Early Diagnosis and Real-Time Monitoring of Regional Lung Function Changes to Prevent Chronic Obstructive Pulmonary Disease Progression to Severe Emphysema.
Early Diagnosis and Real-Time Monitoring of Regional Lung Function Changes to Prevent Chronic Obstructive Pulmonary Disease Progression to Severe Emphysema.
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早期诊断和实时监测局部肺功能变化预防慢性阻塞性肺疾病进展为严重肺气肿。
DOI：
10.3390/jcm10245811
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发表时间：
2021-12-12
影响因子：
3.9
通讯作者：
Vij N
中科院分区：
文献类型：
--
作者：
Jung T;Vij N
第一手和第二手暴露于烟雾或空气污染物是慢性阻塞性肺疾病（COPD）发病的主要原因，其中遗传和年龄相关因素使受试者易患阻塞性肺疾病。简而言之，气道炎症，特别是支气管炎，引发肺部疾病，导致呼吸困难（呼吸困难）和咳嗽作为初始症状，随后由于肺泡损伤（肺气肿）导致空气滞留和空气流入肺部的抑制。此外，粘液阻塞和受损的肺清除机制导致复发性急性加重，引起肺功能进行性下降，最终需要肺移植和其他挽救生命的干预措施来防止死亡。值得注意的是，COPD在人群中比目前诊断的更常见，因为截至2018年，据报道只有1600万美国成年人被诊断患有COPD，尽管估计另有1400万美国成年人患有COPD，但未被当前标准治疗（SOC）诊断诊断，即基于肺功能测试（PFT）的肺功能测试（PFT）诊断。因此，导致COPD的不良疾病结局和显著死亡率的主要问题是在疾病的早期阶段缺乏及时诊断。COPD肺气肿的当前治疗方案在COPD发作时早期实施时最有效，其中通过及时干预缓解症状和恶化可以防止肺功能急剧下降和疾病进展为重度肺气肿。因此，有效对抗COPD的关键在于早期发现。因此，早期检测局部肺功能和结构变化以监测适度的疾病进展对于实施及时干预和有效消除肺气肿进展是重要的。目前，COPD诊断涉及使用诸如COPD筛查问卷、PFT、动脉血气分析和/或肺成像的技术，但是这些模态在其用于早期诊断和局部肺功能变化的实时疾病监测的能力方面是有限的。因此，有前途的新兴技术，如X射线相位对比、光声断层扫描、超声计算机断层扫描、电阻抗断层扫描、强迫振荡技术和由强大的人工智能和机器学习分析能力驱动的脉冲多普勒测量系统，正在成为早期检测和真实的时间监测COPD进展以及时干预的新解决方案。我们在此讨论了当前SOC和新兴COPD诊断的范围、风险和局限性，并展望了提供真实的实时局部肺功能监测的新型诊断，以及预测急性加重和/或疾病发作以进行基于肺水肿的及时干预以限制COPD-肺气肿进展。
First- and second-hand exposure to smoke or air pollutants is the primary cause of chronic obstructive pulmonary disease (COPD) pathogenesis, where genetic and age-related factors predispose the subject to the initiation and progression of obstructive lung disease. Briefly, airway inflammation, specifically bronchitis, initiates the lung disease, leading to difficulty in breathing (dyspnea) and coughing as initial symptoms, followed by air trapping and inhibition of the flow of air into the lungs due to damage to the alveoli (emphysema). In addition, mucus obstruction and impaired lung clearance mechanisms lead to recurring acute exacerbations causing progressive decline in lung function, eventually requiring lung transplant and other lifesaving interventions to prevent mortality. It is noteworthy that COPD is much more common in the population than currently diagnosed, as only 16 million adult Americans were reported to be diagnosed with COPD as of 2018, although an additional 14 million American adults were estimated to be suffering from COPD but undiagnosed by the current standard of care (SOC) diagnostic, namely the spirometry-based pulmonary function test (PFT). Thus, the main issue driving the adverse disease outcome and significant mortality for COPD is lack of timely diagnosis in the early stages of the disease. The current treatment regime for COPD emphysema is most effective when implemented early, on COPD onset, where alleviating symptoms and exacerbations with timely intervention(s) can prevent steep lung function decline(s) and disease progression to severe emphysema. Therefore, the key to efficiently combatting COPD relies on early detection. Thus, it is important to detect early regional pulmonary function and structural changes to monitor modest disease progression for implementing timely interventions and effectively eliminating emphysema progression. Currently, COPD diagnosis involves using techniques such as COPD screening questionnaires, PFT, arterial blood gas analysis, and/or lung imaging, but these modalities are limited in their capability for early diagnosis and real-time disease monitoring of regional lung function changes. Hence, promising emerging techniques, such as X-ray phase contrast, photoacoustic tomography, ultrasound computed tomography, electrical impedance tomography, the forced oscillation technique, and the impulse oscillometry system powered by robust artificial intelligence and machine learning analysis capability are emerging as novel solutions for early detection and real time monitoring of COPD progression for timely intervention. We discuss here the scope, risks, and limitations of current SOC and emerging COPD diagnostics, with perspective on novel diagnostics providing real time regional lung function monitoring, and predicting exacerbation and/or disease onset for prognosis-based timely intervention(s) to limit COPD–emphysema progression.
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DOI：
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发表时间：
2016-12-15
影响因子：
24.7
作者：
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发表时间：
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期刊：
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影响因子：
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影响因子：
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DOI：
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2012-07-01
影响因子：
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