Esther Pompe

Extract Interstitial lung abnormalities (ILA) are incidental CT findings, characterised by non-dependent parenchymal abnormalities -as ground-glass opacities, reticulation, and traction bronchiectasis- affecting at least 5% of a lung zone [1]. Their detection is increasing with widespread CT use in e.g. cancer screening and cardiovascular diagnostic imaging. Prevalence ranges from 2 to 35%, occurring commonly in older individuals, smokers, and those with a family history of interstitial lung disease (ILD).

Cigarette smoke affects the small pulmonary vasculature through mechanisms involving endothelial dysfunction, oxidative stress, inflammation, smooth muscle proliferation, and fibrosis, some of which are more acute and others more chronic [1]. These changes contribute to various lung diseases, including COPD, emphysema and pulmonary hypertension, and also increase the risk of cardiovascular complications such as right-sided heart failure [2].

Role of visual assessment of chronic obstructive pulmonary disease on chest CT: beauty is in the eye of the beholder Esther Pompe, Firdaus A. A. Mohamed Hoesein

Background: Little is known about factors associated with emphysema progression in cigarette smokers. We evaluated factors associated with change in emphysema and forced expiratory volume in 1 second (FEV1) in participants with and without chronic obstructive pulmonary disease (COPD). Methods: This retrospective study included individuals participating in the COPD Genetic Epidemiology study who completed the 5-year follow-up, including inspiratory and expiratory computed tomography (CT) and spirometry. All paired CT scans were analyzed using micro-mapping, which classifies individual voxels as emphysema or functional small airway disease (fSAD). Presence and progression of emphysema and FEV1 were determined based on comparison to nonsmoker values. Logistic regression analyses were used to identify clinical parameters associated with disease progression. Results: A total of 3088 participants were included with a mean +/- SD age of 60.7 +/- 8.9 years, including 72 nonsmokers. In all Global initiative for chronic Obstructive Lung Disease (GOLD) stages, the presence of emphysema at baseline was associated with emphysema progression (odds ratio [OR]: GOLD 0: 4.32; preserved ratio-impaired spirometry [PRISm]; 5.73; GOLD 1: 5.16; GOLD 2: 5.69; GOLD 3/4: 5.55; all p <= 0.01). If there was no emphysema at baseline, the amount of fSAD at baseline was associated with emphysema progression (OR for 1% increase: GOLD 0: 1.06; PRISm: 1.20; GOLD 1: 1.7; GOLD 3/4: 1.08; all p <= 0.03). In 1735 participants without spirometric COPD, progression in emphysema occurred in 105 ( 6.1%) participants and only 21 (1.2%) had progression in both emphysema and FEV1. Conclusions: The presence of emphysema is an important predictor of emphysema progression. In patients without emphysema, fSAD is associated with the development of emphysema. In participants without spirometric COPD, emphysema progression occurred independently of FEV1 decline.

A large proportion of emphysema progression in smokers with and those without airflow limitation was not accounted for by changes in forced expiratory volume in 1 second, suggesting that CT-detecte... Background CT is used to quantify abnormal changes in the lung parenchyma of smokers that might overlap chronic obstructive pulmonary disease (COPD), but studies on the progression of expiratory ai...

We evaluated the prevalence of significant lung abnormalities on computed tomography (CT) in patients who died from a respiratory illness other than lung cancer in the National Lung Screening Trial (NLST).In this retrospective case–control study, NLST participants in the CT arm who died of respiratory illness other than lung cancer were matched for age, sex, pack-years and smoking status to a surviving control. A chest radiologist and a radiology resident blinded to the outcome independently scored baseline CT scans visually and qualitatively for the presence of emphysema, airway wall thickening and fibrotic lung disease. The prevalence of CT abnormalities was compared between cases and controls by using chi-squared tests.In total, 167 participants died from a respiratory cause other than lung cancer. The prevalence of severe emphysema, airway wall thickening and fibrotic lung disease were 28.7%versus4.8%, 26.9%versus13.2% and 18.6%versus0.5% in cases and controls, respectively. Radiological findings were significantly more prevalent in deaths compared with controls (all p<0.001).CT-diagnosed severe emphysema, airway wall thickening and fibrosis were much more common in NLST participants who died from respiratory disease, and CT may provide an additional means of identifying these diseases.