Table 2.

Radiologic and Clinical Features of COPD Comorbidities

Comorbidities	Radiologic Features	Clinical Features
Lung cancer	Radiographic features of emphysema and air trapping and the severity of airflow obstruction are risk factors for lung cancer and cancer mortality.	The USPSTF states with moderate certainty that annual screening for lung cancer with low-dose CT scan has a moderate net benefit in people at high risk (age, total cumulative tobacco use exposure, and years since quitting).
PH	Chest radiography may provide clues to the presence of PH with dilatation of the pulmonary artery. On CT scan, the ratio of the main PA to ascending aorta diameter > 1.0 may predict PH.	Transthoracic echocardiography is the initial test of choice but may not be accurate due to lung hyperinflation. It estimates systolic PA pressure and evaluates hypertrophy and dilatation of the right ventricle. Right heart catheterization confirms the diagnosis.
Bronchiectasis	Radiological criteria are broncho-arterial ratio >1, lack of bronchial tapering, and visualization of peripheral bronchi within 1 cm of the pleural surface	Patients have greater sputum production, higher inflammatory biomarkers, worse airflow obstruction, and higher exacerbation rates. Colonization with potentially pathogenic organisms such as Paeruginosa.
ILA	Often incidentally detected on chest CT scan imaging and seen with emphysema. Fibrotic ILA with traction bronchiectasis has worse prognosis.	ILAs may be independent predictors of mortality; 50% will progress over 5 years. Follow-up needed to evaluate for progressive physiologic or symptomatic impairment.
Tobacco use-related interstitial fibrosis or airspace enlargement and fibrosis	These are overlapping histologic terms indicating the presence of fibrosis in individuals who smoke cigarette. Radiologic findings include centrilobular nodularity, ground-glass abnormality, and cysts.	Occurs in individuals who use tobacco; 5-y survival high, most are asymptomatic.
CPFE	The presence of emphysema predominantly in the upper lobes and parenchymal fibrosis in the lower lobes on CT scan imaging	CPFE predisposes to lung cancer and pulmonary hypertension and is associated with relatively high mortality. A low Dlco and severe exercise hypoxemia are found often with mild spirometry changes.
Coronary artery disease	Coronary calcifications seen on CT scans.	Validated risk assessment for coronary artery disease
Osteoporosis	Osteoporosis, vertebral fractures, and degenerative spine disease may be detected on chest CT scan imaging and often are underreported.	Preventive measures for low bone mineral density and vertebral fractures are needed for many patients with COPD.
Pulmonary cachexia	CT scan imaging provides a noninvasive means of assessing skeletal muscle bulk.	Reduced muscle size is associated with poorer clinical outcomes.

CPFE = combined pulmonary fibrosis with emphysema; Dlco = diffusing capacity of the lungs for carbon monoxide; ILA = interstitial lung abnormality; PA = pulmonary artery; PH = pulmonary hypertension; USPSTF = United States Preventive Services Task Force.