Obstructive Lung Diseases: COPD Phenotypes |

Individual Management of COPD: New Insight Into CT FREE TO VIEW

Yating Peng, PhD; Aiyuan Zhou; Ping Chen, PhD; Zijing Zhou; Yiyang Zhao
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Respiratory Disease Research Institute, Changsha, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A400. doi:10.1016/j.chest.2016.02.415
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: Computed tomography (CT) is a minimally invasive imaging technique and is independent of power or age. Take full advantage of CT technology may help clinicians better understand the complexity of the disease, thus improving patient outcome.

METHODS: To search the PUBMED database and summarize the newest study about CT exam in COPD patients.

RESULTS: Compared to spirometry, CT were able identify earlier COPD, especially in older, younger or obese individuals[1]. Spirometry cannot diagnose the airway obstruction of COPD until about 30% of lung function is impaired. By measuring emphysema coefficient, low-dose CT scans/lung scanning can diagnose early COPD when only about 10% of the lung function is affected[2]. Besides, the cost of each CT examination was only about 300 RMB (45 US dollars). According to the dominancy and the presence of emphysema and wall thickening, COPD can be classified into A, E and M phenotype, despite with the same levels of FEV1[3]. By using computational fluid dynamics, an obvious increase in distal airway volume (iVaw) and decrease in airway resistance (Raw) was observed after administration of budesonide/formoterol 4 hours later. However, no lung function parameter showed a significant change[4]. CT scan can differentiated the patient who is mainly responsive to salbutamol or ipratropium bromide[5] but PF can’t. Emphysema evaluated by HRCT is a good criterion to predict therapeutic effectiveness of endobronchial valve. In VENT study, 220 COPD treated with operation therapy shows high-heterogeneity subgroup received greater benefit than low-subgroup[6]. Parametric Response Map (PRM) combined I/E CT scans can precisely characterize phenotypes and monitor outcome[7]. Functional small airways disease (fSAD) will be easy to identify and quantify. A follow-up CT [8] by PRM of a GOLD 4 stage showed a drop in fSAD and an increase in emphysema 11 months later. However, FEV1 was unchanged from 18% to 17% over this time interval. 1 Chest.2015 2 J Thorac Dis.2012 3 Respirology.2006 4 Eur Respir J.2012 5 Int J COPD.2011 6 N Engl J Med.2010 7 Nat Med.2012 8 Acad Radiol.2015

CONCLUSIONS: CT is a precision medicine which can precisely tell what COPD looks like. Imageology complemente standard clinical techniques and CT biomarker may be utility in the future scientific research or clinical practice.

CLINICAL IMPLICATIONS: Emerging role of CT in the early diagnose, phenotypes identifying, treatment options, and follow up suggesting that CT is a promising tool to reach the goal to manage COPD individually.

DISCLOSURE: The following authors have nothing to disclose: Yating Peng, Aiyuan Zhou, Ping Chen, Zijing Zhou, Yiyang Zhao

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