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Original Research: COPD |

Dynamic Expiratory Tracheal Collapse in COPDDynamic Expiratory Tracheal Collapse in COPD: Correlation With Clinical and Physiologic Parameters

Phillip M. Boiselle, MD, FCCP; Gaetane Michaud, MD, FCCP; David H. Roberts, MD, FCCP; Stephen H. Loring, MD; Hilary M. Womble, MD; Mary E. Millett, RN; Carl R. O’Donnell, ScD, MPH
Author and Funding Information

From the Center for Airway Imaging and the Departments of Radiology (Dr Boiselle and Ms Millett), the Department of Interventional Pulmonology (Dr Michaud), the Department of Pulmonary, Critical Care, and Sleep Medicine (Drs Roberts, Womble, and O’Donnell), and the Department of Anesthesia and Critical Care (Dr Loring), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.Dr Michaud is currently at the Yale School of Medicine (New Haven, CT).

Correspondence to: Phillip M. Boiselle, MD, FCCP, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; e-mail: pboisell@bidmc.harvard.edu


Funding/Support: This study was funded by the National Institutes of Health [Grant R01HL084331].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1539-1544. doi:10.1378/chest.12-0299
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Background:  COPD has been described as a risk factor for excessive expiratory tracheal collapse, but its prevalence and clinical correlates have not been fully determined. The purpose of this study is to prospectively determine the prevalence of excessive expiratory tracheal collapse among patients with COPD and to test the hypothesis that clinical and/or physiologic parameters will correlate with the presence of excessive tracheal collapse.

Methods:  We studied 100 adults meeting GOLD (Global Initiative for Obstructive Lung Disease) criteria for COPD, who underwent full pulmonary function tests (PFTs), 6-min walk test (6MWT), St. George’s Respiratory Questionnaire (SGRQ), and low-dose CT scan at total lung capacity and during dynamic exhalation with spirometric monitoring. We examined correlations between percentage dynamic expiratory tracheal collapse and PFTs, 6MWT distance, and SGRQ scores.

Results:  Patients included 48 women and 52 men with mean age 65 ± 7 years, FEV1 64% ± 22% predicted, and percentage expiratory collapse 59% ± 19%. Twenty of 100 participants met study criteria for excessive expiratory collapse. There was no significant correlation between percentage expiratory tracheal collapse and any pulmonary function measure, total SGRQ score, or 6MWT distance. The SGRQ symptom subscale was weakly correlated with percentage collapse of the mid trachea (R = 0.215, P = .03).

Conclusions:  Excessive expiratory tracheal collapse is observed in a subset of patients with COPD, but the magnitude of collapse is independent of disease severity and does not correlate significantly with physiologic parameters. Thus, the incidental identification of excessive expiratory tracheal collapse in a general COPD population may not necessarily be clinically significant.


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