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Contribution of Emphysema and Small Airways in COPD FREE TO VIEW

Arthur F. Gelb; James C. Hogg; Nestor L. Müller; Mark J. Schein; Joseph Kuei; Donald P. Tashkin; Joel D. Epstein; Jozef Kollin; Robert H. Green; Noe Zamel; W. Mark Elliott; Lida Hadjiaghai
Author and Funding Information

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada

Affiliations: From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles; and School of Medicine,  From the Pulmonary Division, Department of Pathology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Pulmonary Research Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,  From the Pulmonary Division, Department of Radiology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Departments of Medicine and Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, School of Medicine,  From the Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Pathology, Lakewood Regional Medical Center, and University of California Los Angeles,  From the Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada,  From the Department of Biomathematics, UCLA School of Medicine, Pulmonary Division, Department of Medicine University of Toronto, School of Medicine, Toronto, Canada


1996 BY THE AMERICAN COLLEGE OF CHEST PHYSICIANS


Chest. 1996;109(2):353-359. doi:10.1378/chest.109.2.353
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Published online

Abstract

Background: The contribution and role of emphysema and small airways disease in causing expiratory airflow limitation in COPD is controversial.

Methods: We obtained high-resolution thin-section 2-mm CT scans of the lung for emphysema grading and lung function in 116 consecutively seen COPD outpatients with fixed expiratory airflow limitation. In this group, inflated whole lung(s) were subsequently obtained in 24 patients (23 autopsy, 1 surgery) for morphologic studies and results compared with lung CT. Airway histologic condition was studied in 17 of the 24 patients.

Results: There was fair to weak negative correlation between CT emphysema score and either FEV1/FVC percent (r=−0.51, p=0.001) or FEV1 percent predicted (r=−0.31, p=0.001). In only 24 of the 81 patients (30%) with FEV1 less than 50% predicted, the CT emphysema score was 60 or more, indicating severe emphysema. In the 24 patients studied, there was a good correlation (r=0.86, p=0.001) between CT and pathologic grade of emphysema. While respiratory bronchioles (RBs) and membranous bronchioles (MBs) demonstrated marked morphologic abnormalities, there was a weak correlation with emphysema grade (for RB, r=0.36, p=0.16; for MB, r=0.41, p=0.10) or with FEV1 percent predicted (for RB, r=−0.21, p=0.42; for MB, r=−0.28, p=0.28). There was no correlation between emphysema and FEV1 percent predicted (r=−0.13, p=0.54).

Conclusions: High-resolution CT lung scans are an in vivo surrogate to quantitate moderate to severe morphologic emphysema. Emphysema does not appear to be primarily responsible for severe expiratory airflow limitation in most patients with severe COPD. There was no correlation between severity of small airway histologic condition and emphysema or FEV1 percent predicted. The causes of the lesions responsible for small airways obstruction need to be identified.


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