Paratracheal Paraseptal Emphysema and Expiratory Central Airway Collapse in Smokers

Carla R Copeland; Hrudaya Nath; Nina L. J Terry; Carla G Wilson; Young-il Kim; David A Lynch; Sandeep Bodduluri; J. Michael Wells; Mark T Dransfield; Alejandro A Díaz; George R Washko; Marilyn G Foreman; Surya P Bhatt; Genetic Epidemiology of COPD (COPDGene) Investigators

doi:10.1513/AnnalsATS.201709-713OC

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Paratracheal Paraseptal Emphysema and Expiratory Central Airway Collapse in Smokers

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Paratracheal Paraseptal Emphysema and Expiratory Central Airway Collapse in Smokers

Carla R Copeland, Hrudaya Nath, Nina L. J Terry, Carla G Wilson, Young-il Kim, David A Lynch, Sandeep Bodduluri, J. Michael Wells, Mark T Dransfield, Alejandro A Díaz, …

Annals of the American Thoracic Society, Vol.15(4), pp.479-484

04/2018

DOI: 10.1513/AnnalsATS.201709-713OC

PMCID: PMC5879141

PMID: 29298081

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Abstract

Rationale: Expiratory central airway collapse is associated with respiratory morbidity independent of underlying lung disease. However, not all smokers develop expiratory central airway collapse, and the etiology of expiratory central airway collapse in adult smokers is unclear. Paraseptal emphysema in the paratracheal location, by untethering airway walls, may predispose smokers to developing expiratory central airway collapse. Objectives: To evaluate whether paratracheal paraseptal emphysema is associated with expiratory central airway collapse. Methods: We analyzed paired inspiratory and expiratory computed tomography scans from participants enrolled in a multicenter study (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) of smokers aged 45 to 80 years. Expiratory central airway collapse was defined as greater than or equal to 50% reduction in cross-sectional area of the trachea during expiration. In a nested case-control design, participants with and without expiratory central airway collapse were included in a 1:2 fashion, and inspiratory scans were further analyzed using the Fleischner Society criteria for presence of centrilobular emphysema, paraseptal emphysema, airway wall thickening, and paratracheal paraseptal emphysema (maximal diameter ≥ 0.5 cm). Results: A total of 1,320 patients were included, 440 with and 880 without expiratory central airway collapse. Those with expiratory central airway collapse were older, had higher body mass index, and were less likely to be men or current smokers. Paratracheal paraseptal emphysema was more frequent in those with expiratory central airway collapse than control subjects (16.6 vs. 11.8%; P = 0.016), and after adjustment for age, race, sex, body mass index, smoking pack-years, and forced expiratory volume in 1 second, paratracheal paraseptal emphysema was independently associated with expiratory central airway collapse (adjusted odds ratio, 1.53; 95% confidence interval, 1.18–1.98; P = 0.001). Furthermore, increasing size of paratracheal paraseptal emphysema (maximal diameter of at least 1 cm and 1.5 cm) was associated with greater odds of expiratory central airway collapse (adjusted odds ratio, 1.63; 95% confidence interval, 1.18–2.25; P = 0.003 and 1.77; 95% confidence interval, 1.19–2.64; P = 0.005, respectively). Conclusions: Paraseptal emphysema adjacent to the trachea is associated with expiratory central airway collapse. The identification of this risk factor on inspiratory scans should prompt further evaluation for expiratory central airway collapse.

Details

Title: Subtitle: Paratracheal Paraseptal Emphysema and Expiratory Central Airway Collapse in Smokers
Creators: Carla R Copeland - Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Lung Imaging Core, UAB Lung Health Center
Hrudaya Nath - UAB Lung Imaging Core, Department of Radiology, and
Nina L. J Terry - Department of Radiology, and
Carla G Wilson - Department of Biostatistics and Bioinformatics and
Young-il Kim - Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
David A Lynch - Department of Radiology, National Jewish Health, Denver, Colorado
Sandeep Bodduluri - Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Lung Imaging Core
J. Michael Wells - Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Lung Health Center
Mark T Dransfield - Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Lung Imaging Core, UAB Lung Health Center
Alejandro A Díaz - Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
George R Washko - Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
Marilyn G Foreman - Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia
Surya P Bhatt - Division of Pulmonary, Allergy, and Critical Care Medicine, UAB Lung Imaging Core, UAB Lung Health Center
Genetic Epidemiology of COPD (COPDGene) Investigators
Contributors: Eric A Hoffman (Contributor) - University of Iowa, Radiology
Resource Type: Journal article
Publication Details: Annals of the American Thoracic Society, Vol.15(4), pp.479-484
DOI: 10.1513/AnnalsATS.201709-713OC
PMID: 29298081
PMCID: PMC5879141
NLM abbreviation: Ann Am Thorac Soc
ISSN: 2329-6933
eISSN: 2325-6621
Publisher: American Thoracic Society
Language: English
Date published: 04/2018
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Internal Medicine
Record Identifier: 9984051790002771

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