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PubMed1994

Emphysema: definition, imaging, and quantification.

This review will discuss imaging of the chest in patients with pulmonary emphysema. Imaging findings must be related to the structure of the lung because emphysema is defined in anatomic terms. Accordingly, we first review the anatomic definitions of emphysema and its consequences and then review the imaging findings, with emphasis on CT, in patients with this disease. The more severe the morphologic emphysema, the more likely a radiographic diagnosis will be made, no matter what criteria are used. The criterion of arterial deficiency is specific but insensitive. The criteria used to assess overinflation are sensitive but not specific. CT can be used for both qualitative and quantitative assessment of emphysema. The presence and extent of emphysema can be determined by visual assessment of areas of abnormally low attenuation or by objective quantification based on the attenuation values. Statistically significant correlations between emphysema and CT findings have been shown in numerous studies, but mild morphologic emphysema may be missed by CT, and occasionally CT scans give false-positive findings. In patients with moderate to severe emphysema, the severity of emphysema is underestimated on the basis of CT findings by a factor of approximately three when compared directly with results of pathologic examination of lung specimens. In spite of these limitations, CT is the best way of recognizing emphysema in living patients and probably has a significant role in recognizing localized emphysema that is amenable to surgical treatment.

Female↗
PubMed2006

Advanced emphysema in African-American and white patients: do differences exist?

BACKGROUND: Emphysema is the only smoking-related disease in which white patients have higher prevalence and higher attributable mortality rates than African-American patients. Epidemiologic studies have not addressed, nor explained, the observed racial differences in emphysema. STUDY OBJECTIVES: To determine whether white and African-American patients differ with respect to the magnitude, anatomic distribution, and physiologic impairments of emphysema. PATIENTS: Characteristics of patients with severe and very severe emphysema enrolled in the National Emphysema Treatment Trial were examined and compared. Patient demographics, cardiopulmonary function, quality of life, and severity/distribution of the emphysema by quantitative CT were analyzed. RESULTS: Of the 1,218 patients enrolled in the trial, 42 were African American (3.4%) and 1,156 were white (95%). African Americans were younger (mean age +/- SD, 63 +/- 7 years vs 67 +/- 6 years) and smoked less (26 +/- 14 cigarettes per day vs 32 +/- 14 cigarettes per day) than white patients (p = 0.01). There was no difference between the two racial groups in pulmonary function (FEV1, 27 +/- 6% predicted vs 27 +/- 7% predicted), gas exchange (Pa(O2), 66 +/- 11 mm Hg vs 65 +/- 10 mm Hg), and exercise (33 +/- 14 W vs 36 +/- 21 W), respectively. Quality of life measures were similar between the groups, but African Americans had a lower socioeconomic status, lower education level, and fewer were married. Radiographic analysis of the extent of emphysema in African Americans, who were matched with selected white patients, revealed significantly less emphysema in the former group and different distribution of severe emphysema. CONCLUSIONS: African Americans with emphysema were younger and had a similar degree of lung impairment as the white study population despite smoking less. In a subgroup of matched patients, the severity and distribution of emphysema by quantitative radiographic analysis were different.

Black or African American↗
PubMed2006

[Quantification of pulmonary emphysema in multislice-CT using different software tools].

PURPOSE: The data records of thin-section MSCT of the lung with approx. 300 images are difficult to use in manual evaluation. A computer-assisted pre-diagnosis can help with reporting. Furthermore, post-processing techniques, for instance, for quantification of emphysema on the basis of three-dimensional anatomical information might be improved and the workflow might be further automated. MATERIALS AND METHODS: The results of 4 programs (Pulmo, Volume, YACTA and PulmoFUNC) for the quantitative analysis of emphysema (lung and emphysema volume, mean lung density and emphysema index) of 30 consecutive thin-section MSCT datasets with different emphysema severity levels were compared. The classification result of the YACTA program for different types of emphysema was also analyzed. RESULTS: Pulmo and Volume have a median operating time of 105 and 59 minutes respectively due to the necessity for extensive manual correction of the lung segmentation. The programs PulmoFUNC and YACTA, which are automated to a large extent, have a median runtime of 26 and 16 minutes, respectively. The evaluation with Pulmo and Volume using 2 different datasets resulted in implausible values. PulmoFUNC crashed with 2 other datasets in a reproducible manner. Only with YACTA could all graphic datasets be evaluated. The lung volume, emphysema volume, emphysema index and mean lung density determined by YACTA and PulmoFUNC are significantly larger than the corresponding values of Volume and Pulmo (differences: Volume: 119 cm(3)/65 cm(3)/1 %/17 HU, Pulmo: 60 cm(3)/96 cm(3)/1 %/37 HU). Classification of the emphysema type was in agreement with that of the radiologist in 26 panlobular cases, in 22 paraseptalen cases and in 15 centrilobular emphysema cases. CONCLUSION: The substantial expenditure of time obstructs the employment of quantitative emphysema analysis in the clinical routine. The results of YACTA and PulmoFUNC are affected by the dedicated exclusion of the tracheobronchial system. These fully automatic tools enable not only fast quantification without manual interaction, but also a reproducible measurement without user dependence.

Adolescent↗
PubMed2000

Lobar distribution of emphysema in computed tomographic densitometric analysis.

RATIONALE AND OBJECTIVES: The aims of this study were to determine the extent of emphysema in individual lobes and to investigate whether the lobar distribution of emphysema influences pulmonary function. METHODS: Helical CT and pulmonary function tests were performed in 50 emphysema patients. Percentages of low attenuation volume (extent of emphysema) were calculated for each lobe by using CT densitometric analysis. RESULTS: The extent of emphysema of the whole lung in these patients was 44%. Airflow limitation (r = -0.82, P<0.0001) and residual volume (r = -0.52, P<0.01) were closely correlated with the extent of emphysema in both lower lobes. Diffusing capacity (r = -0.61, P<0.0001) was closely correlated with the extent of emphysema in both upper lobes. On the basis of the lobar distribution of emphysema as determined by CT densitometry, we divided these emphysema patients into predominantly upper-lobe disease and predominantly lower-lobe disease groups. The predominantly lower-lobe disease group had significantly greater severe airflow limitation (P<0.0001), greater residual volume (P<0.01), and greater total lung capacity (P<0.05) than did the predominantly upper-lobe disease group. CONCLUSIONS: CT densitometry showed a distinct lobar distribution of emphysema. Pulmonary function is significantly different between predominantly upper- and lower-lobe emphysema groups.

Absorptiometry, Photon↗
PubMed1991

Putative role of neutrophil elastase in the pathogenesis of emphysema.

Emphysema in humans takes several different forms: centrilobular, panacinar, paraseptal, and airspace enlargement with fibrosis. The varying morphologic and background features of these forms of emphysema suggest that they differ in pathogenesis. Elastic fiber rupture and fraying are a feature of emphysema. Experimental emphysema may be induced by human neutrophil elastase and other elastolytic enzymes but not by nonelastolytic proteases. Disruption of elastic fibers also appears to be the underlying feature of lathyrogen-induced airspace enlargement and of the emphysema in the blotchy mouse. However, there is no evidence of elastic fiber destruction in cadmium-induced airspace enlargement with fibrosis or in emphysema associated with hyperoxia or severe starvation. Thus, elastic fiber disruption is not common to all forms of experimental emphysema. We posit that airspace enlargement may be a stereotyped response of the lungs to different injuries. Emphysema can be induced in experimental animals by repeated induction of pulmonary neutrophilia. However, the evidence for involvement of neutrophil elastase in human emphysema is not clear: there are studies using a variety of approaches that weigh on both sides of the question. There is also in vitro evidence that alveolar macrophages can degrade elastin or elastic fibers with which they are in contact by means of a metalloelastase or the cooperative action of plasminogen activator and an acid cysteine protease. We conclude that the pathogenesis of emphysema is complex. Neutrophil elastase likely plays a major role in the development of some forms of emphysema, but our understanding of the interactions between the alveolar walls and neutrophils is still fragmentary.

Animals↗
PubMed2004

Retinoic acid fails to reverse emphysema in adult mouse models.

BACKGROUND: Previous work has shown that all-trans-retinoic acid reverses elastase induced emphysema in rats. Since there is currently no effective treatment for pulmonary emphysema, the effect of retinoic acid should be further investigated in other adult species. A study was undertaken using two murine models of emphysema to evaluate the effect of retinoic acid. METHODS: The models used were an elastase induced emphysema model for acute alveolar destruction and a tumour necrosis factor (TNF)-alpha transgenic mouse which exhibits chronic air space enlargement, loss of elastic recoil, increased lung volume, and pulmonary hypertension comparable to human pulmonary emphysema. All-trans-retinoic acid (2 mg/kg) was injected for 12 successive days after the establishment of emphysema. The effects of treatment were evaluated using physiological and morphometric analyses. RESULTS: In contrast to the rat, administration of all-trans-retinoic acid in these murine models did not improve the emphysema. Moreover, worsening of emphysema was observed in TNF-alpha transgenic mice treated with all-trans-retinoic acid. The level of keratinocyte chemoattractant (KC), a CXC chemokine, in bronchoalveolar lavage fluid was increased in TNF-alpha transgenic mice following retinoic acid treatment. These data raise the possibility that retinoic acid causes deterioration of emphysema by promoting inflammation in this model. CONCLUSIONS: In these models, retinoic acid did not show positive effects on emphysema. The effect of retinoic acid in the treatment of pulmonary emphysema remains controversial, and further studies are required to determine its physiological effects under a variety of experimental conditions.

Animals↗
PubMed1993

Association of silicosis, lung dysfunction, and emphysema in gold miners.

BACKGROUND: In an earlier study of gold miners men with silicosis were found to have abnormal lung function, including airflow obstruction and reduced diffusing capacity. In a follow up study a sample of these men was examined by computed tomography to determine whether emphysema accounted for these abnormalities, which are associated with silicosis in this working population. METHODS: A sample of 70 men from a cohort of older gold miners with and without silicosis who had worked underground for a mean period of 29 years was examined by computed tomography to determine whether each man had emphysema. In addition, each man had lung function tests and routine chest radiography (125 kV). RESULTS: A total of 48 men had emphysema on examination by computed tomography. On the basis of the results in a chest radiograph 55 of the men had silicosis. Emphysema was related to silicosis, being present in five of the 15 men without silicosis and in 43 of the 55 with silicosis. Diffuse emphysema was apparent in two men without silicosis (14%) and in 25 men with silicosis (45%). The proportion of men with diffuse emphysema increased from 14% in those with International Labour Organisation category 0 nodule profusion to 46% in those with category 1, 48% in those with category 2, and 67% in those with category 3. Emphysema was also related to smoking: eight of the 18 who had never smoked and 40 of the 52 smokers had emphysema. All of those who had never smoked and had emphysema had silicosis with category 2/2 or greater nodule profusion. Lung function tests showed changes associated with silicosis that could be explained by the associated emphysema. CONCLUSIONS: In this population emphysema occurred in association with silicosis and accounted for the abnormalities in lung function associated with silicosis.

Gold↗
PubMed1996

Contribution of emphysema and small airways in COPD.

BACKGROUND: The contribution and role of emphysema and small airways disease in causing expiratory airflow limitation in COPD is controversial. METHODS: We obtained high-resolution thin-section 2-mm CT scans of the lung for emphysema grading and lung function in 116 consecutively seen COPD outpatients with fixed expiratory airflow limitation. In this group, inflated whole lung(s) were subsequently obtained in 24 patients (23 autopsy, 1 surgery) for morphologic studies and results compared with lung CT. Airway histologic condition was studied in 17 of the 24 patients. RESULTS: There was fair to weak negative correlation between CT emphysema score and either FEV1/FVC percent (r = -0.51, p = 0.001) or FEV1 percent predicted (r = -0.31, p = 0.001). In only 24 of the 81 patients (30%) with FEV1 less than 50% predicted, the CT emphysema score was 60 or more, indicating severe emphysema. In the 24 patients studied, there was a good correlation (r = 0.86, p = 0.001) between CT and pathologic grade of emphysema. While respiratory bronchioles (RBs) and membranous bronchioles (MBs) demonstrated marked morphologic abnormalities, there was a weak correlation with emphysema grade (for RB, r = 0.36, p = 0.16; for MB, r = 0.41, p = 0.10) or with FEV1 percent predicted (for RB, r = -0.21, p = 0.42; for MB, r = -0.28, p = 0.28). There was no correlation between emphysema and FEV1 percent predicted (r = -0.13, p = 0.54). CONCLUSIONS: High-resolution CT lung scans are an in vivo surrogate to quantitate moderate to severe morphologic emphysema. Emphysema does not appear to be primarily responsible for severe expiratory airflow limitation in most patients with severe COPD. There was no correlation between severity of small airway histologic condition and emphysema or FEV1 percent predicted. The causes of the lesions responsible for small airways obstruction need to be identified.

Aged↗
PubMed2000

Preoperative severity of emphysema predictive of improvement after lung volume reduction surgery: use of CT morphometry.

STUDY OBJECTIVE: To determine how the volume and severity of emphysema measured by CT morphometry (CTM) before and after lung volume reduction surgery (LVRS) relates to the functional status of patients after LVRS. DESIGN: A histologically validated CT algorithm was used to quantify the volume and severity of emphysema in 35 patients before and after LVRS: total lung volume (TLV), normal lung volume (< 6.0 mL gas per gram of tissue), volume of mild/moderate emphysema (ME; 6.0 to 10.2 mL gas per gram of tissue), volume of severe emphysema (> 10.2 mL gas per gram of tissue), surface area/volume (SA/V; meters squared per milliliter), and surface area (SA; meters squared). Outcome parameters included maximal cardiopulmonary exercise (CPX) performance in 21 patients and routine pulmonary function in all patients. We hypothesized that baseline CTM parameters predict response to LVRS and that the change in these parameters may offer insight into mechanisms of improvement. PATIENTS AND INTERVENTION: Thirty-five patients with severe emphysema who had successful LVRS. RESULTS: The significant decrease in TLV following LVRS was entirely accounted for by a decrease in severe emphysema. The SA/V and the SA both increased significantly following LVRS. The change in maximal CPX in watts following surgery correlated significantly with baseline values of severe emphysema (r = 0.60), which was collinear with TLV, and SA/V. The change in diffusing capacity of the lung for carbon monoxide revealed a significant positive linear relationship with preoperative severe emphysema (r = 0.37) and a negative relationship with ME (r = -0.37). Change in watts revealed a strong relationship with changes in severe emphysema (r = -0.75) and weaker but significant relationships with change in TLV, ME, SA/V, and SA. Other measures of pulmonary function revealed significant albeit less dominant relationships with baseline CTM and change in these indexes. CONCLUSION: Using CTM, we have identified a close relationship between baseline severe emphysema, or change in severe emphysema, and the improvement in CPX after LVRS. These observations support a potential role of CTM in future clinical trials for predicting responders to LVRS and identifying mechanisms of improvement.

Algorithms↗
PubMed2005

Paired inspiratory/expiratory volumetric thin-slice CT scan for emphysema analysis: comparison of different quantitative evaluations and pulmonary function test.

PURPOSES: The aim of the study was to use three-dimensional high-resolution CT scan data sets in inspiration and expiration for the quantitative evaluation of emphysema. Using an advanced dedicated semiautomatic analysis tool, the functional inspiratory/expiratory shifts of emphysema volume and clusters were quantified. The pulmonary function test (PFT) served as the clinical "gold standard." MATERIALS AND METHODS: Thirty-one patients (9 women and 22 men; mean [+/- SD] age, 60 +/- 8 years) who had severe emphysema due to COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] class III and IV) were included in the study. All patients underwent paired inspiratory/expiratory multidetector CT scans (slice thickness, 1/0.8 mm) and pulmonary function tests (PFTs). CT scan data were analyzed with self-written emphysema detection solftware. It provides lung volume (LV), emphysema volume (EV), emphysema index (EI), and four clusters of emphysema with different volumes (from 2, 8, 65, and 120 mm(3)). These results were correlated with total lung capacity (TLC), intrathoracic gas volume (ITGV), and residual volume (RV) derived from PFT results. RESULTS: Inspiratory LV correlated with TLC (r = 0.9), expiratory LV with ITGV (r = 0.87), and RV (r = 0.83). Expiratory EV correlated better with ITGV (r = 0.88) and RV (r = 0.93) than with inspiratory EV (r = 0.83 and 0.88, respectively). The mean inspiratory EI was 54 +/- 13%, and it decreased to 43 +/- 15% in expiration. However, the individuals showed a broad spectrum of changes of EI (mean, 11%; range, 1 to 28%), and no differences in inspiratory/expiratory EI and changes in EI or LV were found between GOLD III and GOLD IV patients. In expiration, there was a change from the large emphysema cluster (-37%) to the intermediate cluster (+15%) and small cluster (+13% and +11%, respectively). The change of volume of the large emphysema cluster after expiration correlated well with the changes in LV (r = 0.9), EV (r = 0.99), EI (r = 0.85), and MLD (r = 0.76). CONCLUSION: Emphysema volumes measured from expiratory MDCT scans better reflect PFT abnormalities in patients with severe emphysema than those from inspiratory scans. Volumetric cluster analysis provided deeper insights into the local hyperinflation and expiratory obstruction of large emphysematous clusters.

Adult↗
PubMed2005

The contribution of intrapleural pressures to the pathogenesis of emphysema.

This paper maintains that negative intrapleural pressure is a prerequisite for the appearance of emphysema, either simply by the enlargement of the air space in combination with elastolytic enzymatic factors, or, frequently, by its contribution to the breakdown of collagen and elastin fibers through the increase in intrapulmonary pressures. Hence the factors that make the intrapleural pressure more negative play an indirect part in causing emphysema. Thus the development of collagen fibers, whatever its cause, gives rise to a reduction in the lung compliance which may produce more negative intrapleural pressure and, in consequence, an increase in the intrapulmonary pressures. The development of collagen fibers also contributes to the unequal distribution of these pressures in various regions, including the microenvironment of the lung, resulting in the breakdown of fibers in some areas due to the powerful forces that develop in them. It is by this mechanism that the development of collagen fibers contributes to the development of emphysema in areas that have suffered damage, in combination with enzymatic factors or even without them. Moreover, the intensified functioning of the respiratory muscles which may result from a reduction in the functional capacity of the lung parenchyma may also contribute indirectly to the pathogenesis of emphysema through the more negative intrapleural pressure. A chest radiogram cannot distinguish what is occurring in the microenvironment of the lung; it can, however, follow from a distance the overall changes throughout the subjects' lives. The present work is the product of such a follow-up. Chest radiograms show that very often the pulmonary fibrosis may be combined with emphysema or may precede the emphysema. The more negative the intrapleural pressure becomes, the greater its role in the production of emphysema. It is claimed that the form of the emphysema depends on the conditions created in the lung microenvironment and that negative intrapleural pressure plays a greater or lesser role in all forms of emphysema, including panacinar emphysema.

Collagen↗
PubMed2006

Evaluation of excised lung gas volume measurements in animals with genetic or induced emphysema.

Emphysema, a leading cause of respiratory disability and mortality in humans, is characterized by destruction of alveolar walls and enlargement of airspaces. Animal studies are critical in understanding the pathogenesis of emphysema. However, current measurements of airspace enlargement and emphysema in small laboratory animals are labor intensive and may not be sensitive enough for measuring alterations in lung function and structure at the early stages of emphysema. In this study, we have investigated the excised lung gas volume (ELGV) measurement as a potential index for determining airspace enlargement in pallid mice with developing emphysema, in tight-skin mice with developed emphysema, or in Wistar rats with emphysema induced by an intratracheal instillation of pancreatic elastase. Our results showed that values of both ELGV per lung and per gram lung tissue were significantly increased in all three emphysema models, compared to control. The ELGV values were correlated well with morphometric evaluation of emphysema. Variations in transpulmonary pressures caused by different termination procedures were critical factors influencing the ELGV values. The present study demonstrates that ELGV measurement is a simple and sensitive method to monitor the development of emphysema.

Age Factors↗
PubMed2005

[Does HRCT-emphysema index represent the entire lung?].

PURPOSE: : Comparison of emphysema index derived of thin section MD-CT of the entire lung volume and HRCT, simulated by calculation of every twentieth image of the whole data-set. MATERIALS AND METHODS: Pulmonary emphysema was quantified by semiautomatic, segmentation of lung borders and assessment of lung volume and emphysema volume within these borders. The emphysema index (pixel index) was calculated. Statistical analysis was done by the sign-test and Bland-Altman-analysis. RESULTS: Median lung volume, emphysema volume and emphysema index are significantly higher in simulated HRCT. Median lung volume (emphysema volume) calculated by HRCT is 5118 ml (407 ml) and 5040 ml (367 ml) calculated by the entire MD-CT data-set, representing differences of 1 and 8 % related to the median lung and emphysema volumes. Emphysema index is 0.09 (HRCT) and 0.08 (MD-CT). CONCLUSION: HRCT overrates emphysema index compared to thin section MD-CT of the entire lung volume.

Adolescent↗
PubMed2001

Aortic root dilatation in patients with emphysema.

BACKGROUND: Abdominal aortic aneurysms have been recognized to occur more frequently in patients with emphysema. However, the prevalence of aortic root dilatation in patients with emphysema and its relationship to risk factors for aortic enlargement have not been previously described. METHODS: We studied 47 patients, past smokers (aged 67 +/- 6 years, 18 women) with severe emphysema diagnosed by a pulmonary function test and an ultrafast computed tomographic scan. Two-dimensional echocardiography was used to measure the aortic root at the aortic annulus, sinus of Valsalva, sinotubular junction and proximal part of the ascending aorta. Measured mean values were compared with published normal values and age- and sex-matched patients without emphysema. The relationship between aortic root size and cardiac risk factors (hypertension, hypercholesterolemia, and diabetes) was also examined. RESULTS: In patients with emphysema the mean aortic root dimensions were significantly larger than normal values at each measured site (P <.0001) and those of patients without emphysema (P <.05 to.0001). A substantial percentage of patients with emphysema had larger sinus of Valsalva (43%) and proximal ascending aorta (59%) than the upper limit of normal. In the multivariable regression model, emphysema was a significant determinant of aortic root size at all measured sites and hypertension was associated with additional dilatation at the sinus of Valsalva, sinotubular junction, and proximal ascending aorta. CONCLUSIONS: (1) In patients with emphysema the aortic root dimension is significantly larger than in patients without emphysema. (2) Systemic hypertension is associated with additional enlargement of the proximal ascending aorta, the sinus of Valsalva, and the sinotubular junction.

Aged↗
PubMed2003

Hypothalamic digoxin, hemispheric chemical dominance, and chronic bronchitis emphysema.

The isoprenoid pathway produces three key metabolites--endogenous digoxin (membrane sodium-potassium ATPase inhibitor, immunomodulator, and regulator of neurotransmitter/amino acid transport), dolichol (regulates N-glycosylation of proteins), and ubiquinone (free radical scavenger). This was assessed in patients with chronic bronchitis emphysema. The pathway was also assessed in patients with right hemispheric, left hemispheric, and bihemispheric dominance to find the role of hemispheric dominance in the pathogenesis of chronic bronchitis emphysema. All the 15 patients with chronic bronchitis emphysema were right-handed/left hemispheric dominant by the dichotic listening test. In patients with chronic bronchitis emphysema there was elevated digoxin synthesis, increased dolichol, and glycoconjugate levels, and low ubiquinone and elevated free radical levels. There was also an increase in tryptophan catabolites and a reduction in tyrosine catabolites. There was an increase in cholesterol:phospholipid ratio and a reduction in glycoconjugate levels of RBC membrane in patients with chronic bronchitis emphysema. The same biochemical patterns were obtained in individuals with right hemispheric dominance. Endogenous digoxin by activating the calcineurin signal transduction pathway of T-cell can contribute to immune activation in chronic bronchitis emphysema. Increased free radical generation can also lead to immune activation. Endogenous synthesis of nicotine can contribute to the pathogenesis of the disease. Altered glycoconjugate metabolism and membranogenesis can lead to defective lysosomal stability contributing to the disease process by increased release of lysosomal proteases. The role of an endogenous digoxin and hemispheric dominance in the pathogenesis of chronic bronchitis emphysema and in the regulation of lung structure/function is discussed. The biochemical patterns obtained in chronic bronchitis emphysema is similar to those obtained in left-handed/right hemispheric chemically dominant individuals by the dichotic listening test. But all the patients with chronic bronchitis emphysema were right-handed/left hemispheric dominant by the dichotic listening test. Hemispheric chemical dominance has no correlation with handedness or the dichotic listening test. Chronic bronchitis emphysema occurs in right hemispheric chemically dominant individuals and is a reflection of altered brain function. Hemispheric chemical dominance can play a role in the regulation of lung function and structure.

Analysis of Variance↗
PubMed2004

Decreased expression of interleukin 13 in human lung emphysema.

BACKGROUND: The overexpression of interferon (IFN)gamma or interleukin (IL)-13 in the adult murine lung induces the development of changes that mirror human lung emphysema. METHODS: IL-13 and IFNgamma expression was determined in lung samples from five groups of PATIENTS: severe emphysema without alpha(1)-antitrypsin deficiency (SE+, n = 10); severe emphysema with alpha(1)-antitrypsin deficiency (SE-, n = 5); mild localised emphysema (ME, n = 8); non-emphysema smokers (NE-S, n = 9), and non-emphysema non-smokers (NE-NS, n = 11). Lung IL-13 and IFNgamma mRNA were analysed by RT-PCR. Lung concentrations of IL-13 protein were assessed by ELISA. RESULTS: The expression of IFNgamma mRNA was similar in patients with or without emphysema. IL-13 mRNA was markedly decreased in the SE+ group compared with the SE- (p = 0.04), ME (p = 0.02), and non-emphysema groups (p = 0.01). IL-13 mRNA correlated with forced expiratory volume in 1 second (r = 0.5, p = 0.04) and arterial oxygen tension (r = 0.45, p = 0.03) in emphysema patients. In contrast to the non-emphysematous lung, IL-13 protein was below the detection limit of the assay in most emphysematous lung homogenates. CONCLUSION: The lung IL-13 content is reduced in patients with severe emphysema without alpha(1)-antitrypsin deficiency.

Adult↗
PubMed1993

Microscopic emphysema in relation to age and smoking habit.

BACKGROUND: The increases in airspace size within the human lung associated with microscopic emphysema can be assessed by measuring the airspace wall surface area per unit volume of lung tissue (AWUV). In a previous study the limits of normality of AWUV with age were estimated in lifelong non-smokers by the 95% prediction limits of the regression line for these variables. The aims of this study were to study the incidence of microscopically assessed emphysema in a group of smokers and to examine the influence of smoking habit on the susceptibility to and severity of microscopically assessed emphysema. METHODS: AWUV was measured on tissue sections from 125 lung specimens obtained from tobacco smokers (mean age 61.1 (range 33-85) years) with the fast interval processor, a rapid automatic scanning device. The mean AWUV value was calculated for each specimen and this figure was plotted against the age of the subject. The limits of normal AWUV were plotted, and AWUV values below these limits were taken as indicative of microscopically assessed emphysema. Details of the number of cigarettes smoked each day were obtained for 97 of the smokers. These subjects were grouped according to smoking habit: group 1, 1-19 cigarettes/day; group 2, 20-29 cigarettes/day; group 3, at least 30 cigarettes/day. The AWUV results from each of these groups were then assessed. RESULTS: Mean AWUV decreased with age in this group of smokers, but only 26% had microscopically assessed emphysema, indicating that within the group there were two subgroups of smokers with differing susceptibility to microscopically assessed emphysema. There were no sex differences in the incidence of microscopically assessed emphysema, nor were the incidence and severity increased with increased daily cigarette consumption. CONCLUSIONS: Susceptibility to microscopically assessed emphysema was found to be similar in male and female smokers. Daily cigarette consumption did not appear to be the primary factor influencing the susceptibility to or severity of microscopically assessed emphysema. Susceptibility differences within the smoking population should be taken into consideration in studies of the pathogenesis of emphysema.

Adult↗
PubMed2001

Prevalence of emphysema in individuals who underwent screening CT for lung cancer in Nagano prefecture of Japan.

BACKGROUND: Screening for lung cancer with low-dose spiral computed tomography (CT) was carried out in Nagano prefecture in Japan. OBJECTIVE: To study the prevalence of emphysema in 7,847 individuals based on the Nagano spiral CT screening and to correlate the prevalence and severity of emphysema with various factors. METHODS: Spiral CT images with scan parameters of 120 kV, 50 mA, 10-mm collimation and a pitch of 2 obtained at full inspiration were retrospectively evaluated in 7,847 individuals. Emphysema was defined as the presence of low-attenuation areas in the lung parenchyma. Extent of emphysema was graded on a four-level scale and correlated with gender, age and smoking habits. RESULTS: There were 4,288 males and 3,559 females. Mean age of the subjects was 61 years; 45.8% of the participants were smokers. Overall prevalence of emphysema was 2.9%; the prevalence was significantly higher in males (5.0%) than in females (0.5%); it was also significantly higher in smokers, and increased with age. Emphysema was positively correlated with age, but there was no correlation with smoking indices. Emphysema was mostly mild and localized in the upper lung. The logistic model revealed that gender, age and smoking indices were significant factors for developing emphysema. CONCLUSIONS: Overall prevalence of emphysema was 2.9%. The prevalence was higher in males and in older people. Smoking was also related to a higher prevalence of emphysema but not to its severity.

Adult↗