title: Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD?
abstract: A substantial proportion of patients with chronic obstructive pulmonary disease (COPD) develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory-expiratory low dose computed tomography (CT) and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28) and in females (n=27). Women with a predominant conductive airway phenotype (n=10) showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001). Intrathoracic tracheal collapsibility was directly correlated with inspiratory-expiratory volume variation at CT and with forced expiratory volume (1 second), and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD are closely correlated. In patients with a predominant emphysematous phenotype, a reduced collapsibility may reflect the mechanical properties of the stiff hyperinflated emphysematous lung. The high collapsibility in patients with predominant airway disease, mild airway obstruction, and in women with this phenotype may reflect chronic airway inflammation. The lack of relationship with such symptoms as wheezing, cough, and dyspnea could indicate that intrathoracic tracheal collapsibility itself should be considered neither an abnormal feature of COPD nor a relevant clinical finding.
authors.affiliation: Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
authors.forename: Gianna
authors.initials: G
authors.lastname: Camiciottoli
authors.affiliation: Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, Cesena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Diciotti
authors.affiliation: Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bigazzi
authors.affiliation: Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Lombardo
authors.affiliation: Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bartolucci
authors.affiliation: Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Paoletti
authors.affiliation: Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Mascalchi
authors.affiliation: Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Pistolesi
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D010641:Phenotype; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011829:Radiation Dosage; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D014132:Trachea / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014797:Vital Capacity
keywords: airway; computed tomography; lung density; lung volumes; pulmonary function