The Correlations between Different Evaluation Methods for Small Airways in Chronic Obstructive Pulmonary Disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZhangPan ¹ ,  YuHuapeng ¹ , FanHuizhen ¹ , WuShuhan ¹ , LiuJielu ¹ , YanChaoqun ² , QuanXianyue ²

1. Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, 510280, China;
2. ;

Corresponding author：

YuHuapeng, Email: huapengyu@aliyun.com

Keywords：

Chronic obstructive pulmonary disease; Small airway; Emphysema; High resolution computed tomography; Impulse oscillometry system

DOI：

10.7507/1671-6205.2016028

Video：

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Objective To evaluate the relationship between small airway disease and the progression of chronic obstructive pulmonary disease (COPD), and explore the application value of high resolution computed tomography (HRCT) and impulse oscillometry system (IOS) in assessing small airways in COPD patients. Methods A total of 132 stable COPD patients and 43 healthy controls volunteered to take the IOS and pulmonary function test. The correlations between resonance frequency (Fres), small airway resistance (R5-R20) and spirometry were analyzed. The patients were also examined by HRCT to measure the thickness of the third generation of apical bronchus of the right upper lobe (WT), the adjacent pulmonary artery diameter (BWT) and the degree of emphysema (LAA%). The ratio of WT to BWT (WT/BWT) was calculated to estimate bronchial wall thickening. Relationships between WT/BWT, emphysema and spirometry, IOS were also studied. Results There were negative correlations between Fres and FEV₁%pred, FEF_25%-75%%pred, FEF_50%%pred (r=-0.694, -0.561, -0.619, all P<0.01). R5-R20 was negatively associated with FEV₁%pred, FEF_25%-75%%pred and FEF_50%%pred as well (r=-0.622, -0.537, -0.560, P<0.01). The analysis of receiver operating characteristic curve showed larger areas under the Fres and R5-R20 curves, and the cutoff points to diagnose COPD were 13.93 Hz and 0.055 kPa·L^-1·s^-1, respectively. LAA% and WT/BWT increased with airflow limitation (F=4.859, 9.792, both P<0.01). WT/BWT was negatively associated with FEV₁%pred (r=-0.329, P<0.05), and positively with Fres and R5-R20 (r=0.259, 0.241, P<0.05). LAA% was negatively correlated with FEV₁%pred (r=-0.566, P<0.05), and correlations also existed between LAA% and physiological indices of small airways such as FEF_25%-75%%pred, FEF_50%%pred, Fres and R5-R20 (r=-0.456, -0.474, 0.466, 0.340, all P<0.05). Conclusions The peripheral airway resistance is increased and bronchial wall thickens in patients with COPD, and these changes can reflect the severity of the disease. Small airway disease measured by HRCT and IOS are related to the spirometric indices, and represent the structural and functional changes of small airways. Combinations of these two tests with spirometry will be possible to make early diagnosis and better control the disease.

Citation： ZhangPan, YuHuapeng, FanHuizhen, WuShuhan, LiuJielu, YanChaoqun, QuanXianyue. The Correlations between Different Evaluation Methods for Small Airways in Chronic Obstructive Pulmonary Disease. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(2): 109-114. doi: 10.7507/1671-6205.2016028 Copy

1.	Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2013, 187:347-365.
2.	Usmani OS. Small airways dysfunction in asthma: evaluation and management to improve asthma control. Allergy Asthma Immunol Res, 2014, 6:376.
3.	Hogg JC, Macklem PT, Thurlbeck WM. Site and nature of airway obstruction in chronic obstructive lung disease.NEngl J Med, 1968, 278:1355-1360.
4.	Patel BD, Coxson HO, Pillai SG, et al. Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2008, 178:500-505.
5.	Contoli M, Bousquet J, Fabbri LM, et al. The small airways and distal lung compartment in asthma and COPD:atime for reappraisal. Allergy, 2010, 65:141-151.
6.	Mineshita M, Shikama Y, Nakajima H, et al. The application of impulse oscillation system for the evaluation of treatment effects in patients with COPD. Respir Physiol Neurobiol, 2014, 202:1-5.
7.	Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med, 2010, 182:598-604.
8.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版).中华结核和呼吸杂志, 2013, 36:1-10.
9.	Oostveen E, MacLeod D, Lorino H, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J, 2003, 22:1026-1041.
10.	Laszlo G. Standardisation of lung function testing: helpful guidance from the ATS/ERS Task Force. Thorax, 2006, 61:744-746.
11.	Hasegawa M, Nasuhara Y, Onodera Y, et al. Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2006, 173:1309-1315.
12.	Kitaguchi Y, Fujimoto K, Kubo K, et al. Characteristics of COPD phenotypes classified according to the findings of HRCT. Respir Med, 2006, 100:1742-1752.
13.	Timmins SC, Coatsworth N, Palnitkar G, et al. Day-to-day variability of oscillatory impedance and spirometry in asthma and COPD. Respir Physiol Neurobiol, 2013, 185:416-424.
14.	Verbanck S. Physiological measurement of the small airways. Respiration, 2012, 84:177-188.
15.	张洪波, 林耀广, 林江涛, 等.脉冲振荡响应频率检测小气道功能障碍的应用价值.中日友好医院学报, 2002, Z1:271-273.
16.	Pisi R, Aiello M, Zanini A, et al. Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2015, 10:1191-1197.
17.	McDonough JE, Yuan R, Suzuki M, et al. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease.NEnglJMed, 2011, 365:1567-1575.
18.	Nakano Y, Wong JC, de Jong PA, et al. The prediction of small airway dimensions using computed tomography. Am J Respir Crit Care Med, 2005, 171:142-146.
19.	Kanda S, Fujimoto K, Komatsu Y, et al. Evaluation of respiratory impedance in asthma and COPD by an impulse oscillation system. Intern Med, 2010, 49:23-30.
20.	Burgel PR. The role of small airways in obstructive airway diseases. Eur Respir Rev, 2011, 20:23-33.

1. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2013, 187:347-365.
2. Usmani OS. Small airways dysfunction in asthma: evaluation and management to improve asthma control. Allergy Asthma Immunol Res, 2014, 6:376.
3. Hogg JC, Macklem PT, Thurlbeck WM. Site and nature of airway obstruction in chronic obstructive lung disease.NEngl J Med, 1968, 278:1355-1360.
4. Patel BD, Coxson HO, Pillai SG, et al. Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2008, 178:500-505.
5. Contoli M, Bousquet J, Fabbri LM, et al. The small airways and distal lung compartment in asthma and COPD:atime for reappraisal. Allergy, 2010, 65:141-151.
6. Mineshita M, Shikama Y, Nakajima H, et al. The application of impulse oscillation system for the evaluation of treatment effects in patients with COPD. Respir Physiol Neurobiol, 2014, 202:1-5.
7. Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med, 2010, 182:598-604.
8. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版).中华结核和呼吸杂志, 2013, 36:1-10.
9. Oostveen E, MacLeod D, Lorino H, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J, 2003, 22:1026-1041.
10. Laszlo G. Standardisation of lung function testing: helpful guidance from the ATS/ERS Task Force. Thorax, 2006, 61:744-746.
11. Hasegawa M, Nasuhara Y, Onodera Y, et al. Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2006, 173:1309-1315.
12. Kitaguchi Y, Fujimoto K, Kubo K, et al. Characteristics of COPD phenotypes classified according to the findings of HRCT. Respir Med, 2006, 100:1742-1752.
13. Timmins SC, Coatsworth N, Palnitkar G, et al. Day-to-day variability of oscillatory impedance and spirometry in asthma and COPD. Respir Physiol Neurobiol, 2013, 185:416-424.
14. Verbanck S. Physiological measurement of the small airways. Respiration, 2012, 84:177-188.
15. 张洪波, 林耀广, 林江涛, 等.脉冲振荡响应频率检测小气道功能障碍的应用价值.中日友好医院学报, 2002, Z1:271-273.
16. Pisi R, Aiello M, Zanini A, et al. Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2015, 10:1191-1197.
17. McDonough JE, Yuan R, Suzuki M, et al. Small-airway obstruction and emphysema in chronic obstructive pulmonary disease.NEnglJMed, 2011, 365:1567-1575.
18. Nakano Y, Wong JC, de Jong PA, et al. The prediction of small airway dimensions using computed tomography. Am J Respir Crit Care Med, 2005, 171:142-146.
19. Kanda S, Fujimoto K, Komatsu Y, et al. Evaluation of respiratory impedance in asthma and COPD by an impulse oscillation system. Intern Med, 2010, 49:23-30.
20. Burgel PR. The role of small airways in obstructive airway diseases. Eur Respir Rev, 2011, 20:23-33.

Chinese Journal of Respiratory and Critical Care Medicine

The Correlations between Different Evaluation Methods for Small Airways in Chronic Obstructive Pulmonary Disease

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