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CT Diagnosis of Tracheomalacia in Patients with COPD

慢阻肺患者气管软化的CT诊断

基本信息

批准号：
8209205
负责人：
PHILLIP M BOISELLE
金额：
$ 34.93万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-01-01 至 2013-12-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): The broad, long-term goals of the proposed study are to determine the prevalence and natural history of tracheomalacia among patients with chronic obstructive pulmonary disease (COPD) and to establish the role of a novel CT method in guiding therapy and assessing response to intervention. This work also has the potential to reduce morbidity among patients with coexisting COPD and tracheomalacia. Chronic cough is the fifth most common symptom for which patients seek medical care in the United States, accounting for more than 30 million office visits per year. Acquired tracheomalacia, a condition defined by excessive expiratory collapse of the trachea due to weakness of the airway walls and/or supporting cartilage, is a relatively common but frequently overlooked cause of chronic cough. Tracheomalacia is associated with a variety of risk factors, most notably COPD. Importantly, tracheomalacia can cause significant respiratory morbidity if left untreated, and it may rarely be fatal. Our preliminary studies demonstrate that paired inspiratory-dynamic expiratory CT is a highly accurate, noninvasive method for diagnosing tracheomalacia, with comparable accuracy to the current gold standard of bronchoscopy, an invasive procedure. We propose a diagnostic study which will be a collaborative, multidisciplinary effort by the departments of radiology, pulmonary medicine, thoracic surgery, pathology, and anesthesia at Beth Israel Deaconess Medical Center and Harvard Medical School, a center that has established expertise in the diagnosis and treatment of this disorder. We propose the following specific aims: Aim 1: Determine the prevalence of tracheomalacia among patients with COPD; Aim 2: Identify physiological and clinical parameters that are predictive of tracheomalacia in patients with COPD; Aim 3: Determine the natural history of tracheomalacia in the absence of intervention among subjects who are asymptomatic or mildly symptomatic; and Aim 4: Identify factors that are predictive of a positive response to intervention by assessing longitudinal changes in key parameters among severely symptomatic participants following therapy. The import of the proposed study is two-fold: 1) it will noninvasively determine the prevalence and natural history of tracheomalacia among patients with COPD; and 2) it has the potential to reduce morbidity among patients with coexisting COPD and tracheomalacia. Narrative: Acquired tracheomalacia, a condition defined by excessive expiratory collapse of the trachea due to weakness of the airway walls and/or supporting cartilage, is a common but often overlooked cause of chronic respiratory symptoms that is associated with a variety of risk factors, most notably chronic obstructive pulmonary disease (COPD). The broad, long-term goals of the proposed study are to determine the prevalence and natural history of tracheomalacia among patients with COPD and to establish the role of a novel CT method in guiding therapy and assessing response to intervention. This work also has the potential to reduce morbidity among patients with coexisting COPD and tracheomalacia.

描述（由申请方提供）：拟议研究的广泛、长期目标是确定慢性阻塞性肺疾病（COPD）患者中气管软化的患病率和自然史，并确定新型CT方法在指导治疗和评估干预反应中的作用。这项工作也有可能降低COPD和气管软化并存患者的发病率。慢性咳嗽是美国患者就医的第五大常见症状，每年就诊人数超过3000万。获得性气管软化是一种由气道壁和/或支撑软骨的虚弱导致的气管过度呼气塌陷所定义的病症，是慢性咳嗽的一种相对常见但经常被忽视的原因。气管软化症与多种危险因素相关，最显著的是COPD。重要的是，如果不治疗，气管软化可引起显著的呼吸系统疾病，并且很少是致命的。我们的初步研究表明，成对的吸气-动态呼气CT是一种诊断气管软化症的高度准确的非侵入性方法，其准确性与目前的金标准支气管镜检查（一种侵入性检查）相当。我们提出了一项诊断研究，这将是一个合作，多学科的努力，由放射科，肺内科，胸外科，病理学，麻醉部门在贝丝以色列女执事医疗中心和哈佛医学院，一个中心，已建立专门知识，在诊断和治疗这种疾病。我们提出了以下具体目标：目标1：确定COPD患者中气管软化的患病率;目标2：确定预测COPD患者气管软化的生理和临床参数;目标3：确定无症状或轻度症状受试者在无干预情况下气管软化的自然史;目标4：通过评估严重症状参与者治疗后关键参数的纵向变化，确定预测干预积极反应的因素。拟议研究的重要性有两个方面：1）它将无创地确定COPD患者中气管软化的患病率和自然史; 2）它有可能降低COPD和气管软化并存患者的发病率。叙述：获得性气管软化症是一种由气道壁和/或支撑软骨的虚弱导致的气管过度呼气塌陷所定义的病症，是慢性呼吸道症状的常见但经常被忽视的原因，其与各种风险因素相关，最显著的是慢性阻塞性肺病（COPD）。本研究的广泛、长期目标是确定COPD患者气管软化的患病率和自然史，并确定新型CT方法在指导治疗和评估干预反应中的作用。这项工作也有可能降低COPD和气管软化并存患者的发病率。