The percentage of small pulmonary vessels (<5 mm) significantly increased over a two-year period in patients, particularly in those who were ex-smokers.
Emphysematous changes in lung structure significantly increased during the follow-up period.
The airway wall area percentage at distal airways decreased or tended to decrease.
Changes in the percentage of small pulmonary vessels did not occur in proportion to the progression of emphysema.
Exacerbations were associated with greater emphysematous changes in patients.
Smoking cessation may allow for some reversibility in airway disease and vascular remodeling.
Simplified
BACKGROUND: Recent advances in (MDCT) facilitate acquiring important clinical information for managing patients with . MDCT can detect the loss of lung tissue associated with emphysema as a (LAA) and the thickness of airways as the wall area percentage (WA%). The percentage of small pulmonary vessels <5 mm(% cross-sectional area [CSA] <5) has been recently recognized as a parameter for expressing pulmonary perfusion. We aimed to analyze the longitudinal changes in structural abnormalities using these CT parameters and analyze the effect of exacerbation and smoking cessation on structural changes in COPD patients. 2
METHODS: We performed pulmonary function tests (PFTs), an MDCT, and a COPD assessment test (CAT) in 58 patients with COPD at the time of their enrollment at the hospital and 2 years later. We analyzed the change in clinical parameters including CT indices and examined the effect of exacerbations and smoking cessation on the structural changes.
RESULTS: The CAT score and forced expiratory volume in 1 second (FEV) did not significantly change during the follow-up period. The parameters of emphysematous changes significantly increased. On the other hand, the WA% at the distal airways significantly decreased or tended to decrease, and the %CSA <5 slightly but significantly increased over the same period, especially in ex-smokers. The parameters of emphysematous change were greater in patients with exacerbations and continued to progress even after smoking cessation. In contrast, the WA% and %CSA <5 did not change in proportion to emphysema progression. 1
CONCLUSION: The WA% at the distal bronchi and the %CSA <5 did not change in parallel with parameters of LAA over the same period. We propose that airway disease and vascular remodeling may be reversible to some extent by smoking cessation and appropriate treatment. Optimal management may have a greater effect on pulmonary vascularity and airway disease than parenchymal deconstruction in the early stage of COPD.
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