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Type:
Educational Exhibit
Keywords:
Transplantation, Education and training, Chronic obstructive airways disease, Treatment effects, Surgery, Education, CT-Quantitative, CT-High Resolution, CT, Thorax, Lung, Interventional non-vascular
Authors:
G. Milanese1, M. Silva1, A. Borghesi2, M. Bezzi3, M. Bonifazi4, M. Novali2, N. Sverzellati1; 1Parma/IT, 2Brescia/IT, 3Firenze/IT, 4Ancona/IT
DOI:
10.1594/ecr2016/C-1796
Background
COPD is characterized by incompletely reversible expiratory airflow obstruction,
and its severity is rated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification,
which defines four stages of disease,
according to the post-bronchodilator airflow limitation.
HRCT allows the categorization of COPD patients into subtypes that are distinguished accordingly to different structural and functional alterations [1]; two main phenotypes are described,
namely bronchitic or emphysematous.
Bronchitic COPD has worse prognosis because of the high frequency of exacerbation.
Conversely,
emphysematous COPD is more stable,
although poorly treatable.
Indeed,
the emphysematous patient shows limited clinical improvement even after optimal medical treatment because major mechanical unbalances cause irreversible airflow limitation.
Therefore,
therapeutic options other than medical approach have been evaluated to impact severe emphysema.
Surgical and bronchoscopic procedures are available for treatment of severe emphysema.
Bronchoscopic treatment mainly includes positioning of endobronchial valves (EBV) or coils (LVRC),
these are low invasivity options that can substitute surgical approach (e.g.
lung volume reduction surgery,
LVRS; lung transplantation),
in selected patients.
The optimal procedure is chosen according to specific features of emphysematous lung,
which are described by HRCT; indeed,
severity,
extent and pattern of emphysema can be visually and quantitatively evaluated through HRCT,
therefore an accurate assessment is mandatory before treatment.