Airway count and emphysema assessed by chest CT imaging predicts clinical outcome in smokers

Alejandro A. Diaz, Clarissa Valim, Tsuneo Yamashiro, Raúl San José Estépar, James C. Ross, Shin Matsuoka, Brian Jack Bartholmai, Hiroto Hatabu, Edwin K. Silverman, George R. Washko

Research output: Contribution to journalArticle

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Abstract

Background: Recently, it has been shown that emphysematous destruction of the lung is associated with a decrease in the total number of terminal bronchioles. It is unknown whether a similar decrease is visible in the more proximal airways. We aimed to assess the relationships between proximal airway count, CT imaging measures of emphysema, and clinical prognostic factors in smokers, and to determine whether airway count predicts the BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Methods: In 50 smokers, emphysema was measured on CT scans and airway branches from the third to eighth generations of the right upper lobe apical bronchus were counted manually. The sum of airway branches from the sixth to eighth generations represented the total airway count (TAC). For each subject, the BODE index was determined. We used logistic regression to assess the ability of TAC to predict a high BODE index (≥ 7 points). Results: TAC was inversely associated with emphysema (r = -0.54, P < .0001). TAC correlated with the modified Medical Research Council dyspnea score (r = -0.42, P = .004), FEV1% predicted (r = 0.52, P = .0003), 6-min walk distance (r = 0.36, P = .012), and BODE index (r = -0.55, P < .0001). The C-statistics, which correspond to the area under the receiver operating characteristic curve, for the ability of TAC alone and TAC, emphysema, and age to predict a high BODE index were 0.84 and 0.92, respectively. Conclusions: TAC is lower in subjects with greater emphysematous destruction and is a predictor of a high BODE index. These results suggest that CT imaging-based TAC may be a unique COPD-related phenotype in smokers.

Original languageEnglish (US)
Pages (from-to)880-887
Number of pages8
JournalChest
Volume138
Issue number4
DOIs
StatePublished - Oct 1 2010

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Emphysema
Dyspnea
Thorax
Bronchioles
Bronchi
ROC Curve
Chronic Obstructive Pulmonary Disease
Biomedical Research
Logistic Models
Phenotype
Lung

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Diaz, A. A., Valim, C., Yamashiro, T., Estépar, R. S. J., Ross, J. C., Matsuoka, S., ... Washko, G. R. (2010). Airway count and emphysema assessed by chest CT imaging predicts clinical outcome in smokers. Chest, 138(4), 880-887. https://doi.org/10.1378/chest.10-0542

Airway count and emphysema assessed by chest CT imaging predicts clinical outcome in smokers. / Diaz, Alejandro A.; Valim, Clarissa; Yamashiro, Tsuneo; Estépar, Raúl San José; Ross, James C.; Matsuoka, Shin; Bartholmai, Brian Jack; Hatabu, Hiroto; Silverman, Edwin K.; Washko, George R.

In: Chest, Vol. 138, No. 4, 01.10.2010, p. 880-887.

Research output: Contribution to journalArticle

Diaz, AA, Valim, C, Yamashiro, T, Estépar, RSJ, Ross, JC, Matsuoka, S, Bartholmai, BJ, Hatabu, H, Silverman, EK & Washko, GR 2010, 'Airway count and emphysema assessed by chest CT imaging predicts clinical outcome in smokers', Chest, vol. 138, no. 4, pp. 880-887. https://doi.org/10.1378/chest.10-0542
Diaz AA, Valim C, Yamashiro T, Estépar RSJ, Ross JC, Matsuoka S et al. Airway count and emphysema assessed by chest CT imaging predicts clinical outcome in smokers. Chest. 2010 Oct 1;138(4):880-887. https://doi.org/10.1378/chest.10-0542
Diaz, Alejandro A. ; Valim, Clarissa ; Yamashiro, Tsuneo ; Estépar, Raúl San José ; Ross, James C. ; Matsuoka, Shin ; Bartholmai, Brian Jack ; Hatabu, Hiroto ; Silverman, Edwin K. ; Washko, George R. / Airway count and emphysema assessed by chest CT imaging predicts clinical outcome in smokers. In: Chest. 2010 ; Vol. 138, No. 4. pp. 880-887.
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abstract = "Background: Recently, it has been shown that emphysematous destruction of the lung is associated with a decrease in the total number of terminal bronchioles. It is unknown whether a similar decrease is visible in the more proximal airways. We aimed to assess the relationships between proximal airway count, CT imaging measures of emphysema, and clinical prognostic factors in smokers, and to determine whether airway count predicts the BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Methods: In 50 smokers, emphysema was measured on CT scans and airway branches from the third to eighth generations of the right upper lobe apical bronchus were counted manually. The sum of airway branches from the sixth to eighth generations represented the total airway count (TAC). For each subject, the BODE index was determined. We used logistic regression to assess the ability of TAC to predict a high BODE index (≥ 7 points). Results: TAC was inversely associated with emphysema (r = -0.54, P < .0001). TAC correlated with the modified Medical Research Council dyspnea score (r = -0.42, P = .004), FEV1{\%} predicted (r = 0.52, P = .0003), 6-min walk distance (r = 0.36, P = .012), and BODE index (r = -0.55, P < .0001). The C-statistics, which correspond to the area under the receiver operating characteristic curve, for the ability of TAC alone and TAC, emphysema, and age to predict a high BODE index were 0.84 and 0.92, respectively. Conclusions: TAC is lower in subjects with greater emphysematous destruction and is a predictor of a high BODE index. These results suggest that CT imaging-based TAC may be a unique COPD-related phenotype in smokers.",
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AU - Diaz, Alejandro A.

AU - Valim, Clarissa

AU - Yamashiro, Tsuneo

AU - Estépar, Raúl San José

AU - Ross, James C.

AU - Matsuoka, Shin

AU - Bartholmai, Brian Jack

AU - Hatabu, Hiroto

AU - Silverman, Edwin K.

AU - Washko, George R.

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N2 - Background: Recently, it has been shown that emphysematous destruction of the lung is associated with a decrease in the total number of terminal bronchioles. It is unknown whether a similar decrease is visible in the more proximal airways. We aimed to assess the relationships between proximal airway count, CT imaging measures of emphysema, and clinical prognostic factors in smokers, and to determine whether airway count predicts the BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Methods: In 50 smokers, emphysema was measured on CT scans and airway branches from the third to eighth generations of the right upper lobe apical bronchus were counted manually. The sum of airway branches from the sixth to eighth generations represented the total airway count (TAC). For each subject, the BODE index was determined. We used logistic regression to assess the ability of TAC to predict a high BODE index (≥ 7 points). Results: TAC was inversely associated with emphysema (r = -0.54, P < .0001). TAC correlated with the modified Medical Research Council dyspnea score (r = -0.42, P = .004), FEV1% predicted (r = 0.52, P = .0003), 6-min walk distance (r = 0.36, P = .012), and BODE index (r = -0.55, P < .0001). The C-statistics, which correspond to the area under the receiver operating characteristic curve, for the ability of TAC alone and TAC, emphysema, and age to predict a high BODE index were 0.84 and 0.92, respectively. Conclusions: TAC is lower in subjects with greater emphysematous destruction and is a predictor of a high BODE index. These results suggest that CT imaging-based TAC may be a unique COPD-related phenotype in smokers.

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