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(Chest. 2004;125:1714-1718.)
© 2004 American College of Chest Physicians

Assessment of Emphysema in COPD*

A Functional and Radiologic Study

Isa Cerveri, MD; Roberto Dore, MD; Angelo Corsico, MD, PhD; Maria C. Zoia, MD; Riccardo Pellegrino, MD; Vito Brusasco, MD and Ernesto Pozzi, MD

* From the Clinica di Malattie dell’Apparato Respiratorio (Drs. Cerveri, Corsico, Zoia, and Pozzi) and Istituto di Radiologia Medica (Dr. Dore), Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Università di Pavia, Pavia, Italy; Servizio di Fisiopatologia Respiratoria (Dr. Pellegrino), AO S. Croce e Carle, Cuneo, Italy; and Servizio di Fisiopatologia Respiratoria, Dipartimento di Medicina Interna (Dr. Brusasco), Università di Genova, Genova, Italy.

Correspondence to: Isa Cerveri, MD, Clinica di Malattie dell’Apparato Respiratorio, IRCCS Policlinico S. Matteo, via Taramelli 5, 27100 Pavia, Italy; e-mail: i.cerveri{at}libero.it

Objectives: A combination of functional measurements reflecting a decrease in maximum flow, a degree of lung hyperinflation, the relationship between maximum inspiratory and expiratory flows, bronchodilator response, and diffusing capacity of the lung for carbon monoxide (DLCO) was used to quantify the extent of emphysema, as assessed by high-resolution CT (HRCT) scanning.

Design: Forced inspiratory and expiratory spirometry, lung volumes, reversibility test, and single-breath diffusing capacity were assessed before and after inhaling albuterol, 200 µg. Relationships between lung function variables and emphysema extent, as determined by HRCT scanning, were tested by univariate and multivariate analyses.

Subjects: Thirty-nine COPD outpatients with moderate-to-severe obstruction.

Measurements and results: Emphysema extent, as assessed by HRCT scanning, ranged from 18 to 70%. All of the lung function parameters that were studied, except for the change in FEV1 percent predicted after salbutamol inhalation, correlated significantly with the extent of emphysema (r2 range, 0.19 to 0.44). Functional residual capacity, forced expiratory flow at 50% of FVC/forced inspiratory flow at 50% of FVC, DLCO/alveolar volume ratio, and bronchodilator-induced change in FEV1/FVC ratio were the only variables retained by stepwise multiple regression analysis. The multiple regression model explained 71% of the variability of emphysema extent measured by HRCT scanning.

Conclusions: The combination of lung function measurements reflecting lung hyperinflation, bronchial collapsibility, lung diffusing capacity, and bronchodilator response provides a good estimate of the extent of emphysema, as evaluated by HRCT scanning. These data suggest that pulmonary function tests are useful in assessing and monitoring parenchymal damage in COPD patients.

Key Words: bronchodilation • diffusing capacity • high-resolution CT • lung volumes • spirometry




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