Thorax 2000;55:198-204 ( March )

Airflow obstruction in bronchiectasis: correlation between computed tomography features and pulmonary function tests

H R Roberts^a, A U Wells^a, D G Milne^b, M B Rubens^a, J Kolbe^b, P J Cole^a, D M Hansell^a

^a Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK, ^b Green Lane Hospital, Auckland, New Zealand

Correspondence to: Dr A U Wells

Received 15 March 1999; Returned to authors 11 June 1999; Revised version received 3 November 1999; Accepted for publication 25 November 1999

BACKGROUNDAn obstructive defect is usual in bronchiectasis, but the pathophysiological basis of airflow obstruction remains uncertain. High resolution computed tomographic (CT) scanning now allows quantitation of static morphological abnormalities, as well as dynamic changes shown on expiratory CT scans. The aim of this study was to determine which static and dynamic structural abnormalities on the CT scan are associated with airflow obstruction in bronchiectasis.
METHODSThe inspiratory and expiratory features on the CT scan of 100 patients with bronchiectasis undergoing concurrent lung function tests were scored semi-quantitatively by three observers.
RESULTSOn univariate analysis the extent and severity of bronchiectasis, the severity of bronchial wall thickening, and the extent of decreased attenuation on the expiratory CT scan correlated strongly with the severity of airflow obstruction; the closest relationship was seen between decreased forced expiratory volume in one second (FEV₁) and the extent of decreased attenuation on the expiratory CT scan (R_s = -0.55, p<0.00005). On multivariate analysis bronchial wall thickness and decreased attenuation were consistently the strongest independent determinants of airflow obstruction. The extent of decreased attenuation was positively associated with the severity of bronchial wall thickness, but was not independently linked to gas transfer levels. Endobronchial secretions seen on CT scanning had no functional significance; the severity of bronchial dilatation was negatively associated with airflow obstruction after adjustment for other morphological features.
CONCLUSIONSThese findings indicate that airflow obstruction in bronchiectasis is primarily linked to evidence of intrinsic disease of small and medium airways on CT scanning and not to bronchiectatic abnormalities in large airways, emphysema, or retained endobronchial secretions.


Keywords: bronchiectasis; computed tomography; lung function; obliterative bronchiolitis

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© 2000 by Thorax
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