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Response patterns to bronchodilator and quantitative computed tomography in chronic obstructive pulmonary disease
Jae Seung Lee1, Jin Won Huh, Eun Jin Chae
1Department of Pulmonary and Critical Care Medicine, Asthma Center and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Clinical Physiology and Functional Imaging
|December 14, 2011
Summary
Emphysema and air trapping in COPD patients influence bronchodilator response. Quantitative CT scans reveal emphysema correlates with expiratory flow changes and air trapping with lung volume changes.
Area of Science:
- Pulmonary Medicine
- Radiology
- Respiratory Physiology
Background:
- Patients with Chronic Obstructive Pulmonary Disease (COPD) exhibit varied spirometric responses to bronchodilators.
- Some patients show improvements primarily in expiratory flow (forced expiratory volume in 1 second; FEV1), while others respond with increased lung volume (forced vital capacity; FVC).
- The underlying mechanisms for these distinct bronchodilator response patterns in COPD remain incompletely understood.
Purpose of the Study:
- To investigate the relationship between bronchodilator responsiveness and quantitative computed tomography (CT) imaging indices in COPD patients.
- To explore how emphysema and air trapping, as measured by CT, correlate with different spirometric response patterns to bronchodilators.
Main Methods:
- Retrospective analysis of data from 101 stable COPD patients.
- Bronchodilator response assessed by changes in FEV1 and FVC after salbutamol inhalation.
- Volumetric CT used to quantify emphysema (V(950)), air trapping (mean lung density ratio), and airway wall thickness.
Main Results:
- The CT emphysema index (V(950 insp)) significantly negatively correlated with post-bronchodilator FEV1 change (R = -0.213, P = 0.004).
- The CT air-trapping index positively correlated with post-bronchodilator FVC change (R = 0.286, P≤0.001).
- Multiple linear regression confirmed independent associations of the CT emphysema index with FEV1 change and the CT air-trapping index with FVC change.
Conclusions:
- The extent of emphysema and air trapping are significant contributors to the heterogeneous bronchodilator response patterns observed in COPD.
- Quantitative CT indices provide valuable insights into the mechanisms underlying differential bronchodilator responsiveness in COPD patients.
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