-
European Journal of Radiology Jul 2024We determine and compare the prevalence, subtypes, severity, and risk factors for emphysema assessed by low-dose CT(LDCT) in Chinese and Dutch general populations.
PURPOSE
We determine and compare the prevalence, subtypes, severity, and risk factors for emphysema assessed by low-dose CT(LDCT) in Chinese and Dutch general populations.
METHODS
This cross-sectional study included LDCT scans of 1143 participants between May and October 2017 from a Chinese Cohort study and 1200 participants with same age range and different smoking status between May and October 2019 from a Dutch population-based study. An experienced radiologist visually assessed the scans for emphysema presence (≥trace), subtype, and severity. Logistic regression analyses, overall and stratified by smoking status, were performed and adjusted for fume exposure, demographic and smoking data.
RESULTS
The Chinese population had a comparable proportion of women to the Dutch population (54.9 % vs 58.9 %), was older (61.7 ± 6.3 vs 59.8 ± 8.1), included more never smokers (66.4 % vs 38.3 %), had a higher emphysema prevalence ([58.8 % vs 39.7 %], adjusted odds ratio, aOR = 2.06, 95 %CI = 1.68-2.53), and more often had centrilobular emphysema (54.8 % vs 32.8 %, p < 0.001), but no differences in emphysema severity. After stratification, only in never smokers an increased odds of emphysema was observed in the Chinese compared to the Dutch (aOR = 2.55, 95 %CI = 1.95-3.35). Never smokers in both populations shared older age (aOR = 1.59, 95 %CI = 1.25-2.02 vs 1.26, 95 %CI = 0.97-1.64) and male sex (aOR = 1.50, 95 %CI = 1.02-2.22 vs 1.93, 95 %CI = 1.26-2.96) as risk factors for emphysema.
CONCLUSIONS
Only never smokers had a higher prevalence of mainly centrilobular emphysema in the Chinese general population compared to the Dutch after adjusting for confounders, indicating that factors other than smoking, age and sex contribute to presence of CT-defined emphysema.
Topics: Humans; Female; Male; Prevalence; Middle Aged; Netherlands; Pulmonary Emphysema; Cross-Sectional Studies; Tomography, X-Ray Computed; China; Risk Factors; Aged; Smoking; Severity of Illness Index; East Asian People
PubMed: 38761443
DOI: 10.1016/j.ejrad.2024.111503 -
Therapeutic Advances in Respiratory... 2019Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. However, whether CPFE... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. However, whether CPFE has a higher or lower mortality than idiopathic pulmonary fibrosis (IPF) alone is still not clear. In this study we conducted a meta-analysis to assess the survival rate (SR) of CPFE IPF alone in clinical trials.
METHODS
We performed a systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials for trials published prior to 31 March 2018. Extracts from the literature were analyzed with Review Manager version 5.3.
RESULTS
Thirteen eligible trials were included in this analysis (involving 1710 participants). Overall, the pooled results revealed that no statistically significant difference was detected in the 1-year [relative risk (RR) = 0.98, 95% confidence interval (CI): 0.94-1.03, = 0.47], 3-year (RR = 0.83, 95% CI: 0.68-1.01, = 0.06), and 5-year (RR = 0.80, 95% CI: 0.59-1.07, = 0.14) SRs of CPFE IPF alone.
CONCLUSIONS
CPFE exhibits a very poor prognosis, similar to IPF alone. Additional studies are needed to provide more convincing data to investigate the natural history and outcome of patients with CPFE in comparison to IPF.
Topics: Humans; Idiopathic Pulmonary Fibrosis; Prognosis; Pulmonary Emphysema; Survival Rate
PubMed: 31722622
DOI: 10.1177/1753466619888119 -
International Journal of Chronic... 2018The aim of the study was to assess the relationship between computed tomography (CT) densitometry and routine clinical markers in patients with chronic obstructive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of the study was to assess the relationship between computed tomography (CT) densitometry and routine clinical markers in patients with chronic obstructive pulmonary disease (COPD) and alpha-1 anti-trypsin deficiency (AATD).
METHODS
Multiple databases were searched using a combination of pertinent terms and those articles relating quantitatively measured CT densitometry to clinical outcomes. Studies that used visual scoring only were excluded, as were those measured in expiration only. A thorough review of abstracts and full manuscripts was conducted by 2 reviewers; data extraction and assessment of bias was conducted by 1 reviewer and the 4 reviewers independently assessed for quality. Pooled correlation coefficients were calculated, and heterogeneity was explored.
RESULTS
A total of 112 studies were identified, 82 being suitable for meta-analysis. The most commonly used density threshold was -950 HU, and a significant association between CT density and all included clinical parameters was demonstrated. There was marked heterogeneity between studies secondary to large variety of disease severity within commonly included cohorts and differences in CT acquisition parameters.
CONCLUSION
CT density shows a good relationship to clinically relevant parameters; however, study heterogeneity and lack of longitudinal data mean that it is difficult to compare studies or derive a minimal clinically important difference. We recommend that international consensus is reached to standardize CT conduct and analysis in future COPD and AATD studies.
Topics: Aged; Chi-Square Distribution; Densitometry; Female; Forced Expiratory Volume; Humans; Lung; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Pulmonary Diffusing Capacity; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Quality of Life; Severity of Illness Index; Spirometry; Tomography, X-Ray Computed; Vital Capacity; alpha 1-Antitrypsin Deficiency
PubMed: 29445272
DOI: 10.2147/COPD.S143066 -
Respiratory Medicine Feb 2022Chronic obstructive pulmonary disease (COPD) is a major comorbid disease of Mycobacterium avium complex pulmonary disease (MAC-PD). Emphysema is one of the main...
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a major comorbid disease of Mycobacterium avium complex pulmonary disease (MAC-PD). Emphysema is one of the main pathological findings in COPD, a risk factor for chronic pulmonary aspergillosis (CPA), and is associated with poor prognosis. We aimed to clarify the effect of emphysema on mortality in MAC-PD.
METHODS
We retrospectively analyzed 203 patients with MAC-PD at The Jikei Daisan Hospital between January 2014 and December 2018. We investigated the mortality and CPA development rates after MAC-PD diagnosis in patients with or without emphysema.
RESULTS
Multivariate Cox proportional hazards regression analysis showed the following negative prognostic factors in patients with MAC-PD: emphysema (hazard ratio [HR]: 11.46; 95% confidence interval [CI]: 1.30-100.90; P = 0.028); cavities (HR: 3.12; 95% CI: 1.22-7.94; P = 0.017); and low body mass index (<18.5 kg/m) (HR: 4.62; 95% CI: 1.63-13.11; P = 0.004). The mortality and occurrence of CPA were higher in MAC-PD patients with than without emphysema (log-rank test, P < 0.0001 and P < 0.0001).
CONCLUSION
Our study findings showed that emphysema detected by computed tomography was associated with an increased risk of CPA development and mortality in MAC-PD.
Topics: Emphysema; Humans; Lung Diseases; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prognosis; Pulmonary Emphysema; Retrospective Studies
PubMed: 35051876
DOI: 10.1016/j.rmed.2022.106738 -
Academic Radiology Apr 2017Emphysema is characterized by airspace dilation, inflammation, and irregular deposition of elastin and collagen in the interstitium. Computed tomographic studies have...
RATIONALE AND OBJECTIVE
Emphysema is characterized by airspace dilation, inflammation, and irregular deposition of elastin and collagen in the interstitium. Computed tomographic studies have reported that lung mass (LM) may be increased in smokers, a finding attributed to inflammatory and parenchymal remodeling processes observed on histopathology. We sought to examine the epidemiologic and clinical associations of LM in smokers.
MATERIALS AND METHODS
Baseline epidemiologic, clinical, and computed tomography (CT) data (n = 8156) from smokers enrolled into the COPDGene Study were analyzed. LM was calculated from the CT scan. Changes in lung function at 5 years' follow-up were available from 1623 subjects. Regression analysis was performed to assess for associations of LM with forced expiratory volume in 1 second (FEV) and FEV decline.
RESULTS
Subjects with Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 chronic obstructive pulmonary disease had greater LM than either smokers with normal lung function or those with GOLD 2-4 chronic obstructive pulmonary disease (P < 0.001 for both comparisons). LM was predictive of the rate of the decline in FEV (decline per 100 g, -4.7 ± 1.7 mL/y, P = 0.006).
CONCLUSIONS
Our cross-sectional data suggest the presence of a biphasic radiological remodeling process in smokers: the presence of such nonlinearity must be accounted for in longitudinal computed tomographic studies. Baseline LM predicts the decline in lung function.
Topics: Aged; Airway Remodeling; Cross-Sectional Studies; Female; Humans; Longitudinal Studies; Lung; Male; Middle Aged; Organ Size; Pulmonary Emphysema; Regression Analysis; Respiratory Function Tests; Smokers; Smoking; Tomography, X-Ray Computed; United States
PubMed: 27940230
DOI: 10.1016/j.acra.2016.10.011 -
RMD Open 2019This multicentre study aimed to investigate the overall mortality of combined pulmonary fibrosis and emphysema (CPFE) in systemic sclerosis (SSc) and to compare CPFE-SSc...
OBJECTIVES
This multicentre study aimed to investigate the overall mortality of combined pulmonary fibrosis and emphysema (CPFE) in systemic sclerosis (SSc) and to compare CPFE-SSc characteristics with those of other SSc subtypes (with interstitial lung disease-ILD, emphysema or neither).
METHODS
Chest CTs, anamnestic data, immunological profile and pulmonary function tests of patients with SSc were retrospectively collected. Each chest CT underwent a semiquantitative assessment blindly performed by three radiologists. Patients were clustered in four groups: SSc-CPFE, SSc-ILD, SSc-emphysema and other-SSc (without ILD nor emphysema). The overall mortality of these groups was calculated by Kaplan-Meier method and compared with the stratified log-rank test; Kruskal-Wallis test, t-Student test and χ² test assessed the differences between groups. P<0.05 was considered statistically significant.
RESULTS
We enrolled 470 patients (1959 patient-year); 15.5 % (73/470) died during the follow-up. Compared with the SSc-ILD and other-SSc, in SSc-CPFE there was a higher prevalence of males, lower anticentromere antibodies prevalence and a more reduced pulmonary function (p<0.05). The Kaplan-Meier survival analysis demonstrates a significantly worse survival in patients with SSc-CPFE (HR vs SSc-ILD, vs SSc-emphysema and vs other-SSc, respectively 1.6 (CI 0.5 to 5.2), 1.6 (CI 0.7 to 3.8) and 2.8 (CI 1.2 to 6.6).
CONCLUSIONS
CPFE increases the mortality risk in SSc along with a highly impaired lung function. These findings strengthen the importance to take into account emphysema in patients with SSc with ILD.
Topics: Aged; Biomarkers; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prevalence; Prognosis; Pulmonary Emphysema; Pulmonary Fibrosis; Scleroderma, Systemic; Tomography, X-Ray Computed
PubMed: 30886735
DOI: 10.1136/rmdopen-2018-000820 -
Annals of the American Thoracic Society Feb 2018Almost 70 years ago, Drs. Baldwin, Cournand, and Richards defined chronic pulmonary insufficiency by the presence of respiratory symptoms, radiologic evidence of...
Almost 70 years ago, Drs. Baldwin, Cournand, and Richards defined chronic pulmonary insufficiency by the presence of respiratory symptoms, radiologic evidence of pulmonary emphysema on chest radiography, and physiologic gas trapping. A decade later, airflow obstruction on spirometry was added to the definition and insufficiency became a disease. Contemporary studies are reviving the diagnostic approach described by these early luminaries, with researchers finding that symptomatic smokers with preserved spirometry have increased exacerbations and that smokers and non-smokers with normal spirometry but emphysema on chest computed tomography have increased mortality. Hence, the Baldwin-Cournand-Richards concept of disease defined by respiratory symptoms, radiologic findings, and physiology-regardless of spirometric criteria-is being rediscovered. Baldwin, Cournand, and Richards also stated that "functionally, it is obvious that the pulmonary and circulatory apparatus are one unit," and they defined combined cardiopulmonary insufficiency as chronic pulmonary insufficiency with (left or right) cardiac and pulmonary artery enlargement. They appreciated the complexity of these interactions, which include the potential role of gas trapping in heart failure with reduced ejection fraction; the impact of emphysema on blood flow in heart failure with preserved ejection fraction; multiple contributions to cor pulmonale with increased pulmonary artery pressure; and cor pulmonale parvus in emphysema; all of which may be amenable to specific therapeutic interventions. Given the complexity of heart-lung interactions originally identified by Baldwin, Cournand, and Richards and the potentially large therapeutic opportunities, large-scale studies are still warranted to find specific therapies for subphenotypes of combined cardiopulmonary insufficiency.
Topics: Forced Expiratory Volume; Humans; Lung; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Pulmonary Heart Disease; Smoking; Spirometry; Tomography, X-Ray Computed; Ventricular Function, Right
PubMed: 29461894
DOI: 10.1513/AnnalsATS.201708-667KV -
The Turkish Journal of Pediatrics 2022Placental transmogrification of the lung (PTL) is a clinical spectrum varying from asymptomatic to severe pulmonary impairment; such as recurrent pneumothorax,...
BACKGROUND
Placental transmogrification of the lung (PTL) is a clinical spectrum varying from asymptomatic to severe pulmonary impairment; such as recurrent pneumothorax, bronchopneumonia, respiratory distress syndrome and chronic obstructive airway disease. PTL usually presents as a bullous lesion, and rarely can appear in nodule or cyst formation on chest imaging. PTL with giant bullous emphysema has a male preference, is more commonly unilateral and mostly affects one lobe, but can rarely involve more than one lobe.
CASE
Here we report a 13-year-old boy presenting with bullous emphysema and coexisting with a borderline testicular tumor. He had no complaints of cough, sputum, or shortness of breath. He had a past medical history of pneumonia five years ago. In order to elucidate the underlying lung pathology, a wedge lung biopsy was performed and the patient was diagnosed with PTL. Scrotum ultrasonography was performed because of hydrocele in both testes, and bilateral epididymal cysts with papillary solid projections were reported. Pathological examination of the epididymal tumor revealed a `Mullerian type borderline epithelial neoplasm` which is an analogue of the ovarian serous borderline tumor.
CONCLUSIONS
In conclusion, we reported the youngest PTL case in the literature, a rare disease with unknown pathophysiology, presenting as bullous emphysema and coincidental Mullerian type borderline epithelial neoplasm. It is important to diagnose placental transmogrification of the lung in a child with bullous emphysema because compared to other cystic lung diseases it is a benign disease and if no additional malignity exists, lobectomy or pneumonectomy is the cure for the disease.
Topics: Child; Male; Female; Humans; Pregnancy; Adolescent; Placenta; Pulmonary Emphysema; Lung; Emphysema; Neoplasms, Glandular and Epithelial
PubMed: 36305451
DOI: 10.24953/turkjped.2021.5515 -
Annals of the American Thoracic Society Aug 2016Alpha-1 antitrypsin (AAT) deficiency, characterized by low plasma levels of the serine protease inhibitor AAT, is associated with emphysema secondary to insufficient... (Review)
Review
Alpha-1 antitrypsin (AAT) deficiency, characterized by low plasma levels of the serine protease inhibitor AAT, is associated with emphysema secondary to insufficient protection of the lung from neutrophil proteases. Although AAT augmentation therapy with purified AAT protein is efficacious, it requires weekly to monthly intravenous infusion of AAT purified from pooled human plasma, has the risk of viral contamination and allergic reactions, and is costly. As an alternative, gene therapy offers the advantage of single administration, eliminating the burden of protein infusion, and reduced risks and costs. The focus of this review is to describe the various strategies for AAT gene therapy for the pulmonary manifestations of AAT deficiency and the state of the art in bringing AAT gene therapy to the bedside.
Topics: Adenoviridae; Animals; Dependovirus; Genetic Therapy; Genetic Vectors; Humans; Plasmids; Pulmonary Emphysema; Serine Proteinase Inhibitors; alpha 1-Antitrypsin; alpha 1-Antitrypsin Deficiency
PubMed: 27564673
DOI: 10.1513/AnnalsATS.201506-344KV -
Chronic Respiratory Disease May 2016Breathlessness and impaired quality of life are prominent features in patients with severe emphysema even when conventional methods of treatment are optimal. Lung volume... (Review)
Review
Breathlessness and impaired quality of life are prominent features in patients with severe emphysema even when conventional methods of treatment are optimal. Lung volume reduction using endobronchial management for emphysema has emerged as a new method to relieve symptoms and improve lung function tests in this group. The endobronchial valves (EBVs) are the most widely used treatment. This article outlines current criteria of patients' selection with literature review and evidence of efficacy. Complications of EBV insertion as well as current shortfalls of this method of treatment are also discussed.
Topics: Bronchoscopy; Forced Expiratory Volume; Humans; Patient Selection; Pneumonectomy; Prosthesis Implantation; Pulmonary Emphysema; Quality of Life; Treatment Outcome
PubMed: 26879696
DOI: 10.1177/1479972316631139