Letter for article CT-Based Commercial Software Applications: Impr

Mr Editor

With interest, we read the review article by Wang et al.1 published in the latest issue of International Journal of Chronic Obstructive Pulmonary Diseases (COPD). They argued that the course of COPD is difficult to predict with readily available data, such as pulmonary function tests (PFTs). The use of quantitative computed tomography (QCT) techniques are alternative modalities for assessing the disease profile of COPD instead of PFT. Although QCT and other tools are increasingly used in research and clinical settings, OCT has not yet been routinely adopted for the diagnosis of COPD.

The authors summarized well regarding QCT analytical software. However, the most critical point of COPD diagnosis in the context of the COVID-19 pandemic is totally overlooked. After the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the public, the diagnostic approach to COPD has often been disrupted. PFT, including spirometry, could generate aerosolized droplets and increase the risk of transmission of respiratory viruses, including SARS-Cov-2, to healthcare workers. Based on this COVID-19 prevention warning, PFT diagnostic procedures are not recommended in the context of the COVID-19 pandemic.2 On the other hand, COPD is a significant risk for disease progression of COVID-19.3 Thus, alternative modalities for the diagnosis of COPD instead of PFT are urgently needed for the reduction of COPD morbidity and mortality. QCT may be the strongest modality for the accurate diagnosis of COPD. It seems very likely that the pandemic will accelerate the type of innovation, the use of new diagnostic tools. While such imaging tools, including OCT, are increasingly used in research and clinical settings, they have not yet been routinely adopted for the diagnostic workup of COPD. The type of argument has not been discussed in the current summary document.

To diagnose someone with COPD, a potential patient must undergo a simple breathing test called spirometry. However, your healthcare provider will perform medical imaging, a form of testing that results in a visual representation of the patient’s lungs. In such cases, an imaging test, such as a chest X-ray, CT scan, or ECG, can be used to identify other potential causes of COPD symptoms and confirm its diagnosis. CT is the most sensitive and accurate option for detecting and measuring emphysema. Additionally, a high resolution CT scan is also excellent for detecting and determining the severity of bronchiectasis and other lung disease within the scope of COPD.

It has also been suggested that visual assessment and CT phenotyping in patients with COPD is feasible and can help identify functional and clinically different patient subsets.4

Quantitative computed tomography is increasingly being used to quantify features of COPD, particularly emphysema, air entrapment, and airway abnormalities. Several authors have shown that current smokers seem to have lower levels of emphysema than former smokers.5 Therefore, smoking status should always be considered when assessing the severity of emphysema by quantitative CT.6 Although quantitative CT measurements correlate with visually assessed emphysema severity, the level of correlation is not strong. Thus, several limitations exist when using clinical chest CT scans to diagnose and assess COPD and its severity. However, in the context of the COVID-19 pandemic, measurement of chest CT scans is a safe, accurate, and effective modality for assessing disease severity.seven Therefore, chest computed tomography represents a promising initial screening tool for COPD that may facilitate targeted treatment in at-risk individuals with COPD with or without COVID-19.


The author reports no conflict of interest in this communication.


1. Wang JM, Ram S, Labaki WW, Han MK, Galban CJ. Commercial CT-Based Software Applications: Improving Patient Care Through Accurate COPD Subtyping. Int J Chron Obstruct Pulmon Dis. 2022;17:919–930. doi:10.2147/COPD.S334592

2. Hull JH, Lloyd JK, Cooper BG. Pulmonary function test in COVID-19 endemic. Respir Med Lancet. 2020;8:666–667. doi:10.1016/S2213-2600(20)30246-0

3. Teramoto S. Famous Japanese comedian with COPD was killed by pneumonia caused by SARS-CoV-2 – implication for smoking risk and ECMO indication. Int Clin Med. 2020;4:1–2. doi:10.15761/ICM.1000180

4. da Silva SMD, Paschoal I, De Capitani E, et al. COPD phenotypes on computed tomography and its correlation with some lung function variables in severe patients. Int J Chron Obstruct Pulmon Dis. 2016;11:503–513. doi:10.2147/COPD.S90638

5. Barr RG, Berkowitz EA, Bigazzi F, et al. A combined chest radiology workshop for visual assessment of COPD: study design, chest CT results and concordance with quantitative assessment. COPD. 2012;9:151–159. doi:10.3109/15412555.2012.654923

6. Shaker SB, Stavngaard T, Laursen LC, Stoel BC, Dirksen A. Rapid fall in lung density after smoking cessation in COPD. COPD. 2011;8:2–7. doi:10.3109/15412555.2010.541306

7. Teramoto S, Yamamoto H, Yamaguchi Y, Matsuse T, Ouchi Y. Global burden of COPD in Japan and Asia. Lancet. 2003;362(9397):1764–1765. doi:10.1016/S0140-6736(03)14865-9

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