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CHRONIC OBSTRUCTIVE PULMONARY DISEASE |
1 Department of Experimental and Clinical Medicine, University of Ferrara, Ferrara, Italy
2 Department of Surgery, Anesthesiology and Radiology, University of Ferrara, Ferrara, Italy
3 Section of Respiratory Physiopathology, University-Hospital of Ferrara, Ferrara, Italy
4 Department of Internal Medicine, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
5 Department of Respiratory Diseases, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
6 Department of Biochemistry, University of Pavia, Pavia, Italy
7 Department of Medicine, Oncology and Radiology, Section of Respiratory Diseases, University of Modena & Reggio Emilia, Modena, Italy
Correspondence to:
Correspondence to:
Dr P Boschetto
Dipartimento di Medicina Clinica e Sperimentale, Sezione di Igiene e Medicina del Lavoro, Via Fossato di Mortara 64/b, 44100 Ferrara, Italy; bsp{at}unife.it
Background: The predominant emphysema phenotype is associated with more severe airflow limitation in patients with chronic obstructive pulmonary disease (COPD). A study was undertaken to investigate whether COPD patients, with or without emphysema quantitatively confirmed by high resolution computed tomography (HRCT), have different COPD severity as assessed by the BODE index (body mass index, airflow obstruction, dyspnoea, exercise performance) and inspiratory capacity to total lung capacity ratio (IC/TLC), and by different biological markers of lung parenchymal destruction.
Methods: Twenty six outpatients with COPD and eight healthy non-smokers were examined. Each subject underwent HRCT scanning, pulmonary function tests, cell counts, and measurements of neutrophil elastase, matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinase (TIMP)-1 in induced sputum, as well as measurement of desmosine, a marker of elastin degradation in urine, plasma and sputum.
Results: Patients with HRCT confirmed emphysema had a higher BODE index and lower IC/TLC ratio than subjects without HRCT confirmed emphysema and controls. Forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity ratio, and carbon monoxide transfer coefficient were lower, whereas the number of eosinophils, MMP-9, and the MMP-9/TIMP-1 ratio in sputum were higher in patients with emphysema. In COPD patients the number of sputum eosinophils was the biological variable that correlated positively with the HRCT score of emphysema (p = 0.04).
Conclusions: These results suggest that COPD associated with HRCT confirmed emphysema is characterised by more severe lung function impairment, more intense airway inflammation and, possibly, more serious systemic dysfunction than COPD not associated with HRCT confirmed emphysema.
Abbreviations: BODE index, body mass index, airflow obstruction, dyspnoea, exercise performance; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; FRC, functional residual capacity; FVC, forced vital capacity; HRCT, high resolution computed tomography; IC, inspiratory capacity; KCO, carbon monoxide transfer coefficient; MLD, mean lung density; MMP, matrix metalloproteinase; NE, neutrophil elastase; PaO2, arterial oxygen tension; PaCO2, arterial carbon dioxide tension; RV, residual volume; TIMP, tissue inhibitor of metalloproteinase; TLC, total lung capacity
Keywords: chronic obstructive pulmonary disease; emphysema; biological markers; outcomes
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