Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study
Abstract Background Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined...
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| creator | Smith, Benjamin M., MD, MS Austin, John H.M., MD Newell, John D., MD D'Souza, Belinda M., MD Rozenshtein, Anna, MD Hoffman, Eric A., PhD Ahmed, Firas, MD, MPH Barr, R. Graham, MD, DrPH |
| description | Abstract Background Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics. Methods The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with chronic obstructive pulmonary disease (COPD) and controls ages 50-79 years with ≥10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal, and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines. Results Twenty-seven percent of 318 smokers had emphysema on CT. Interrater reliability of emphysema subtype was substantial (K: 0.70). Compared with participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with paraseptal emphysema were similar to controls, except for male predominance. Centrilobular, but not panlobular or paraseptal, emphysema was associated with greater smoking history (+21 pack-years P |
| doi_str_mv | 10.1016/j.amjmed.2013.09.020 |
| format | Article |
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Graham, MD, DrPH</creator><creatorcontrib>Smith, Benjamin M., MD, MS ; Austin, John H.M., MD ; Newell, John D., MD ; D'Souza, Belinda M., MD ; Rozenshtein, Anna, MD ; Hoffman, Eric A., PhD ; Ahmed, Firas, MD, MPH ; Barr, R. Graham, MD, DrPH</creatorcontrib><description>Abstract Background Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics. Methods The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with chronic obstructive pulmonary disease (COPD) and controls ages 50-79 years with ≥10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal, and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines. Results Twenty-seven percent of 318 smokers had emphysema on CT. Interrater reliability of emphysema subtype was substantial (K: 0.70). Compared with participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with paraseptal emphysema were similar to controls, except for male predominance. Centrilobular, but not panlobular or paraseptal, emphysema was associated with greater smoking history (+21 pack-years P <.001). Panlobular, but not other types of emphysema, was associated with reduced body mass index (−5 kg/m2 ; P = .01). Other than for dyspnea, these findings were independent of the forced expiratory volume in 1 second. Seventeen percent of smokers without COPD on spirometry had emphysema, which was independently associated with reduced walk distance. Conclusions Emphysema subtypes on CT are common in smokers with and without COPD. Centrilobular and panlobular emphysema, but not paraseptal emphysema, have considerable symptomatic and physiological consequences.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2013.09.020</identifier><identifier>PMID: 24384106</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Centrilobular ; Chronic obstructive pulmonary disease ; Computed tomography ; Dyspnea - etiology ; Emphysema ; Exercise Tolerance ; Female ; Humans ; Internal Medicine ; Lung - diagnostic imaging ; Lung - pathology ; Lung - physiopathology ; Male ; Middle Aged ; Observer Variation ; Panlobular ; Paraseptal ; Pulmonary Disease, Chronic Obstructive - complications ; Pulmonary Disease, Chronic Obstructive - diagnostic imaging ; Pulmonary Disease, Chronic Obstructive - pathology ; Pulmonary Disease, Chronic Obstructive - physiopathology ; Pulmonary Emphysema - complications ; Pulmonary Emphysema - diagnostic imaging ; Pulmonary Emphysema - etiology ; Pulmonary Emphysema - pathology ; Pulmonary Emphysema - physiopathology ; Respiratory Function Tests ; Severity of Illness Index ; Spirometry ; Tomography ; Tomography, X-Ray Computed ; Walking</subject><ispartof>The American journal of medicine, 2014, Vol.127 (1), p.94.e7-94.e23</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Jan 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c491t-75bef375066bebb0464d0dc9c6de94598f0948e3c1b705a83da349fac8c7e32f3</citedby><cites>FETCH-LOGICAL-c491t-75bef375066bebb0464d0dc9c6de94598f0948e3c1b705a83da349fac8c7e32f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjmed.2013.09.020$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,4010,27904,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24384106$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Benjamin M., MD, MS</creatorcontrib><creatorcontrib>Austin, John H.M., MD</creatorcontrib><creatorcontrib>Newell, John D., MD</creatorcontrib><creatorcontrib>D'Souza, Belinda M., MD</creatorcontrib><creatorcontrib>Rozenshtein, Anna, MD</creatorcontrib><creatorcontrib>Hoffman, Eric A., PhD</creatorcontrib><creatorcontrib>Ahmed, Firas, MD, MPH</creatorcontrib><creatorcontrib>Barr, R. Graham, MD, DrPH</creatorcontrib><title>Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>Abstract Background Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics. Methods The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with chronic obstructive pulmonary disease (COPD) and controls ages 50-79 years with ≥10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal, and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines. Results Twenty-seven percent of 318 smokers had emphysema on CT. Interrater reliability of emphysema subtype was substantial (K: 0.70). Compared with participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with paraseptal emphysema were similar to controls, except for male predominance. Centrilobular, but not panlobular or paraseptal, emphysema was associated with greater smoking history (+21 pack-years P <.001). Panlobular, but not other types of emphysema, was associated with reduced body mass index (−5 kg/m2 ; P = .01). Other than for dyspnea, these findings were independent of the forced expiratory volume in 1 second. Seventeen percent of smokers without COPD on spirometry had emphysema, which was independently associated with reduced walk distance. Conclusions Emphysema subtypes on CT are common in smokers with and without COPD. Centrilobular and panlobular emphysema, but not paraseptal emphysema, have considerable symptomatic and physiological consequences.</description><subject>Aged</subject><subject>Centrilobular</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Computed tomography</subject><subject>Dyspnea - etiology</subject><subject>Emphysema</subject><subject>Exercise Tolerance</subject><subject>Female</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Lung - diagnostic imaging</subject><subject>Lung - pathology</subject><subject>Lung - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observer Variation</subject><subject>Panlobular</subject><subject>Paraseptal</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Pulmonary Disease, Chronic Obstructive - diagnostic imaging</subject><subject>Pulmonary Disease, Chronic Obstructive - pathology</subject><subject>Pulmonary Disease, Chronic Obstructive - physiopathology</subject><subject>Pulmonary Emphysema - complications</subject><subject>Pulmonary Emphysema - diagnostic imaging</subject><subject>Pulmonary Emphysema - etiology</subject><subject>Pulmonary Emphysema - pathology</subject><subject>Pulmonary Emphysema - physiopathology</subject><subject>Respiratory Function Tests</subject><subject>Severity of Illness Index</subject><subject>Spirometry</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed</subject><subject>Walking</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFq3DAQhkVoSTZJ36AUQy-92B1Zsmz1UAjbTVNISGC3ZyHL48aubTmSXfDbV2YTCrn0JAZ984_0DSHvKSQUqPjcJrpve6ySFChLQCaQwgnZ0CzL4pyK9A3ZAEAaS8bZGTn3vg0lyEyckrOUs4JTEBty8zB3vR20W6JdPz4uHnsd7edyWkb0kR2ire3HecIqOtje_nI6MF-iwyNGd7v9VbS9f_gW7ae5Wi7J21p3Ht89nxfk5_XusL2Jb--__9he3caGSzrFeVZizfIMhCixLIELXkFlpBEVSp7JogbJC2SGljlkumCVZlzW2hQmR5bW7IJ8OuaOzj7N6CfVN95g1-kB7ewV5RJyoCnkAf34Cm3t7IbwukDlRSqAMREofqSMs947rNXomj4IURTUalq16mharaYVSBVMh7YPz-Fzud69NL2oDcDXI4DBxp8GnfKmwcFg1Tg0k6ps878JrwNM1wyN0d1vXND_-4vyqQK1X7e9LpsygIJzyf4ClYSjlw</recordid><startdate>2014</startdate><enddate>2014</enddate><creator>Smith, Benjamin M., MD, MS</creator><creator>Austin, John H.M., MD</creator><creator>Newell, John D., MD</creator><creator>D'Souza, Belinda M., MD</creator><creator>Rozenshtein, Anna, MD</creator><creator>Hoffman, Eric A., PhD</creator><creator>Ahmed, Firas, MD, MPH</creator><creator>Barr, R. Graham, MD, DrPH</creator><general>Elsevier Inc</general><general>Elsevier Sequoia S.A</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>2014</creationdate><title>Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study</title><author>Smith, Benjamin M., MD, MS ; Austin, John H.M., MD ; Newell, John D., MD ; D'Souza, Belinda M., MD ; Rozenshtein, Anna, MD ; Hoffman, Eric A., PhD ; Ahmed, Firas, MD, MPH ; Barr, R. Graham, MD, DrPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c491t-75bef375066bebb0464d0dc9c6de94598f0948e3c1b705a83da349fac8c7e32f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Centrilobular</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Computed tomography</topic><topic>Dyspnea - etiology</topic><topic>Emphysema</topic><topic>Exercise Tolerance</topic><topic>Female</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Lung - diagnostic imaging</topic><topic>Lung - pathology</topic><topic>Lung - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Observer Variation</topic><topic>Panlobular</topic><topic>Paraseptal</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Pulmonary Disease, Chronic Obstructive - diagnostic imaging</topic><topic>Pulmonary Disease, Chronic Obstructive - pathology</topic><topic>Pulmonary Disease, Chronic Obstructive - physiopathology</topic><topic>Pulmonary Emphysema - complications</topic><topic>Pulmonary Emphysema - diagnostic imaging</topic><topic>Pulmonary Emphysema - etiology</topic><topic>Pulmonary Emphysema - pathology</topic><topic>Pulmonary Emphysema - physiopathology</topic><topic>Respiratory Function Tests</topic><topic>Severity of Illness Index</topic><topic>Spirometry</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed</topic><topic>Walking</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Benjamin M., MD, MS</creatorcontrib><creatorcontrib>Austin, John H.M., MD</creatorcontrib><creatorcontrib>Newell, John D., MD</creatorcontrib><creatorcontrib>D'Souza, Belinda M., MD</creatorcontrib><creatorcontrib>Rozenshtein, Anna, MD</creatorcontrib><creatorcontrib>Hoffman, Eric A., PhD</creatorcontrib><creatorcontrib>Ahmed, Firas, MD, MPH</creatorcontrib><creatorcontrib>Barr, R. Graham, MD, DrPH</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Benjamin M., MD, MS</au><au>Austin, John H.M., MD</au><au>Newell, John D., MD</au><au>D'Souza, Belinda M., MD</au><au>Rozenshtein, Anna, MD</au><au>Hoffman, Eric A., PhD</au><au>Ahmed, Firas, MD, MPH</au><au>Barr, R. Graham, MD, DrPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2014</date><risdate>2014</risdate><volume>127</volume><issue>1</issue><spage>94.e7</spage><epage>94.e23</epage><pages>94.e7-94.e23</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>Abstract Background Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics. Methods The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with chronic obstructive pulmonary disease (COPD) and controls ages 50-79 years with ≥10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal, and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines. Results Twenty-seven percent of 318 smokers had emphysema on CT. Interrater reliability of emphysema subtype was substantial (K: 0.70). Compared with participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with paraseptal emphysema were similar to controls, except for male predominance. Centrilobular, but not panlobular or paraseptal, emphysema was associated with greater smoking history (+21 pack-years P <.001). Panlobular, but not other types of emphysema, was associated with reduced body mass index (−5 kg/m2 ; P = .01). Other than for dyspnea, these findings were independent of the forced expiratory volume in 1 second. Seventeen percent of smokers without COPD on spirometry had emphysema, which was independently associated with reduced walk distance. Conclusions Emphysema subtypes on CT are common in smokers with and without COPD. Centrilobular and panlobular emphysema, but not paraseptal emphysema, have considerable symptomatic and physiological consequences.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24384106</pmid><doi>10.1016/j.amjmed.2013.09.020</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Centrilobular Chronic obstructive pulmonary disease Computed tomography Dyspnea - etiology Emphysema Exercise Tolerance Female Humans Internal Medicine Lung - diagnostic imaging Lung - pathology Lung - physiopathology Male Middle Aged Observer Variation Panlobular Paraseptal Pulmonary Disease, Chronic Obstructive - complications Pulmonary Disease, Chronic Obstructive - diagnostic imaging Pulmonary Disease, Chronic Obstructive - pathology Pulmonary Disease, Chronic Obstructive - physiopathology Pulmonary Emphysema - complications Pulmonary Emphysema - diagnostic imaging Pulmonary Emphysema - etiology Pulmonary Emphysema - pathology Pulmonary Emphysema - physiopathology Respiratory Function Tests Severity of Illness Index Spirometry Tomography Tomography, X-Ray Computed Walking |
| title | Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study |
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