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Airflow Limitation and Airway Dimensions in Chronic Obstructive Pulmonary Disease

First Department of Medicine and Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan

Correspondence and requests for reprints should be addressed to Masaharu Nishimura, M.D., First Department of Medicine, Hokkaido University School of Medicine, N-15 W-7 Kita-ku, Sapporo 060-8638, Japan. E-mail: ma-nishi{at}med.hokudai.ac.jp

Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation caused by emphysema and/or airway narrowing. Computed tomography has been widely used to assess emphysema severity, but less attention has been paid to the assessment of airway disease using computed tomography.

Objectives: To obtain longitudinal images and accurately analyze short axis images of airways with an inner diameter 2 mm located anywhere in the lung with new software for measuring airway dimensions using curved multiplanar reconstruction.

Methods: In 52 patients with clinically stable COPD (stage I, 14; stage II, 22; stage III, 14; stage IV, 2), we used the software to analyze the relationship of the airflow limitation index (FEV₁, % predicted) with the airway dimensions from the third to the sixth generations of the apical bronchus (B1) of the right upper lobe and the anterior basal bronchus (B8) of the right lower lobe.

Measurements and Main Results: Airway luminal area (Ai) and wall area percent (WA%) were significantly correlated with FEV₁ (% predicted). More importantly, the correlation coefficients (r) improved as the airways became smaller in size from the third (segmental) to sixth generations in both bronchi (Ai: r = 0.26, 0.37, 0.58, and 0.64 for B1; r = 0.60, 0.65, 0.63, and 0.73 for B8).

Conclusions: We are the first to use three-dimensional computed tomography to demonstrate that airflow limitation in COPD is more closely related to the dimensions of the distal (small) airways than proximal (large) airways.

Key Words: airway luminal area • airway wall • computed tomography • multiplanar reconstruction • small airway

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