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ObjectiveCT-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.DesignRetrospective cohort study.SettingReferral centre hospital for respiratory disease.Participants1272 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 measurementsOverall 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.ResultsOverall, 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.ConclusionsPatients 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.

AOSD can produce lung involvement. TBLB is useful in the diagnosis of pulmonary lesions.

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A 75-year-old man with chronic gastritis and gastro-esophageal regurgitation syndrome was admitted to our hospital complaining of continuous productive cough, and an abnormal shadow was noted on a chest X-ray film. Chest computed tomography revealed a nodule 2.8 cm in diameter with a regular margin on the right apex. Fiberoptic bronchoscopy was performed, but did not yield a definitive diagnosis. We suspected primary lung cancer, and therefore, lung partial resection was performed under thoracoscopic surgery. The intraoperative pathological findings revealed inflammatory granuloma with necrosis, and pulmonary dirofilariasis was finally diagnosed. Pulmonary dirofilariasis is an important differential diagnosis in elderly patients with a chest abnormal nodular shadow. Lesions have been reportedly observed in the peripheral portion of the right lower lobe in many previous reports. However, in this case, a nodular lesion was noted in the right apex.