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Observational Study
. 2019 Dec 30;14(12):e0227141.
doi: 10.1371/journal.pone.0227141. eCollection 2019.

Longitudinal Changes in Structural Lung Abnormalities Using MDCT in Chronic Obstructive Pulmonary Disease With Asthma-Like Features

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Free PMC article
Observational Study

Longitudinal Changes in Structural Lung Abnormalities Using MDCT in Chronic Obstructive Pulmonary Disease With Asthma-Like Features

Rie Anazawa et al. PLoS One. .
Free PMC article

Abstract

Background: Some patients with chronic obstructive pulmonary disease (COPD) have asthma-like features. However, there have been few reports on the structural lung abnormalities found in this patient population. Multi-detector computed tomography (MDCT) can detect emphysematous low-attenuation areas (LAA) within the lung, airway thickness (wall area percentage, WA%), and the loss of pulmonary vasculature as the percentage of small pulmonary vessels with cross-sectional area (CSA) less than 5 mm2 (%CSA<5). We analyzed differences in structural lung changes over time between patients with COPD and those with COPD with asthma-like features using these CT parameters.

Material and methods: We performed pulmonary function tests (PFTs), MDCT, and a COPD assessment test (CAT) in 50 patients with COPD and 29 patients with COPD with asthma-like features at the time of enrollment and two years later. We analyzed changes in clinical parameters and CT indices over time and evaluated differences in structural changes between groups.

Results: The CAT score and FEV1 did not significantly change during the follow-up period in either group. Emphysematous LAA regions significantly increased in both groups. The %CSA<5 showed a small but significant increase in COPD patients, but a significant decrease in patients with COPD with asthma-like features. The WA% at the distal bronchi was significantly decreased in COPD, but did not significantly change in COPD with asthma -like features.

Conclusion: Emphysematous LAA increased in patients with COPD with and without asthma-like features. The %CSA<5 and WA% at the distal bronchi did not change in parallel with LAA. Furthermore, changes in %CSA<5 were significantly different between patients with COPD and those with COPD with asthma-like features. Patients with COPD with asthma-like features may have different longitudinal structural changes than those seen in COPD patients.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the study participants.
Fig 2
Fig 2. Changes in radiological parameters over two years of follow-up.
Notes: Radiological parameters were compared between enrollment and two-year follow-up with the Wilcoxon signed-rank test. WA% shows the mean wall area percentage at the 5th generation of bronchi. The thick horizontal bars at the sides of each graph show the median, while the thin horizontal bars at the sides of each graph show the interquartile range. Abbreviations: ALF, asthma-like features; LAA, low-attenuation area; CSA<5, the cross-sectional area of pulmonary vessels < 5 mm2; WA%, wall area percentage; NS, not significant.

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Grant support

NK recieved the grants from the Ministry of Education, Science, Sports and Culture, Grant-in-Aid for Scientific Research (C) (16K01407,19K12816), the Chiba Foundation for Health Promotion & Disease Prevention(No.1272). KT recieved the grants from the Respiratory Failure Research Group (H26-Intractable diseases-General-076) from the Ministry of Health, Labour and Welfare, Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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