Utility of Chest Computed Tomography for Chronic Obstructive Pulmonary Disease Patients

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development.1 Currently, the diagnosis of COPD is based on the clinical history of the patient along with a post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio lower than 0.70 on spirometry. Even though spirometry is considered the most valuable tool in diagnosing COPD, it lacks in certain aspects such as covering the morphological analysis of the disease and correlating between the lesions and lung function. Also, spirometry usually becomes abnormal pretty late in the disease evolution, and hence, is unable to identify early and pre-COPD patients leading to delayed diagnosis. Chest computed tomography (CT) scan provides in vivo assessment of organ structure and can prove itself to be a useful tool to provide additional information about parenchymal remodeling, airway dilation, and vascular calcification. This, in turn, can be useful to not only detect and stratify the severity of the disease but can also to predict its clinical course. We must consider the utility of CT scan to offer impactful therapy for what is found in those images. However, does this additional information really makes a difference in the management of COPD patients? Can this information be obtained using inexpensive and easy methods (such as spirometry and questionnaires)? Does this additional information really justify the expense of radiation exposure? This article highlights the utility, limitations, and future prospects of adding a chest CT scan as a routine investigation in patients with COPD.