Unfolding the mechanisms of progression of pulmonary emphysema in COPD

Pellegrino, Riccardo; Antonelli, Andrea

doi:10.1183/09031936.00030112

Cited by 5 publications

(3 citation statements)

References 27 publications

(18 reference statements)

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“…These mechanical factors are believed to be the start of an unstoppable cascade of increasing tissue destruction. A recent editorial addressed this as an important step in the understanding of emphysema progression [8]. Therefore, if inflammation is the only cause of emphysema progression this should be a function of the length of smoking cessation: none to minimal in subjects who stopped smoking a long time ago and strong in current smokers.…”

Section: Introductionmentioning

confidence: 99%

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study

Hoesein¹,

Zanen²,

Jong³

et al. 2013

Respiratory Research

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BackgroundLittle is known about the factors associated with CT-quantified emphysema progression in heavy smokers. The objective of this study was to investigate the effect of length of smoking cessation and clinical / demographical factors on the rate of emphysema progression and FEV1-decline in male heavy smokers.Methods3,670 male smokers with mean (SD) 40.8 (17.9) packyears underwent chest CT scans and pulmonary function tests at baseline and after 1 and 3 years follow-up. Smoking status (quitted ≥5, ≥1-<5, <1 years or current smoker) was noted. Rate of progression of emphysema and FEV1-decline after follow-up were assessed by analysis of variance adjusting for age, height, baseline pulmonary function and emphysema severity, packyears, years in study and respiratory symptoms. The quitted ≥5 group was used as reference.ResultsMedian (Q1-Q3) emphysema severity,<-950 HU, was 8.8 (5.1 – 14.1) and mean (SD) FEV1 was 3.4 (0.73) L or 98.5 (18.5) % of predicted. The group quitted ‘>5 years’ showed significantly lower rates of progression of emphysema compared to current smokers, 1.07% and 1.12% per year, respectively (p<0.001). Current smokers had a yearly FEV1-decline of 69 ml, while subjects quit smoking >5 years had a yearly decline of 57.5 ml (p<0.001).ConclusionQuit smoking >5 years significantly slows the rate of emphysema progression and lung function decline.Trial registrationRegistered at http://www.trialregister.nl with trial number ISRCTN63545820.

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Section: Introductionmentioning

confidence: 99%

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study

Hoesein¹,

Zanen²,

Jong³

et al. 2013

Respiratory Research

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“…Furthermore, smoking-induced emphysema was also commonly observed in upper lung lobes. It was reported that higher mechanical stress and more negative intrapleural pressures during inhalation in the upper lung lobes may result in the high distribution of emphysema in the upper lung lobes [ 16 , 17 ]. Nevertheless, further studies should be performed to clarify this association.…”

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confidence: 99%

Higher alveolar deposition of particulate matter in emphysematous lobes of COPD

Tùng

et al. 2021

ERJ Open Res

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Emphysema can be examined quantitatively on high-resolution computed tomography (HRCT) by measuring the low-attenuation areas of the lung and has been associated with decrease in lung function in patients with COPD [1]. Previous studies have associated levels of air pollution with emphysema severity of the total lung [2, 3]. However, the relationship between inhaled particulate matter (PM) deposition in the lungs and the degree of emphysema at the lung lobar level remains poorly understood. We examined the association of lung lobe-deposited doses of PM 2.5 (particles with a 50% cut-off aerodynamic diameter of 2.5 μm) with the extent of emphysema in different lung lobes of COPD subjects.

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“…Meanwhile, the decrease in the lymphatic drainage in the upper lobes due to gravity could result in a decline in particle clearance, thus facilitating the development of emphysema (18,63). Furthermore, the higher mechanical stress and more intrapleural pressures in the upper lung lobes may also result in the high distribution of emphysema in the upper lung lobes (65)(66)(67). However, this needs further investigations in future studies.…”

Section: Discussionmentioning

confidence: 99%

Association Between Air Pollution and Lung Lobar Emphysema in COPD

Tùng

et al. 2021

Front. Med.

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The development of emphysema has been linked to air pollution; however, the association of air pollution with the extent of lobar emphysema remains unclear. This study examined the association of particulate matter <2.5 μm in aerodynamic diameters (PM2.5) (≤2.5 μm), nitrogen dioxide (NO2), and ozone (O3) level of exposure with the presence of emphysema in 86 patients with chronic obstructive pulmonary disease (COPD). Exposure to the air pollution estimated using the land-use regression model was associated with lung function, BODE (a body mass index, degree of obstruction, dyspnea severity, and exercise capacity index) quartiles, and emphysema measured as low-attenuation areas on high-resolution CT (HR-CT) lung scans. Using paraseptal emphysema as the reference group, we observed that a 1 ppb increase in O3 was associated with a 1.798-fold increased crude odds ratio of panlobular emphysema (p < 0.05). We observed that PM2.5 was associated with BODE quartiles, modified Medical Research Council (mMRC) dyspnea score, and exercise capacity (all p < 0.05). We found that PM2.5, NO2, and O3 were associated with an increased degree of upper lobe emphysema and lower lobe emphysema (all p < 0.05). Furthermore, we observed that an increase in PM2.5, NO2, and O3 was associated with greater increases in upper lobe emphysema than in lower lobe emphysema. In conclusion, exposure to O3 can be associated with a higher risk of panlobular emphysema than paraseptal emphysema in patients with COPD. Emphysema severity in lung lobes, especially the upper lobes, may be linked to air pollution exposure in COPD.

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Unfolding the mechanisms of progression of pulmonary emphysema in COPD

Cited by 5 publications

References 27 publications

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study

Rate of progression of CT-quantified emphysema in male current and ex-smokers: a follow-up study

Higher alveolar deposition of particulate matter in emphysematous lobes of COPD

Association Between Air Pollution and Lung Lobar Emphysema in COPD

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