New Methods Allow More Precise Calculation of Mortality Risk in Smokers

COPD is a progressive disease of the lungs that obstructs airflow and makes breathing difficult. Millions of people in the United States suffer from COPD, with approximately 150,000 dying from it each year. Although there are many risk factors for COPD, smoking is the primary cause.

A fascinating breakthrough was recently discovered by Dr. Surya Bhatt and Dr. Sandeep Bodduluri, both members of the Division of Pulmonary, Allergy and Critical Care Medicine in the University of Alabama at Birmingham Department of Medicine. The researchers showed that a large percentage of smokers without airflow obstruction — individuals who would be considered to have either minor or no COPD according to the traditional methods of diagnosis — could and should be identified as individuals with high mortality risk.

Using CT scans of the lungs of smokers along with a mathematical function called airway fractal dimension, the scientists were able to estimate the increased risk of death for individuals who were otherwise not identified as being at risk for COPD or increased mortality.

A fractal is defined as a pattern that repeats itself over and over in increasingly smaller scales. Lungs develop in a fractal pattern: the large bronchi split into increasingly thinner bronchi. Eventually these bronchi split into approximately 3 million tiny air sacs, known as alveoli. In an adult, the alveoli have approximately the same surface area as a full-size tennis court.

The major breakthrough achieved using airway fractal dimension can be explained as follows. The current methods of analysis of CT scans of the lungs can find narrowing of the larger bronchi, and the loss or narrowing of major branches, but cannot detect damage to smaller fractal pathways. The researchers showed airway fractal dimension (AFD) allowed them to quantify the loss of airway branching complexity, i.e. damage to smaller elements of the lung tissue.

In a study of more than 8,000 smokers, the researchers were able to demonstrate that AFD was far more capable of detecting airflow obstruction, respiratory morbidity, and lung function decline than traditional methods. The research was published in the Journal of Clinical Investigation.

Laurel Bay Health and Rehabilitation Center, in the scenic beach town of Keansburg, NJ, specializes in pulmonary care, including COPD. Headed by leading pulmonary specialist Dr. Avtar Parhar, our program is the most highly advanced pulmonary rehabilitation program in Monmouth County. At Laurel Bay, we focus on restorative and preventive care for those who suffer with chronic respiratory disease.

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