Quantitative assessment of emphysema and bronchial wall thickness in patients with stable chronic obstructive pulmonary disease: comparison between the eosinophilic and non-eosinophilic phenotypes

Stival, Rebecca Saray Marchesini; Rabelo, Lêda Maria; Leão, Giovanna Lemes; Drevenowski, Diogo; Serafini, Joel; Vieira, Vítor Lopes Galvão; Escuissato, Dante Luiz

doi:10.1590/0100-3984.2021.0088

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Original Article • Radiol Bras 55 (04) • Jul-Aug 2022 • https://doi.org/10.1590/0100-3984.2021.0088 copy

Quantitative assessment of emphysema and bronchial wall thickness in patients with stable chronic obstructive pulmonary disease: comparison between the eosinophilic and non-eosinophilic phenotypes

Avaliação quantitativa de enfisema e espessamento parietal brônquico em pacientes com doença pulmonar obstrutiva crônica estável: comparação entre os fenótipos eosinofílico e não eosinofílico

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To perform a quantitative assessment of bronchial wall thickening and the emphysema score in patients with stable chronic obstructive pulmonary disease (COPD), comparing the eosinophilic and non-eosinophilic COPD phenotypes.

Materials and Methods:

This was a retrospective observational study of patients with COPD followed between August 2018 and July 2019. The patients were divided into two groups by the eosinophil count in peripheral blood: eosinophilic (≥ 300 cells/µL); and non-eosinophilic (< 300 cells/µL). Quantitative, automated assessments of emphysema and bronchial wall thickness were performed by evaluating computed tomography scans of the chest.

Results:

We evaluated the records of 110 patients diagnosed with COPD: 28 (25.5%) in the eosinophilic group; and 82 (74.5%) in the non-eosinophilic group. The demographic, clinical, functional, and therapeutic variables were comparable between the two groups. There were no significant differences between the two groups in terms of the emphysema score or bronchial wall thickness (p > 0.05 for both).

Conclusion:

Patients with eosinophilic COPD do not appear to have lower emphysema scores or greater bronchial wall thickening than do those with non-eosinophilic phenotypes of the disease.

Keywords:
Pulmonary disease, chronic obstructive; Eosinophils; Tomography, X-ray computed

Variable	All patients (N = 110)	Group		P ^† † Student’s t-test for independent samples, Fisher’s exact test, or chi-square test.
Variable	All patients (N = 110)	Eosinophilic (n = 28)	Non-eosinophilic (n = 82)
Age (years)	67.4 ± 9 (38-87)	69.3 ± 11.6 (42-87)	66.8 ± 8 (38-87)	0.294
Sex, n (%)
Female	62 (56.4)	15 (53.6%)	47 (57.3%)
Male	48 (43.6)	13 (46.4%)	35 (42.7%)	0.826
White, n (%)	97 (88.2)	23 (82.1)	74 (90.2)
Body mass index (kg/m²)	25.8 ± 5.9 (12.3-48)	25.1 ± 6.5 (12.3-48)	26.1 ± 5.6 (15.2-8.7)	0.422
GOLD group^‡ ‡ Groups A and B include patients who have had no exacerbations or one previous exacerbation that did not require hospital admission, respectively; groups C and D include patients who have had two or more exacerbations or at least one exacerbation requiring hospital admission, respectively, in the previous year. , n (%)
A	25 (22.7)	7 (25)	18 (22)
B	39 (35.5)	11 (39.3)	28 (34.2)
C	6 (5.5)	0 (0)	6 (7.3)
D	40 (36.4)	10 (35.7)	30 (36.6)	0.514
GOLD grade^§ § The number provides information regarding the severity of airflow limitation: grade 1 = forced expiratory volume in 1 second (FEV1) ≥ 80% of predicted; grade 2 = FEV1 50-79% of predicted; grade 3 = FEV1 30-49% of predicted; and grade 4 = FEV1 < 30% of predicted. , n (%)
1	8 (7.3)	2 (7.1)	6 (7.3)
2	42 (38.2)	11 (39.3)	31 (37.8)
3	36 (32.7)	9 (32.1)	27 (32.9)
4	24 (21.8)	6 (21.4)	18 (22)	0.999
Peripheral oxygen saturation (%)	92.1 ± 4.5 (77-98)	92 ± 4.5 (80-98)	92.1 ± 4.6 (77-98)	0.910
Current smoking, n (%)	23 (20.9)	6 (21.4)	17 (20.7)	1
Smoking history (pack-years)	53 ± 31.2 (0-155)	60.2 ± 39.8 (0-155)	50.5 ± 27.6 (1-150)	0.291

Variable	All patients (N = 110)	Group		P ^† † Student’s t-test for independent samples, nonparametric Mann-Whitney U test, chi-square test, or Fisher’s exact test.
Variable	All patients (N = 110)	Eosinophilic (n = 28)	Non-eosinophilic (n = 82)
Moderate exacerbations without hospitalization^‡ ‡ In the last year before data collection. (n)	0.5 ± 0.9 (0-5)	0.4 ± 0.9 (0-4)	0.5 ± 0.9 (0-5)	0.621
0-1, n (%)	99 (90.0)	27 (96.5)	72 (87.8)
≥ 2, n (%)	11 (10.0)	1 (3.6)	10 (12.1)
Severe exacerbations with hospitalization^‡ ‡ In the last year before data collection. (n)	0.3 ± 0.6 (0-3)	0.4 ± 0.7 (0-3)	0.4 ± 0.7 (0-3)	0.835
≥ 1, n (%)	29 (26.3)	8 (28.6)	21 (25.6)
Low-dose ICS^§ § At the time of data collection. (budesonide < 800 µg)				1
No, n (%)	88 (80.0)	23 (82.1)	65 (79.3)
Yes, n (%)	22 (20.0)	5 (17.9)	17 (20.7)
High-dose ICS^§ § At the time of data collection. (budesonide ≥ 800 µg)				0.517
No, n (%)	61 (55.5)	14 (50.0)	47 (57.3)
Yes, n (%)	49 (44.5)	14 (50.0)	35 (42.7)

Segment	Patients evaluated (n)	All patients (N = 101)^† † In nine patients, bronchial thickness could not be evaluated, because of errors in airway segmentation.	Group		P ^‡ ‡ Student’s t-test for independent samples.
Segment	Patients evaluated (n)		Eosinophilic (n = 25)	Non-eosinophilic (n = 76)	P ^‡ ‡ Student’s t-test for independent samples.
Trachea	101	3.1 ± 0.5 (2.3-4.9)	3.0 ± 0.4 (2.3-3.8)	3.1 ± 0.6 (2.3-4.9)	0.180
MRB	101	3.0 ± 0.5 (2.2-4.3)	2.9 ± 0.4 (2.2-3.8)	3.0 ± 0.5 (2.2-4.3)	0.451
RUL	101	2.6 ± 0.4 (1.7-3.5)	2.6 ± 0.4 (2.0-3.5)	2.7 ± 0.4 (1.7-3.4)	0.346
Ant-RUL	101	2.2 ± 0.3 (1.2-3.2)	2.3 ± 0.4 (1.6-3.1)	2.2 ± 0.3 (1.2-3.2)	0.305
Api-RUL	101	2.1 ± 0.4 (1.4-3.2)	2.2 ± 0.4 (1.5-3.2)	2.1 ± 0.4 (1.4-3.2)	0.742
Pos-RUL	101	2.1 ± 0.3 (0.9-2.8)	2.1 ± 0.3 (1.6-2.8)	2.1 ± 0.3 (0.9-2.8)	0.917
ML	100	2.4 ± 0.4 (1.7-4.3)	2.3 ± 0.3 (1.7-2.8)	2.5 ± 0.4 (1.7-4.3)	0.074
M-ML	99	2.1 ± 0.4 (1.4-3.2)	2.2 ± 0.4 (1.4-3.1)	2.1 ± 0.4 (1.4-3.2)	0.244
L-ML	99	2.1 ± 0.4 (1.1-3.1)	2.1 ± 0.4 (1.3-3.1)	2.0 ± 0.4 (1.1-3.1)	0.324
RLL	100	2.6 ± 0.4 (1.9-4.0)	2.5 ± 0.4 (1.9-3.7)	2.6 ± 0.5 (1.9-4.0)	0.280
U-RLL	99	2.3 ± 0.4 (1.5-3.5)	2.3 ± 0.3 (1.9-3.0)	2.3 ± 0.4 (1.5-3.5)	0.838
AB-RLL	99	2.2 ± 0.3 (1.3-3.0)	2.2 ± 0.3 (1.5-3.0)	2.2 ± 0.3 (1.3-2.8)	0.930
PB-RLL	99	2.1 ± 0.3 (1.5-2.9)	2.1 ± 0.3 (1.7-2.7)	2.1 ± 0.3 (1.5-2.9)	0.963
MB-RLL	98	2.0 ± 0.3 (1.4-2.9)	2.0 ± 0.3 (1.5-2.7)	2.0 ± 0.3 (1.4-2.9)	0.632
LB-RLL	99	2.2 ± 0.3 (1.5-3.1)	2.2 ± 0.3 (1.5-3.0)	2.2 ± 0.3 (1.6-3.1)	0.489

Segment	Patients evaluated (n)	All patients (N = 101)^† † In nine patients, bronchial thickness could not be evaluated, because of errors in airway segmentation.	Group		P‡
Segment	Patients evaluated (n)		Eosinophilic (n = 25)	Non-eosinophilic (n = 76)	P‡
MLB	101	3.0 ± 0.5 (2.1-4.4)	3.0 ± 0.5 (2.2-3.8)	3.0 ± 0.5 (2.1-4.4)	0.474
LUL	101	2.9 ± 0.5 (1.8-5.0)	2.7 ± 0.4 (1.8-3.7)	2.9 ± 0.6 (1.8-5.0)	0.084
Ant-LUL	100	2.2 ± 0.4 (0.9-3.2)	2.2 ± 0.4 (0.9-3.2)	2.3 ± 0.3 (1.6-3.1)	0.530
Api-Pos-LUL	100	2.2 ± 0.4 (1.4-3.2)	2.3 ± 0.4 (1.4-3.1)	2.2 ± 0.3 (1.6-3.2)	0.393
LgL	101	2.4 ± 0.4 (1.7-3.8)	2.4 ± 0.4 (1.9-3.5)	2.5 ± 0.4 (1.7-3.8)	0.844
U-LgL	99	2.0 ± 0.3 (1.3-2.8)	2.0 ± 0.3 (1.5-2.7)	2.0 ± 0.3 (1.3-2.8)	0.991
L-LgL	100	2.0 ± 0.3 (1.3-2.8)	2.0 ± 0.2 (1.3-2.4)	2.0 ± 0.3 (1.3-2.8)	0.386
LLL	100	3.0 ± 0.5 (2.0-4.4)	2.9 ± 0.5 (2.0-3.9)	3.0 ± 0.5 (2.0-4.4)	0.265
U-LLL	100	2.3 ± 0.3 (1.4-3.1)	2.3 ± 0.4 (1.4-3.1)	2.3 ± 0.3 (1.7-3.1)	0.999
AMB-LLL	100	2.2 ± 0.3 (1.5-3.4)	2.3 ± 0.3 (1.5-3.4)	2.2 ± 0.3 (1.6-3.0)	0.413
PB-LLL	100	2.2 ± 0.3 (1.6-3.2)	2.2 ± 0.3 (1.6-3.0)	2.2 ± 0.3 (1.7-3.2)	0.647
LB-LLL	99	2.3 ± 0.3 (1.6-3.7)	2.3 ± 0.4 (1.7-3.0)	2.3 ± 0.4 (1.6-3.7)	0.680
Overall (both lungs)	101	2.4 ± 0.2 (2.0-2.9)	2.4 ± 0.2 (2.0-2.8)	2.4 ± 0.2 (2.0-2.9)	0.802

Segment	All patients (N = 108)^† † In two patients, emphysema could not be quantified, because of architectural distortion of the lung parenchyma.	Group		P ^‡ ‡ Student’s t-test for independent samples or nonparametric Mann-Whitney U test.
Segment		Eosinophilic (n = 27)	Non-eosinophilic (n = 81)
RL Vol. (L)	2.9 ± 0.7 (0.8-5.1)	2.9 ± 0.8 (0.8-4.2)	2.9 ± 0.7 (1.7-5.1)	0.965
LL Vol. (L)	2.5 ± 0.7 (0.8-4.6)	2.5 ± 0.8 (0.8-3.9)	2.5 ± 0.6 (1.3-4.6)	0.920
Total Vol. (L)	5.4 ± 1.3 (2.2-9.0)	5.4 ± 1.6 (2.2-8.1)	5.4 ± 1.3 (2.5-9.0)	0.874
RL Emph. %	26 ± 19 (1-94)	23 ± 18 (1-58)	26 ± 20 (1-94)	0.471
LL Emph. %	22 ± 18 (0-91)	± 17 (0-58)	± 19 (1-91)	0.587
Total Emph. %	24 ± 18 (0-91)	± 17 (1-58)	± 18 (0-91)	0.528
RL Emph. Vol. (L)	0.71 ± 0.64 (0.01-2.41)	0.71 ± 0.64 (0.01-2.41)	0.82 ± 0.72 (0.01-3.51)	0.456
LL Emph. Vol. (L)	0.58 ± 0.60 (0-2.29)	0.58 ± 0.60 (0-2.29)	0.63 ± 0.63 (0.01-3.26)	0.708
Total Emph. Vol. (L)	1.29 ± 1.22 (0.02-4.71)	1.29 ± 1.22 (0.02-4.71)	1.40 ± 1.23 (0.01-6.41)	0.702

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[1] Correspondence: Giovanna Lemes Leão. Rua Padre Saboya de Medeiros, 259, Planalto. São Bernardo do Campo, SP, Brazil, 09890-540. giovanna.leao@yahoo.com.