Manju Sara Ooman, (2017) A Comparative study to assess the clinico-radiological characterstics of COPD phenotypes and their varied response to bronchodilators in a tertiary care hospital. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity around the globe. GOLD guidelines recommend an holistic method in approaching COPD by considering symptoms of patients using a grading system for dyspnea( MMRC), exacerbations over the past year as well as airflow limitation to grade COPD severity. However, COPD patients are a heterogenous population with varying mechanisms and degrees of airflow obstruction. Identifying specific phenotypes with distinct clinical characterstics among them will help guide a targeted approach to therapy. OBJECTIVES: To classify COPD (Group D as per GOLD) into three main phenotypes based on morphological features on high resolution computed tomography (HRCT), assess their clinic-radiological and spirometeric features and change in FEV1 after 3 months of LABA+ICS. METHODS: A prospective observational study was conducted in the thoracic medicine department of RGGH, Chennai and Institute of Thoracic Medicine, Chetpet from November 2015 to August 2016. Consecutive, 147, newly diagnosed COPD (Group D) subjects were studied. Based on the chest HRCT features of low attenuation area (LAA) and bronchial wall thickness (BWT), patients were grouped as emphysematous (E) or airway (A) predominant or as combination of emphysematous+airway thickening (mixed) phenotypes. The clinical (age, gender, BMI, atopy, smoking index, symptoms, plasma eosinophil levels, MMRC, CAT Score, 6MWT, exacerbations) and pulmonary function test parameters were recorded. All were treated with LABA+ICS for 3 months and their change in FEV1 was compared. The results were statistically analysed. RESULTS: Of the 147 subjects, 33 were excluded and another 20 patients dropped out from the study. In the remaining 94 subjects, 54% (n=51) were grouped as emphysematous, 29% (n=27) airway predominant and 17% (n=16) as mixed phenotypes. In the E phenotype, males were predominant, had lower BMI, higher smoking index, greater exercise intolerance when compared to A, higher CAT score and a higher mean LAA score. Amongst the 3 groups, females were highest in the A phenotype. This group had a higher BMI, more of never smokers, more history of exposure to noxious particles other than tobacco, higher baseline FEV1, and more bronchial wall thickening. The M phenotype had more exacerbations and hospitalizations, more patients with history of atopy, greater mean plasma eosinophil levels, least baseline FEV1 and had both emphysema and bronchial wall thickening on HRCT. CONCLUSION: The COPD phenotypes classified according to morphological patterns on HRCT showed several clinical characteristics and varied response to bronchodilators.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | COPD, emphysema, chronic bronchitis, phenotyping, pulmonary function test, radiology. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 20 Jul 2020 03:24 |
| Last Modified: | 20 Jul 2020 15:08 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12575 |
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