Predictors of pneumonia on routine chest radiographs in patients with COPD- Video Abstract ID 142530

Video abstract of original research paper “Predictors of pneumonia on routine chest radiographs in patients with COPD: a post hoc analysis of two 1-year randomized controlled trials” published in the open access International Journal of COPD by authors Rubin DB, Ahmad HA, O’Neal M, et al.

Hi i’m dr. david rubin of pullman l is the medical director and respiratory r&d at glaxosmithkline i’m presenting on predictors of pneumonia on routine chest radiographs in patients with copd post-hoc analysis of two one-year randomized control trials a publication written by myself and colleagues at gsk in my own clinic that readers of this journal know that

Patients with copd at a higher risk for pneumonia pneumonia related death compared to patients without copd a pulmonary quote unquote dogmas that anatomic changes to the lungs make them susceptible to pneumonia and therefore we speculated that anatomic abnormalities identified on a chest x-ray could predict pneumonia risk we found 5 observations on a routine chest

X-ray that increases the odds for developing a pneumonia over one year when compared to copd patients without these findings in order the highest the lowest risk these are elevated hemidiaphragm the trachea tracheal esophageal stripe narrow cardiac silhouette calcified pleural plaques / mid chest pleural thickening and prominent pulmonary artery this first example

Is a chest x-ray of a normal copd chest x-ray quote-unquote note the flat diaphragms on pa and lateral here’s an example of an elevated hemidiaphragm a radiographic sign with about a seven fold risk for developing pneumonia respectively that elevated hemidiaphragm incites loss of lung volume and may result in inability of clear mucus and microbes this next lateral

Film shows arrows indicating a thick tracheal esophageal stripe conveying more than a four-fold risk for pneumonia a thick te stripe can indicate esophageal disease associated with gerd and hence increased aspiration risk as a cause for pneumonia this next slide a narrow cardiac silhouette the classic copd radiographic sign indicates a three-fold risk for the

Moment we found significantly lowere fev1 in patients with narrow cardiac silhouette compared to those without this finding and believe that when mediastinal structures are rotated to reflect copd severity of hyperinflation and it’s known that pneumonia risk increases with increased airflow obstruction also with the threefold risk of pneumonia is the calcified

Pleural plaques lashem in chest pleural thickening that could reflect asbestosis or prior pneumonia entities related to increased pneumonia risk possibly indicative of an underlying abnormal lung substratum right for infection and last a large pulmonary artery shadow which predicts a nearly a two-fold risk for pneumonia and patients with this sign tended to have

A lower fev1 and we speculate that the large pulmonary shadow reflux disease severity wherein hypoxia could be related to the large pulmonary artery shadow indicative of pulmonary hypertension because this is a post hoc analysis we can only hypothesize that these anatomic changes are closely linked to pneumonia risk ideally prospective studies monitoring these

Findings would be needed we hope that readers of this article we stimulated a monitor these abnormalities prospectively in their copd patients and determine the true relationship between these chest x-ray findings and pneumonia thank you for your attention

Transcribed from video
Predictors of pneumonia on routine chest radiographs in patients with COPD- Video Abstract ID 142530 By Dove Medical Press