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      International Journal of COPD (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on pathophysiological processes underlying Chronic Obstructive Pulmonary Disease (COPD) interventions, patient focused education, and self-management protocols. Sign up for email alerts here.

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      Assessment Of Changes In Regional Xenon-Ventilation, Perfusion, And Ventilation-Perfusion Mismatch Using Dual-Energy Computed Tomography After Pharmacological Treatment In Patients With Chronic Obstructive Pulmonary Disease: Visual And Quantitative Analysis

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          Abstract

          Purpose

          To assess changes in regional ventilation (V), perfusion (Q), and V-Q mismatch in patients with chronic obstructive pulmonary disease (COPD) after pharmacologic treatment using combined xenon-enhanced V and iodine-enhanced Q dual-energy CT (DECT).

          Patients and methods

          Combined V and Q DECT were performed at baseline and after three-month pharmacologic treatment in 52 COPD patients. Anatomically co-registered virtual non-contrast images, V, Q, and V/Q ratio maps were obtained. V/Q pattern was visually determined to be matched, mismatched, or reversed-mismatched and compared with the regional parenchymal disease patterns of each segment. DECT parameters for V, Q, and V-Q imbalance were quantified.

          Results

          The parenchymal patterns on CT were not changed at follow-up. The segments with matched V/Q pattern were increased (80.2% to 83.6%) as the segments with reversed-mismatched V/Q pattern were decreased with improving ventilation (17.6% to 13.8%) after treatment. Changes of V/Q patterns were mostly observed in segments with bronchial wall thickening. Compared with patients without bronchial wall thickening, the quantified DECT parameters of V-Q imbalance were significantly improved in patients with bronchial wall thickening ( p < 0.05). Changes in forced expiratory volume in one second after treatment were correlated with changes in the quantified DECT parameters ( r = 0.327–0.342 or r = −0.406 and −0.303; p < 0.05).

          Conclusion

          DECT analysis showed that the V-Q imbalance was improved after the pharmacological treatment in COPD patients, although the parenchymal disease patterns remained unchanged. This improvement of V-Q imbalance may occur mostly in the areas with bronchial wall thickening.

          Most cited references32

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

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            Site and nature of airway obstruction in chronic obstructive lung disease.

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              Hypoxemia in patients with COPD: cause, effects, and disease progression

              Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                COPD
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                25 September 2019
                2019
                : 14
                : 2195-2203
                Affiliations
                [1 ]Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Songpa-Gu, Seoul 138-736, South Korea
                [2 ]Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine , Songpa-Gu, Seoul 138-736, South Korea
                [3 ]Department of Radiology, Ansan Hospital, Korea University College of Medicine , Danwon-gu, Ansan-si, Gyeonggi-do, Korea
                Author notes
                Correspondence: Sang Min Lee Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center , 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul138-736, South KoreaTel +82 2 3010 5766Fax +82 2 476 4719 Email asellion@hanmail.net
                Author information
                http://orcid.org/0000-0003-3508-2870
                http://orcid.org/0000-0002-2173-2193
                http://orcid.org/0000-0003-0271-7884
                http://orcid.org/0000-0003-4130-1486
                http://orcid.org/0000-0002-3438-2217
                Article
                210555
                10.2147/COPD.S210555
                6768130
                8ba4e172-8a9b-446a-a3d9-f2043c4a6ac7
                © 2019 Hwang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 29 March 2019
                : 05 September 2019
                Page count
                Figures: 4, Tables: 2, References: 34, Pages: 9
                Categories
                Original Research

                Respiratory medicine
                chronic obstructive pulmonary disease,dual-energy computed tomography,ventilation-perfusion mismatch,pharmacotherapy

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