PT  - JOURNAL ARTICLE
AU  - Yee Tung (Eric) Kuo
AU  - Kenneth Lau
AU  - Garun Hamilton
AU  - Eunice Dai
AU  - Paul Leong
AU  - Philip Bardin
TI  - A pilot study of CPAP therapy for excessive dynamic airway collapse during acute exacerbation of COPD
DP  - 2014 Sep 01
TA  - European Respiratory Journal
PG  - 3401
VI  - 44
IP  - Suppl 58
4099  - http://erj.ersjournals.com/content/44/Suppl_58/3401.short
4100  - http://erj.ersjournals.com/content/44/Suppl_58/3401.full
SO  - Eur Respir J2014 Sep 01; 44
AB  - Background: Excessive dynamic airway collapse (EDAC) occurs in expiration when the posterior wall of the trachea bulges forward causing ≥ 50% cross sectional area reduction. EDAC can be diagnosed with four-dimensional dynamic volume 320-slice multi-detector computed tomography (4D-CT) and has been reported to occur in 20% of patients with COPD. Whether EDAC persists in stable COPD or occurs predominantly during exacerbations is unknown. Overall effectiveness of CPAP in EDAC has also not been assessed.Aims: To determine whether CPAP therapy reduced EDAC in patients with acute exacerbation of COPD (AECOPD) and if EDAC persisted after recovery from AECOPD.Methods: Patients with AECOPD requiring hospitalization (n = 11) were recruited. 4D-CT of the larynx and trachea (2-4 mSv) was performed within 48 hours of admission and repeated immediately after with 10-12cmH2O CPAP. CT was repeated at 6-8 weeks post discharge (without CPAP). EDAC was diagnosed if expiratory tracheal area was reduced by ≥ 50%.Results: Of the 11 patients recruited, four had EDAC detected. EDAC severity ranged from 60-64% (median = 63.5%). EDAC resolved with CPAP in all four patients (median narrowing = 39.5% [29%-49%]). EDAC was not evident in the three patients who completed follow-up CT (one CT not done).Conclusions: EDAC in AECOPD can be improved by CPAP. Larger studies are warranted to further evaluate the functional significance of EDAC and clinical benefits of CPAP treatment.