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.
- 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.
- Muller-Quernheim, J.
- Benea, G.
- Leprotti, S.
- Boschetto, P.
- Gorecka, D.
- Nowinski, A.
- Oniszh, K.
- Castell, W. Z.
- Hagen, M.
- Barta, I.
- Dome, B.
- Strausz, J.
- Greulich, T.
- Vogelmeier, C.
- Koczulla, A. R.
- Gut, I.
- Hohlfeld, J.
- Welte, T.
- Lavae-Mokhtari, M.
- Ziegler-Heitbrock, L.
- Brightling, C.
- Parr, D. G.
Keywords
- Adult
- Aged
- Europe
- Female
- Forced Expiratory Volume
- Humans
- Male
- Middle Aged
- *Phenotype
- Pulmonary Disease, Chronic Obstructive/*diagnostic imaging/*physiopathology
- Pulmonary Emphysema/*diagnostic imaging
- Respiratory System/physiopathology
- Spirometry
- Tomography, X-Ray Computed/*standards