Chronic obstructive pulmonary disease (COPD) is commonly a combination of pulmonary emphysema and chronic bronchitis. Emphysema is a pathologically defined disease that can be accurately diagnosed using CT. Furthermore, CT is useful for determination of the subtypes, extent and distribution of emphysema. Objective quantification of emphysema is feasible using CT densitometry of lung parenchyma, that can be used for selection of adequate candidates and monitoring clinical results of various therapeutic measures for severe emphysema. Imaging parameters in CT densitometry should be kept constant in follow up examination for an effective comparison of the results. Chronic bronchitis is diagnosed by symptomatic criteria with nonspecific CT findings. Airway dimensions can be objectively measured using CT, enabling further understanding of pathophysiology of COPD.
Bronchitis, Chronic ; Densitometry ; Emphysema ; Follow-Up Studies ; Lung ; Lung Diseases, Obstructive ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Emphysema ; Thorax

BACKGROUND: Smoking is the most important and consistent determinant of the development and progression of COPD(Ed Note : Define COPD). The fact that cigarette smokers develop a different type of COPD, chronic bronchitis and emphysema, with different clinical and pathological aspects, suggests that the development of COPD has a relationship with other smoking-associated factors beyoud just a simple smoking history. The aim of this was to analyze the smoking habits and history of patients with COPD and to evaluate the development of different types of COPD accordint to patient's smoking habits. METHOD: To evaluate the differences in the smoking patterens of patients with chronic bronchitis and emphysema, a pulmonary function test was conducted, and the smoking history and patterns was obtained through a smoking history questionnaire by a direct personal interview from 333 male cigarette smokers diagnosed with COPD, in the Yeungnam university medical center(190 patients diagnosed with chronic bronchitis, 143 patients diagnosed with emphysema). RESULT: The patients with emphysema smoked earlier and had a higher smoking history(ie, more pachyears, more total amounts of smoked cigarette, and more deep inhalation and longer duration of plain cigarette exposure) than those with chronic bronchitis. The depth of ingalation was also significantly higher in the emphysema patients after taking into account age, cumulative cagarette consumption and the type of cigarette smoked. CONCLUSION: Emphysema was more associated with the increasing degree of inhalation as assessed by the depth of inhalation. A high alveolar smoke exposure may be a significant risk factor for the development of emphysema.
Bronchitis, Chronic* ; Emphysema* ; Humans ; Inhalation ; Male ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Risk Factors ; Smoke* ; Smoking* ; Tobacco Products

Chronic obstructive pulmonary disease (COPD) encompasses several clinical syndromes, most notably emphysema and chronic bronchitis. Most of the current treatments fail to attenuate severity and progression of the disease, thereby requiring better mechanistic understandings of pathogenesis to develop disease-modifying therapeutics. A number of theories on COPD pathogenesis have been promulgated wherein an increase in protease burden from chronic inflammation, exaggerated production of reactive oxygen species and the resulting oxidant injury, or superfluous cell death responses caused by enhanced cellular injury/damage were proposed as the culprit. These hypotheses are not mutually exclusive and together likely represent the multifaceted biological processes involved in COPD pathogenesis. Recent studies demonstrate that mitochondria are involved in innate immune signaling that plays important roles in cigarette smoke-induced inflammasome activation, pulmonary inflammation and tissue remodeling responses. These responses are reviewed herein and synthesized into a view of COPD pathogenesis whereby mitochondria play a central role.
Biological Processes ; Bronchitis, Chronic ; Cell Death ; Emphysema ; Inflammasomes ; Inflammation ; Mitochondria ; Pneumonia ; Pulmonary Disease, Chronic Obstructive* ; Reactive Oxygen Species ; Tobacco Products

PURPOSE: To determine the utility of HRCT in the diagnosis of chronic airflow obstruction and to correlate the morphologic abnormalities revealed by this modality with functional impairment in patients with chronic air-flow obstruction. MATERIALS AND METHODS:This study involved 80 patients with chronic airflow obstruction who underwent HRCT and a pulmonary function test. Final clinical diagnosis in these patients was determined by a chest physician on the basis of clinical features, bronchoscopy, pulmonary function test, and HRCT. In order to diagnose and determine the extent of areas of decreased attenuation revealed by HRCT (the CT score), the find-ings of HRCT were retrospectively reviewed by two radiologists, who reached a consensus. Clinical and HRCT diagnoses were then compared, and the rate of agreement between them was calculated. The relation-ship between the extent of areas of decreased attenuation revealed by HRCT and by FEV1/FVC was evaluated using Correl 's account and Student 's unpaired t-test. RESULTS: The agreement rate between clinical and HRCT diagnoses was 77.5% (62/80). The rates for bronchiec-tasis (88.9%, 24/27), emphysema (93.9%, 31/33), and bronchiolitis obliterans (100%, 6/6) were considerably higher than those for chronic bronchitis and bronchial asthma. The correlation rate between CT score and FEV1/FVC was significant in bronchiectasis (p<0.05; r: -0.76) and bronchiolitis obliterans (p<0.01; r:-0.66), but not in cases involving emphysema, bronchial asthma, or chronic bronchitis (p>0.05). CONCLUSION: HRCT is valuable in the diagnosis and prediction of physiologic impairment in patients with bronchiectasis and bronchiolitis obliterans, but has limited value in those with emphysema, chronic bronchitis or asthma.
Asthma ; Bronchiectasis ; Bronchiolitis Obliterans ; Bronchitis, Chronic ; Bronchoscopy ; Consensus ; Diagnosis* ; Emphysema ; Humans ; Pulmonary Disease, Chronic Obstructive* ; Pulmonary Emphysema ; Respiratory Function Tests* ; Retrospective Studies ; Thorax

BACKGROUND: Unexplained weight loss, which commonly occurs in patients with chronic obstructive pulmonary disease(COPD), is important because weight loss is an independent risk factor of mortality and morbidity in these patients. Leptin is known to play an important role in regulating body weight. In addition, the tumor necrosis factor(TNF-α) might also play a potential role in the weight loss experienced in chronic wasting disease. The aim of this study was to determine the influence of plasma leptin and the circulating TNF-α system to the difference in the body compositions in patients with COPD. METHODS: Spirometry, body composition analysis and the plasma concentrations of leptin, TNF-α and a soluble TNF receptor 55, 75 were measured in 31 patients with chronic bronchitis and 10 patients with emphysema. The COPD subtype was classified by the transfer coefficient of carbon monoxide, DLco/VA. RESULTS: The circulating levels of leptin were significantly lower in those patients with emphysema(108.5±39.37 pg/ml) than those with chronic bronchitis(180.9±57.7 pg/ml). The circulating levels of sTNF-R55 were significantly higher in the emphysema patients(920.4±116.4 pg/ml) than in those with chronic bronchitis(803.2±80.8 pg/ml). There was no relationship between the circulating leptin levels and the activated TNF system in patients with chronic bronchitis and emphysema. However, the circulating leptin levels correlated well with the BMI and fat mass in both patient groups. CONCLUSION: These results suggest that the weight loss noted in emphysema patients may be associated with the activation of the TNF-α system rather than the plasma leptin level.
Body Composition ; Body Weight ; Bronchitis, Chronic* ; Carbon Monoxide ; Emphysema* ; Humans ; Leptin* ; Mortality ; Necrosis ; Plasma* ; Pulmonary Disease, Chronic Obstructive ; Receptors, Tumor Necrosis Factor ; Risk Factors ; Spirometry ; Tumor Necrosis Factor-alpha* ; Wasting Disease, Chronic ; Weight Loss*

BACKGROUND: Chronic obstructive pulmonary disease is characterized by emphysema, chronic bronchitis, and small airway remodeling. The alveolar destruction associated with emphysema cannot be repaired by current clinical practices. Stem cell therapy has been successfully used in animal models of cigarette smoke- and elastase-induced emphysema. However, the optimal dose of mesenchymal stem cells (MSCs) for the most effective therapy has not yet been determined. It is vital to determine the optimal dose of MSCs for clinical application in emphysema cases. METHODS: In the present study, we evaluated the therapeutic effects of various doses of MSCs on elastase-induced emphysema in mice. When 3 different doses of MSCs were intravenously injected into mice treated with elastase, only 5x10(4) MSCs showed a significant effect on the emphysematous mouse lung. We also identified action mechanisms of MSCs based on apoptosis, lung regeneration, and protease/antiprotease imbalance. RESULTS: The MSCs were not related with caspase-3/7 dependent apoptosis. But activity of matrix metalloproteinase 9 increased by emphysematous lung was decreased by intravenously injected MSCs. Vascular endothelial growth factor were also increased in lung from MSC injected mice, as compared to un-injected mice. CONCLUSION: This is the first study on the optimal dose of MSCs as a therapeutic candidate. This data may provide important basic data for determining dosage in clinical application of MSCs in emphysema patients.
Airway Remodeling ; Animals ; Apoptosis ; Bronchitis, Chronic ; Emphysema ; Humans ; Lung ; Matrix Metalloproteinase 9 ; Mesenchymal Stromal Cells* ; Methods ; Mice ; Models, Animal ; Pancreatic Elastase* ; Pulmonary Disease, Chronic Obstructive ; Regeneration ; Stem Cells ; Tobacco Products ; Vascular Endothelial Growth Factor A

BACKGROUND: Weight loss is common in patients with chronic obstructive pulmonary disease (COPD). However, the mechanisms of this weight loss are still unclear. METHDOS: Sixty male patients with stable COPD and 45 healthy male controls participated in this study. The COPD patients were divided into two groups, that is, the emphysema and chronic bronchitis groups, by the transfer coefficient of carbon monoxide. The body composition, resting energy expenditure (REE), plasma leptin levels and serum tumor necrosis factor-alpha (TNF-alpha) were measured in all the study participants. The difference and correlation of these parameters were investigated between the two groups. RESULTS: Emphysematous patients were characterized by a lower body mass index (BMI) and fat-mass (FM) compared with the chronic bronchitis patients (p<0.001). The plasma leptin levels, as corrected for the FM, were not different between the COPD patients and healthy controls (78.3+/-30.9 pg/mL/kg vs. 70.9+/-17.3 pg/mL/kg, respectively), and the plasma leptin levels, as adjusted for the FM, were also not different between the two groups of COPD patients. In the chronic bronchitis patients, the plasma leptin concentration was correlated with the BMI (r=0.866, p<0.001) but it was not correlated with the BMI in the emphysema patients. The serum TNF-alpha levels were higher in the stable COPD patients than those in the controls, but there was no statistical difference (10.7+/-18.6 pg/mL vs. 7.2+/-3.5 pg/mL, respectively, p>0.05). The leptin concentration was well correlated with the BMI and %FM in the patients with chronic bronchitis and the leptin concentration was only correlated with the %FM (r=0.450, p=0.027) in emphysema patients. There was no correlation between the plasma leptin concentration, as adjusted for the fat mass, and the activity of the TNF-alpha system. CONCLUSION: The interaction of leptin and the activity of the TNF-alpha system in the pathogenesis of tissue depletion may not play an important role in chronic stable COPD patients.
Aged ; Body Composition ; Bronchitis, Chronic ; Case-Control Studies ; Emphysema ; Energy Metabolism ; Humans ; Leptin/*blood/physiology ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/*physiopathology ; Respiratory Function Tests ; Tumor Necrosis Factor-alpha/*blood/physiology ; *Weight Loss

Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease, characterized by irreversible airflow limitation, with a partially reversible component. The pathological abnormalities of COPD are associated with lung inflammation, imbalances of proteinase and antiproteinase, and oxidative stress, which are induced by noxious particles and gases in susceptible individuals. The physiological changes of COPD are mucus hyper-secretion, ciliary dysfunction, airflow limitation, pulmonary hyperinflation, gas exchange abnormalities, pulmonary hypertension, cor pulmonale and systemic effects. The airflow limitation principally results from an increase in the resistance of the small conducting airways and a decrease in pulmonary elastic recoil due to emphysematous lung destruction. This article provides a general overview of the pathophysiology of COPD.
Emphysema ; Gases ; Hypertension, Pulmonary ; Lung ; Mucus ; Oxidative Stress ; Pneumonia ; Pulmonary Disease, Chronic Obstructive* ; Pulmonary Heart Disease

BACKGROUND: Chronic bronchitis (CB) is an important phenotype in chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate different pattern of COPD assessment test (CAT) score between CB and non-CB patients. METHODS: Patients were recruited from 45 centers in Korea, as part of the Korean COPD Subgroup Study cohort. CB was defined when sputum continued for at least 3 months. RESULTS: Total 958 patients with COPD were eligible for analysis. Among enrolled patients, 328 (34.2%) were compatible with CB. The CAT score was significantly higher in patients with CB than non-CB, and each component of CAT score showed a similar result. CB was significantly associated with CAT score when adjusted with age, sex, modified Medical Research Council, and post-bronchodilator forced expiratory volume in 1 second. Each component of CAT score between patients with CB and non-CB showed different pattern according to Global Initiative for Chronic Obstructive Lung Disease grade. CONCLUSION: CAT score is significantly higher in patients with CB than non-CB. Each component of CAT score was significantly different between two groups.
Animals ; Bronchitis* ; Bronchitis, Chronic* ; Cats ; Cohort Studies ; Forced Expiratory Volume ; Humans ; Korea ; Phenotype ; Pulmonary Disease, Chronic Obstructive* ; Quality of Life ; Sputum

No abstract available.
Positive-Pressure Respiration, Intrinsic ; Airway Resistance ; Bronchitis, Chronic ; Lung Compliance ; Vena Cava, Inferior ; Work of Breathing ; Heart Ventricles ; Blood Pressure ; Pulmonary Disease, Chronic Obstructive ; Lung ; Respiratory Muscles ; Pulmonary Emphysema ; Emphysema ; Pneumonia ; Cardiac Output ; Lung Transplantation ; Intensive Care Units ; Positive-Pressure Respiration ; Barotrauma ; Hypotension ; Korea