SESSION TITLE: COPD
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 08:45 AM - 10:00 AM
PURPOSE: To assess high resolution computed tomography (HRCT) characteristics in non-smoking COPD patients attending a COPD Clinic at a tertiary level medical college hospital.
METHODS: Out of 507 COPD patients (men, 404 and women, 103) diagnosed as per GOLD guidelines and who were attending the COPD Clinic at our Institute during the study period, 63 patients (men, 16 and women, 47) had no smoking history. HRCT characteristics in these non-smoking COPD patients were studied and their correlations with risk factors other than smoking were analyzed.
RESULTS: Out of 507 COPD patients, 63 were non-smokers; 45.63% of women and 3.9% of men had no smoking history. The mean age of non-smoking COPD patients was 58.43 ± 11.75 years. The duration of illness was 7.81 ± 7.06 years. The FEV1 was 1.05 ± 0.44 L. The risk factors in non-smoking COPD were: cooking using solid fuel (85.7%), occupational exposure (84.1%), passive smoking (ETS) (76.2%), heating using solid fuel (74.6%), and air pollution only in (23.8%) of patients. Features of emphysema were observed in 27/63 non-smoking COPD patients. Centriacinar emphysema was most frequent type (25.4%) followed by panacinar (19.0%) and paraseptal (6.3%) emphysema. The emphysema extent was related to duration of exposure to air pollution. The characteristic patterns observed over HRCT were: directly visible small airways (66.5%), vascular attenuation (30.2%), mosaic attenuation (23.8%), vascular distortion (11.1%), saber sheath trachea (11.1%), increased thoracic cross sectional area (76.2%), increased thoracic cage ratio (28.6%), increased sterno-aortic distance (7.9%). Exposure to cooking smoke, past history of asthma and BMI strongly correlated with major airway wall thickness. Extent of occupational exposure was strongly related to hyperinflation features of HRCT. Regression analysis revealed the risk factors in non-smoking COPD patients predicted major airway wall thickness but did not predict variations in features of hyperinflation or extent of emphysema.
CONCLUSIONS: We observed HRCT characteristics distinct to COPD in significant proportion of non-smoking COPD patients. Many of these HRCT features had strong correlations with associated risk factors in these nonsmoking COPD subjects.
CLINICAL IMPLICATIONS: This is perhaps first study that has characterized HRCT features in non-smoking COPD patients and their correlations with risk factors other than smoking. HRCT has been observed to be an important diagnostic tool in smoking related COPD in prior studies.
DISCLOSURE: The following authors have nothing to disclose: Prem Parkash Gupta, Rohtas Yadav, Sumit Mittal
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