In patients with severe AECOPD, CT-determined emphysema is associated with decreased lung function and poor HRQoL and the stepwise multiple linear regression model showed that FEV1/FVC and age could be predictors of %LAA−950.
Abstract
Background The high prevalence of chronic obstructive pulmonary disease (COPD) poses a significant social burden. Emphysema is a basic pathological change associated with poor lung function in stable COPD. However, few studies have focused on the potential role of emphysema in acute exacerbation of COPD (AECOPD). The current study aimed to explore the correlation between CT-determined emphysema and other main physiological parameters of severe AECOPD. Methods In total 90 hospitalized patients with AECOPD participated in this cross-sectional study. All of them underwent chest CT scans and lung function tests as planned. Emphysema was defined as the percentage of low attenuation areas (LAA) below −950 Hounsfield Units (%LAA−950) on inspiratory CT scans. Health-Related Quality of Life (HRQoL) was assessed using four questionnaires, including the St. George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council dyspnea scale, COPD Assessment Test, and EXAcerbation of Chronic Pulmonary Disease Tool (EXACT). Qualified data from 73 patients were included in the analysis. Results %LAA−950 was significantly correlated with spirometry parameters and HRQoL scores. The SGRQ and EXACT scores were significantly positively correlated with %LAA−950 (ρ = 0.399, p < 0.001; ρ = 0.370, p = 0.001, respectively). The ratio of the forced expiratory volume in the first 1 s to the forced vital capacity of the lungs and the percentage of predicted forced expiratory volume in first 1 s, which are functional indicators of airflow limitation, were significantly negatively correlated with %LAA−950 (ρ = −0.735, p < 0.00; ρ = −0.602, p < 0.001, respectively). Based on the stepwise multiple linear regression model showed that FEV1/FVC and age could be predictors of %LAA−950 (R2 = 0.592, F = 50.762, p < 0.001). Conclusion In patients with severe AECOPD, CT-determined emphysema is associated with decreased lung function and poor HRQoL. Trial registration The study was registered on the Chinese Clinical Trial Registry (registration number: ChiCTR2000033101).
Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder frequently
associated with pulmonary vascular remodeling and pulmonary hypertension, both of which contribute to
increased morbidity and mortality.
To evaluate pulmonary artery diameters using computed tomography in patients with chronic obstructive
pulmonary disease, compare the findings with non-COPD participants, and assess the influence of smoking on
pulmonary artery dimensions.
Materials and Methods: A hospital-based cross-sectional study was conducted among 200 participants (100
females and 100 males) aged 18–70 years. Chest CT examinations were performed using a standardized
multidetector CT protocol. The diameters of the main pulmonary artery (MPA), left pulmonary artery (LPA), and
right pulmonary artery (RPA) were measured on axial CT images. Participants were categorized into COPD and
non-COPD groups and further classified according to smoking status. Descriptive statistics were calculated, and
independent Student's t-tests were used to compare pulmonary artery diameters between groups. A p-value <0.05
was considered statistically significant.
Results: The mean age of the study population was 42.20 ± 15.91 years. The mean diameters of the MPA, LPA,
and RPA were 26.36 ± 2.45 mm, 16.11 ± 1.68 mm, and 17.15 ± 1.61 mm, respectively. COPD patients
demonstrated significantly larger pulmonary artery diameters than non-COPD participants, including the MPA
(27.46 ± 2.51 mm vs. 25.47 ± 2.02 mm; p < 0.01), LPA (16.72 ± 1.46 mm vs. 15.61 ± 1.69 mm; p < 0.01), and
RPA (17.85 ± 1.55 mm vs. 16.58 ± 1.43 mm; p < 0.02). Smokers also exhibited significantly greater pulmonary
artery diameters than non-smokers, with the MPA measuring 27.48 ± 2.35 mm versus 25.26 ± 2.03 mm (p <
0.001). Histogram analysis demonstrated that most COPD patients had MPA diameters between 25 and 29 mm,
while a subset exceeded the 29 mm threshold for pulmonary artery dilatation.
Conclusion: Pulmonary artery diameters measured by computed tomography are significantly increased in
patients with COPD and in smokers, indicating pulmonary vascular remodeling associated with chronic lung
disease and tobacco exposure. CT-based assessment of pulmonary artery dimensions, particularly the main
pulmonary artery, represents a simple, reproducible, and non-invasive imaging biomarker that may facilitate the
early identification of pulmonary vascular involvement and aid in the screening of patients at risk for pulmonary
hypertension.
S. K. Diwakar, Rajul Rastogi· International Journal of Dru...· 0 citations
BACKGROUND
Combined pulmonary fibrosis and emphysema (CPFE) is an important phenotype in patients with fibrotic interstitial lung disease (ILD).
RESEARCH QUESTIONS
(1) What is the prevalence of CPFE? (2) What is the predictive performance of the CPFE Index and of physiological airflow obstruction for computed tomography (CT) emphysema extents? (3) Is extent of CT emphysema associated with outcomes in patients with fibrotic ILD?
STUDY DESIGN AND METHODS
Consecutive patients with idiopathic pulmonary fibrosis (IPF) and non-IPF fibrotic ILD who had a standardized visual assessment of the baseline high-resolution CT chest from a prospective registry were included. CPFE was defined as CT emphysema extent of ≥15%, with sensitivity analyses using different thresholds: ≥5%, ≥10%, and ≥20%. Emphysema subtypes were categorized based on their predominant distribution: centrilobular, paraseptal, or panlobular. The CPFE Index was derived using measurements of spirometry and diffusion capacity for carbon dioxide.
RESULTS
The prevalence of CPFE at baseline was 20% for IPF (92/455) and 7% in non-IPF fibrotic ILD (84/1121). Both FEV1/FVC ratio < lower limit of normal and <0.70 had poor sensitivity (IPF: 11.1-18.9%; non-IPF fibrotic ILD: 13.1-23.7%) for detecting CT emphysema, although high specificity (IPF: 96.2-98.8%; non-IPF fibrotic ILD: 92.8-95.8%). The CPFE Index was moderately correlated with CT emphysema extent in both IPF (r=0.48) and non-IPF fibrotic ILD (r=0.41), but with poor agreement and wide limits of agreement on Bland-Altman analysis. CT emphysema extent ≥20% was consistently associated with differences in lung function trajectories and worse transplant-free survival in IPF and non-IPF fibrotic ILD. There were no significant relationships between emphysema subtypes and health outcomes.
Y. Khor, Daniel-Costin Marinescu, H. Manganas et al.· Chest· 0 citations
The AE non CB and AE-CB phenotypes were found to have the most significant impact on HR-QoL among COPD patients, suggesting that individuals with the AE-CB phenotype notably require a tailored treatment approach that specifically addresses both the frequent exacerbations and the chronic bronchitis component to improve their overall QoL.
Naresh Bhagora, S. Meena, Pushpendra Bairwa et al.· Journal of Clinical and Diag...· 0 citations
Aims: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous condition with variable clinical presentation and disease progression. This study aimed to investigate the distribution of patients across defined COPD phenotypes and to compare their clinical, radiological, and functional characteristics.
Methods: This cross-sectional descriptive study included 96 patients diagnosed with COPD. Patients were classified into four phenotype groups: asthma–COPD overlap syndrome (ACOS), non-exacerbator (NE), frequent exacerbator with emphysema (FEE), and frequent exacerbator with chronic bronchitis (FECB). Demographic, clinical, and pulmonary function parameters were analyzed and compared among groups. Forced expiratory volume in one second (FEV1), body mass index (BMI), COPD Assessment Test (CAT), diffusing capacity for carbon monoxide (DLCO), and inspiratory capacity/total lung capacity (IC/TLC) ratio were evaluated.
Results: Of the patients, 83 (86.5%) were male and 13 (13.5%) were female, with a mean age of 65.22±7.85 years. The distribution of phenotypes was as follows: ACOS (9%), NE (53%), FEE (19%), and FECB (19%). The mean annual exacerbation rate was 1.27±1.2, and the mean FEV1 was 50.21±16.56%. The ACOS phenotype was characterized by a higher proportion of female patients, younger age, history of asthma and atopy, better clinical status, and relatively preserved lung function. In contrast, the FEE phenotype demonstrated a higher exacerbation frequency, poorer quality of life, and more severe airflow limitation. Patients in the FEE group had lower FEV1 and BMI, higher CAT scores, increased lung volumes and airway resistance, lower DLCO and partial pressure of oxygen (pO2), and an IC/TLC ratio below 25%.
Conclusion: Distinct COPD phenotypes, particularly ACOS and FEE, exhibit significant differences in clinical and functional characteristics. Recognition of these phenotypes may help guide individualized management strategies, including pulmonary rehabilitation, nutritional support, and optimization of pharmacological and interventional treatments.
Duygu Acar Karagül, S. Saryal· Journal of Pulmonology and I...· 0 citations
Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterized by pulmonary
vascular changes and airflow obstruction. Pulmonary hypertension is a significant morbidity in COPD patients and can deteriorate
with progressive COPD.
Objective: To assess the relationship between forced expiratory volume in one second and pulmonary artery pressure in patients
with chronic obstructive pulmonary disease (COPD).
Methods: The cross-sectional study was carried out in the Pulmonology Unit, MTI Khyber Teaching Hospital, Peshawar, from
March 2025 to August 2025. The total number of patients enrolled using non-probability consecutive sampling was 73 COPD
patients. Demographic and clinical information were collected. Spirometry was used to measure FEV1, and a transthoracic
echocardiogram was used to assess pulmonary artery pressure. The data were analyzed using Pearson correlation.
Results: The mean age was 57.38 +/- 10.30 years. There are 73 patients, of whom 31 are male and 42 are female. The mean FEV1
percentage predicted was 58.38 +/- 23.52, and the mean pulmonary artery pressure was 47.71 +/- 20.11 mmHg. There was a
strong negative correlation between FEV1 and pulmonary artery pressure (r = -0.547, p < 0.001).
Conclusion: In COPD patients, reduced FEV1 was significantly associated with increased pulmonary artery pressure.
Sehrish Khan, Anila Anila, Shahid Zia et al.· International Journal of Dru...· 0 citations
BACKGROUND AND OBJECTIVE
Combined pulmonary fibrosis and emphysema (CPFE) is characterized by coexisting upper-zone emphysema and lower-zone fibrosis, but standardized diagnostic criteria and clinical outcomes remain poorly defined. This study aimed to evaluate survival, acute exacerbation incidence, and disease progression in CPFE patients using international classification criteria with visual assessment of emphysema extent.
METHODS
This multicentre prospective cohort study at 29 Japanese hospitals enrolled 1016 patients with idiopathic interstitial pneumonias (IIPs) or chronic obstructive pulmonary disease (COPD) between 2013 and 2016. CPFE was defined as ≥ 5% emphysema determined by visual assessment of CT scans for IIP patients, according to international classification criteria. Patients were followed for 5 years.
RESULTS
Among 528 IIP patients, 92 (17.4%) had CPFE. CPFE patients showed a significantly worse 5-year survival compared with non-CPFE IIP patients (51.4% vs. 63.1%, p = 0.026) and COPD patients (51.4% vs. 84.0%, p < 0.001). After adjustment for covariates including IIP subtype, CPFE remained independently associated with increased mortality among IIP patients (HR of 1.85 [95% CI, 1.27-2.69], p < 0.001). CPFE patients also had a significantly higher acute exacerbation rate than did non-CPFE IIP patients (p < 0.001). The prognostic impact of CPFE was most pronounced in patients with idiopathic pulmonary fibrosis (IPF), with CPFE/IPF patients showing the worst outcomes.
CONCLUSION
Visual assessment with a ≥ 5% emphysema threshold effectively identified CPFE patients with a distinct clinical phenotype characterized by poor survival and an increased acute exacerbation incidence. These findings validate international classification criteria and emphasize the need for enhanced surveillance and tailored management strategies for this high-risk population.
K. Tsubouchi, Y. Kotetsu, Tomotsugu Takano et al.· Respirology (Carlton South....· 0 citations
