Kronik obstrüktif akciğer hastalığında radyolojik fenotiplerin yaşam süresine etkisi

Year 2024, Volume: 38 Issue: 1, 108 - 119, 23.07.2024

Sami Deniz , Emine Sena Dikmentepe Yılmaz Ahmet Emin Erbaycu

An Erratum to this article was published on July 23, 2024. https://dergipark.org.tr/en/pub/ighd/issue/84984/1549940

Abstract

Sami Deniz 1, Emine Sena Dikmentepe Yılmaz 1, Ahmet Emin Erbaycu 2

1 Sağlık Bilimleri Üniversitesi, Dr Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği,
2 zmir Bakırçay Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı


Giriş ve Amaç: Amfizem, kronik bronşit ve bronşektazi kronik obstrüktif akciğer hastalığı (KOAH)’da görülen baskın fenotipler olup zamanla farklı oranlarda gelişebilir. Çalışmada KOAH’lı hastalarda bu üç radyolojik fenotipin yaşam süresine etkisinin araştırılması amaçlandı.
Gereç ve Yöntem: Çalışma retrospektif ve kesitsel olarak tasarlandı. 2015-2019 yılları içinde başvuran, stabil KOAH’lı olup toraks yüksek çözünürlüklü bilgisayarlı tomografi ile radyolojik olarak üç fenotipten birinin belirlendiği hastalar çalışmaya alındı. Otuzu bronşektazi, 30’u amfizem ve 30’u kronik bronşit olmak üzere toplam 90 erkek hasta dahil edildi. Hastaların yaş, vücut kitle indeksi, spirometrik ölçüm değerleri, kan testleri, tanı konulma zamanı, ölüm zamanı, komorbiditeleri ve demografik verileri kaydedildi.
Bulgular: Üç grup arasında yaş, temel laboratuvar ve spirometrik değerlerde FEV1/FVC hariç istatistiksel olarak fark saptanmadı. Amfizem baskın KOAH’da FEV1/FVC oranı diğer iki fenotipe göre daha düşük bulundu (p=0,023). Üç grup arasında hipertansiyon, diyabet, kronik kalp yetmezliği gibi komorbiditeler benzer sıklıktayken, koroner arter hastalığı amfizem grubunda anlamlı şekilde yüksek bulundu (p=0,030). En kısa yaşam süresi kronik bronşit ve amfizem baskın KOAH’da, en uzun yaşam süresi bronşektazi baskın KOAH grubunda belirlendi (p=0.037).
Sonuç: KOAH’lı hastalarda kronik bronşit, amfizem, bronşektazi fenotipleri arasında yaş, laboratuvar testleri, vücut kitle indeksi gibi temel değerlerde ve FEV1/FVC oranı hariç spirometrik ölçümler benzerdir düzeydedir. Bu üç fenotip başta kardiyak olmak üzere yüksek oranda komorbiditeyle birliktedir. En kısa yaşam süresi kronik bronşit ve amfizem fenotipinde, en uzun yaşam süresi bronşektazi fenotipindedir.

Keywords

Kronik obstrüktif akciğer hastalığı, amfizem, kronik bronşit, bronşektazi, yaşam süresi

Ethical Statement

vardır

The effect of radiological phenotypes on survival of chronic obstructive pulmonary disease

An Erratum to this article was published on July 23, 2024. https://dergipark.org.tr/en/pub/ighd/issue/84984/1549940

Abstract

Introduction and Aim: Emphysema, chronic bronchitis and bronchiectasis are the predominant phenotypes seen in chronic obstructive pulmonary disease (COPD) and may develop at different rates over time. The aim of the study was to investigate the effects of these three radiological phenotypes on survival in patients with COPD.
Materials and Methods: The study was designed as retrospective and cross-sectional. Patients with stable COPD who applied between 2015 and 2019 and whose thorax high-resolution computed tomography were diagnosed with one of the three phenotypes radiologically were included in the study. A total of 90 male patients, 30 of whom had bronchiectasis, 30 had emphysema, and 30 had chronic bronchitis, were included. Age, body mass index, spirometry measurement values, blood tests, time of diagnosis, time of death, comorbidities and demographic data of the patients were recorded.
Results: There was no statistical difference between the three groups in terms of age, baseline laboratory and spirometry values, except for FEV1/FVC. The FEV1/FVC ratio was found to be lower in emphysema-predominant COPD than in the other two phenotypes (p=0.023). While comorbidities such as hypertension, diabetes, and chronic heart failure were at a similar frequency between the three groups, coronary artery disease was found to be significantly higher in the emphysema group (p=0.030). The shortest survival was determined in chronic bronchitis and emphysema-predominant COPD, and the longest in the bronchiectasis-predominant COPD group (p=0.037).
Conclusion: The phenotypes of chronic bronchitis, emphysema, and bronchiectasis in patients with COPD are similar in baseline values such as age, laboratory tests, body mass index, and spirometry measurements, excluding FEV1/FVC ratio. These three phenotypes are associated with a high rate of comorbidity, primarily cardiac. The shortest lifespan is in the chronic bronchitis and emphysema phenotype, and the longest in the bronchiectasis phenotype.

Keywords

Chronic obstructive pulmonary disease, emphysema, chronic bronchitis, bronchiectasis, survival.

References

• 1. Guerreiro I, Soccal PM; COPD and phenotypes. Rev Med Suisse 2019; 13; 15: 2082-6.
• 2. Carolan BJ, Sutherland ER; Clinical reviews in allergy and immunology. Leung DYM, Ledford DK (eds). In: Clinical phenotypes of chronic obstructive pulmonary disease and asthma: Recent advances. Am Acad Allergy Asthma & Immunology 2013; 627-34.
• 3. Vestbo J, Anderson W, Coxson HO, Crim C, Dawber F, Edwards L, Hagan G, Knobil K, Lomas DA, MacNee W, Silverman EK, Tal-Singer R, ECLIPSE investigators;. Evaluation of COPD longitudinally to identify predictive surrogate endpoints (ECLIPSE). Eur Respir J 2008; 31: 869–73.
• 4. Couper D, LaVange LM, Han M, Barr RG, Bleecker E, Hoffman EA, Kanner R, Kleerup E, Martinez FJ, Woodruff PG, Rennard S, SPIROMICS Research Group; Design of the subpopulations and intermediate outcomes in copd study (spiromics). Thorax 2014; 69: 491-4.
• 5. Burgel PR, Paillasseur JL, Caillaud D, Tillie-Leblond I, Chanez P, Escamilla R, Court-Fortune I, Perez T, Carré P, Roche N, Initiatives BPCO Scientific Committee; Clinical COPD phenotypes: a novel approach using principal component and cluster analyses. Eur Respir J 2010; 36: 531-9.
• 6. Dirksen A, Wille MMW; Computed tomography-based subclassification of chronic obstructive pulmonary disease. Ann Am Thorac Soc 2016; 13 (Suppl 2): S114-7.
• 7. Bhaskar R, Singh S, Singh P; Correlation of COPD phenotypes according to HRCT findings and as per severity of illness. Afr Health Sci 2018; 18: 90-101.
• 8. Hacking C; Chronic obstructive pulmonary disease. Available at: https://radiopaedia.org/articles/chronic-obstructive-pulmonary-disease-1 (Erişim tarihi: 16.04.2023)
• 9. Gatheral T, Kumar N, Sansom B, Lai D, Nair A, Vlahos I, Baker EH; COPD-related bronchiectasis; independent impact on disease course and outcomes. COPD 2014; 11: 605-14.
• 10. Luong D; Bronchiectasis. Available at: https://radiopaedia.org/articles/bronchiectasis (Erişim tarihi: 16.04.2023)
• 11. Corlateanua A, Mendez Y, Wang Y, Garnicad RJA, Botnarua V, Siafakase N. Chronic obstructive pulmonary disease and phenotypes: a state-of-the-art. Pulmonol 2020; 26: 95-100.
• 12. Martinez-Garcia MA, Miravitlles M; Bronchiectasis in COPD patients: More than a comorbidity? Int J Chron Obstruct Pulmon Dis 2017; 12: 1401-11.
• 13. Mao B, Lu HW, Li MH, Fan LC, Yang JW, Miao XY, Xu JF; The existence of bronchiectasis predicts worse prognosis in patients with COPD. Sci Rep 2015; 16: 10961.
• 14. Friedlander AL, Lynch D, Dyar LA, Bowler RP; Phenotypes of chronic obstructive pulmonary disease. COPD 2007; 4: 355-84.
• 15. Burgel PR, Paillasseur JL, Peene B, Dusser D, Roche N, Coolen J, Troosters T, Decramer M, Janssens W; Two distinct chronic obstructive pulmonary disease (COPD) phenotypes are associated with high risk of mortality. PLoS One 2012; 7: e51048.
• 16. Martinez FJ, Foster G, Curtis JL, Criner G, Weinmann G, Fishman A, DeCamp MM, Benditt J, Sciurba F, Make B, Mohsenifar Z, Diaz P, Hoffman E, Wise R, NETT Research Group; Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 2006; 173: 1326–34.
• 17. Manian P; Chronic obstructive pulmonary disease classification, phenotypes and risk assessment. J Thorac Dis 2019; 11 (Suppl 14): S1761-S1766.
• 18. Barnes PJ, Vestbo J, Calverley PM; The pressing need to redefine “COPD”. Chronic Obstr Pulm Dis 2019; 6: 380-3.