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ERJ Open Res. 2018 Nov 23;4(4). pii: 00044-2018. doi: 10.1183/23120541.00044-2018. eCollection 2018 Oct.

Pulmonary vascular pruning in smokers with bronchiectasis.

Author information

1
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2
Division of Pulmonary Diseases and Critical Care, University of Texas Health Science Center, San Antonio, TX, USA.
3
Dept of Radiology, University of California, San Diego, CA, USA.
4
Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
5
Dept of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Japan.
6
Dept of Radiology, National Jewish Health, Denver, CO, USA.
7
Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
8
Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA.
9
Dept of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

There are few studies looking at the pulmonary circulation in subjects with bronchiectasis. We aimed to evaluate the intraparenchymal pulmonary vascular structure, using noncontrast chest computed tomography (CT), and its clinical implications in smokers with radiographic bronchiectasis. Visual bronchiectasis scoring and quantitative assessment of the intraparenchymal pulmonary vasculature were performed on CT scans from 486 smokers. Clinical, lung function and 6-min walk test (6MWT) data were also collected. The ratio of blood vessel volume in vessels <5 mm2 in cross-section (BV5) to total blood vessel volume (TBV) was used as measure of vascular pruning, with lower values indicating more pruning. Whole-lung and lobar BV5/TBV values were determined, and regression analyses were used to assess the differences in BV5/TBV between subjects with and without bronchiectasis. 155 (31.9%) smokers had bronchiectasis, which was, on average, mild in severity. Compared to subjects without bronchiectasis, those with lower-lobe bronchiectasis had greater vascular pruning in adjusted models. Among subjects with bronchiectasis, those with vascular pruning had lower forced expiratory volume in 1 s and 6MWT distance compared to those without vascular pruning. Smokers with mild radiographic bronchiectasis appear to have pruning of the distal pulmonary vasculature and this pruning is associated with measures of disease severity.

Conflict of interest statement

Conflict of interest: A.A. Diaz received research grants from the NIH and Brigham and Women's Hospital, and speaker fees from Novartis Inc. outside of the submitted work. Conflict of interest: D.J. Maselli has nothing to disclose. Conflict of interest: F. Rahaghi has nothing to disclose. Conflict of interest: C.E. Come received NIH/NHLBI grant K23HL114735 during the conduct of the study. Conflict of interest: A. Yen reports receiving salary support from the NIH under COPDGene R01-HL089897 during the conduct of the study. Conflict of interest: E.S. Maclean has nothing to disclose. Conflict of interest: Y. Okajima reports receiving grants from Canon Medical Systems, grants from Ziosoft, outside the submitted work. Conflict of interest: C.H. Martinez has nothing to disclose. Conflict of interest: T. Yamashiro has nothing to disclose. Conflict of interest: D.A. Lynch reports receiving grants from the NHLBI, research supports from Parexel and Veracyte, and personal fees from Boehringer Ingelheim and Genentech/Roche, outside the submitted work. Conflict of interest: W. Wang has nothing to disclose. Conflict of interest: G.L. Kinney has nothing to disclose. Conflict of interest: G.R. Washko reports receiving grants from the NIH, grants and other support from Boehringer Ingelheim, and other support from Genentech, Quantitative Imaging Solutions and PulmonX, during the conduct of the study. G.R. Washko's spouse works for Biogen, which is focused on developing therapies for fibrotic lung disease. Conflict of interest: R. San José Estépar reports receiving grants from the NHLBI during the conduct of the study. He is founder and co-owner of Quantitative Imaging Solutions, which is a company that provides image-based consulting and develops software to enable data sharing.

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