Cynthia Kim, MD1* Wei Ouyang, MD2* Chandra Dass, MD2 Huaqing Zhao, PhD3 Gerard J. Criner, MD1 and the COPDGene Investigators
Author Affiliations
- Department of Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania
- Temple Clinical Research Center, Temple University School of Medicine, Philadelphia, Pennsylvania
*Co-first Authors
Address correspondence to:
Cynthia Kim, MD
Temple Lung Center
7th Floor Parkinson Pavilion
3401 North Broad Street
Philadelphia, PA 19140
Phone: 267-858-2735
Email: cynthia.kim@tuhs.temple.edu
Abstract
Background: Gastroesophageal reflux disease (GERD) is associated with frequent chronic obstructive pulmonary disease (COPD) exacerbations. Hiatal hernia (HH) contributes to GERD pathogenesis and is identifiable on chest high-resolution computed tomography (HRCT). We hypothesize that the presence of an HH on HRCT identifies those at increased risk for acute exacerbation of COPD.
Methods: We retrospectively reviewed a prospectively enrolled cohort of smokers with and without airflow obstruction. HHs were identified visually on inspiratory HRCT. Individuals’ demographic and clinical information was compared with secondary analysis performed using a propensity score generated matched cohort.
Results: There were 523 COPD individuals and 607 unobstructed smokers. COPD individuals had more HHs than unobstructed smokers, (11.6% versus 6.1%, p < 0.001). COPD individuals with hernias were older, female, overweight and GERD positive as compared to those without hernia. There was no difference in self-reported exacerbation rates or hospitalizations per year, but similar severity of obstruction, smoking rates and long-term oxygen use. Analysis with the matched cohort revealed no significant difference in exacerbation rates.
Conclusions: Presence of HHs on inspiratory HRCT scan did not predict worse symptoms or exacerbation rate in COPD individuals. Those with HHs were older, more obese, and predominantly female compared to those without HHs.
Citation
Citation: Kim C, Ouyang W, Dass C, Zhao H, Criner GJ, COPDGene Investigators. Hiatal hernia on chest high-resolution computed tomography and exacerbation rates in COPD individuals. J COPD F. 2016; 3(2): 570-579. doi: http://doi.org/10.15326/jcopdf.3.2.2015.0158