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CT-diagnosed emphysema and prognosis of chronic airflow obstruction: a retrospective study.

Kurashima K, Fukuda C, Nakamoto K, Takaku Y, Hijikata N, Hoshi T, Kanauchi T, Ueda M, Takayanagi N, Sugita Y, Araki R - BMJ Open (2013)

Bottom Line: Retrospective cohort study.Each subgroup had distinct prognostic factors.Presence of emphysema was an independent risk factor for de novo lung cancer among patients with CAO.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.

ABSTRACT

Objective: CT-diagnosed emphysema is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Its clinical impacts on prognoses of asthma with chronic airflow obstruction (CAO) are not well known. We sought to compare mortalities and prognostic factors in COPD and asthma with CAO by the presence or absence of CT-diagnosed emphysema.

Design: Retrospective cohort study.

Setting: Referral centre hospital for respiratory disease.

Participants: 1272 patients aged over 40 years with CAO (January 2000 to December 2011). CAO was defined as a forced expiratory volume in 1 s/forced vital capacity <0.7 after bronchodilator use throughout the observation period.

Primary and secondary outcome measurements: Overall mortality served as the primary endpoint. We compared mortalities and prognostic factors of COPD and asthma subgroups with or without emphysema. Secondary endpoints were the prevalence of COPD and asthma in patients with CAO.

Results: Overall, diagnoses included COPD with emphysema in 517 (40.6%) patients, COPD without emphysema in 104 (8.2%) patients, asthma with emphysema in 178 (13.9%) patients, asthma without emphysema in 169 (13.3%) patients, other respiratory diseases (RD) with emphysema in 128 (10.1%) patients, and other RD without emphysema in 176 (13.8%) patients. Patients with asthma without emphysema had the best prognosis followed by those with asthma with emphysema, COPD without emphysema and COPD with emphysema. Each subgroup had distinct prognostic factors. Presence of emphysema was an independent risk factor for de novo lung cancer among patients with CAO.

Conclusions: Patients with asthma with CAO have a better prognosis than patients with COPD. The presence of CT-diagnosed emphysema predicts poor prognosis in COPD and asthma with CAO.

No MeSH data available.


Related in: MedlinePlus

Phenotypes of chronic airflow obstruction (CAO). CAO was defined as postbronchodilator FEV1/FVC<0.7 throughout the observation period. Patients were classified by the high-resolution CT findings of emphysema and other clinical examinations. FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; RD, respiratory diseases.
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BMJOPEN2013003541F1: Phenotypes of chronic airflow obstruction (CAO). CAO was defined as postbronchodilator FEV1/FVC<0.7 throughout the observation period. Patients were classified by the high-resolution CT findings of emphysema and other clinical examinations. FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; RD, respiratory diseases.

Mentions: All deaths were classified into the following five groups: (1) primary RD, (2) lung cancer, (3) malignancy other than lung cancer, (4) respiratory infectious diseases and (5) other or unknown. The HRCT study was ordered by the chest physician in charge for a closer examination of symptoms or evaluation of the diseases. The algorithm used to classify CAO is shown in online supplementary figure S1. All tests involved in the study were taken in a stable phase, with no evidence of any exacerbations for at least 6 weeks. HRCT images obtained within 6 months of the initiation time were considered acceptable for the evaluation. Medications used from the start of the observation period were also recorded.


CT-diagnosed emphysema and prognosis of chronic airflow obstruction: a retrospective study.

Kurashima K, Fukuda C, Nakamoto K, Takaku Y, Hijikata N, Hoshi T, Kanauchi T, Ueda M, Takayanagi N, Sugita Y, Araki R - BMJ Open (2013)

Phenotypes of chronic airflow obstruction (CAO). CAO was defined as postbronchodilator FEV1/FVC<0.7 throughout the observation period. Patients were classified by the high-resolution CT findings of emphysema and other clinical examinations. FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; RD, respiratory diseases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3822307&req=5

BMJOPEN2013003541F1: Phenotypes of chronic airflow obstruction (CAO). CAO was defined as postbronchodilator FEV1/FVC<0.7 throughout the observation period. Patients were classified by the high-resolution CT findings of emphysema and other clinical examinations. FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; RD, respiratory diseases.
Mentions: All deaths were classified into the following five groups: (1) primary RD, (2) lung cancer, (3) malignancy other than lung cancer, (4) respiratory infectious diseases and (5) other or unknown. The HRCT study was ordered by the chest physician in charge for a closer examination of symptoms or evaluation of the diseases. The algorithm used to classify CAO is shown in online supplementary figure S1. All tests involved in the study were taken in a stable phase, with no evidence of any exacerbations for at least 6 weeks. HRCT images obtained within 6 months of the initiation time were considered acceptable for the evaluation. Medications used from the start of the observation period were also recorded.

Bottom Line: Retrospective cohort study.Each subgroup had distinct prognostic factors.Presence of emphysema was an independent risk factor for de novo lung cancer among patients with CAO.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.

ABSTRACT

Objective: CT-diagnosed emphysema is associated with poor prognosis in chronic obstructive pulmonary disease (COPD). Its clinical impacts on prognoses of asthma with chronic airflow obstruction (CAO) are not well known. We sought to compare mortalities and prognostic factors in COPD and asthma with CAO by the presence or absence of CT-diagnosed emphysema.

Design: Retrospective cohort study.

Setting: Referral centre hospital for respiratory disease.

Participants: 1272 patients aged over 40 years with CAO (January 2000 to December 2011). CAO was defined as a forced expiratory volume in 1 s/forced vital capacity <0.7 after bronchodilator use throughout the observation period.

Primary and secondary outcome measurements: Overall mortality served as the primary endpoint. We compared mortalities and prognostic factors of COPD and asthma subgroups with or without emphysema. Secondary endpoints were the prevalence of COPD and asthma in patients with CAO.

Results: Overall, diagnoses included COPD with emphysema in 517 (40.6%) patients, COPD without emphysema in 104 (8.2%) patients, asthma with emphysema in 178 (13.9%) patients, asthma without emphysema in 169 (13.3%) patients, other respiratory diseases (RD) with emphysema in 128 (10.1%) patients, and other RD without emphysema in 176 (13.8%) patients. Patients with asthma without emphysema had the best prognosis followed by those with asthma with emphysema, COPD without emphysema and COPD with emphysema. Each subgroup had distinct prognostic factors. Presence of emphysema was an independent risk factor for de novo lung cancer among patients with CAO.

Conclusions: Patients with asthma with CAO have a better prognosis than patients with COPD. The presence of CT-diagnosed emphysema predicts poor prognosis in COPD and asthma with CAO.

No MeSH data available.


Related in: MedlinePlus