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Mona Bafadhel, MBChB; Christopher E. Brightling, PhD, FCCP; Salman Siddiqui, PhD
Author and Funding Information

Institute for Lung Health and Department of Infection, Immunity and Inflammation, University of Leicester.

Correspondence to: Mona Bafadhel, MBChB, Department of Infection, Immunity and Inflammation, Glenfield Hospital, Groby Rd, Leicester, LE3 9QP, England; e-mail: mb353@le.ac.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Siddiqui received a gift in aid from Chiesi Pharmaceuticals Inc for the study of small airways disease 2010 to 2011 and has received pharmaceutic grant monies and participated in speaking activities for Merck, Sharp, and Dome. Dr Brightling has received consultancy fees from Medimmune, AstraZeneca, GlaxoSmithKline, and Roche, and has received research grants from AstraZeneca, Medimmune, and GlaxoSmithKline. Drs Bafadhel have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1385. doi:10.1378/chest.11-1542
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To the Editor:

We thank Dr Hochhegger and colleagues for their comments on our recent article in CHEST.1 The research conducted aimed to highlight that COPD is a heterogeneous condition and requires a multidimensional approach to characterization. CT scanning is now emerging as an important noninvasive tool in the multidimensional approach to phenotyping COPD, and our study demonstrated that spirometry and physiologic assessments alone could not differentiate between the radiologic phenotypes that exist within COPD. In particular, the study found that there was a great overlap in the detection of bronchiectasis, bronchial wall thickening, and emphysema in subjects with COPD. In their correspondence, Dr Hochhegger and colleagues correctly point out that there is a superior role of emphysema description using quantitative CT scan analysis; however, there is a recognized difficulty in quantification of airway wall dimensions required for bronchial wall thickening and bronchiectasis in COPD.2 In our study, we have defined the presence of bronchiectasis, bronchial wall thickening, and emphysema using established international thoracic radiologic guidelines,3 and more importantly, we have previously demonstrated that at our institution, the interobserver correlation of diagnosis of emphysema, bronchial wall thickening, and bronchiectasis is good4 while using tools widely available in clinical practice. This is particularly important because COPD is defined by chronic airflow limitation, which can include parenchymal destruction or airway wall thickening.

We agree with Dr Hochhegger and colleagues that the multidimensional phenotyping of COPD is important and that quantitative CT scanning analysis should be part of this for emphysema, especially in early disease. Better methods are required to interpret the airway wall geometry and airway densitometry with careful quality control of quantitative CT scanning in terms of standardized algorithms to capture the images, corrections for scanner variability, and standardized software for analysis.5 However, as an aid in the advancement of the field, we concur wholeheartedly that CT scanning is an important tool in phenotyping COPD.

Bafadhel M, Umar I, Gupta S, et al. The role of CT scanning in multidimensional phenotyping of COPD. Chest. 2011;1403:634-642 [CrossRef] [PubMed]
 
Coxson HO. Quantitative computed tomography assessment of airway wall dimensions: current status and potential applications for phenotyping chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;59:940-945 [CrossRef] [PubMed]
 
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;2463:697-722 [CrossRef] [PubMed]
 
Gupta S, Siddiqui S, Haldar P, et al. Qualitative analysis of high-resolution CT scans in severe asthma. Chest. 2009;1366:1521-1528 [CrossRef] [PubMed]
 
EvA, emphysema versus airways disease. Emphysema versus Airways DiseaseEvA, emphysema versus airways disease. Emphysema versus Airways Disease Web site.http://www.eva-copd.eu. Accessed June 18, 2011.
 

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References

Bafadhel M, Umar I, Gupta S, et al. The role of CT scanning in multidimensional phenotyping of COPD. Chest. 2011;1403:634-642 [CrossRef] [PubMed]
 
Coxson HO. Quantitative computed tomography assessment of airway wall dimensions: current status and potential applications for phenotyping chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;59:940-945 [CrossRef] [PubMed]
 
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;2463:697-722 [CrossRef] [PubMed]
 
Gupta S, Siddiqui S, Haldar P, et al. Qualitative analysis of high-resolution CT scans in severe asthma. Chest. 2009;1366:1521-1528 [CrossRef] [PubMed]
 
EvA, emphysema versus airways disease. Emphysema versus Airways DiseaseEvA, emphysema versus airways disease. Emphysema versus Airways Disease Web site.http://www.eva-copd.eu. Accessed June 18, 2011.
 
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