Published ahead of print on March 23, 2006, doi:10.1164/rccm.200601-037OC
Am. J. Respir. Crit. Care Med., Volume 173, Number 12, June 2006, 1309-1315
A more recent version of this article appeared on June 15, 2006
Submitted on January 9, 2006
Accepted on March 23, 2006
Airflow Limitation and Airway Dimensions in Chronic Obstructive Pulmonary Disease
Masaru Hasegawa1, Yasuyuki Nasuhara1, Yuya Onodera1, Hironi Makita1, Katsura Nagai1, Satoshi Fuke1, Yoko Ito1, Tomoko Betsuyaku1, and Masaharu Nishimura1*
1 First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan; Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan
* To whom correspondence should be addressed. 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 (forced expiratory volume in 1 sec (FEV1), % predicted) with the airway dimensions from the 3rd to the 6th 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 3rd to 6th 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: small airway; airway luminal area; airway wall; multiplanar reconstruction (MPR); computed tomography
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