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Subramanian, D.R.* ; Gupta, S.* ; Burggraf, D. ; vom Silberberg, S. ; Heimbeck, I. ; Heiss-Neumann, M.S. ; Haeussinger, K. ; Newby, C.* ; Hargadon, B.* ; Raj, V.* ; Singh, D.* ; Kolsum, U.* ; Hofer, T.P. ; Al-Shair, K.* ; Luetzen, N.* ; Prasse, A.* ; Müller-Quernheim, J.* ; Benea, G.* ; Leprotti, S.* ; Boschetto, P.* ; Gorecka, D.* ; Nowinski, A.* ; Oniszh, K.* ; zu Castell, W. ; Hagen, M. ; Barta, I.* ; Döme, B.* ; Strausz, J.* ; Greulich, T.* ; Vogelmeier, C.* ; Koczulla, A.R.* ; Gut, I.* ; Hohlfeld, J.* ; Welte, T.* ; Lavae-Mokhtari, M.* ; Ziegler-Heitbrock, L. ; Brightling, C.* ; Parr, D.G.*

Emphysema- and airway-dominant COPD phenotypes defined by standardised quantitative computed tomography.

Eur. Respir. J. 48, 92-103 (2016)

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EvA (Emphysema versus Airway disease) is a multicentre project to study mechanisms and identify biomarkers of emphysema and airway disease in chronic obstructive pulmonary disease (COPD). The objective of this study was to delineate objectively imaging-based emphysema-dominant and airway disease-dominant phenotypes using quantitative computed tomography (QCT) indices, standardised with a novel phantom-based approach.441 subjects with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-3) were assessed in terms of clinical and physiological measurements, laboratory testing and standardised QCT indices of emphysema and airway wall geometry.QCT indices were influenced by scanner non-conformity, but standardisation significantly reduced variability (p<0.001) and led to more robust phenotypes. Four imaging-derived phenotypes were identified, reflecting "emphysema-dominant", "airway disease-dominant", "mixed" disease and "mild" disease. The emphysema-dominant group had significantly higher lung volumes, lower gas transfer coefficient, lower oxygen (PO2 ) and carbon dioxide (PCO2 ) tensions, higher haemoglobin and higher blood leukocyte numbers than the airway disease-dominant group.The utility of QCT for phenotyping in the setting of an international multicentre study is improved by standardisation. QCT indices of emphysema and airway disease can delineate within a population of patients with COPD, phenotypic groups that have typical clinical features known to be associated with emphysema-dominant and airway-dominant disease.

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