Chronic Obstructive Pulmonary Disease Clinical Ct Lung Function Studies, Assessment Of New Methods And Emphysema Phenotype

Section1The clinical applicability of the new assessment of chronic obstructive pulmonary diseaseObjective:There have been great reinforcements in the Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease (GOLD) according to recent advancement of clinical researches. To those who are diagnosed chronic obstructive pulmonary disease(COPD), the assessment of "stage" according to forced expiratory volume in1second(FEV,) alone is no longer acceptable. Those patients who are suffering from COPD should be assessed by combined methods including modified Medical Research Council (mMRC) or COPD assessment test (CAT), pulmonary function test (PFT) and numbers of acute exacerbation of COPD(AECOPD). The grades according to PFT, which represent airflow limitation, are as usual. The risks are assessed by the grades or AECOPD history, those who are in severe and very severe grade or those who undergo2or more exacerbations are more at risks. The purpose of this study is to discuss preliminarily the applicability of the new assessment of2011GOLD.Methods:The subjects were all voluntarily enrolled in this study during the first visiting in outpatient department or in wards of Peking Union Medical College hospital. All of them fulfilled pulmonary function test, the CAT and the AECOPD history were also required. The correlation between CAT scores and PFT results, between CAT scores and AECOPD history, between PFT results and AECOPD history were analyzed, and differences of two ways to assess COPD patients are to be compared according to the2011GOLD.Results:There were172subjects with135males and37females. The mean age was (44.0±18.7) years old, the mean numbers of AECOPD were (1.2±1.3), the mean values of CAT scores were (15.7±7.9). There were negative correlations between FEV,%and CAT scores, and the correlation coefficient was-0.31. There were also negative correlations between FEV,%and numbers of AECOPD, the correlation coefficient of which was-0.31. There were correlations between FEV1%and CAT scores with the correlation of-0.18. There were positive correlations between numbers of AECOPD and CAT scores, and the correlation coefficient was0.352. The consistency between the two ways to assess COPD was weak, which means there were differences between the two ways.Conclusion:1,There were correlations between CAT scores, numbers of AECOPD and PFT results, but the correlation coefficient of them were small.2,There were statistically significant differences between the two ways to assess COPD, which suggested the heterogeneity of COPD and was confirmed indirectly that the complexity of COPD. It is indispensible to assess COPD patients with CAT scores, PFT and numbers of AECOPD. Section2The Study of CT Pulmonary Function Test in Emphysema Phenotype Patients of Chronic Obstructive Pulmonary DiseaseObjective:To investigate the correlation between CT pulmonary function test(CT PFT) and common pulmonary function test, to explore the clinical characteristics of emphysema phenotype by CT PFT, to compare the patients in those with or without emphysema and to evaluate the applicability of CT PFT in2011GOLD.Methods:The subjects of stable COPD were all voluntarily enrolled in this study during the first visiting in outpatient department of Peking Union Medical College hospital. The subjects were scanned by64-slice multi-detector row computed tomography of Siemens SOMATOM Sensation. Volume scans of the entire lung were acquired and no contrast medium was used. In each case, CT of the thorax was performed from the lung apex through the base with the patient breath-holding at full inspiration. The data were analyzed by postprocessing software. The low attenuation area(LAA) was defined below-950hounsfield unit(Hu), and the LAA percentage of the whole lung in end-inspiratory was calculated. The subjects were assessed also by CAT individually and independently in the same day when they performed PFT, and the questionnaires were taken back on the spot. The AECOPD history was also required.Results:There were54subjects with43males and11females. The mean age was (62.1±8.9) years old, the mean numbers of AECOPD were (2.0±1.5), the mean values of CAT scores were (14.7±8.8). The mean value of LAA percentage of the whole lung(LAA%) was (15.5±12.6). There were correlations between CT PFT and FEV1,FEV1/FVC, RV/TLC with the correlation coefficient-0.445,-0.445,0.358, respectively. There were positive correlations between LAA%and numbers of AECOPD with coefficient of0.377. There were also positive correlations between LAA%and CAT scores with coefficient0.339. The subjects were divided into2groups (emphysema group and non-emphysema group) according to the LAA%. The subjects of emphysema group were older, more severe in airflow limitation, more frequent in exacerbation and had higher CAT scores with statistical significance.Conclusion:1,There are correlations between CT PFT and common PFT. The CT PFT can provide clinical evidence to those who can not cooperate in common PFT, thus it is a supplement of common PFT.2,The subjects of emphysema phenotype are older, more frequent exacerbation and have high CAT scores. It is necessary to intervene earlier for the emphysema patients.