Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Analysis With Clusters of QUAntitative Tomodensitometric Vascular, bronchIal and Parenchymal Pulmonary Parameters for COPD Patients
Chronic obstructive pulmonary disease (COPD) is caused by tobacco consumption. The goal is to characterize on clinical and radiological data, using computed tomography, this illness in order to improve diagnostic and be able to evaluate the prognostic of each patient.
Chronic obstructive pulmonary disease (COPD) is characterized by emphysematous destruction of
pulmonary parenchyma, airway obstruction that participate in chronic temporary obstruction of
airways. COPD has multiple clinical presentations that define phenotypes but doesn't take
into account those anatomo-pathologic modifications. Moreover, the prognostic interest of
those structural alteration is unknown. Until now, only PFT allowed to define the severity of
the disease, whereas multiple others tools may be useful, such as, symptoms scores,
exacerbation frequencies, denutrition. Those structural alterations are available using
computed tomography (CT), that may also have an interest in prognostic or in treatment
follow- up.
CT is widely used in clinical practice for COPD patients at basal state and in exacerbations.
Quantitative CT is able to combine acquisition of objective and reproductible informations on
parenchymal destruction (emphysema), bronchial wall remodeling, and pulmonary vessels
alteration. The investigators' team developed software tools to determine quantitative
structural modifications of airways, emphysema and small pulmonary vessels1,2.
The team has been able to build a score "Paw score" combining PaO2 with CT parameters of
bronchial wall thickness and small pulmonary vessels percentage2. This score allowed to
predict the presence of severe pulmonary hypertension in patients with COPD. Pulmonary
hypertension is a complication of COPD that increase morbi-mortality.
The hypothesis is that morphological quantitative analysis combined with structural
alterations of airways has a prognostic interest.
The main goal is to determine morphological phenotypes of COPD using a cluster analysis
combining emphysema, bronchial wall thickness and pulmonary vessels.
The other main goal is to predict evolution of COPD patients based on clinical outcomes
(exacerbations frequency, mortality, mMRC, SGQLQ) and lung function testing (decline in FEV-1
TLCO, PaO2).
The team also wants to analyze clinical data of survival, exacerbation and symptoms in
following years of the CT of each cluster in historic-prospective way.
The secondary goals are to describe clinical, functional and biological clusters. Analyse of
correlations will be studied. Moreover, we will investigate the interest of the "Paw score"
as a prognostic marker and as a correlated parameter.
This is a retrospective study. We want to take information from the year before CT, to the
year after CT. At the date of the consultation concomitant with CT we want to know all the
clinical, functional and biological data of each patient.
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