Beyond airflow limitation: another look at COPD

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Abstract
In this issue of Thorax, investigators from the Universities of Kyoto, Shiga, and Vancouver,2 continuing a long history of research activity in the field of the in vivo anatomical study of COPD by high resolution computed tomography (HRCT), elegantly bring back to life and strengthen Burrows’ findings of 1966 (see page 20).2 Ogawa and colleagues2 found, indeed, that patients with COPD who, at HRCT, had reduced x ray attenuation values, compatible with emphysematous destruction of lung parenchyma, were thinner than those who had bronchial wall thickening compatible with chronic inflammatory changes of the conductive airways. A significant inverse relationship was found between body mass index (BMI) and emphysema extent at HRCT, whereas no correlation was present between BMI and thickness of the bronchial wall. FEV1 was inversely correlated with BMI, HRCT emphysema extent and bronchial wall thickness, but there was no significant difference in mean FEV1 between the two HRCT phenotypes of COPD.2

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