Chronic Obstructive Pulmonary Disease
Conditions
Keywords
prognostic, phenotype, Computed tomography, Chronic Obstructive Pulmonary Disease
Brief summary
Chronic obstructive pulmonary disease (COPD) is caused by tobacco consumption. The goal is to characterize on clinical and radiological data, using computed tomography, this illness in order to improve diagnostic and be able to evaluate the prognostic of each patient.
Detailed description
Chronic obstructive pulmonary disease (COPD) is characterized by emphysematous destruction of pulmonary parenchyma, airway obstruction that participate in chronic temporary obstruction of airways. COPD has multiple clinical presentations that define phenotypes but doesn't take into account those anatomo-pathologic modifications. Moreover, the prognostic interest of those structural alteration is unknown. Until now, only PFT allowed to define the severity of the disease, whereas multiple others tools may be useful, such as, symptoms scores, exacerbation frequencies, denutrition. Those structural alterations are available using computed tomography (CT), that may also have an interest in prognostic or in treatment follow- up. CT is widely used in clinical practice for COPD patients at basal state and in exacerbations. Quantitative CT is able to combine acquisition of objective and reproductible informations on parenchymal destruction (emphysema), bronchial wall remodeling, and pulmonary vessels alteration. The investigators' team developed software tools to determine quantitative structural modifications of airways, emphysema and small pulmonary vessels1,2. The team has been able to build a score Paw score combining PaO2 with CT parameters of bronchial wall thickness and small pulmonary vessels percentage2. This score allowed to predict the presence of severe pulmonary hypertension in patients with COPD. Pulmonary hypertension is a complication of COPD that increase morbi-mortality. The hypothesis is that morphological quantitative analysis combined with structural alterations of airways has a prognostic interest. The main goal is to determine morphological phenotypes of COPD using a cluster analysis combining emphysema, bronchial wall thickness and pulmonary vessels. The other main goal is to predict evolution of COPD patients based on clinical outcomes (exacerbations frequency, mortality, mMRC, SGQLQ) and lung function testing (decline in FEV-1 TLCO, PaO2). The team also wants to analyze clinical data of survival, exacerbation and symptoms in following years of the CT of each cluster in historic-prospective way. The secondary goals are to describe clinical, functional and biological clusters. Analyse of correlations will be studied. Moreover, we will investigate the interest of the Paw score as a prognostic marker and as a correlated parameter. This is a retrospective study. We want to take information from the year before CT, to the year after CT. At the date of the consultation concomitant with CT we want to know all the clinical, functional and biological data of each patient.
Interventions
None listed
Sponsors
Transitionnal Research International Laboratory
University Hospital, Bordeaux
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
40 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 40 years * Inhalated toxic exposure: * Tobacco exposure (present or past, over 10 pack years) * And/or professional exposure to a toxic * Obstructive syndrome with a FEV1/FVC ≤ 0.7 after inhalation of a bronchodilatator and measured at stable state (without exacerbation) * Computed tomography performed without injection contrast during common care
Exclusion criteria
* Patients with an exacerbation within 6 weeks before computed tomography * Artefacts movements on computed tomography incompatible with quantitative analyse * Broncho-pulmonary cancer (old or present) * History of pulmonary surgery * No follow-up for 1 year after scan * Opposition of the patient to the use of his data (clinical, functional and imaging).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phenotypes of Chronic obstructive pulmonary disease (COPD) | Day 1 | Measure of emphysema |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical data of survival | Day 1 | Date of death |
| Exacerbations | Day 1 | Number of exacerbations |
Other
| Measure | Time frame | Description |
|---|---|---|
| Pulmonary function test | Day 1 | Forced Expiratory Volume - FEV1 (L) |
| Arterial blood gazes | Day1 | pH |
| Number of pack per year of tobacco | Day 1 | Number of pack per year of tobacco |
| Clinical parameter | Day1 | weight (kilograms) |
| Biology | Day1 | C-reactive protein; cross-reacting protein (mg/l). |
| Clinical scores | Day 1 | Score COPDAssessmentTest CAT Scale range: minimum value: 0, maximum value: 40. Only total score is reported. Higher values are considered to be bad outcome. Subscale are not reported, but there are combined by summed to compute the total score. |
| Clinical data | Day 1 | Six minute walk test (meters, and % predicted) |
Countries
France
Contacts
Primary ContactFrançois LAURENT, MD, PhD
Backup ContactRkia ACHKIR
Outcome results
None listed