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Bacterial-derived Neutrophilic Inflammation Drives Lung Remodeling in a Mouse Model of Chronic Obstructive Pulmonary Disease.
Richmond BW, Du RH, Han W, Benjamin JT, van der Meer R, Gleaves L, Guo M, McKissack A, Zhang Y, Cheng DS, Polosukhin VV, Blackwell TS
(2018) Am J Respir Cell Mol Biol 58: 736-744
MeSH Terms: Airway Remodeling, Aminopyridines, Animals, Bacillus, Benzamides, Cyclopropanes, Disease Models, Animal, Mice, Inbred C57BL, Mice, Mutant Strains, Neutrophils, Pneumonia, Bacterial, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Receptors, Cell Surface
Show Abstract · Added March 21, 2018
Loss of secretory IgA is common in the small airways of patients with chronic obstructive pulmonary disease and may contribute to disease pathogenesis. Using mice that lack secretory IgA in the airways due to genetic deficiency of polymeric Ig receptor (pIgR mice), we investigated the role of neutrophils in driving the fibrotic small airway wall remodeling and emphysema that develops spontaneously in these mice. By flow cytometry, we found an increase in the percentage of neutrophils among CD45 cells in the lungs, as well as an increase in total neutrophils, in pIgR mice compared with wild-type controls. This increase in neutrophils in pIgR mice was associated with elastin degradation in the alveolar compartment and around small airways, along with increased collagen deposition in small airway walls. Neutrophil depletion using anti-Ly6G antibodies or treatment with broad-spectrum antibiotics inhibited development of both emphysema and small airway remodeling, suggesting that airway bacteria provide the stimulus for deleterious neutrophilic inflammation in this model. Exogenous bacterial challenge using lysates prepared from pathogenic and nonpathogenic bacteria worsened neutrophilic inflammation and lung remodeling in pIgR mice. This phenotype was abrogated by antiinflammatory therapy with roflumilast. Together, these studies support the concept that disruption of the mucosal immune barrier in small airways contributes to chronic obstructive pulmonary disease progression by allowing bacteria to stimulate chronic neutrophilic inflammation, which, in turn, drives progressive airway wall fibrosis and emphysematous changes in the lung parenchyma.
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14 MeSH Terms
Per cent emphysema is associated with respiratory and lung cancer mortality in the general population: a cohort study.
Oelsner EC, Carr JJ, Enright PL, Hoffman EA, Folsom AR, Kawut SM, Kronmal RA, Lederer DJ, Lima JA, Lovasi GS, Smith BM, Shea SJ, Barr RG
(2016) Thorax 71: 624-32
MeSH Terms: Aged, Aged, 80 and over, Cause of Death, Female, Humans, Lung Neoplasms, Male, Middle Aged, Prognosis, Pulmonary Emphysema, Respiratory Function Tests, Respiratory Tract Diseases, Risk Factors, Smoking, Tomography, X-Ray Computed
Show Abstract · Added September 29, 2016
BACKGROUND - Emphysema on CT is a risk factor for all-cause mortality in persons with and without airflow obstruction; however, causes of death associated with emphysema remain uncertain, particularly in the general population.
AIMS - To test associations between quantitatively assessed emphysema on CT and cause of death in persons with and without a substantial smoking history.
METHODS - The Multi-Ethnic Study of Atherosclerosis recruited 6814 participants, aged 45-84 years and without clinical cardiovascular disease, in 2000-2002. Per cent emphysema was defined on cardiac CT as per cent of lung voxels less than -950 Hounsfield units; emphysema on CT was defined as per cent emphysema above the upper limit of normal. Cause of death was classified by administrative codes. Proportional-hazards models were adjusted for age, race/ethnicity, gender, body mass index, smoking status, pack-years, coronary artery calcium, site and education. Additional adjustment for lung function was made in a subset with spirometry from 2004 to 2006.
RESULTS - There were 1091 deaths over 12 years median follow-up. Emphysema on CT was strongly associated with increased mortality due to respiratory diseases (adjusted HR 2.94, 95% CI 1.68 to 5.15), particularly chronic lower respiratory diseases (adjusted HR 9.54, 95% CI 4.70 to 19.35), and lung cancer (adjusted HR 1.84, 95% CI 1.09 to 3.12), but not cardiovascular disease. Associations persisted among participants with fewer than 10 pack-years and those without physician-diagnosed respiratory disease, and were similar after adjustment for airflow measures and in persons without airflow limitation.
CONCLUSIONS - Quantitatively assessed emphysema on CT is associated with greater respiratory disease and lung cancer mortality, even among persons without traditional risk factors.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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15 MeSH Terms
Influence of pulmonary emphysema on COPD assessment test-oriented categorization in GOLD document.
Suzuki T, Tada Y, Kawata N, Ikari J, Kasahara Y, Sakurai Y, Iesato K, Nishimura R, West J, Tatsumi K
(2015) Int J Chron Obstruct Pulmon Dis 10: 1199-205
MeSH Terms: Aged, Female, Forced Expiratory Volume, Hospitals, University, Humans, Japan, Lung, Lung Volume Measurements, Male, Middle Aged, Multidetector Computed Tomography, Phenotype, Predictive Value of Tests, Pulmonary Diffusing Capacity, Pulmonary Disease, Chronic Obstructive, Pulmonary Emphysema, Respiratory Function Tests, Severity of Illness Index
Show Abstract · Added April 2, 2019
BACKGROUND - The COPD assessment test (CAT) score is a key component of the multifactorial assessment of COPD in the Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines of 2014. Nevertheless, little is known regarding the differences among COPD categories in terms of clinical parameters such as pulmonary function or radiological findings. Thus, our aims in this study were to evaluate the associations between CAT scores and pulmonary clinical parameters, and to investigate factors that could discriminate between a "less symptomatic group" (categories A and C) and a "more symptomatic group" (categories B and D) among stable COPD patients.
METHODS - We enrolled 200 outpatients at Chiba University Hospital. Study subjects were assessed by CAT, pulmonary function testing, and multidetector computed tomography (MDCT). We assessed possible correlations between these indices.
RESULTS - CAT scores were negatively correlated with percentage of the forced expiratory volume in 1 second predicted value (FEV1 %predicted) and percentage of the diffusing capacity for carbon monoxide per liter of lung volume predicted value (DLCO/VA [%predicted]) results and positively correlated with low attenuation volume percentage (LAV%) and residual volume to total lung capacity ratios (RV/TLC). In the "more symptomatic group" (category B or D), the mean DLCO/VA (%predicted) was significantly lower and the mean LAV% and RV/TLC was significantly higher than those in the "less symptomatic group" (category A or C), respectively. Interestingly, those in category B had higher mean LAV% compared to those in category C.
CONCLUSION - CAT scores were significantly correlated with pulmonary function parameters and emphysematous changes on MDCT. The new GOLD classification system would be a step toward a phenotypic approach, especially taking into account the degree of emphysema and hyperinflation.
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Association between emphysema-like lung on cardiac computed tomography and mortality in persons without airflow obstruction: a cohort study.
Oelsner EC, Hoffman EA, Folsom AR, Carr JJ, Enright PL, Kawut SM, Kronmal R, Lederer D, Lima JA, Lovasi GS, Shea S, Barr RG
(2014) Ann Intern Med 161: 863-73
MeSH Terms: Aged, Aged, 80 and over, Female, Heart, Humans, Lung, Lung Volume Measurements, Male, Middle Aged, Mortality, Prospective Studies, Pulmonary Emphysema, Pulmonary Ventilation, Risk Factors, Smoking, Spirometry, Tomography, X-Ray Computed
Show Abstract · Added August 24, 2015
BACKGROUND - Low lung function is known to predict mortality in the general population, but the prognostic significance of emphysema on computed tomography (CT) in persons without chronic obstructive pulmonary disease (COPD) is uncertain.
OBJECTIVE - To determine whether greater emphysema-like lung on CT is associated with all-cause mortality among persons in the general population without airflow obstruction or COPD.
DESIGN - Prospective cohort study.
SETTING - Population-based, multiethnic sample from 6 U.S. communities.
PARTICIPANTS - 2965 participants aged 45 to 84 years without airflow obstruction on spirometry.
MEASUREMENTS - Emphysema-like lung was defined as the number of lung voxels with attenuation less than -950 Hounsfield units on cardiac CT and was adjusted for the number of total imaged lung voxels.
RESULTS - Among 2965 participants, 50.9% of whom had never smoked, there were 186 deaths over a median of 6.2 years. Greater emphysema-like lung was independently associated with increased mortality (adjusted hazard ratio per one-half interquartile range, 1.14 [95% CI, 1.04 to 1.24]; P=0.004) after adjustment for potential confounders, including cardiovascular risk factors and FEV1. Generalized additive models supported a linear association between emphysema-like lung and mortality without evidence for a threshold. The association was of greatest magnitude among smokers, although multiplicative interaction terms did not support effect modification by smoking status.
LIMITATIONS - Cardiac CT scans did not include lung apices. The number of deaths was limited among subgroup analyses.
CONCLUSION - Emphysema-like lung on CT was associated with all-cause mortality among persons without airflow obstruction or COPD in a general population sample, particularly among smokers. Recognition of the independent prognostic significance of emphysema on CT among patients without COPD on spirometry is warranted.
PRIMARY FUNDING SOURCE - National Heart, Lung, and Blood Institute.
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17 MeSH Terms
Variation in the percent of emphysema-like lung in a healthy, nonsmoking multiethnic sample. The MESA lung study.
Hoffman EA, Ahmed FS, Baumhauer H, Budoff M, Carr JJ, Kronmal R, Reddy S, Barr RG
(2014) Ann Am Thorac Soc 11: 898-907
MeSH Terms: Age Distribution, Aged, Aged, 80 and over, Ethnic Groups, Female, Follow-Up Studies, Humans, Lung Volume Measurements, Male, Middle Aged, Population Surveillance, Prevalence, Prospective Studies, Pulmonary Emphysema, Reference Values, Sex Distribution, Tomography, X-Ray Computed, United States
Show Abstract · Added October 10, 2014
RATIONALE - Computed tomography (CT)-based lung density is used to quantitate the percentage of emphysema-like lung (hereafter referred to as percent emphysema), but information on its distribution among healthy nonsmokers is limited.
OBJECTIVES - We evaluated percent emphysema and total lung volume on CT scans of healthy never-smokers in a multiethnic, population-based study.
METHODS - The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study investigators acquired full-lung CT scans of 3,137 participants (ages 54-93 yr) between 2010-12. The CT scans were taken at full inspiration following the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) protocol. "Healthy never-smokers" were defined as participants without a history of tobacco smoking or respiratory symptoms and disease. "Percent emphysema" was defined as the percentage of lung voxels below -950 Hounsfield units. "Total lung volume" was defined by the volume of lung voxels.
MEASUREMENTS AND MAIN RESULTS - Among 854 healthy never-smokers, the median percent emphysema visualized on full-lung scans was 1.1% (interquartile range, 0.5-2.5%). The percent emphysema values were 1.2 percentage points higher among men compared with women and 0.7, 1.2, and 1.2 percentage points lower among African Americans, Hispanics, and Asians compared with whites, respectively (P < 0.001). Percent emphysema was positively related to age and height and inversely related to body mass index. The findings were similar for total lung volume on CT scans and for percent emphysema defined at -910 Hounsfield units and measured on cardiac scans. Reference equations to account for these differences are presented for never, former and current smokers.
CONCLUSIONS - Similar to lung function, percent emphysema varies substantially by demographic factors and body size among healthy never-smokers. The presented reference equations will assist in defining abnormal values for percent emphysema and total lung volume on CT scans, although validation is pending.
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Genome-wide study of percent emphysema on computed tomography in the general population. The Multi-Ethnic Study of Atherosclerosis Lung/SNP Health Association Resource Study.
Manichaikul A, Hoffman EA, Smolonska J, Gao W, Cho MH, Baumhauer H, Budoff M, Austin JH, Washko GR, Carr JJ, Kaufman JD, Pottinger T, Powell CA, Wijmenga C, Zanen P, Groen HJ, Postma DS, Wanner A, Rouhani FN, Brantly ML, Powell R, Smith BM, Rabinowitz D, Raffel LJ, Hinckley Stukovsky KD, Crapo JD, Beaty TH, Hokanson JE, Silverman EK, Dupuis J, O'Connor GT, Boezen HM, Rich SS, Barr RG
(2014) Am J Respir Crit Care Med 189: 408-18
MeSH Terms: Aged, Aged, 80 and over, Female, Follow-Up Studies, Genetic Markers, Genome-Wide Association Study, Genotyping Techniques, Humans, Male, Mannosidases, Middle Aged, N-Acetylglucosaminyltransferases, Nerve Tissue Proteins, Polymorphism, Single Nucleotide, Pulmonary Emphysema, RNA Helicases, Thiolester Hydrolases, Tomography, X-Ray Computed, United States, alpha-Mannosidase, snRNP Core Proteins
Show Abstract · Added February 15, 2014
RATIONALE - Pulmonary emphysema overlaps partially with spirometrically defined chronic obstructive pulmonary disease and is heritable, with moderately high familial clustering.
OBJECTIVES - To complete a genome-wide association study (GWAS) for the percentage of emphysema-like lung on computed tomography in the Multi-Ethnic Study of Atherosclerosis (MESA) Lung/SNP Health Association Resource (SHARe) Study, a large, population-based cohort in the United States.
METHODS - We determined percent emphysema and upper-lower lobe ratio in emphysema defined by lung regions less than -950 HU on cardiac scans. Genetic analyses were reported combined across four race/ethnic groups: non-Hispanic white (n = 2,587), African American (n = 2,510), Hispanic (n = 2,113), and Chinese (n = 704) and stratified by race and ethnicity.
MEASUREMENTS AND MAIN RESULTS - Among 7,914 participants, we identified regions at genome-wide significance for percent emphysema in or near SNRPF (rs7957346; P = 2.2 × 10(-8)) and PPT2 (rs10947233; P = 3.2 × 10(-8)), both of which replicated in an additional 6,023 individuals of European ancestry. Both single-nucleotide polymorphisms were previously implicated as genes influencing lung function, and analyses including lung function revealed independent associations for percent emphysema. Among Hispanics, we identified a genetic locus for upper-lower lobe ratio near the α-mannosidase-related gene MAN2B1 (rs10411619; P = 1.1 × 10(-9); minor allele frequency [MAF], 4.4%). Among Chinese, we identified single-nucleotide polymorphisms associated with upper-lower lobe ratio near DHX15 (rs7698250; P = 1.8 × 10(-10); MAF, 2.7%) and MGAT5B (rs7221059; P = 2.7 × 10(-8); MAF, 2.6%), which acts on α-linked mannose. Among African Americans, a locus near a third α-mannosidase-related gene, MAN1C1 (rs12130495; P = 9.9 × 10(-6); MAF, 13.3%) was associated with percent emphysema.
CONCLUSIONS - Our results suggest that some genes previously identified as influencing lung function are independently associated with emphysema rather than lung function, and that genes related to α-mannosidase may influence risk of emphysema.
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21 MeSH Terms
Genetic ancestry and the relationship of cigarette smoking to lung function and per cent emphysema in four race/ethnic groups: a cross-sectional study.
Powell R, Davidson D, Divers J, Manichaikul A, Carr JJ, Detrano R, Hoffman EA, Jiang R, Kronmal RA, Liu K, Punjabi NM, Shahar E, Watson KE, Rotter JI, Taylor KD, Rich SS, Barr RG
(2013) Thorax 68: 634-642
MeSH Terms: Aged, Aged, 80 and over, Cross-Sectional Studies, Ethnic Groups, Female, Follow-Up Studies, Forced Expiratory Volume, Humans, Male, Middle Aged, Prevalence, Prospective Studies, Pulmonary Emphysema, Risk Factors, Smoking, Spirometry, United States, Vital Capacity
Show Abstract · Added February 15, 2014
BACKGROUND - Cigarette smoking is the major cause of chronic obstructive pulmonary disease and emphysema. Recent studies suggest that susceptibility to cigarette smoke may vary by race/ethnicity; however, they were generally small and relied on self-reported race/ethnicity.
OBJECTIVE - To test the hypothesis that relationships of smoking to lung function and per cent emphysema differ by genetic ancestry and self-reported race/ethnicity among Caucasians, African-Americans, Hispanics and Chinese-Americans.
DESIGN - Cross-sectional population-based study of adults age 45-84 years in the USA.
MEASUREMENTS - Principal components of genetic ancestry and continental ancestry estimated from one million genome-wide single nucleotide polymorphisms; pack-years of smoking; spirometry measured for 3344 participants; and per cent emphysema on computed tomography for 8224 participants.
RESULTS - The prevalence of ever-smoking was: Caucasians, 57.6%; African-Americans, 56.4%; Hispanics, 46.7%; and Chinese-Americans, 26.8%. Every 10 pack-years was associated with -0.73% (95% CI -0.90% to -0.56%) decrement in the forced expiratory volume in 1 s to forced vital capacity (FEV1 to FVC) and a 0.23% (95% CI 0.08% to 0.38%) increase in per cent emphysema. There was no evidence that relationships of pack-years to the FEV1 to FVC, airflow obstruction and per cent emphysema varied by genetic ancestry (all p>0.10), self-reported race/ethnicity (all p>0.10) or, among African-Americans, African ancestry. There were small differences in relationships of pack-years to the FEV1 among male Chinese-Americans and to the FEV1 to FVC ratio with African and Native American ancestry among male Hispanics only.
CONCLUSIONS - In this large cohort, there was little to no evidence that the associations of smoking to lung function and per cent emphysema differed by genetic ancestry or self-reported race/ethnicity.
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18 MeSH Terms
Percent emphysema and right ventricular structure and function: the Multi-Ethnic Study of Atherosclerosis-Lung and Multi-Ethnic Study of Atherosclerosis-Right Ventricle Studies.
Grau M, Barr RG, Lima JA, Hoffman EA, Bluemke DA, Carr JJ, Chahal H, Enright PL, Jain A, Prince MR, Kawut SM
(2013) Chest 144: 136-144
MeSH Terms: African Continental Ancestry Group, Aged, Aged, 80 and over, Asian Continental Ancestry Group, Cohort Studies, European Continental Ancestry Group, Female, Heart Ventricles, Hispanic Americans, Humans, Lung, Magnetic Resonance Imaging, Male, Middle Aged, Prevalence, Prospective Studies, Pulmonary Emphysema, Smoking, Spirometry, Tomography, X-Ray Computed, Ventricular Dysfunction, Right
Show Abstract · Added February 28, 2014
BACKGROUND - Severe COPD can lead to cor pulmonale and emphysema and is associated with impaired left ventricular (LV) filling. We evaluated whether emphysema and airflow obstruction would be associated with changes in right ventricular (RV) structure and function and whether these associations would differ by smoking status.
METHODS - The Multi-Ethnic Study of Atherosclerosis (MESA) performed cardiac MRI on 5,098 participants without clinical cardiovascular disease aged 45 to 84 years. RV and emphysema measures were available for 4,188 participants. Percent emphysema was defined as the percentage of voxels below -910 Hounsfield units in the lung windows on cardiac CT scans. Generalized additive models were used to control for confounders and adjust for respective LV parameters.
RESULTS - Participants consisted of 13% current smokers, 36% former smokers, and 52% never smokers. Percent emphysema was inversely associated with RV end-diastolic volume, stroke volume, cardiac output, and mass prior to adjustment for LV measures. After adjustment for LV end-diastolic volume, greater percent emphysema was associated with greater RV end-diastolic volume (+1.5 mL, P=.03) among current smokers, smaller RV end-diastolic volume (-0.8 mL, P=.02) among former smokers, and similar changes among never smokers.
CONCLUSIONS - Percent emphysema was associated with smaller RV volumes and lower mass. The relationship of emphysema to cardiac function is complex but likely involves increased pulmonary vascular resistance, predominantly with reduced cardiac output, pulmonary hyperinflation, and accelerated cardiopulmonary aging.
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Technical parameters and interpretive issues in screening computed tomography scans for lung cancer.
Donnelly EF
(2012) J Thorac Imaging 27: 224-9
MeSH Terms: Humans, Image Processing, Computer-Assisted, Lung Diseases, Interstitial, Lung Neoplasms, Pulmonary Emphysema, Radiation Dosage, Radiography, Abdominal, Radiography, Thoracic, Solitary Pulmonary Nodule, Tomography, X-Ray Computed
Show Abstract · Added February 28, 2014
Lung cancer screening computed tomographies (CTs) differ from traditional chest CT scans in that they are performed at very low radiation doses, which allow the detection of small nodules but which have a much higher noise content than would be acceptable in a diagnostic chest CT. The technical parameters require a great deal of attention on the part of the user, because inappropriate settings could result in either excess radiation dose to the large population of screened individuals or in low-quality images with impaired nodule detectability. Both situations undermine the main goal of the screening program, which is to detect lung nodules using as low a radiation dose as can reasonably be achieved. Once an image has been obtained, there are unique interpretive issues that must be addressed mainly because of the very high noise content of the images and the high prevalence of incidental findings in the chest unrelated to the sought-after pulmonary nodules.
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Lung cancer following bronchoscopic lung volume reduction for severe emphysema: a case and its management.
Tummino C, Maldonado F, Laroumagne S, Astoul P, Dutau H
(2012) Respiration 83: 418-20
MeSH Terms: Aged, Bronchoscopy, Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Male, Pneumonectomy, Pulmonary Emphysema, Severity of Illness Index, Tomography, X-Ray Computed
Show Abstract · Added February 1, 2016
Bronchoscopic lung volume reduction using endobronchial valves has been suggested as a potentially safer alternative to surgery in selected cases. Complications of this technique include pneumothoraces, pneumonia, COPD exacerbations, hemoptysis, and valve migrations. We report the case of a male patient who developed a parenchymal mass in the treated lobe after valve insertion. Due to severe emphysema, transthoracic needle aspiration was not feasible. Removal of the valves was mandatory to perform transbronchialbiopsies which revealed a non-small cell primary lung cancer. This first description illustrates the potential risk of lung cancer development following bronchoscopic lung volume reduction and highlights the different approach to diagnosis and management of indeterminate peripheral lung lesions needed in this context.
Copyright © 2011 S. Karger AG, Basel.
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10 MeSH Terms