High resolution computed tomography in chronic obstructive pulmonary disease

Pragati Rao D., Aruna Talatam, Chakradhar B., Bhargavi K., Bhagyaraj A.


Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease characterised by persistent respiratory symptoms and airflow limitation with varied presentations (bronchitis and emphysema). High resolution computed tomography (HRCT) plays an important role in identifying the various morphologies thereby reducing morbidity and mortality. The aim of the present study was to evaluate the role of high resolution computed tomography in COPD patients. The Objectives of the present study was to differentiate emphysema predominant, airway predominant and mixed phenotypes and to identify other disease processes and complications.

Methods: 50 COPD patients attending Respiratory medicine Department, NRI general hospital were advised for chest x-rays and pulmonary function tests. All the patients selected were smokers with no other co-morbid illnesses. Those patients whose chest x-rays showed no other changes except for COPD changes were selected for HRCT chest.

Results: Out of 50 COPD patients emphysema predominance was present in 28 patients (56%), bronchitis predominance in 19 patients (38%) and 3(6%) patients had mixed pattern. In emphysema centriacinar pattern was commonly seen (42.9%), paraseptal in 35.71%, panacinar in 3.57% and bullae in 17.8% cases. All the patients were chronic smokers with pack years >20. All are males with average age above 45 years. Emphysema was common in elderly patients with age above 50 years. Chronic bronchitis is predominantly seen in the age group 40-50 years. Additional diagnoses like bronchiectasis, mass, ILD were identified in 28% cases.

Conclusions: HRCT plays a significant role in COPD patients in differentiating phenotypes which have different modes of therapy. Other subtle changes in lungs which cannot be identified on chest x ray are discernible on HRCT. Early identification of complications reduces morbidity and mortality.


Bronchitis, Chronic obstructive pulmonary disease, Emphysema, High resolution computed tomography

Full Text:



Global Initiative for Chronic Obstructive Lung Disease -Global Initiative for Chronic Obstructive Lung Disease - GOLD. 2018. Available at:

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006 Nov 28;3(11):e442.

Washko GR. The role and potential of imaging in COPD. Medi Clin. 2012 Jul 1;96(4):729-43.

Matsuoka S, Yamashiro T, Washko GR, Kurihara Y, Nakajima Y, Hatabu H. Quantitative CT assessment of chronic obstructive pulmonary disease. Radiographics. 2010 Jan;30(1):55-66.

Gupta PP, Yadav R, Verma M, Gupta KB, Agarwal D. High-resolution computed tomography features in patients with chronic obstructive pulmonary disease. Singapore Med J. 2009;50(2):193-200.

Koshiol J, Rotunno M, Consonni D, Pesatori AC, De Matteis S, Goldstein AM, et al. Chronic obstructive pulmonary disease and altered risk of lung cancer in a population-based case-control study. PLoS One. 2009 Oct 8;4(10):e7380.

Gupta PP, Yadav R, Verma M, Agarwal D, Kumar M. Correlation between high-resolution computed tomography features and patients' characteristics in chronic obstructive pulmonary disease. Ann Thoracic Med. 2008 Jul;3(3):87.

Mehfooz N, Bhargava R, Ahmad Z, Ahmad I, Patigaroo SA. HRCT findings in early cases of COPD-an experience. Int J Basic Applied Med Sci. 2013;3(3):20-31.

Klein JS, Gamsu G, Webb WR, Golden JA, Müller NL. High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. Radiol. 1992 Mar;182(3):817-21.

Singh A, Kumar S, Mishra AK, Kumar M, Kant S, Verma SK, et al. Correlation between clinical characteristics, spirometric indices and high resolution computed tomography findings in patients of chronic obstructive pulmonary disease. Lung India: official organ of Indian Chest Society. 2016 Jan;33(1):42.

Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology. 2004 May;231(2):440-5.

Thurlbeck WM, Müller NL. Emphysema: definition, imaging, and quantification. AJR. Am J Roentgenol. 1994 Nov;163(5):1017-25.

National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume–reduction surgery with medical therapy for severe emphysema. N Eng J Med. 2003 May 22;348(21):2059-73.