CT Diagnosis of Tracheomalacia in Patients with COPD

描述（由申请人提供）：拟议研究的广泛、长期目标是确定慢性阻塞性肺疾病（COPD）患者气管软化症的患病率和自然史，并建立一种新的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并发COPD和气管软化患者的发病率。在美国，慢性咳嗽是患者寻求医疗护理的第五大常见症状，每年有超过3000万次就诊。获得性气管软化症是一种由于气道壁和/或支撑软骨的软弱而导致气管过度呼气塌陷的疾病，是一种相对常见但经常被忽视的慢性咳嗽原因。气管软化症与多种危险因素有关，最明显的是慢性阻塞性肺病。重要的是，如果不及时治疗，气管软化症会导致严重的呼吸系统疾病，而且很少会致命。我们的初步研究表明，配对吸气-动态呼气CT是诊断气管软化症的一种高度准确、无创的方法，其准确性与目前的支气管镜检查（一种有创手术）的金标准相当。我们建议进行一项诊断研究，该研究将由贝斯以色列女执事医疗中心和哈佛医学院的放射科、肺内科、胸外科、病理学和麻醉科等多学科合作进行，哈佛医学院在诊断和治疗这种疾病方面已经建立了专业知识。我们提出以下具体目的：目的1：确定COPD患者中气管软化症的患病率；目的2：确定预测COPD患者气管软化症的生理和临床参数；目的3：在无症状或轻度症状的受试者中，在没有干预的情况下确定气管软化症的自然史；目标4：通过评估治疗后严重症状参与者关键参数的纵向变化，确定预测干预积极反应的因素。该研究的重要意义有两方面：1)它将无创地确定COPD患者气管软化症的患病率和自然病史；2)它有可能降低并发COPD和气管软化患者的发病率。叙述性：获得性气管软化症是一种由气道壁和/或支撑软骨无力引起的气管过度呼气塌陷所定义的疾病，是一种常见但常被忽视的慢性呼吸道症状，与多种危险因素相关，最明显的是慢性阻塞性肺疾病（COPD）。该研究的广泛和长期目标是确定COPD患者气管软化症的患病率和自然病史，并建立一种新的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并发COPD和气管软化患者的发病率。

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.