The Role of Chest Computed Tomography in the Evaluation and Management of the Patient with COPD.

The Role of Chest Computed Tomography in the Evaluation and Management of the Patient with COPD.

Am J Respir Crit Care Med. 2017 Jun 29;:

Authors: Labaki WW, Martinez CH, Martinez FJ, Galbán CJ, Ross BD, Washko GR, Barr RG, Regan EA, Coxson HO, Hoffman EA, Newell JD, Curran-Everett D, Hogg JC, Crapo JD, Lynch DA, Kazerooni EA, Han MK

Abstract
Chronic obstructive pulmonary disease (COPD) exhibits significant heterogeneity in clinical presentation and rate of disease progression, owing at least in part to differing underlying morphologic abnormalities. Symptom assessment and spirometry have traditionally been used to determine disease severity and guide management. However, chest computed tomography (CT) is a widely available and increasingly used imaging modality that can provide additional insight into structural and pathophysiologic pulmonary parameters. While chest CT is not currently recommended as part of the routine evaluation for COPD beyond aiding with advanced therapy decision making in severe disease, the expanding use of CT now demands that clinicians understand how to treat relevant information that becomes available. Emphysema, airway disease, air trapping and pulmonary vascular abnormalities have all been associated with a number of important outcomes, including respiratory symptoms, COPD exacerbations and mortality. CT can also provide information on important comorbidities such as coronary artery disease and osteoporosis that have been recognized as essential components of COPD care. While visual assessment of these parameters is already currently routine in chest CT interpretation, quantification methods are becoming more reliable and increasingly accessible to the everyday clinician. In this article, we review the most readily available CT assessment methods and their clinical implications as well as highlight the value of assessing non-pulmonary structures (coronary arteries and vertebral bone). Chest CT clearly has the potential to become a powerful tool in the quest to personalize medicine, but its value will ultimately depend on our ability to extract clinically important information that changes management.

PMID: 28661698 [PubMed - as supplied by publisher]

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