Functional respiratory imaging: heterogeneity of acute exacerbations of COPD.

Background: Exacerbations of COPD are a major burden to patients, and yet little is understood about heterogeneity. It contributes to the current persistent one-size-fits-all treatment. To replace this treatment by more personalized, precision medicine, new insights are required. We assessed the heterogeneity of exacerbations by functional respiratory imaging (FRI) in 3-dimensional models of airways and lungs.
Methods: The trial was designed as a multicenter trial of patients with an acute exacerbation of COPD who were assessed by FRI, pulmonary function tests, and patient-reported outcomes, both in the acute stage and during resolution.
Results: Forty seven patients were assessed. FRI analyses showed significant improvements in hyperinflation (a decrease in total volume at functional residual capacity of -0.25±0.61 L, p ≤0.01), airway volume at total lung capacity (+1.70±4.65 L, p =0.02), and airway resistance. As expected, these improvements correlated partially with changes in the quality of life and in conventional lung function test parameters. Patients with the same changes in pulmonary function differ in regional disease activity measured by FRI.
Conclusion: FRI is a useful tool to get a better insight into exacerbations of COPD, and significant improvements in its indices can be demonstrated from the acute phase to resolution even in relatively small groups. It clearly visualizes the marked variability within and between individuals in ventilation and resistance during exacerbations and is a tool for the assessment of the heterogeneity of COPD exacerbations.
Competing Interests: Disclosure WHVG received an ERS Fellowship STRTF 2016 and reports a grant from Novartis to the institution for an investigator-initiated trial outside of the submitted work. WV reports grants from GSK, during the conduct of the study, and personal fees from FLUIDDA nv, outside of the submitted work. JDB is the founder and shareholder of FLUIDDA nv, a company that develops and markets part of the technology described in this paper. AC reports a grant from GSK, outside of the submitted work. OSU reports grants from AstraZeneca, GSK, Prosonix, and Edmond Pharma; personal fees from Boehringer Ingelheim, Aerocrine, Napp, Mundipharma, Sandoz, Takeda, Zentiva, and Cipla; and grants and personal fees from Chiesi, outside of the submitted work. CVH reports a grant from FLUIDDA nv, during the conduct of the study and also outside of the submitted work. HAMK reports that his institution has received a per patient fee for participation in the trial reported from FLUIDDA nv. BH, MP, and WDB report no conflicts of interest in this work.