COUNTERPOINT: Should Chest CT Be Part of Routine Clinical Care for COPD? No

[摘要] Figures Figure 1 Distribution of participants from the Framingham Offspring Cohort and Copenhagen City Heart Study demonstrating four lung function trajectories, T1 to T4, defined according to baseline level of FEV₁ (below or above 80% of predicted value) and presence or absence of GOLD grade > 2 COPD at the final examination.¹⁰ The solid lines represent the schematic natural history of FEV₁ for the age range of those studied, whereas the broken lines represent hypothetical trajectories. The line in red indicates individuals who experienced rapid decline in COPD and are likely to be most amenable to disease-modifying therapies as opposed to those represented by the blue line, who began with lower adult lung function but experienced less rapid decline. GOLD = Global Initiative for Chronic Obstructive Lung Disease. Figure 2 A and B, Plots of average deaths per 100 person-years by percent emphysema in COPDGene (A) and SPIROMICS (B). Blue dots represent raw averages for death rates grouped by nearest emphysema percentile. Age-adjusted estimates for average deaths per 100 person-years shown via linear splines in blue (using every percentile of emphysema) and in red (smoothed). C and D, Plots of mean exacerbations per year by percent emphysema in COPDGene (C) and SPIROMICS (D). Blue dots represent raw averages for exacerbation rates grouped by nearest emphysema percentile. Age-adjusted estimates for average exacerbations per year shown via linear splines in blue (using every percentile of emphysema) and in red (smoothed).¹⁶ COPDGene = Genetic Epidemiology of COPD; SPIROMICS = Subpopulations and Intermediate Outcome Measures in COPD Study. Chest CT scans are rapidly becoming routine among smokers at risk for COPD in order to screen for lung cancer and evaluate pulmonary nodules detected on chest radiographs. Further, such imaging techniques are also frequently used in advanced COPD to plan for lung transplantation and lung volume reduction surgery.¹ However, despite this growing use and widespread availability, chest CT imaging is still not currently considered part of routine clinical practice for individuals with mild to moderate COPD and has not yet been incorporated into general clinical guidelines for disease diagnosis, prognosis, or treatment.

[学科分类] 呼吸医学