title: Emphysema distribution and annual changes in pulmonary function in male patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The progression of chronic obstructive pulmonary disease (COPD) considerably varies among patients. Those with emphysema identified by quantitative computed tomography (CT) are associated with the rapid progression assessed by forced expiratory volume in one second (FEV1). However, whether the rate of the decline in lung function is independently affected by the regional distribution or the severity of emphysema in the whole lung is unclear.
  
  
  METHODS
  We followed up 131 male patients with COPD for a median of 3.7 years. We measured wall area percent (WA%) in right apical segmental bronchus, total lung volume, percent low attenuation volume (LAV%), and the standard deviation (SD) of LAV% values from CT images of 10 isovolumetric partitions (SD-LAV) as an index of cranial-caudal emphysema heterogeneity. Annual changes in FEV1 were then determined using a random coefficient model and relative contribution of baseline clinical parameters, pulmonary function, and CT indexes including LAV%, SD-LAV, and WA% to annual changes in FEV1 were examined.
  
  
  RESULTS
  The mean (SD) annual change in FEV1 was -44.4 (10.8) mL. Multivariate random coefficient model showed that higher baseline FEV1, higher LAV%, current smoking, and lower SD-LAV independently contributed to an excessive decline in FEV1, whereas ratio of residual volume to total lung capacity, ratio of diffusing capacity to alveolar ventilation, and WA% did not, after adjusting for age, height, weight, and ratio of CT-measured total lung volume to physiologically-measured total lung capacity.
  
  
  CONCLUSIONS
  A more homogeneous distribution of emphysema contributed to an accelerated decline in FEV1 independently of baseline pulmonary function, whole-lung emphysema severity, and smoking status. In addition to whole-lung analysis of emphysema, CT assessment of the cranial-caudal distribution of emphysema might be useful for predicting rapid, progressive disease and for developing a targeted strategy with which to prevent disease progression.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Tanabe
authors.forename: Shigeo
authors.initials: S
authors.lastname: Muro
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Susumu
authors.initials: S
authors.lastname: Sato
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Oguma
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kiyokawa
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kinose
authors.forename: Yuma
authors.initials: Y
authors.lastname: Hoshino
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubo
authors.forename: Emiko
authors.initials: E
authors.lastname: Ogawa
authors.forename: Toyohiro
authors.initials: T
authors.lastname: Hirai
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
mesh_terms: D000368:Aged; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D014057:Tomography, X-Ray Computed