A Comparison Between Clinical, Roentgenologic, Functional and Morphologic Criteria in Chronic Bronchitis, Emphysema, Asthma and Bronchiectasis

Thurlbeck, William M.; Henderson, John; Fraser, Robert G.; Bates, David V.

doi:10.1097/00005792-197003000-00001

Cited by 188 publications

(68 citation statements)

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“…Indeed, it has previously been suggested that loss of alveolar capillary bed surface area may contribute to the elevation of pulmonary arterial pressure associated with severe emphysema [25]. tests in COPD, a previous study of 33 patients addressed whether pulmonary artery end diastolic pressure estimated echocardiographically correlated with pulmonary function indices and found a correlation with KCO but not Pa,O 2 [26].…”

Section: Discussionmentioning

confidence: 99%

Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD

Higham¹,

Dawson²,

Joshi³

et al. 2001

Eur Respir J

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Studies have confirmed the close correlation of echocardiographically estimated pulmonary arterial pressure with invasive measurements in patients with chronic obstructive pulmonary disease (COPD), but there are few data on utility of echocardiographic measurement in assessing pulmonary arterial hypertension (PH) in COPD and correlation with pulmonary function tests.Presence or absence of tricuspid regurgitation (TR) was determined by Doppler echocardiography in 73 consecutive COPD patients attending a hospital outpatient clinic. Transtricuspid pressure gradient (TTPG) was calculated. PH was defined as TTPG ¢30 mmHg. Patients also underwent spirometry, forced expiratory volume in one second (FEV1), single breath gas transfer (carbon monoxide transfer coefficient; (KCO) and carbon monoxide diffusing capacity of the lung; DL,CO) and arterial blood gas measurement.Measurable TR was observed in 56/73 patients (77%). There were no differences between the group in which TR was observed compared to that in which it was absent, with regard to age, smoking history nor pulmonary function variables. PH was seen in 31/56 cases (55%), with good reproducibility. There were statistically significant correlations of TTPG with FEV1 (r~-0.26, p~0.05), KCO (r~-0.31, p~0.04) and DL,CO (r~-0.42, p~0.006) expressed as % pred. Stepwise regression analysis showed that age and KCO combined provide a multivariate model for prediction of TTPG.It is concluded the presence and degree of pulmonary arterial hypertension is readily and reliably determined by echocardiography in the majority of chronic obstructive pulmonary disease patients. Pulmonary arterial hypertension is common in severe chronic obstructive pulmonary disease and transtricuspid pressure gradient correlates with spirometry and indices of gas transfer, similar to previous invasive studies. In view of the adverse effects of pulmonary arterial hypertension on morbidity and mortality routine echocardiography in patients with severe chronic obstructive pulmonary disease may be warranted. Eur Respir J 2001; 17: 350-355.

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Section: Discussionmentioning

confidence: 99%

Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD

Higham¹,

Dawson²,

Joshi³

et al. 2001

Eur Respir J

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“…Emphysema is a chronic disorder of the lower respiratory tract characterized by destruction of the walls of the alveoli (1,2). When sufficient numbers of alveoli are involved, affected individuals develop dyspnea and hypoxemia that worsen with exertion (2, 3).…”

Section: Introductionmentioning

confidence: 99%

Risk factors for emphysema. Cigarette smoking is associated with a reduction in the association rate constant of lung alpha 1-antitrypsin for neutrophil elastase.

Ogushi¹,

Hubbard²,

Vogelmeier³

et al. 1991

J. Clin. Invest.

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The increased risk of developing emphysema among individuals who smoke cigarettes and who have normal levels of alantitrypsin (a1AT) is hypothesized to result from a decrease in the antineutrophil elastase capacity of the lower respiratory tract alAT of smokers compared with nonsmokers. To evaluate this hypothesis we compared the time-dependent kinetics of the inhibition of neutrophil elastase by lung alAT from healthy, young cigarette smokers (n = 8) and nonsmokers (n = 12). al-antitrypsin was purified from lavage fluid using affinity and molecular sieve chromatography, and the association rate constant (k assoc) for neutrophil elastase quantified. The k assoc of smoker plasma alAT (9.5±0.5 X 106 M-ls-1) was similar to that of nonsmoker plasma (9.3±0.7 x 106 M-1s-1, P > 0.5). In marked contrast, the k assoc ofsmoker lower respiratory tract alAT was significantly lower than that of nonsmoker alAT (6.5±0.4 X 106 M-1s-1 vs. 8.1±0.5 X 106 M's-', P < 0.01). Furthermore, the smoker lower respiratory tract alAT k assoc was significantly less than that of autologous plasma (P < 0.01). When considered in the context of the concentration of alAT in the lower respiratory tract epithelial lining fluid, the inhibition time for neutrophil elastase of smoker lung alAT was twofold greater than that of nonsmoker lung alAT (smoker: 0.34±0.05 s vs. nonsmoker: 0.17±0.05 s, P < 0.01). Consequently, for concentrations of alAT in the lower respiratory tract it takes twice as long for an equivalent amount of neutrophil elastase to be inhibited in the smoker's lung compared with the nonsmoker's lung. These observations support the concept that cigarette smoking is associated with a decrease in the lower respiratory tract neutrophil elastase inhibitory capacity, thus increasing the vulnerability of the lung to elastolytic destruction and thereby increasing the risk for the development of emphysema. (J. Clin.

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“…Although other radiographic parameters such as lung length and retrosternal lucency are also correlated with a COPD diagnosis, we chose the height of the right diaphragmatic arc based on the results of Reich et al, 15 the greater dependence of other parameters (such as lung length) on the subject's morphometry (such as height), and studies showing diaphragm flattening as having a better correlation with postmortem changes in emphysema. 33 For instance, in our study, an ROC analysis showed that the lung length (distance from the tubercle of the first rib to the top of the dome of the right diaphragm on a posteriorto-anterior chest projection) did not predict adherence (area under the curve of 0.49, P ϭ .91) and that lung length significantly correlated with the subject's height (r ϭ 0.46, P Ͻ .01).…”

Section: Discussionmentioning

confidence: 48%

Hyperinflation on Chest Radiograph as a Marker of Low Adherence to Positive Airway Pressure Therapy in the Overlap Syndrome

Theerakittikul

Hatipoğlu²,

Aboussouan

2013

Respir Care

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BACKGROUND: Positive airway pressure (PAP) in subjects with both obstructive sleep apnea and COPD reduces the risk of pulmonary hypertension, death, and hospitalizations from COPD exacerbations, but adherence to the intervention is low, similar to the experience with noninvasive ventilation in stable COPD. We sought to assess whether hyperinflation on chest radiographs contributes to low adherence to PAP therapy in the overlap syndrome. METHODS: Records of patients with a listed diagnosis of COPD at the time of polysomnography were reviewed. Overlap syndrome was diagnosed when COPD was clinically confirmed with spirometry showing a fixed airway obstruction and when the apnea-hypopnea index was > 5. Hyperinflation was evaluated by a review of the right diaphragm height on a lateral chest radiograph. Adherence was assessed clinically or through device download at a 3-month follow-up, and later adherence was assessed by telephone interviews. A receiver operating curve was used to determine whether diaphragm height was associated with adherence. RESULTS: Twenty-one of 41 subjects (51%) were considered adherent to PAP therapy at the 3-month visit. Adherent subjects were more overweight compared with non-adherent subjects (body mass index of 36.0 ؎ 5.7 vs 32.0 ؎ 5.7 kg/m 2 , P ‫؍‬ .03), sleepier at the onset (Epworth sleepiness scale score of 13.0 ؎ 5.8 vs 9.4 ؎ 5.4, P < .05), and less likely to have hyperinflation as defined by a right diaphragm height < 2.45 cm (33% vs 65%, P ‫؍‬ .04). The body mass index and initial sleepiness no longer predicted adherence beyond 3 months, but 35% of subjects with a right diaphragm height < 2.45 cm were adherent beyond 3 months compared with 75% of those with a right diaphragm height > 2.45 cm (P ‫؍‬ .04 by Fisher exact test). CONCLUSIONS: Hyperinflation is associated with decreased adherence to PAP therapy in the overlap syndrome.

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A Comparison Between Clinical, Roentgenologic, Functional and Morphologic Criteria in Chronic Bronchitis, Emphysema, Asthma and Bronchiectasis

Cited by 188 publications

References 0 publications

Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD

Utility of echocardiography in assessment of pulmonary hypertension secondary to COPD

Risk factors for emphysema. Cigarette smoking is associated with a reduction in the association rate constant of lung alpha 1-antitrypsin for neutrophil elastase.

Hyperinflation on Chest Radiograph as a Marker of Low Adherence to Positive Airway Pressure Therapy in the Overlap Syndrome

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