Quantitative study on the degree of small airway disease and emphysema injury in pulmonary lobes of patients with smoking combined with chronic obstructive pulmonary disease based on biphasic CT / 中华放射学杂志

Objective:To explore the value of biphasic quantitative CT on small airway disease and emphysema injury in patients with smoking combined with chronic obstructive pulmonary disease (COPD).Methods:A total of 186 male physical examination subjects who underwent biphasic CT and pulmonary function (PFT) examinations in the Affiliated Hospital of Yan′an University from July 2018 to September 2020 were enrolled in this retrospective study. These subjects were divided into 121 smokers with COPD (COPD group), aged 34 to 84 (64±8) years old and 65 smokers without COPD (non-COPD group) aged 34 to 72 (61±5) years old. According to the guidelines of the COPD global initiative, patients in COPD group were divided into Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) Ⅰ-Ⅳ grades. The original DICOM data of CT were imported into the "Digital Lung" test and analysis platform. Quantitative parameters of functional small airway disease percentage (fSAD%) and emphysema area percentage (Emph%) of each lobe were calculated. The differences of CT quantitative parameters among non-COPD group and each grade in COPD group were analyzed by One-Way ANOVA or Kruskal-Wallis H test. The correlation between the smoking index and CT quantitative parameters was analyzed by Spearman correlation analysis. Results:There were significant differences in fSAD% and Emph% of each lobe among non-COPD group and COPD group GOLD Ⅰ-Ⅳ ( P<0.001). Except that the Emph% in right middle lobe of GOLD grade Ⅰ was higher than that of GOLD grade Ⅱ in COPD group, the fSAD% and Emph% in other lobes increased gradually with the increase of GOLD grade in COPD group. The fSAD% and Emph% were larger in the right middle lobe and both upper lobes of COPD group GOLD Ⅰ-Ⅳ. The comparison among each lobe showed that the differences were statistically significant ( P<0.01), except for the fSAD% and Emph% of GOLD Ⅳ ( P=0.395, 0.840). The smoking index was positively correlated with fSAD% and Emph% in each lung lobe. Among them, smoking index was highly correlated with fSAD% in the lower right lobe and Emph% in the lower left lobe ( r=0.474, 0.619, P<0.001). Conclusion:The biphasic quantitative CT can early and sensitively reflect the degree of small airway disease and emphysema injury in smoking combined with COPD, which is of great significance for the early diagnosis and evolution of COPD.

Small airway disease in COPD associated to biomass exposure

Abstract Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous entity that may result from different causative agents and risk factors and may follow diverse clinical courses, including COPD secondary to biomass smoke exposure. At present, this phenotype is becoming more important for two reasons: first, because at least almost half of the world’s population is exposed to biomass smoke, and second, because the possibility of it being diagnosed is increasing. Biomass smoke exposure COPD affects primarily women and is related with insults to the airways occurred during early life. Although constituents of biomass smoke and tobacco smoke are similar, the physiopathological changes they induce differ depending not only on the chemical composition (related with the type of fuel used) but also on the particle size and the inhalation pattern. Evidence has shown that biomass smoke exposure affects the airway, predominantly the small airways causing anthracofibrosis and peribronchiolar fibrosis changes that will clinically translate into chronic bronchitis symptoms, with a high impact on the quality of life. In this review, we focus especially on the main epidemiological and clinical differences between COPD secondary to biomass exposure and COPD caused by tobacco exposure.

Early diagnosis of COPD and quantitative evaluation of lung function by CT using a voxel-based morphometry / 西安交通大学学报(医学版)

Objective: To improve the time window of early diagnosis of chronic obstructive pulmonary disease (COPD) and make quantitative evaluation of lung function using the voxel-based quantitative CT. Methods: Early COPD and COPD patients who had received inspiratory and expiratory CT scanning were consecutively recruited from the multi-center study named Digital Lung. Quantitative parameters of functional small-airway disease (fSAD) and emphysema (Emph) were measured. For the all COPD patients, Pearson correlation analysis or Spearman rank correlation analysis was used to test the correlation between the quantitative measurements of CT and pulmonary function. Results: Finally, 37 patients with early COPD and 50 patients with COPD were included. The mean value of Emph in early COPD was (3.50±3.36)% and the average value of fSAD was (18.12±12.73)%. Meanwhile, the mean value of Emph in COPD patients was (13.46±9.03)% and the mean value of fSAD was (36.57±9.88)%. Emph was negatively correlated with FEV1% and FEV1/FVC (r=-0.470, P=0.001; r=-0.334, P=0.018), respectively. fSAD was negatively correlated with FEV1% and FEV1/FVC (r=-0.453, P=0.001; r=-0.320, P=0.001). Conclusion: The voxel-based quantitative CT is helpful in early detection of small airway injury in early COPD with respiratory symptoms but no pulmonary function can be achieved.

Structural and Functional Features on Quantitative Chest Computed Tomography in the Korean Asian versus the White American Healthy Non-Smokers

OBJECTIVE: Considering the different prevalence rates of diseases such as asthma and chronic obstructive pulmonary disease in Asians relative to other races, Koreans may have unique airway structure and lung function. This study aimed to investigate unique features of airway structure and lung function based on quantitative computed tomography (QCT)-imaging metrics in the Korean Asian population (Koreans) as compared with the White American population (Whites). MATERIALS AND METHODS: QCT data of healthy non-smokers (223 Koreans vs. 70 Whites) were collected, including QCT structural variables of wall thickness (WT) and hydraulic diameter (Dh) and functional variables of air volume, total air volume change in the lung (ΔVair), percent emphysema-like lung (Emph%), and percent functional small airway disease-like lung (fSAD%). Mann-Whitney U tests were performed to compare the two groups. RESULTS: As compared with Whites, Koreans had smaller volume at inspiration, ΔVair between inspiration and expiration (p < 0.001), and Emph% at inspiration (p < 0.001). Especially, Korean females had a decrease of ΔVair in the lower lobes (p < 0.001), associated with fSAD% at the lower lobes (p < 0.05). In addition, Koreans had smaller Dh and WT of the trachea (both, p < 0.05), correlated with the forced expiratory volume in 1 second (R = 0.49, 0.39; all p < 0.001) and forced vital capacity (R = 0.55, 0.45; all p < 0.001). CONCLUSION: Koreans had unique features of airway structure and lung function as compared with Whites, and the difference was clearer in female individuals. Discriminating structural and functional features between Koreans and Whites enables exploration of inter-racial differences of pulmonary disease in terms of severity, distribution, and phenotype.

The Effect of Lower Airway Disease on the Severity of Chronic Rhinosinusitis

BACKGROUND AND OBJECTIVES: The relationship between the upper airway disease and the lower airway disease has been studied for several decades. In this study, we propose to investigate the prevalence of asthma, asymptomatic bronchial hyperresponsiveness (aBHR) and small airway disease among the chronic rhinosinusitis (CRS) patients and to evaluate their influence on the severity of CRS. MATERIAL AND METHODS: For the evaluation of lower airway diseases, sixty-eight adult patients with CRS underwent skin prick tests, pulmonary function tests with or without bronchodilator tests and methacholine bronchial provocation tests. The severity of CRS was determined in accordance to three factors ; subjective symptoms, the degree of nasal polyposis and the extent of disease on the CT scan. RESULTS: Asthma, aBHR and small airway disease were diagnosed among seven (10.3%), five (7.4%) and eleven (16.2%) patients, respectively. The lower airway diseases had no significant influence on the severity of CRS. CONCLUSION: CRS patients may have various lower airway diseases, symptomatic or asymptomatic, which should be considered when managing CRS patients.

Small Airway Diseases: Clinical Characteristics and Pathological Interpretation

Small airway diseases are seen in many clinical conditions. The locations of small airway diseases are small bronchioles including terminal and respiratory bronchioles, and alveolar duct. The histopathologic features of bronchiolar injury have been described variously and have led to confusing and overlapping terms. The purpose of this article is to describe the clinical characteristics and histopathologic interpretation of small airway diseases. We classify the small airway diseases as primary bronchiolar diseases, and secondary bronchiolar diseases including pulmonary parenchymal diseases, and large airway diseases with prominent bronchiolar involvement. Primary bronchiolar diseases include respiratory bronchiolitis, acute bronchiolitis, constrictive bronchiolitis, follicular bronchiolitis, diffuse panbronchiolitis, mineral dust airway diseases, and a few other variants. Pulmonary parenchymal diseases with bronchiolar involvement include respiratory bronchiolitis-associated interstitial lung disease, organizing pneumonia, hypersensitivity pneumonitis, pulmonary Langerhans' cell histiocytosis, sarcoidosis and idiopathic pulmonary fibrosis. Bronchiolar changes can also be seen in large airway diseases such as chronic bronchitis, bronchiectasis, cystic fibrosis and asthma. The patterns of bronchiolar response to various injuries are relatively limited and these patterns are generally non-specific in regard to the etiology. Appropriate interpretation and diagnosis of small airway diseases depend on judicious correlation of clinical, radiologic, and histopathologic characteristics.

The predicting value of small airway diseases for asthma in patients with chronic cough / 中国实用内科杂志

Objective The aim of this study is to investigate the correlation between small airway disease and airway hyper-responsiveness,and explore the predicting value of small airway diseases for asthma.Methods Pulmonary function tests and bronchial provocation tests were performed in 249 patients with chronic cough from Sep. 2004 to Sep. 2006.The incidence of small airway disease and airway hyper-responsiveness were observed.Results There were 91 patients with small airway disease,and 103 patients with positive tests for bronchial provocation in total 249 chronic cough patients.The incidence of positive tests for bronchial provocation in 91 patients(73.63%)with small airway disease was significantly higher than that in 158 patients(22.78%)without it,P