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European Respiratory Society Annual Congress 2013 Abstract Number: 1441 Publication Number: P242 Abstract Group: 1.3. Imaging Keyword 1: COPD - diagnosis Keyword 2: Imaging Keyword 3: No keyword Title: Airway wall volume: Implications for the CT characterization of airway disease in smokers Alejandro A. 6411 Diaz [email protected] MD 1, Dr. Raul 6415 San Jose [email protected] 2 , Mr. James C. 6416 Ross [email protected] 2, Yuka 6445 Okajima [email protected] MD 2, Dr. Juerg 6417 Tschirren [email protected] 3, Meilan K. 6418 Han [email protected] MD 4, Mark T. 6419 Dransfield [email protected] MD 5, R. Graham 6420 Barr [email protected] MD 6, Victor 6421 Kim [email protected] MD 7, Joe 6422 Ramsdell [email protected] MD 8, Edwin J.R. 6423 van Beek [email protected] MD 9, Dawn 6426 Demeo [email protected] MD 10, Mr. Jordan A. 6427 Zach [email protected] 11, Joyce D. 6428 Schroeder [email protected] MD 11, Edwin K. 6429 Silverman [email protected] MD 10, James 6430 Crapo [email protected] MD 12, David A. 6431 Lynch [email protected] MD 11 and George R. 6432 Washko [email protected] MD 1. 1 Medicine, Divsion of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States ; 2 Radiology, Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Brigham and Women's Hospital, Boston, MA, United States ; 3 Diagnostics VIDA, Coralville, IA, United States ; 4 Medicine, Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, United States ; 5 Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama, Birmingham, AL, United States ; 6 Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, United States ; 7 Medicine, Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, PA, United States ; 8 Radiology, University of California San Diego, San Diego, CA, United States ; 9 Clinical Research Imaging Center, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom ; 10 Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States ; 11 Radiology, National Jewish Health, Denver, CO, United States and 12 Medicine, Division of Pulmonary and Critical Care Medicine, National Jewish Health, Denver, CO, United States . Body: Rationale: Prior studies suggest that smoking results in airway wall thickening which on computed tomography (CT) manifests as an increase in the wall area percent ([WA%]=wall area/total bronchial area*100). In the normal lung, the bronchi expand both in length and cross section with inflation. Pathologic processes such as emphysema and hyperinflation may lead to airway elongation with inflation without proportionate dilation because of disruption of the airway-parenchyma interdependence. This could result in an artifactual increase in WA% without a discernable increase in airway wall tissue. Objectives: To determine if the observed increases in the WA% in smokers is due to a gain of mural tissue or mechanical deformation of the airways. Methods: We analyzed CT-based airway dimensions including wall volume as well as lung volume and emphysema measurements along with clinical and lung function data in 7,879 controls, smokers at risk, and smokers with COPD. Results: Airway length increased with COPD severity and hyperinflation. This was accompanied by reductions in lumen volume with negligible changes in wall volume. When examined in cross section this manifested as greater reductions in lumen area than wall area. The result of which is an increase in the WA%. Conclusion: Increases in WA% on the CT scans of smokers appears to be due to mechanical deformation of the airway and not a gain of mural tissue.