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Original Research: COPD |

CT Metrics of Airway Disease and Emphysema in Severe COPD

Woo Jin Kim, MD; Edwin K. Silverman, MD, PhD; Eric Hoffman, PhD; Gerard J. Criner, MD, FCCP; Zab Mosenifar, MD, FCCP; Frank C. Sciurba, MD, FCCP; Barry J. Make, MD, FCCP; Vincent Carey, PhD; Raúl San José Estépar, PhD; Alejandro Diaz, MD; John J. Reilly, MD; Fernando J. Martinez, MD, FCCP; George R. Washko, MD; the NETT Research Group
Author and Funding Information

From the Department of Internal Medicine (Dr. Kim), Kangwon National University, Chuncheon, South Korea; Channing Laboratory (Drs. Silverman and Carey), the Division of Pulmonary and Critical Care Medicine (Drs. Silverman, Diaz, and Washko), and the Department of Radiology (Dr. San José Estépar), Brigham and Women's Hospital, Boston, MA; the Department of Radiology (Dr. Hoffman), University of Iowa, Iowa City, IA; the Division of Pulmonary and Critical Care Medicine (Dr. Criner), Temple University Hospital, Philadelphia, PA; the Division of Pulmonary Medicine (Dr. Mosenifar), Cedars-Sinai Medical Center, Los Angeles, CA; the Division of Pulmonary and Critical Care Medicine (Drs. Sciurba and Reilly), University of Pittsburgh, Pittsburgh, PA; the Division of Pulmonary Sciences and Critical Care Medicine (Dr. Make), National Jewish Medical & Research Center, Denver, CO; and the Division of Pulmonary and Critical Care Medicine (Dr. Martinez), University of Michigan Medical Center, Ann Arbor, MI.

George R. Washko, MD, Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, 75 Francis St, Boston, MA 02115; e-mail: GWashko@Partners.org

*A list of members and participants in the National Emphysema Treatment Trial (NETT) is located in the Appendix.


This research was funded by National Institutes of Health [grant No. 1K23HL089353-01A1] and a grant from the Parker B. Francis Foundation. The NETT is supported by contracts with the National Heart, Lung, and Blood Institute [grants No. N01HR76101, N01HR76102, N01HR76103, N01HR76104, N01HR76105, N01HR76106, N01HR76107, N01HR76108, N01HR76109, N01HR76110, N01HR76111, N01HR76112, N01HR76113, N01HR76114, N01HR76115, N01HR76116, N01HR76118, and N01HR76119], the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):396-404. doi:10.1378/chest.08-2858
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Background:  CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear.

Methods:  Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of −950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV1 and percent predicted value of FEV1 with CT scan measures of emphysema and airway disease.

Results:  In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT (r = −0.28, p = 0.0001) and SRWA (r = −0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV1% predicted (R = −0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (β = −5.2, p = 0.009; β = −2.6, p = 0.008, respectively) and %LAA-950 (β = −10.6, p = 0.03) with the postbronchodilator FEV1% predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA).

Conclusions:  Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.

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