Source: Annual Congress 2003 - COPD: a multicomponent disease
Disease area: Airway diseases

Abstract

We tried to define the relative predominance of chronic bronchitis and emphysema in each of 252 consecutive COPD patients. Patients were classified as predominant chronic bronchitis (pCB) or predominant emphysema (pE) using a standardised set of clinical, functional, and radiographic variables. To ascertain whether the physician‘s subjective process of integrating a number of variables into a specific pattern of COPD could be objectively confirmed, the same set of variables served as input for discriminant analysis (DA). DA selected 8 variables (cough, sputum, hyperfonetic sound, DLCO, FRC, reduced lung density, increased lung volume, right heart enlargement), whose discriminating coefficients were prospectively applied to a different series of 61 COPD patients in whom lung density by spirometric-gated HRCT was also measured. The agreement between subjective classification and DA was 90%. Out of 61 patients, 17 were classified as pCB, 31 as pE. In 13 patients (21%) discriminating scores (DS) overlap between pCB and pE. Significant differences were observed between pCB and pE in clinical, functional, and radiographic parameters. HRCT lung density was higher (p<0.001) in pCB. We conclude that: 1) the subjective process of combining a set of variables into a specific pattern of COPD is objectively confirmed by DA; 2) DS may identify pCB and pE among COPD patients; 3) the term COPD should be applied only to the minority of patients whose DS overlap between pCB and pE.

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G. Camiciottoli, M. Chiostri, N. M. Maluccio, L. Mariani, S. Checcacci, F. Lavorini, W. Castellani, G. A. Fontana, M. Bartolucci, M. Pistolesi (Florence, Italy). Defining the contribution of emphysema and chronic bronchitis in COPD patients. Eur Respir J 2003; 22: Suppl. 45, 3373

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