期刊
ANNALS OF THE AMERICAN THORACIC SOCIETY
卷 16, 期 4, 页码 447-454出版社
AMER THORACIC SOC
DOI: 10.1513/AnnalsATS.201806-424OC
关键词
interstitial lung abnormalities; idiopathic pulmonary fibrosis; square root of AWT for airways with an internal perimeter of 10 mm; airways; lung capacity
资金
- National Institutes of Health (NIH) [T32 HL007633]
- NIH [R01 HL111024, R01 HL130974, R01 HL135142, K08 HL140087, K01 HL118714, R01 HL133137, K25 HL104085, R01 CA203636, K25 HL130637]
- National Heart, Lung, and Blood Institute (NHLBI) [U01 HL089897, U01 HL089856]
- COPD Foundation
- GlaxoSmithKline [SCO104960]
- NHLBI's Framingham Heart Study contract [N01-HC-25195]
- NHLBI [R01 HL130974, U01 HL089856, OT2 OD026553, P01 HL114501, R01 HL113264, R01 HL133135, R01 HL137927, R01 HL129920, U01 HL133232, R01 HL122464, R01 HL116473]
Rationale: There is increasing evidence that aberrant processes occurring in the airways may precede the development of idiopathic pulmonary fibrosis (IPF); however, there has been no prior confirmatory data derived from imaging studies. Objectives: To assess quantitative measures of airway wall thickness (AWT) in populations characterized for interstitial lung abnormalities (ILA) and for IPF. Methods: Computed tomographic imaging of the chest and measures of AWT were available for 6,073, 615, 1,167, and 38 participants from COPDGene (Genetic Epidemiology of COPD study), ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints study), and the Framingham Heart Study (FHS) and in patients with IPF from the Brigham and Women's Hospital Herlihy Registry, respectively. To evaluate these associations, we used multivariable linear regression to compare a standardized measure of AWT (the square root of AWT for airways with an internal perimeter of 10mm[Pi10]) and characterizations of ILA and IPF by computed tomographic imaging of the chest. Results: In COPDGene, ECLIPSE, and FHS, research participants with ILA had increased measures of Pi10 compared with those without ILA. Patients with IPF had mean measures of Pi10 that were even greater than those noted in research participants with ILA. After adjustment for important covariates (e.g., age, sex, race, body mass index, smoking behavior, and chronic obstructive pulmonary disease severity when appropriate), research participants with ILA had increased measures of Pi10 compared with those without ILA (0.03 mm in COPDGene, 95% confidence interval [CI], 0.02-0.03; P, 0.001; 0.02 mm in ECLIPSE, 95% CI, 0.005-0.04; P = 0.01; 0.07 mm in FHS, 95% CI, 0.01-0.1; P = 0.01). Compared with COPDGene participants without ILA older than 60 years of age, patients with IPF were also noted to have increased measures of Pi10 (2.0 mm, 95% CI, 2.0-2.1; P, 0.001). Among research participants with ILA, increases in Pi10 were correlated with reductions in lung volumes in some but not all populations. Conclusions: These results demonstrate that measurable increases in AWT are consistently noted in research participants with ILA and in patients with IPF. These findings suggest that abnormalities of the airways may play a role in, or be correlated with, early pathogenesis of pulmonary fibrosis.
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