department of Surgery, Section of Diagnostic Imaging, University of Parma, Parma, Italy
- Division of Radiology, National Jewish Health, Denver, CO
- Section of Respiratory Medicine, Department of Internal Medicine, University of Florence, Italy
- Diagnostic and Interventional Radiology, University Clinic Heidelberg, Germany
- Service de Radiologie Polyvalente, Diagnostique and Interventionelle, Hospital Pitie-Salpetriere, Paris, France
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
Address correspondence to:
Nicola Sverzellati, MD, PhD
Department of Surgery, Section of Diagnostic Imaging, University of Parma
Padiglione Barbieri, University Hospital of Parma
V. Gramsci 14, 43100, Parma, ITALY
Email: nicola.sverzellati@unipr.it
Tel number: +393384586715
Abstract
Background: The purpose of this study was to define the differences between centrilobular emphysema (CLE) and panlobular emphysema (PLE) phenotypes in cigarette smokers with COPD by a combined qualitative-quantitative computed tomography (CT) analysis .
Methods: Chest CT scans of 116 cigarette smokers were visually scored by 22 chest radiologists and 29 pulmonologists in a single setting for the predominant emphysema phenotype (e.g. CLE or PLE) and automatically quantified for emphysema: percentage ratio of low attenuation area to corresponding lung area (LAA%) ≤ -950 Hounsfield Units (HU) - %LAAinsp-950; gas trapping extent and bronchial metrics (wall area % for segmental [%WAsegm] and subsegmental [%WAsubsegm] bronchi). These quantitative CT indexes were compared and related to forced expiratory volume in 1 second (FEV1), ratio of FEV1 to forced vital capacity (FEV1/FVC), and smoking history as stratified for emphysema phenotype.
Results: Although more frequent than CLE in Global Initiative for chronic Obstructive Lung Disease (GOLD) stages 3 and 4 (p = 0.01), PLE was also scored in 38.2% of combined GOLD stages 1 and 2. PLE was positively associated with %LAAinsp-950(odds ratio [OR] = 1.18, 95% confidence interval [CI]: 1.12 to 1.27, β coefficient = 0.17, p = <0.0001)and negatively associated with pack-years of smoking(OR = 0.97, 95% CI: 0.95 to 0.99, β coefficient = -0.02, p = 0.03). Both %WAsegm and %WAsubsegm were more strongly associated with FEV1% (R2 = 0.6 for both measures, p< 0.001) in CLE as compared to PLE (R2= 0.15, p = 0.02; R2 = 0.26, p< 0.001).
Conclusions: PLE likely represents a more advanced phase of emphysema, which may also occur in earlier COPD stages and show different interplay with airway disease as compared to CLE.
Citation
Citation: Sverzellati N, Lynch DA, Pistolesi M, et al. Physiologic and quantitative computed tomography differences between centrilobular and panlobular emphysema in COPD. J COPD F. 2014; 1(1): 125-132. doi: http://dx.doi.org/10.15326/jcopdf.1.1.2014.0114
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Jennifer M. Yentes, PhD,1 Daniel Blanke, PhD, 1 Stephen I. Rennard, MD, 2 Nicholas Stergiou, PhD 1,3
Author Affiliations
- Department of Health, Physical Education, and Recreation, University of Nebraska at Omaha
- Department of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha
- College of Public Health, University of Nebraska Medical Center, Omaha
Address correspondence to:
Jennifer Yentes, PhD
Phone: 402-554-3251
Email: jyentes@gmail.com
Abstract
Previous work has shown that patients with chronic obstructive pulmonary disease (COPD) demonstrate changes in their gait biomechanics as compared to controls. This pilot study was designed to explore the possibility that biomechanical alterations present in COPD patients might be amenable to treatment by exercise training of skeletal muscle. This study investigated the effect of a 6-week exercise intervention on gait biomechanics in patients with COPD under both a rest and a non-rested condition. Seven patients with COPD underwent a supervised cardio-respiratory and strength training protocol 2-3 times per week for 6-weeks for a total of 16-sessions. Spatiotemporal, kinematic and kinetic gait variables were collected prior to and post intervention. All patients demonstrated significant improvements in strength following the intervention. The knee joint biomechanics demonstrated a significant main effect for intervention and for condition. Step width demonstrated a significant interaction as it decreased from pre- to post-intervention under the rest condition and increased under the non-rested condition. It does appear that being pushed (non-rested) has a strong influence at the knee joint. The quadriceps muscles, the primary knee extensors, have been shown to demonstrate muscular abnormalities in patients with COPD and the intervention may have influenced gait patterns through an effect on this skeletal muscle structure and function. Additionally, the intervention influenced step width closer to a more healthy value. Patients with COPD are more likely to fall and step width is a risk factor for falling suggesting the intervention may address fall risk. Whether a longer duration intervention would have more profound effects remains to be tested.
Citation
Citation: Yentes JM, Blanke D, Rennard SI, Stergiou N. The effect of a short duration, high intensity exercise intervention on gait biomechanics in patients with COPD: findings from a pilot study. J COPD F. 2013; 1(1): 133-147. doi: http://dx.doi.org/10.15326/jcopdf.1.1.2013.0002
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