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Severity Of Emphysema Predicts Mortality

Severity of , as  measured by computed tomography (CT), is a strong independent predictor of all-cause,  cardiovascular, and respiratory mortality in ever-smokers with or without  chronic obstructive pulmonary disease (COPD), according to a study from  researchers in Norway. In patients with severe , airway wall thickness  is also associated with mortality from respiratory causes.

“Ours is the first study to  examine the relationship between degree of emphysema and mortality in a  community-based sample and between airway wall thickness and mortality,” said lead  author , PhD, post-doctoral researcher at Haukeland University  Hospital in Bergen, Norway. “Given the wide use of chest CT scans around the  world, the predictive value of these measures on is of  substantial clinical importance.”

The  findings were published online ahead of print publication in the American  Thoracic Society’s American Journal of  Respiratory and Critical Care Medicine.

The  study included a community-based cohort of 947 ever-smokers with and without  COPD who were followed for eight years. All subjects underwent spirometry and  CT scanning. Degree of emphysema was categorized as low, medium, or high based  on the percent of low attenuation areas (areas  with lower density than normal)  on CT. COPD was diagnosed by spirometric measurement of airway obstruction. Of  the 947 patients, 462 had COPD.

During follow-up, four percent of  the 568 subjects with a low degree of emphysema died, compared with 18 percent of  the 190 patients with a medium degree of emphysema and 44 percent of the 189  patients with a high degree of emphysema.

After adjustment for sex, COPD  status, age, body mass index, smoking and measures of lung function, survival  in the low emphysema group was 19 months longer than survival in the middle and  high emphysema groups for all-cause mortality. Compared with subjects in the  low emphysema group, subjects with a high degree of emphysema had 33 months  shorter survival for respiratory mortality and 37 months shorter survival for 

Emphysema was a significant  predictor of all cause-specific mortalities, with increasing emphysema levels  predicting shorter survival. While airway wall thickness was not an of mortality, increased airway wall thickness reduced survival time  in patients with more severe emphysema.

“The relationship between emphysema levels and  mortality we found can be used in the risk assessment of these patients,”  concluded Dr. Johannessen. “Accurately predicting mortality risk may help  target patients for specific therapeutic interventions which may improve  outcomes.”


“Mortality by level of emphysema and airway wall thickness”, Johannessen, Ane et al.
American Journal of Respiratory Research and Critical Care Medicine