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Computed tomography phenotypes in severe, early-onset chronic obstructive pulmonary disease
Craig P Hersh1, Francine L Jacobson, Ritu Gill
1Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA. craig.hersh@channing.harvard.edu
COPD
|November 21, 2007
Summary
Clinical chest CT scans can identify distinct subtypes of severe, early-onset chronic obstructive pulmonary disease (COPD), including an airway-predominant group with asthma-like features, aiding in epidemiological and genetic studies.
Area of Science:
- Pulmonary Medicine
- Radiology
- Medical Genetics
Background:
- Severe chronic obstructive pulmonary disease (COPD) exhibits significant variability in emphysema severity on chest computed tomography (CT).
- Chest CT scans are common in clinical practice but underutilized in COPD epidemiological and genetic research.
- Identifying COPD subtypes is crucial for understanding disease heterogeneity and genetic contributions.
Purpose of the Study:
- To evaluate the utility of clinically obtained chest CT scans for COPD epidemiological studies.
- To determine if chest CT scans can define subtypes of severe, early-onset COPD.
- To investigate the clinical and potential genetic characteristics of identified COPD subgroups.
Main Methods:
- Retrospective review of 91 clinical chest CT scans from early-onset COPD probands.
- Semi-quantitative emphysema severity scoring (0-24) by pulmonologists and radiologists.
- Comparison of airflow obstruction, bronchodilator response, asthma diagnosis, and serum IgE levels between emphysema-predominant and airway-predominant subgroups.
Main Results:
- Eighty-eight CT scans were suitable for analysis, revealing a wide range of emphysema severity.
- Emphysema-predominant subjects showed more severe airflow obstruction (FEV1 17.4% predicted) compared to airway-predominant subjects (22.4% predicted).
- Airway-predominant subjects had a higher positive bronchodilator response (28.6% vs. 6.7%), increased asthma diagnosis (p=0.04), and a trend towards higher IgE levels (p=0.09).
Conclusions:
- Clinically acquired chest CT scans are valuable for COPD epidemiological research.
- An airway-predominant COPD subgroup with asthma-like features was identified.
- These findings suggest a genetic contribution to COPD subgroups and highlight the potential for CT-based phenotyping.
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