de Torres JP, Bastarrika G, Zagaceta J, Saiz-Mendiguren R, Alcaide AB, Seijo LM, et al. Emphysema presence, severity, and distribution has little impact on the clinical presentation of a cohort of patients with mild to moderate COPD. Chest 2011 Jan;139(1):36-42.
Phenotypic characterization of patients with COPD may have potential
prognostic and therapeutic implications. Available information on the
relationship between emphysema and the clinical presentation in patients with
COPD is limited to advanced stages of the disease. The objective of this study
was to describe emphysema presence, severity, and distribution and its impact on
clinical presentation of patients with mild to moderate COPD. METHODS: One
hundred fifteen patients with COPD underwent clinical and chest CT scan
evaluation for the presence, severity, and distribution of emphysema. Patients
with and without emphysema and with different forms of emphysema distribution
(upper/lower/core/peel) were compared. The impact of emphysema severity and
distribution on clinical presentation was determined. RESULTS: Fifty percent of
the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%).
Upper and core zones had the more severe degree of emphysema. Patients with
emphysema were older, more frequently men, and had lower FEV(1)%, higher total
lung capacity percentage, and lower diffusing capacity of the lung for carbon
monoxide. No differences were found between the clinical or physiologic
parameters of the different emphysema distributions. CONCLUSIONS: In patients
with mild to moderate COPD, although the presence of emphysema has an impact on
physiologic presentation, its severity and distribution seem to have little
impact on clinical presentation.