Chest
Volume 120, Issue 3, September 2001, Pages 725-729
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Clinical Investigations
Smoking
CT Assessment of Subtypes of Pulmonary Emphysema in Smokers

https://doi.org/10.1378/chest.120.3.725Get rights and content

Abstract

Objective

To determine the incidence of subtypes of pulmonary emphysema (PE) identified by CT imaging in male patients who have a significant smoking history.

Patients and setting

We reviewed 945 subjects (619 men and 326 women) who had undergone CT scanning. However, only the data for male subjects were analyzed due to there being too few female subjects. The male subjects were divided into the following two age groups: group A (age, ≤ 50 years) and group B (> 50 years). There were two subtypes of PE found: centrilobular emphysema (CLE) and paraseptal emphysema (PSE). Based on these subtypes, PE was divided into the following three categories: I (CLE or CLE-predominant); II (CLE and PSE of equal extent); and III (PSE or PSE-predominant).

Results

PE was found in 270 of 516 male smokers (10 of 38 female smokers had PE). Among male subjects, in age group A there were 53 subjects with some degree of PE (category I, 12 subjects [22.6%]; category II, 7 subjects[13.2%]; and category III, 34 subjects [64.2%]). Among men in age group B, there were 217 subjects with some degree of PE (category I, 109 subjects [50.2%]; category II, 23 subjects [10.6%]; and category III, 85 subjects [39.2%]).

Conclusion

In age group A, men < 50 years of age who were in category III (PSE or PSE-predominant PE) predominated (34 of 53 subjects; 64.2%). In age group B, men > 50 years of age who were in category I (CLE or CLE-predominant PE) predominated (109 of 217 subjects; 50.2%).

Section snippets

Materials

We reviewed 945 subjects (619 men and 326 women, ranging in age from 21 to 91 years) from the Kagawa Prefectural Cancer Detecting Center and Numakuma Hospital, who had undergone CT scanning between December 1997 and June 1999 because of suspected lung disease seen on chest radiographs or because of respiratory complaints. Because there were too few female smokers, only the data for male smokers were analyzed. PE was diagnosed by the presence of low-attenuation areas (LAAs) on CT scans and not

Results

Of 945 total subjects in the present study, there were only 41 (4.3%) with pulmonary disease other than PE (lung cancer, 10 subjects; interstitial pneumonia, 8 subjects; pneumoconiosis, 8 subjects; inflammatory change including tuberculosis, 9 subjects; and bronchiectasis, 6 subjects). PE was found in 270 of 516 male smokers (10 of 38 female smokers had PE). In male smokers, there were no statistically significant differences in cigarette consumption in number of pack-years according to CT

Discussion

CLE is by far the most common form of emphysema and has a proven association with cigarette smoking.15 PSE can occur as an isolated phenomenon in young adults.5 Bullae can develop in association with any type of PE but are most common with PSE or CLE. A bulla, by definition, is a sharply demarcated area of PE measuring≥ 1 cm in diameter and possessing a wall < 1 mm in thickness.6 PSE can occur in older patients with CLE.5

At least some degree of PE is recognized in more than half of Japanese

Conclusion

CLE (or CLE mixed with PSE) can be found in young subjects (ie, those ≤ 50 years of age), and even in those < 40 years of age. In older subjects (ie, those > 50 years of age), CLE predominates. Although PSE can occur in nonsmokers, both CLE and PSE are strongly related to smoking. Both types progress with age and the cumulative cigarette smoking dose. PE was found in more than half of male smokers. A high incidence of PE was found even in younger subjects.

References (16)

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1

Presently at the Department of Radiology, KKR Takamatsu Hospital, Kagawa, Japan.

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