Emphysema- and airway-dominant COPD phenotypes defined by standardised quantitative computed tomography

Deepak R. Subramanian, Sumit Gupta, Dorothe Burggraf, Suzan J. Vom Silberberg, Irene Heimbeck, Marion S. Heiss-Neumann, Karl Haeussinger, Chris Newby, Beverley Hargadon, Vimal Raj, Dave Singh, Umme Kolsum, Thomas P. Hofer, Khaled Al-Shair, Niklas Luetzen, Antje Prasse, Joachim Müller-Quernheim, Giorgio Benea, Stefano Leprotti, Piera BoschettoDorota Gorecka, Adam Nowinski, Karina Oniszh, Wolfgang Zu Castell, Michael Hagen, Imre Barta, Balázs Döme, Janos Strausz, Timm Greulich, Claus Vogelmeier, Andreas R. Koczulla, Ivo Gut, Jens Hohlfeld, Tobias Welte, Mahyar Lavae-Mokhtari, Loems Ziegler-Heitbrock, Christopher Brightling, David G. Parr

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Abstract

EvA (Emphysema versus Airway disease) is a multicentre project to study mechanisms and identify biomarkers of emphysema and airway disease in chronic obstructive pulmonary disease (COPD). The objective of this study was to delineate objectively imaging-based emphysema-dominant and airway disease-dominant phenotypes using quantitative computed tomography (QCT) indices, standardised with a novel phantom-based approach. 441 subjects with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-3) were assessed in terms of clinical and physiological measurements, laboratory testing and standardised QCT indices of emphysema and airway wall geometry. QCT indices were influenced by scanner non-conformity, but standardisation significantly reduced variability (p<0.001) and led to more robust phenotypes. Four imaging-derived phenotypes were identified, reflecting "emphysema-dominant", "airway disease-dominant", "mixed" disease and "mild" disease. The emphysema-dominant group had significantly higher lung volumes, lower gas transfer coefficient, lower oxygen (PO2) and carbon dioxide (PCO2) tensions, higher haemoglobin and higher blood leukocyte numbers than the airway disease-dominant group. The utility of QCT for phenotyping in the setting of an international multicentre study is improved by standardisation. QCT indices of emphysema and airway disease can delineate within a population of patients with COPD, phenotypic groups that have typical clinical features known to be associated with emphysema-dominant and airway-dominant disease.

Original languageEnglish
Pages (from-to)92-103
Number of pages12
JournalEuropean Respiratory Journal
Volume48
Issue number1
DOIs
Publication statusPublished - Jul 1 2016

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Subramanian, D. R., Gupta, S., Burggraf, D., Vom Silberberg, S. J., Heimbeck, I., Heiss-Neumann, M. S., Haeussinger, K., Newby, C., Hargadon, B., Raj, V., Singh, D., Kolsum, U., Hofer, T. P., Al-Shair, K., Luetzen, N., Prasse, A., Müller-Quernheim, J., Benea, G., Leprotti, S., ... Parr, D. G. (2016). Emphysema- and airway-dominant COPD phenotypes defined by standardised quantitative computed tomography. European Respiratory Journal, 48(1), 92-103. https://doi.org/10.1183/13993003.01878-2015