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. 2021 Dec 6;16(1):805.
doi: 10.4081/mrm.2021.805. eCollection 2021 Jan 15.

Standard spirometry to assess emphysema in patients with chronic obstructive pulmonary disease: the Emphysema Severity Index (ESI)

Roberto W Dal Negro  1 , Matteo Paoletti  2 , Massimo Pistolesi  2
Affiliations

Standard spirometry to assess emphysema in patients with chronic obstructive pulmonary disease: the Emphysema Severity Index (ESI)

Roberto W Dal Negro et al. Multidiscip Respir Med. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a generic term identifying a condition characterized by variable changes in peripheral airways and lung parenchyma. Standard spirometry cannot discriminate the relative role of conductive airways inflammatory changes from destructive parenchymal emphysema changes. The aim of this study was to quantify the emphysema component in COPD by a simple parameter (the Emphysema Severity Index - ESI), previously proved to reflect CT-assessed emphysema.

Methods: ESI was obtained by fitting the descending limb of MEFV curves by a fully automated procedure providing a 0 to 10 score of emphysema severity. ESI was computed in COPD patients enrolled in the CLIMA Study.

Results: The vast majority of ESI values ranged from 0 to 4, compatible with no-to-mild/moderate emphysema component. A limited proportion of patients showed ESI values >4, compatible with severe-to-very severe emphysema. ESI values were greatly dispersed within each GOLD class indicating that GOLD classification cannot discriminate emphysema and conductive airways changes in patients with similar airflow limitation. ESI and diffusing capacity (DLCO) were significantly correlated (p<0.001). However, the great dispersion in their correlation suggests that ESI and DLCO reflect partially different anatomo-functional determinants in COPD.

Conclusions: Airflow limitation has heterogenous determinants in COPD. Inflammatory and destructive changes may combine in CT densitometric alterations that cannot be detected by standard spirometry. ESI computation from spirometric data helps to define the prevailing pathogenetic mechanism underlying the measured airflow limitation. ESI could be a reliable advancement to select large samples of patients in clinical or epidemiological trials, and to compare different pharmacological treatments.

Keywords: COPD; ESI; Emphysema Severity Index; airflow limitation; phenotypes.

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Figures

Figure 1.
Figure 1.
Percent distribution of patients according to ESI values.
Figure 2.
Figure 2.
Percent distribution of patients according to the GOLD classification.
Figure 3.
Figure 3.
Distribution of means and percentiles of ESI values according to GOLD classification.
Figure 4.
Figure 4.
Relationship between individual values of FEV1% and ESI.
Figure 5.
Figure 5.
Distribution of FEV1/FVC means and percentiles according to GOLD classes (out-liners are reported).
Figure 6.
Figure 6.
Relationship between ESI and DLco (% pred.) values.
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