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Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression.

Publication ,  Journal Article
Boueiz, A; Chang, Y; Cho, MH; Washko, GR; San José Estépar, R; Bowler, RP; Crapo, JD; DeMeo, DL; Dy, JG; Silverman, EK; Castaldi, PJ ...
Published in: Chest
January 2018

BACKGROUND: Emphysema has considerable variability in its regional distribution. Craniocaudal emphysema distribution is an important predictor of the response to lung volume reduction. However, there is little consensus regarding how to define upper lobe-predominant and lower lobe-predominant emphysema subtypes. Consequently, the clinical and genetic associations with these subtypes are poorly characterized. METHODS: We sought to identify subgroups characterized by upper-lobe or lower-lobe emphysema predominance and comparable amounts of total emphysema by analyzing data from 9,210 smokers without alpha-1-antitrypsin deficiency in the Genetic Epidemiology of COPD (COPDGene) cohort. CT densitometric emphysema was measured in each lung lobe. Random forest clustering was applied to lobar emphysema variables after regressing out the effects of total emphysema. Clusters were tested for association with clinical and imaging outcomes at baseline and at 5-year follow-up. Their associations with genetic variants were also compared. RESULTS: Three clusters were identified: minimal emphysema (n = 1,312), upper lobe-predominant emphysema (n = 905), and lower lobe-predominant emphysema (n = 796). Despite a similar amount of total emphysema, the lower-lobe group had more severe airflow obstruction at baseline and higher rates of metabolic syndrome compared with subjects with upper-lobe predominance. The group with upper-lobe predominance had greater 5-year progression of emphysema, gas trapping, and dyspnea. Differential associations with known COPD genetic risk variants were noted. CONCLUSIONS: Subgroups of smokers defined by upper-lobe or lower-lobe emphysema predominance exhibit different functional and radiological disease progression rates, and the upper-lobe predominant subtype shows evidence of association with known COPD genetic risk variants. These subgroups may be useful in the development of personalized treatments for COPD.

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

January 2018

Volume

153

Issue

1

Start / End Page

65 / 76

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Severity of Illness Index
  • Respiratory System
  • Pulmonary Emphysema
  • Middle Aged
  • Male
  • Humans
  • Forced Expiratory Volume
  • Female
  • Disease Progression
 

Citation

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Boueiz, A., Chang, Y., Cho, M. H., Washko, G. R., San José Estépar, R., Bowler, R. P., … COPDGene Investigators, . (2018). Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression. Chest, 153(1), 65–76. https://doi.org/10.1016/j.chest.2017.09.022
Boueiz, Adel, Yale Chang, Michael H. Cho, George R. Washko, Raul San José Estépar, Russell P. Bowler, James D. Crapo, et al. “Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression.Chest 153, no. 1 (January 2018): 65–76. https://doi.org/10.1016/j.chest.2017.09.022.
Boueiz A, Chang Y, Cho MH, Washko GR, San José Estépar R, Bowler RP, et al. Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression. Chest. 2018 Jan;153(1):65–76.
Boueiz, Adel, et al. “Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression.Chest, vol. 153, no. 1, Jan. 2018, pp. 65–76. Pubmed, doi:10.1016/j.chest.2017.09.022.
Boueiz A, Chang Y, Cho MH, Washko GR, San José Estépar R, Bowler RP, Crapo JD, DeMeo DL, Dy JG, Silverman EK, Castaldi PJ, COPDGene Investigators. Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression. Chest. 2018 Jan;153(1):65–76.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

January 2018

Volume

153

Issue

1

Start / End Page

65 / 76

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Severity of Illness Index
  • Respiratory System
  • Pulmonary Emphysema
  • Middle Aged
  • Male
  • Humans
  • Forced Expiratory Volume
  • Female
  • Disease Progression