The Correlation of Dyspnea and Radiologic Quantity in Patients with COPD

Background: A lung hyperinflation, or air trapping, caused by expiratory flow-limitation contributes to dyspnea in patients with chronic obstructive pulmonary disease (COPD). Forced expiratory volume in 1 second (FEV1) has served as an important diagnostic measurement of COPD, but does not correlate with patient-centered outcomes such as dyspnea. Therefore, this study was performed to investigate the role of radiologic quantity in evaluating the dyspnea in patients with COPD by measuring lung hyperinflation in chest x-ray and high resolution chest tomography (HRCT). Methods: Fifty patients with COPD were enrolled in this study. Their subjective dyspnea score (modified Borg scale dyspnea index), spirometry, and lung volume were measured. Simultaneous hyperinflations of chest x-ray score (“chest score”) and degree of emphysema of HRCT (“HRCT score”) were measured. The “chest score” were composed of lung length, retrosternal space width, and height of the arc of the diaphragm and “HRCT score” were composed of severity and extent of emphysema. Results: The mean age of patients was 69 years old and their mean FEV1 was 51.7%. The Borg score significantly correlated with parameters of spirometry and lung volume, including FVC, FEV1, FEV1/FVC, RV, RV/TLC, and DLCO. The Borg score correlated well with “HRCT score”, but did not correlate with “chest score”. Also, the Borg scale correlates inversely with body mass index. Conclusion: The quantity of emphysema on chest HRCT may serve as an objective marker of dyspnea in patients with COPD.

keywords: Dyspnea, Chronic obstructive pulmonary disease, Radiology

Reference

Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006;27:397-412.

Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997;349:1498-504.

Kim DS, Kim YS, Jung KS, Chang JH, Lim CM, Lee JH, et al. Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey. Am J Respir Crit Care Med 2005;172:842-7.

Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.

O'Donnell DE, Webb KA. Exertional breathlessness in patients with chronic airflow limitation. The role of lung hyperinflation. Am Rev Respir Dis 1993;148:1351-7.

Mahler DA. Mechanisms and measurement of dyspnea in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2006;3:234-8.

Parker CM, Voduc N, Aaron SD, Webb KA, O'Donnell DE. Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur Respir J 2005;26:420-8.

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;176:532-55.

Celli BR. The importance of spirometry in COPD and asthma: effect on approach to management. Chest 2000;117:15S-9S.

10.

van Schayck CP. Is lung function really a good parameter in evaluating the long-term effects of inhaled corticosteroids in COPD? Eur Respir J 2000;15:238-9.

11.

Mahler DA, Harver A. A factor analysis of dyspnea ratings, respiratory muscle strength, and lung function in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1992;145:467-70.

12.

Wegner RE, Jorres RA, Kirsten DK, Magnussen H. Factor analysis of exercise capacity, dyspnoea ratings and lung function in patients with severe COPD. Eur Respir J 1994;7:725-9.

13.

American Thoracic Society. Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995;152:1107-36.

14.

Pratt PC. Role of conventional chest radiography in diagnosis and exclusion of emphysema. Am J Med 1987;82:998-1006.

15.

Reich SB, Weinshelbaum A, Yee J. Correlation of radiographic measurements and pulmonary function tests in chronic obstructive pulmonary disease. AJR Am J Roentgenol 1985;144:695-9.

16.

Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982;14:377-81.

17.

Expert panel on the identification, evaluation, and treatment of overweight in adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Am J Clin Nutr 1998;68:899-917.

18.

Sakai F, Gamsu G, Im JG, Ray CS. Pulmonary function abnormalities in patients with CT-determined emphysema. J Comput Assist Tomogr 1987;11:963-8.

19.

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;350:1005-12.

20.

Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest 2002;121:1434-40.

21.

American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;152:S77-121.

22.

The COPD Guidelines Group of the Standards of Care Committee of the BTS. BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997;52 Suppl 5:S1-28.

23.

Nicklaus TM, Stowell DW, Christiansen WR, Renzetti AD Jr. The accuracy of the roentgenologic diagnosis of chronic pulmonary emphysema. Am Rev Respir Dis 1966;93:889-99.

24.

Nakano Y, Muro S, Sakai H, Hirai T, Chin K, Tsukino M, et al. Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function. Am J Respir Crit Care Med 2000;162:1102-8.

25.

Rothpearl A, Varma AO, Goodman K. Radiographic measures of hyperinflation in clinical emphysema. Discrimination of patients from controls and relationship to physiologic and mechanical lung function. Chest 1988;94:907-13.

26.

Boschetto P, Quintavalle S, Zeni E, Leprotti S, Potena A, Ballerin L, et al. Association between markers of emphysema and more severe chronic obstructive pulmonary disease. Thorax 2006;61:1037-42.

27.

Agust AG, Gari PG, Sauleda J, Busquets X. Weight loss in chronic obstructive pulmonary disease. Mechanisms and implications. Pulm Pharmacol Ther 2002;15:425-32.

28.

Stevenson NJ, Walker PP, Costello RW, Calverley PM. Lung mechanics and dyspnea during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;172:1510-6.

바로가기메뉴

Article Contents

Vol.66 No.4

The Correlation of Dyspnea and Radiologic Quantity in Patients with COPD

Abstract

Reference

Tuberculosis & Respiratory Diseases