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Multicenter Study
. 2024 Dec 5;64(6):2400191.
doi: 10.1183/13993003.00191-2024. Print 2024 Dec.

Airway tapering in COPD

Sandeep Bodduluri  1   2   3 , Arie Nakhmani  4   3 , Abhilash S Kizhakke Puliyakote  5 , Joseph M Reinhardt  6 , Mark T Dransfield  2 , Surya P Bhatt  4   2
Affiliations
Multicenter Study

Airway tapering in COPD

Sandeep Bodduluri et al. Eur Respir J. .

Abstract

Background: Luminal narrowing is a hallmark feature of airway remodelling in COPD, but current measures focus on airway wall remodelling. Quantification of the natural increase in cumulative cross-sectional area along the length of the human airway tree can facilitate assessment of airway narrowing.

Methods: We analysed the airway trees of 7641 subjects enrolled in the multicentre COPDGene cohort. Airway luminal tapering was assessed by estimating the slope of the change in cumulative cross-sectional area along the length of the airway tree over successive generations (T-Slope). We performed multivariable regression analyses to test the associations between T-Slope and lung function, St George's Respiratory Questionnaire score, modified Medical Research Council dyspnoea score, 6-min walk distance (6MWD), forced expiratory volume in 1 s (FEV1) change, exacerbations and all-cause mortality after adjusting for demographics, emphysema measured as the percentage of voxels with density <-950 HU on inspiratory computed tomography scans (%CT emphysema) and total airway count.

Results: The mean±sd T-Slope decreased with increasing COPD severity: 2.69±0.70 mm-1 in non-smokers and 2.33±0.70, 2.11±0.65, 1.78±0.58, 1.60±0.53 and 1.57±0.52 mm-1 in GOLD stages 0 through 4, respectively (Jonckheere-Terpstra p=0.04). On multivariable analyses, T-Slope was independently associated with FEV1 (β=0.13 (95% CI 0.10-0.15) L; p<0.001), 6MWD (β=15.0 (95% CI 10.8-19.2) m; p<0.001), change in FEV1 (β= -4.50 (95% CI -7.32- -1.67) mL·year-1; p=0.001), exacerbations (incidence risk ratio 0.78 (95% CI 0.73-0.83); p<0.001) and mortality (hazard ratio 0.79 (95% CI 0.72-0.86); p<0.001).

Conclusion: T-Slope is a measure of airway luminal remodelling and is associated with respiratory morbidity and mortality.

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Conflict of interest statement

Conflict of interest: S. Bodduluri, A. Nakhmani and A.S. Kizhakke Puliyakote have nothing to disclose. J.M. Reinhardt reports support for the present study from the NIH and Carver Charitable Trust, grants from the NIH and Carver Charitable Trust, royalties or licences from VIDA Diagnostics, payment for expert testimony from Auris Health, Inc., patents planned, issued or pending, assigned to the University of Iowa, and stock (or stock options) with VIDA Diagnostics. M.T. Dransfield reports grants from the Department of Defense, American Lung Association and NIH, royalties or licences from UpToDate, consultancy fees from AstraZeneca, Genentech, GlaxoSmithKline, Novartis, Pulmonx and Teva, support for attending meetings from GlaxoSmithKline, and a leadership role with the COPD Foundation on the Board of Directors. S.P. Bhatt reports support for the present study from the NHLBI (R01 HL151421, R21 EB027891), grants from Nuvaira, Genentech and Sanofi, consultancy fees from Sanofi, Regeneron, GlaxoSmithKline, Chiesi, Verona Pharma, Genentech, Apreo and Boehringer Ingelheim, payment or honoraria for educational events from IntegrityCE, and participation on a data safety monitoring board with the NIH.

Comment in

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