SESSION TITLE: COPD
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 08:45 AM - 10:00 AM
PURPOSE: High Resolution Computed Tomography Scan (HRCT) is now being used as an important diagnostic test in COPD patients. Various new patterns like emphysema (centriacinar, panacinar, and paraseptal) bronchial wall thickening, bronchiectasis, bullous disease, pulmonary hypertension and other vascular changes are being identified in these patients. In this present study, we have evaluated various HRCT features to identify morphological patterns in COPD and correlated the same with clinical features.
METHODS: 50 patients (42 males and 8 females) of stable COPD attending a tertiary referral hospital were included. According to HRCT findings, 3 predominant patterns were identified as Emphysema, Bronchial wall thickening and Bronchiectasis. This was correlated with smoking status, Body Mass Index, 6 min walk test (6MWT), frequency of exacerbations, and spirometry parameters including bronchodilator reversibility.
RESULTS: COPD patients with Emphysema phenotype on HRCT were more severely affected i.e. they had severe COPD as per GOLD guidelines (55%) with lower (<250m) 6MWT values (55%) and poor bronchodilator reversibility (82.50%) on spirometry. 52% COPD patients with bronchial wall thickening phenotype predominantly had severe COPD as per GOLD guidelines with lower (<250m) 6MWT values (72.22%) and poor bronchodilator reversibility (63.88%) on spirometry. 52% COPD patients with bronchiectasis phenotype predominantly had moderate COPD as per GOLD guidelines. They had better (>250m) 6MWT values (73.68%) with good bronchodilator reversibility (68.42%) on spirometry. However, these patients had higher frequency of infective exacerbation compared with other two groups (52.63%). Correlation of 6 min walk test values among 3 phenotypes of COPD was significant (F value 4.341, P value 0.016).
CONCLUSIONS: Our study results indicate that airway limitation derived from three spirometrically gated thin section CT scans obtained at defined anatomic levels can enable the differentiation of patients who have COPD with emphysema, bronchial wall thickening and bronchiectasis, which is a distinction that correlates with pulmonary functional impairment.
CLINICAL IMPLICATIONS: Spirometry and FEV1 is currently used to diagnose severity of COPD. However this is less accurate for small airway dysfunction (i.e. airflow in airways with internal diameter <2mm). The application of CT imaging provided additionally clinically important information as a non-invasive biomarker of COPD and is crucial for determining the appropriate therapeutic strategy.
DISCLOSURE: The following authors have nothing to disclose: Umang Shah, Jayalakshmi Tk, Girija Nair, Lavina Mirchandani, Aparna Iyer, Abhay Uppe
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