Dyspnea is common both in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). This complicates a differentiation between COPD exacerbation and acute decompensated CHF during emergency hospital admission. Another challenge is the impossibility of spirometry in pronounced bronchial obstruction. Computed tomography (CT) reveals the signs of damage to the lung parenchyma in COPD exacerbations. Therefore, CT can determine additional diagnostic criteria for this disease.

OBJECTIVE

To determine additional criteria to differentiate between COPD exacerbation and acute decompensated CHF.

MATERIAL AND METHODS

The study involved 32 patients admitted to the hospital with pronounced dyspnea and bronchial obstruction signs. The patients were retrospectively divided into two groups based on spirometry, EchoCG, and N-terminal brain natriuretic propeptide content. Group 1 included patients with confirmed COPD (forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) ratio <70%), Group 2 — patients with acute decompensated CHF and normal FEV1/FVC ratio. All patients underwent chest multispiral CT using Optima General Electric apparatus. The results were statistically processed using the Statistica 13.0 software.

RESULTS

100% of Group 1 and 80% of Group 2 patients had CT signs of air trapping and centrilobular emphysema. The probability of COPD was 19.28 times higher in patients with signs of air trapping in 6 or more segments and centrilobular emphysema in 8 or more segments.

CONCLUSION

The signs of air trapping in 6 or more segments and centrilobular emphysema in 8 or more segments can be considered additional criteria for chronic obstructive pulmonary disease in patients with dyspnea.