Paratracheal paraseptal emphysema and expiratory central airway collapse in smokers

Academic Article


  • Rationale: Expiratory central airway collapse is associated with respiratory morbidity independent of underlying lung disease. However, not all smokersdevelop expiratory central airway collapse, andthe etiology of expiratory central airway collapsein adultsmokersisunclear.Paraseptal emphysema in theparatracheal location, by untethering airwaywalls,may predispose smokers to developing expiratory central airway collapse. Objectives: To evaluate whether paratracheal paraseptal emphysema is associated with expiratory central airway collapse. Methods: We analyzed paired inspiratory and expiratory computed tomography scans from participants enrolled in a multicenter study (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) of smokers aged 45 to 80 years. Expiratory central airway collapse was defined as greater than or equal to 50% reduction in cross-sectional area of the trachea during expiration. In a nested case-control design, participants with and without expiratory central airway collapse were included in a 1:2 fashion, and inspiratory scans were further analyzed using the Fleischner Society criteria for presence of centrilobular emphysema, paraseptal emphysema, airway wall thickening, and paratracheal paraseptal emphysema (maximal diameter > 0.5 cm). Results: A total of 1,320 patients were included, 440 with and 880 without expiratory central airway collapse. Those with expiratory central airway collapse were older, had higher body mass index, and were less likely to be men or current smokers. Paratracheal paraseptal emphysema was more frequent in those with expiratory central airway collapse than control subjects (16.6 vs. 11.8%; P = 0.016), and after adjustment for age, race, sex, body mass index, smoking pack-years, and forced expiratory volume in 1 second, paratracheal paraseptal emphysema was independently associated with expiratory central airway collapse (adjusted odds ratio, 1.53; 95% confidence interval, 1.18-1.98; P = 0.001). Furthermore, increasing size of paratracheal paraseptal emphysema (maximal diameter of at least 1 cm and 1.5 cm) was associated with greater odds of expiratory central airway collapse (adjusted odds ratio, 1.63; 95% confidence interval, 1.18-2.25; P = 0.003 and 1.77; 95% confidence interval, 1.19-2.64; P = 0.005, respectively). Conclusions: Paraseptal emphysema adjacent to the trachea is associated with expiratory central airway collapse. The identification of this risk factor on inspiratory scans should prompt further evaluation for expiratory central airway collapse. Clinical trial registered with (NCT 00608764).
  • Digital Object Identifier (doi)

    Author List

  • Copeland CR; Nath H; Terry NLJ; Wilson CG; Kim YI; Lynch DA; Bodduluri S; Michael Wells J; Dransfield MT; Diaz AA
  • Start Page

  • 479
  • End Page

  • 484
  • Volume

  • 15
  • Issue

  • 4