Phenotyping of chronic obstructive pulmonary disease using the modified Bhalla scoring system for high-resolution computed tomography.

BACKGROUND Identifying different phenotypes of chronic obstructive pulmonary disease (COPD) is important for both therapeutic options and clinical outcome of the disease. OBJECTIVE To characterize the phenotypes of COPD according to high-resolution computed tomography (HRCT) findings; and to correlate HRCT scores obtained using the modified Bhalla scoring system with clinical and physiological indicators of systemic inflammation. METHODS The present study included 80 consecutive patients with stable COPD. HRCT scans were evaluated by two independent radiologists according to the modified Bhalla scoring system. RESULTS Fifty-four patients exhibited morphological changes on HRCT examination while 26 had no pathological findings. Patients with HRCT findings had lower spirometric measurements and higher levels of inflammation, and reported more exacerbations in the previous year compared with patients with no findings on HRCT. Patients with morphological changes were classified into one of three groups according to their HRCT phenotype(s): emphysema (E) only, E + bronchiectasis (B)⁄peribronchial thickening (PBT) or B⁄PBT only. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1⁄FVC ratio, C-reactive protein (CRP) levels and the number of exacerbations among the groups were significantly different. Pairwise comparisons between the E only and E+B⁄PBT groups showed significantly lower FVC, FEV1 and FEV1⁄FVC values, and higher CRP levels and number of exacerbations compared with the B⁄PBT group. No significant differences were found between the E+B⁄PBT and the B⁄PBT groups. An inverse correlation was found between the total HRCT score and FVC, FEV1 and FEV1⁄FVC; the correlation was positive with CRP level, erythrocyte sedimentation rate and number of exacerbations. CONCLUSION The present study exposed the intimate relationship between phenotype(s) characterized by HRCT and scoring for morphological abnormalities; and clinical and functional parameters and inflammatory markers. The inclusion of HRCT among routine examinations for COPD may provide significant benefits both in the management and prognosis of COPD patients.

[1]  H. Gietema,et al.  Visual versus Automated Evaluation of Chest Computed Tomography for the Presence of Chronic Obstructive Pulmonary Disease , 2012, PloS one.

[2]  A. Agustí,et al.  Effect of Bronchial Colonisation on Airway and Systemic Inflammation in Stable COPD , 2012, COPD.

[3]  B. van Ginneken,et al.  Quantitative Computed Tomography in COPD: Possibilities and Limitations , 2011, Lung.

[4]  A. O'donnell Bronchiectasis in patients with COPD: a distinct COPD phenotype? , 2011, Chest.

[5]  M. Martínez-García,et al.  Factors associated with bronchiectasis in patients with COPD. , 2011, Chest.

[6]  B. Zemel Quantitative Computed Tomography and Computed Tomography in Children , 2011, Current osteoporosis reports.

[7]  Nicola A Hanania,et al.  Chronic obstructive pulmonary disease exacerbations in the COPDGene study: associated radiologic phenotypes. , 2011, Radiology.

[8]  I. Pavord,et al.  The Role of CT Scanning in Multidimensional Phenotyping of COPD , 2011, Chest.

[9]  B. Stoel,et al.  Therapeutic efficacy of alpha-1 antitrypsin augmentation therapy on the loss of lung tissue: an integrated analysis of 2 randomised clinical trials using computed tomography densitometry , 2010, Respiratory research.

[10]  Edwin K Silverman,et al.  Chronic obstructive pulmonary disease phenotypes: the future of COPD. , 2010, American journal of respiratory and critical care medicine.

[11]  J. Curtis,et al.  Clinical Significance of Radiologic Characterizations in COPD , 2009, COPD.

[12]  P. Paré,et al.  Prediction of the rate of decline in FEV1 in smokers using quantitative computed tomography , 2009, Thorax.

[13]  Janet S. Lee,et al.  The Influence of Radiographic Phenotype and Smoking Status on Peripheral Blood Biomarker Patterns in Chronic Obstructive Pulmonary Disease , 2009, PloS one.

[14]  Stephen Lam,et al.  Quantitative assessment of the airway wall using computed tomography and optical coherence tomography. , 2009, Proceedings of the American Thoracic Society.

[15]  T. Katoh,et al.  Correlation of C‐reactive protein with disease severity in CT diagnosed emphysema , 2009, Respirology.

[16]  H. Coxson,et al.  Quantitative computed tomography assessment of airway wall dimensions: current status and potential applications for phenotyping chronic obstructive pulmonary disease. , 2008, Proceedings of the American Thoracic Society.

[17]  S Muro,et al.  Body mass index in male patients with COPD: correlation with low attenuation areas on CT , 2008, Thorax.

[18]  S. Fuschillo,et al.  Mucosal inflammation in idiopathic bronchiectasis: cellular and molecular mechanisms , 2008, European Respiratory Journal.

[19]  J. Soriano,et al.  Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. , 2007, Chest.

[20]  S. Bojesen,et al.  C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease. , 2007, American journal of respiratory and critical care medicine.

[21]  J. Dodd,et al.  Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis. , 2006, Chest.

[22]  T. Honda,et al.  Characteristics of COPD phenotypes classified according to the findings of HRCT. , 2006, Respiratory medicine.

[23]  N. Anthonisen,et al.  C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease , 2006, Thorax.

[24]  D. Mannino,et al.  Global burden of COPD: systematic review and meta-analysis , 2006, European Respiratory Journal.

[25]  J. Soriano,et al.  C-reactive protein in patients with COPD, control smokers and non-smokers: Thorax 2006;61:23–8 , 2006 .

[26]  E. Wouters,et al.  Raised CRP levels mark metabolic and functional impairment in advanced COPD , 2005, Thorax.

[27]  R. Djukanović,et al.  Relationship between peripheral airway dysfunction, airway obstruction, and neutrophilic inflammation in COPD , 2004, Thorax.

[28]  J. Wedzicha,et al.  Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease. , 2004, American journal of respiratory and critical care medicine.

[29]  P. Calverley,et al.  Chronic obstructive pulmonary disease , 2003, The Lancet.

[30]  David G Milne,et al.  Thin-section CT in obstructive pulmonary disease: discriminatory value. , 2002, Radiology.

[31]  R. Stockley Neutrophils and the pathogenesis of COPD. , 2002, Chest.

[32]  S Bosan,et al.  Core to rind distribution of severe emphysema predicts outcome of lung volume reduction surgery. , 2001, American journal of respiratory and critical care medicine.

[33]  J. Curtis,et al.  Short-term and long-term outcomes after bilateral lung volume reduction surgery : prediction by quantitative CT. , 2001, Chest.

[34]  O. M. Arıyürek,et al.  High resolution CT in children with cystic fibrosis: correlation with pulmonary functions and radiographic scores. , 2001, European journal of radiology.

[35]  M. Ferrer,et al.  Chronic Obstructive Pulmonary Disease Stage and Health-Related Quality of Life , 1997, Annals of Internal Medicine.

[36]  J. Alonso,et al.  Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. , 1997, Annals of internal medicine.

[37]  D. McCauley,et al.  Cystic fibrosis: scoring system with thin-section CT. , 1991, Radiology.