Published: 2018-04-25

Correlation between CT phenotypic patterns with clinical, nutritional and pulmonary function parameters among COPD patients

Vikas Dogra, Balakrishnan Menon, Vishal Bansal, Shailendra Nath Gaur


Background: COPD is a multi-dimensional disorder with multiple phenotypes. The commonly used GOLD guidelines and Spirometry do not fully reflect the heterogeneous nature of the disease, structural abnormalities, and phenotypes. This necessitates CT phenotyping because of difference in treatment strategies, disease progression and response to treatment.

Methods: We conducted our study on 40 male COPD subjects aged more than 45 years, divided them into 4 groups based on CT phenotype as normal, Airway Dominant (AD), Emphysema Dominant (ED) and mixed types.  We compared the clinical parameters, spirometry indices, markers of nutrition (including BMI) across these phenotypes. CT phenotypes were determined by Low Attenuation Area (LAA) and Wall area.

Results: In our study, 16 (40%) had airway dominant (AD), 15 (37.5%) had emphysema dominant (ED), 4 (10%) had mixed, and 5 (12.5%) had normal CT phenotype.  The various nutrition indicators like height, weight, BMI, fat-free mass index was not statistically significant. The difference in the median FEV1/FVC across CT phenotypes was statistically significant (P Value 0.002). The difference in Haemoglobin, Total protein, Albumin, Triglycerides and Total Cholesterol was not statistically significant across CT Phenotypes.

Conclusions: The GOLD guidelines do not fully reflect the heterogeneous nature of the disease which necessitates CT phenotyping. In our study, there was a significant association between BMI, FEV1/FVC ratio with CT phenotypes. Identifying the different phenotypes of COPD will allow us to implement a more personalized treatment and choose the best treatment option.


COPD, Computed tomography, Phenotype, Pulmonary, PFT

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Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176(6):532-55.

Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: global burden of disease study. Lancet. 1997;349(9064):1498-504.

Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28(3):523-32.

Rycroft CE, Heyes A, Lanza L, Becker K. Epidemiology of chronic obstructive pulmonary disease: a literature review. Int J Chron Obstruct Pulmon Dis. 2012;7:457-94.

Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, et al. Indian study on the epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis. 2012;16(9):1270-7.

Burney P, Jithoo A, Kato B, Janson C, Mannino D, Nizankowska-Mogilnicka E, et al. Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty-a BOLD analysis. Thorax. 2014;69(5):465-73.

McKay AJ, Mahesh PA, Fordham JZ, Majeed A. Prevalence of COPD in India: a systematic review. Prim Care Respir J. 2012;21(3):313-21.

Corhay JL, Schleich F, Louis R. [Phenotypes in chronic obstructive pulmonary disease]. Rev Med Liege. 2014;69(7-8):415-21.

Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557-82.

Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347-65.

Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932-46.

Ley-Zaporozhan J, Ley S, Kauczor HU. Morphological and functional imaging in COPD with CT and MRI: present and future. Eur Radiol. 2008;18(3):510-21.

Coxson HO, Rogers RM. Quantitative computed tomography of chronic obstructive pulmonary disease. Acad Radiol. 2005;12(11):1457-63.

Falaschi F, Miniati M, Battolla L, Filippi E, Sostman HD, Laiolo E, et al. [Quantification of pulmonary emphysema with computerized tomography. Comparison with various methods]. Radiol Med. 1995;90(1-2):16-23.

Blue bloater: pink puffer. Br Med J. 1968;2(5606):677.

Makita H, Nasuhara Y, Nagai K, Ito Y, Hasegawa M, Betsuyaku T, et al. Characterisation of phenotypes based on severity of emphysema in chronic obstructive pulmonary disease. Thorax. 2007;62(11):932-7.

Fujimoto K, Kitaguchi Y, Kubo K, Honda T. Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography. Respirology. 2006;11(6):731-40.

Miravitlles M, Calle M, Soler-Cataluna JJ. Clinical phenotypes of COPD: identification, definition, and implications for guidelines. Arch Bronconeumol. 2012;48(3):86-98.

Han MK. Clinical correlations of computed tomography imaging in chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2013;10 Suppl: S131-7.

Vestbo J, Hurd SS, Rodriguez‐Roisin R. The 2011 revision of the global strategy for the diagnosis, management and prevention of COPD (GOLD)-why and what? The clinical respiratory J. 2012;6(4):208-14.

Goddard PR, Nicholson EM, Laszlo G, Watt I. Computed tomography in pulmonary emphysema. Clin Radiol. 1982;33(4):379-87.

Durnin JVGA, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 Years. British J Nutrition. 2007;32(1):77-97.

Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples). Biometrika. 1965;52(3/4):591-611.

Doane DP, Seward LE. Measuring skewness: a forgotten statistic? J Statistics Education. 2011;19(2).

Friedlander AL, Lynch D, Dyar LA, Bowler RP. Phenotypes of chronic obstructive pulmonary disease. COPD. 2007;4(4):355-84.

Ogawa E, Nakano Y, Ohara T, Muro S, Hirai T, Sato S, et al. Body mass index in male patients with COPD: correlation with low attenuation areas on CT. Thorax. 2009;64(1):20-5.

Chen LF, Wang CH, Chou PC, Ho SC, Joa WC, Sheng TF, et al. Association Between Emphysema Score, Six-Minute Walk and Cardiopulmonary Exercise Tests in COPD. Open Respir Med J. 2012;6:104-10.

Van Tho N, Ogawa E, Trang le TH, Ryujin Y, Kanda R, Nakagawa H, et al. A mixed phenotype of airway wall thickening and emphysema is associated with dyspnea and hospitalization for chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2015;12(7):988-96.

Tatsumi K, Kasahara Y, Kurosu K, Tanabe N, Takiguchi Y, Kuriyama T. Clinical phenotypes of COPD: results of a Japanese epidemiological survey. Respirology. 2004;9(3):331-6.

Marti S, Munoz X, Rios J, Morell F, Ferrer J. Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy. Eur Respir J. 2006;27(4):689-96.

Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005-12.

Domingo-Salvany A, Lamarca R, Ferrer M, Garcia-Aymerich J, Alonso J, Felez M, et al. Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(5):680-5.

Miniati M, Monti S, Stolk J, Mirarchi G, Falaschi F, Rabinovich R, et al. Value of chest radiography in phenotyping chronic obstructive pulmonary disease. Eur Respir J. 2008;31(3):509-15.

Hasegawa M, Nasuhara Y, Onodera Y, Makita H, Nagai K, Fuke S, et al. Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173(12):1309-15.

Koyama H, Ohno Y, Nishio M, Takenaka D, Yoshikawa T, Matsumoto S, et al. Three-dimensional airway lumen volumetry: comparison with bronchial wall area and parenchymal densitometry in assessment of airway obstruction in pulmonary emphysema. British J Radiology. 2012;85(1020):1525-32.

Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(26):2645-53.

Man SF, Connett JE, Anthonisen NR, Wise RA, Tashkin DP, Sin DD. C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease. Thorax. 2006;61(10):849-53.

Sin DD, Man SF. Chronic obstructive pulmonary disease: a novel risk factor for cardiovascular disease. Can J Physiol Pharmacol. 2005;83(1):8-13.

Fabbri LM, Hurd SS. Global Strategy for the Diagnosis, Management and Prevention of COPD: 2003 update. Euro Respir J. 2003;22(1):1-2.