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Original Research: COPD |

How Common Is Airflow Limitation in Patients With Emphysema on CT Scan of the Chest?Airflow Limitation in Patients With Emphysema

Sanjiva M. Lutchmedial, MD; Whitney G. Creed, BA; Alastair J. Moore, MD; Ryan R. Walsh, MD; George E. Gentchos, MD; David A. Kaminsky, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Lutchmedial and Kaminsky), the Department of Radiology (Dr Moore), and the Division of Thoracic Radiology (Drs Walsh and Gentchos), University of Vermont College of Medicine (Ms Creed), Burlington, VT.

CORRESPONDENCE TO: David A. Kaminsky, MD, FCCP, Division of Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Given D-213, 89 Beaumont Ave, Burlington, VT 05405; e-mail: david.kaminsky@uvm.edu


FUNDING/SUPPORT: This study was funded in part by the National Heart, Lung, and Blood Institute [Grant 5R34 HL113290 to Dr Kaminsky] and the National Institutes of Health [Grant P30GM103532 to the Vermont Lung Center, University of Vermont].

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


Chest. 2015;148(1):176-184. doi:10.1378/chest.14-1556
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BACKGROUND:  COPD has traditionally been defined by the presence of irreversible airflow limitation on spirometry using either the GOLD (Global Initiative for Chronic Obstructive Lung Disease) or American Thoracic Society/European Respiratory Society criteria (lower limit of normal [LLN]). We have observed that some patients with clinical COPD and emphysema on chest CT scan have no obstruction on spirometry. The purpose of this study was to assess the prevalence of obstruction by GOLD and LLN criteria in patients with emphysema on CT scan and determine which radiographic criteria were associated with a clinical diagnosis of COPD.

METHODS:  We retrospectively analyzed the clinical records and spirometry of all patients who had radiographically defined emphysema on chest CT scans completed at the University of Vermont in 2011. We compared spirometric criteria and CT scan factors with the presence of clinical COPD based on chart review.

RESULTS:  We identified 274 patients with CT scan-defined emphysema. GOLD criteria detected obstruction in 228 patients (83%), and LLN detected obstruction in 206 patients (75%). However, GOLD failed to correctly identify 19 patients (6.9%) and LLN failed to identify 38 patients (13.9%) (average 10.4%) who had radiographic emphysema and a clinical diagnosis of COPD. Obese patients had a lower prevalence of obstruction whether classified by LLN or GOLD. Among patients with spirometric obstruction, there were greater degrees of emphysema and more severely increased airway wall thickness. Factors that were independently associated with clinical COPD were lower FVC % predicted, lower FEV1/FVC ratio, and increasing airway wall thickness.

CONCLUSIONS:  Spirometry missed 10.4% of patients with clinical COPD who have significant emphysema on chest CT scan.

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