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Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications.

Abstract

Background

Pulmonary tuberculosis (PTB) is a risk factor for COPD, but the clinical characteristics and the chest imaging features (emphysema and bronchiectasis) of COPD with previous PTB have not been studied well.

Methods

The presence, distribution, and severity of emphysema and bronchiectasis in COPD patients with and without previous PTB were evaluated by high-resolution computed tomography (HRCT) and compared. Demographic data, respiratory symptoms, lung function, and sputum culture of Pseudomonas aeruginosa were also compared between patients with and without previous PTB.

Results

A total of 231 COPD patients (82.2% ex- or current smokers, 67.5% male) were consecutively enrolled. Patients with previous PTB (45.0%) had more severe (p=0.045) and longer history (p=0.008) of dyspnea, more exacerbations in the previous year (p=0.011), and more positive culture of P. aeruginosa (p=0.001), compared with those without PTB. Patients with previous PTB showed a higher prevalence of bronchiectasis (p<0.001), which was more significant in lungs with tuberculosis (TB) lesions, and a higher percentage of more severe bronchiectasis (Bhalla score ≥2, p=0.031), compared with those without previous PTB. The overall prevalence of emphysema was not different between patients with and without previous PTB, but in those with previous PTB, a higher number of subjects with middle (p=0.001) and lower (p=0.019) lobe emphysema, higher severity score (p=0.028), higher prevalence of panlobular emphysema (p=0.013), and more extensive centrilobular emphysema (p=0.039) were observed. Notably, in patients with TB lesions localized in a single lung, no difference was found in the occurrence and severity of emphysema between the 2 lungs.

Conclusion

COPD patients with previous PTB had unique features of bronchiectasis and emphysema on HRCT, which were associated with significant dyspnea and higher frequency of severe exacerbations. While PTB may have a local effect on bronchiectasis, its involvement in airspace damage in COPD may be extensive, probably through interactions with cigarette smoke.

Authors+Show Affiliations

Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing.Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing.Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing.Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing.Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing. Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29416328

Citation

Jin, Jianmin, et al. "Emphysema and Bronchiectasis in COPD Patients With Previous Pulmonary Tuberculosis: Computed Tomography Features and Clinical Implications." International Journal of Chronic Obstructive Pulmonary Disease, vol. 13, 2018, pp. 375-384.
Jin J, Li S, Yu W, et al. Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications. Int J Chron Obstruct Pulmon Dis. 2018;13:375-384.
Jin, J., Li, S., Yu, W., Liu, X., & Sun, Y. (2018). Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications. International Journal of Chronic Obstructive Pulmonary Disease, 13, pp. 375-384. doi:10.2147/COPD.S152447.
Jin J, et al. Emphysema and Bronchiectasis in COPD Patients With Previous Pulmonary Tuberculosis: Computed Tomography Features and Clinical Implications. Int J Chron Obstruct Pulmon Dis. 2018;13:375-384. PubMed PMID: 29416328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications. AU - Jin,Jianmin, AU - Li,Shuling, AU - Yu,Wenling, AU - Liu,Xiaofang, AU - Sun,Yongchang, Y1 - 2018/01/24/ PY - 2018/2/9/entrez PY - 2018/2/9/pubmed PY - 2018/9/18/medline KW - bronchiectasis KW - chronic obstructive pulmonary disease KW - emphysema KW - tuberculosis SP - 375 EP - 384 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 13 N2 - Background: Pulmonary tuberculosis (PTB) is a risk factor for COPD, but the clinical characteristics and the chest imaging features (emphysema and bronchiectasis) of COPD with previous PTB have not been studied well. Methods: The presence, distribution, and severity of emphysema and bronchiectasis in COPD patients with and without previous PTB were evaluated by high-resolution computed tomography (HRCT) and compared. Demographic data, respiratory symptoms, lung function, and sputum culture of Pseudomonas aeruginosa were also compared between patients with and without previous PTB. Results: A total of 231 COPD patients (82.2% ex- or current smokers, 67.5% male) were consecutively enrolled. Patients with previous PTB (45.0%) had more severe (p=0.045) and longer history (p=0.008) of dyspnea, more exacerbations in the previous year (p=0.011), and more positive culture of P. aeruginosa (p=0.001), compared with those without PTB. Patients with previous PTB showed a higher prevalence of bronchiectasis (p<0.001), which was more significant in lungs with tuberculosis (TB) lesions, and a higher percentage of more severe bronchiectasis (Bhalla score ≥2, p=0.031), compared with those without previous PTB. The overall prevalence of emphysema was not different between patients with and without previous PTB, but in those with previous PTB, a higher number of subjects with middle (p=0.001) and lower (p=0.019) lobe emphysema, higher severity score (p=0.028), higher prevalence of panlobular emphysema (p=0.013), and more extensive centrilobular emphysema (p=0.039) were observed. Notably, in patients with TB lesions localized in a single lung, no difference was found in the occurrence and severity of emphysema between the 2 lungs. Conclusion: COPD patients with previous PTB had unique features of bronchiectasis and emphysema on HRCT, which were associated with significant dyspnea and higher frequency of severe exacerbations. While PTB may have a local effect on bronchiectasis, its involvement in airspace damage in COPD may be extensive, probably through interactions with cigarette smoke. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/29416328/Emphysema_and_bronchiectasis_in_COPD_patients_with_previous_pulmonary_tuberculosis:_computed_tomography_features_and_clinical_implications_ L2 - https://dx.doi.org/10.2147/COPD.S152447 DB - PRIME DP - Unbound Medicine ER -