Background Emphysema on CT is common in older smokers. We hypothesised that emphysema on CT predicts acute episodes of care for chronic lower respiratory disease among older smokers. Materials and Methods Participants in a lung cancer screening study age ≥60 years were recruited into a prospective cohort study in 2001–02. Two radiologists independently visually assessed the severity of emphysema as absent, mild, moderate or severe. Percent emphysema was defined as the proportion of voxels ≤ ？910 Hounsfield Units. Participants completed a median of 5 visits over a median of 6 years of follow-up. The primary outcome was hospitalization, emergency room or urgent office visit for chronic lower respiratory disease. Spirometry was performed following ATS/ERS guidelines. Airflow obstruction was defined as FEV1/FVC ratio <0.70 and FEV1<80% predicted. Results Of 521 participants, 4% had moderate or severe emphysema, which was associated with acute episodes of care (rate ratio 1.89; 95% CI: 1.01–3.52) adjusting for age, sex and race/ethnicity, as was percent emphysema, with similar associations for hospitalisation. Emphysema on visual assessment also predicted incident airflow obstruction (HR 5.14; 95% CI 2.19–21.1). Conclusion Visually assessed emphysema and percent emphysema on CT predicted acute episodes of care for chronic lower respiratory disease, with the former predicting incident airflow obstruction among older smokers.
References
[1]
World Health Organisation (2008) WHO | Burden of Chronic Obstructive Lung Disease. Available: http://www.who.int/respiratory/copd/burd？en/en/index.html. Accessed 2008 Dec 23.
[2]
Minino A, Xu J, Kochanek K (2010) Preliminary Data for 2008. National vital statistics reports 59.
[3]
Camiciottoli G, Cavigli E, Grassi L, Diciotti S, Orlandi I, et al. (2009) Prevalence and correlates of pulmonary emphysema in smokers and former smokers. A densitometric study of participants in the ITALUNG trial. Eur Radiol 19: 58–66 doi:10.1007/s00330-008-1131-6.
[4]
De Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, et al. (2007) Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest 132: 1932–1938 doi:10.1378/chest.07-1490.
[5]
Omori H, Nakashima R, Otsuka N, Mishima Y, Tomiguchi S, et al. (2006) Emphysema detected by lung cancer screening with low-dose spiral CT: prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects. Respirology 11: 205–210 doi:10.1111/j.1440-1843.2006.00827.x.
[6]
Hall WB, Truitt SG, Scheunemann LP, Shah SA, Rivera MP, et al. (2009) The Prevalence of Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to Diagnose Pulmonary Embolism. Arch Intern Med 169: 1961–1965 doi:10.1001/archinternmed.2009.360.
[7]
Onuma Y, Tanabe K, Nakazawa G, Aoki J, Nakajima H, et al. (2006) Noncardiac Findings in Cardiac Imaging With Multidetector Computed Tomography. J Am Coll Cardiol 48: 402–406 doi:10.1016/j.jacc.2006.04.071.
[8]
Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365: 395–409 doi:10.1056/NEJMoa1102873.
[9]
Gevenois P, De Vuyst P, Sy M, Scillia P, Chaminade L, et al. (1996) Pulmonary emphysema: quantitative CT during expiration. Radiology 199: 825–829.
[10]
Bergin C, Müller N, Nichols DM, Lillington G, Hogg JC, et al. (1986) The diagnosis of emphysema. A computed tomographic-pathologic correlation. Am Rev Respir Dis 133: 541–546.
[11]
Coxson HO, Mayo JR, Behzad H, Moore BJ, Verburgt LM, et al. (1995) Measurement of lung expansion with computed tomography and comparison with quantitative histology. J Appl Physiol 79: 1525–1530.
[12]
Hruban RH, Meziane MA, Zerhouni EA, Khouri NF, Fishman EK, et al. (1987) High resolution computed tomography of inflation-fixed lungs. Pathologic-radiologic correlation of centrilobular emphysema. Am Rev Respir Dis 136: 935–940. doi: 10.1164/ajrccm/136.4.935
[13]
Müller NL, Staples CA, Miller RR, Abboud RT (1988) “Density mask”. An objective method to quantitate emphysema using computed tomography. Chest 94: 782–787 doi:10.1378/chest.94.4.782.
[14]
Gelb AF, Hogg JC, Müller NL, Schein MJ, Kuei J, et al. (1996) Contribution of emphysema and small airways in COPD. Chest 109: 353–359. doi: 10.1378/chest.109.2.353
[15]
Gietema HA, Müller NL, Fauerbach PVN, Sharma S, Edwards LD, et al. (2011) Quantifying the extent of emphysema: factors associated with radiologists’ estimations and quantitative indices of emphysema severity using the ECLIPSE cohort. Acad Radiol 18: 661–671 doi:10.1016/j.acra.2011.01.011.
[16]
Zulueta JJ, Wisnivesky JP, Henschke CI, Yip R, Farooqi AO, et al. (2011) Emphysema Scores Predict Death from Chronic Obstructive Pulmonary Disease and Lung Cancer. Chest. Available: http://chestjournal.chestpubs.org/conten？t/early/2011/10/19/chest.11-0101.short. Accessed 2012 July 11.
[17]
Johannessen A, Skorge TD, Bottai M, Grydeland TB, Nilsen RM, et al. (2013) Mortality by Level of Emphysema and Airway Wall Thickness. Am J Respir Crit Care Med. doi:10.1164/rccm.201209-1722OC.
[18]
Haruna A, Muro S, Nakano Y, Ohara T, Hoshino Y, et al. (2010) CT scan findings of emphysema predict mortality in COPD. Chest 138: 635–640 doi:10.1378/chest.09-2836.
[19]
Vestbo J, Edwards LD, Scanlon PD, Yates JC, Agusti A, et al. (2011) Changes in Forced Expiratory Volume in 1 Second over Time in COPD. New England Journal of Medicine 365: 1184–1192 doi:10.1056/NEJMoa1105482.
[20]
Mohamed Hoesein FAA, de Hoop B, Zanen P, Gietema H, Kruitwagen CLJJ, et al. (2011) CT-quantified emphysema in male heavy smokers: association with lung function decline. Thorax. doi:10.1136/thx.2010.145995.
[21]
Hurst JR, Vestbo J, Anzueto A, Locantore N, Müllerova H, et al. (2010) Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 363: 1128–1138 doi:10.1056/NEJMoa0909883.
[22]
Henschke CI, Lee IJ, Wu N, Farooqi A, Khan A, et al. (2006) CT screening for lung cancer: prevalence and incidence of mediastinal masses. Radiology 239: 586–590 doi:10.1148/radiol.2392050261.
[23]
National Lung Screening Trial Research Team (2011) The National Lung Screening Trial: Overview and Study Design. Radiology 258: 243–253 doi:10.1148/radiol.10091808.
[24]
Cazzola M, MacNee W, Martinez FJ, Rabe KF, Franciosi LG, et al. (2008) Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J 31: 416–469 doi:10.1183/09031936.00099306.
[25]
Burge S, Wedzicha JA (2003) COPD exacerbations: definitions and classifications. Eur Respir J Suppl 41: 46s–53s. doi: 10.1183/09031936.03.00078002
[26]
American Thoracic Society (1995) Standardization of spirometry, 1994 update. American Thoracic Society. Am J Respir Crit Care Med 152: 1107–1136. doi: 10.1164/ajrccm.152.3.7663792
[27]
Barr RG, Stemple KJ, Mesia-Vela S, Basner RC, Derk SJ, et al. (2008) Reproducibility and validity of a handheld spirometer. Respir Care 53: 433–441.
[28]
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. (2005) Standardisation of spirometry. Eur Respir J 26: 319–338 doi:10.1183/09031936.05.00034805.
[29]
Celli BR, MacNee W, Agusti A, Anzueto A, Berg B, et al. (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 23: 932–946 doi:10.1183/09031936.04.00014304.
[30]
Aaron SD (2008) Statistical Considerations for COPD Exacerbation Trials, in Chronic Obstructive Pulmonary Disease Exacerbations (Lung Biology in Health and Disease). 1st ed. Martinez FJ, Wedzicha W, editors Informa Healthcare.
[31]
Han MK, Kazerooni EA, Lynch DA, Liu LX, Murray S, et al. (2011) Chronic obstructive pulmonary disease exacerbations in the COPDGene study: associated radiologic phenotypes. Radiology 261: 274–282 doi:10.1148/radiol.11110173.
[32]
Jithoo A, Enright PL, Burney P, Buist AS, Bateman ED, et al. (2012) Case-finding options for COPD: Results from the BOLD Study. Eur Respir J. doi:10.1183/09031936.00132011.
[33]
Wise RA, Drummond MB (2008) The Role of NETT in Emphysema Research. Proc Am Thorac Soc 5: 385–392 doi:10.1513/pats.200709-153ET.
[34]
Tashkin DP, Celli B, Senn S, Burkhart D, Kesten S, et al. (2008) A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med 359: 1543–1554 doi:10.1056/NEJMoa0805800.
