Discriminating dominant computed tomography phenotypes in smokers without or with mild COPD

Respir Med. 2014 Jan;108(1):136-43. doi: 10.1016/j.rmed.2013.08.014. Epub 2013 Aug 30.


Background: Finding phenotypes within COPD patients may prove imperative for optimizing treatment and prognosis. We hypothesized that it would be possible to discriminate emphysematous, large airway wall thickening and small airways disease dominant phenotypes.

Methods: Inspiratory and expiratory CTs were performed in 1140 male smokers without or with mild COPD to quantify emphysema, airway wall thickness and air trapping. Spirometry, residual volume to total lung capacity (RV/TLC) and diffusion capacity (Kco) were measured. Dominant phenotype (emphysema, airway wall thickening or air trapping dominant) was defined as one of the respective CT measure in the upper quartile, with the other measures not in the upper quartile.

Results: 573 subjects had any of the three CT measures in the upper quartile. Of these, 367 (64%) were in a single dominant group and 206 (36%) were in a mixed group. Airway wall thickening dominance was associated with younger age (p < 0.001), higher body mass index (p < 0.001), more wheezing (p < 0.05) and lower FEV1 %predicted (p < 0.001). Emphysema dominant subjects had lower FEV1/FVC (p < 0.05) and Kco %predicted (p < 0.05). There was no significant difference in respiratory related hospitalizations (p = 0.09).

Conclusion: CT measures can discriminate three different CT dominant groups of disease in male smokers without or with mild COPD.

Trial registration number: ISRCTN63545820, registered at www.trialregister.nl.

Keywords: Air trapping; Airway wall thickness; Chronic obstructive pulmonary disease; Computed tomography; Emphysema.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Airway Remodeling*
  • Body Mass Index
  • Forced Expiratory Volume
  • Humans
  • Male
  • Middle Aged
  • Phenotype
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / diagnostic imaging*
  • Pulmonary Disease, Chronic Obstructive / etiology
  • Pulmonary Disease, Chronic Obstructive / pathology*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Emphysema / diagnostic imaging
  • Pulmonary Emphysema / pathology
  • Residual Volume
  • Risk Factors
  • Sensitivity and Specificity
  • Smoking / adverse effects*
  • Tomography, X-Ray Computed / methods*
  • Total Lung Capacity