Precision medicine in Chronic Obstructive Pulmonary Disease, COPD
On-line Platform

What is COPD ?
Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death worldwide and represents one of the major causes of chronic morbidity. Cigarette smoking is the most important risk factor for COPD. In these patients, the airflow limitation is caused by a mixture of small airways disease and parenchyma destruction (emphysema), the relative contribution of which varies from person to person.

The twofold nature of this pathological condition has been studied in the past and according to many authors each patient with COPD, although being the individual clinical expression of a wide and continuous spectrum of pathologic changes (different lesions may coexist) causing expiratory airflow limitation, should be classified as presenting a predominantly bronchial or emphysematous phenotype by clinical, functional, and radiological findings.

Altogether, quantitative and qualitative studies have shown that CT (Computed Tomography) can allow distinguishing not only between airway and parenchymal abnormalities, but also between subtypes of emphysema, i.e. centrilobular, panlobular, and paraseptal.

However, a widespread routine use of CT for the assessment of COPD in clinical practice or clinical trials cannot be currently foreseen in many countries due to various reasons ( i.e. high costs, radiation exposure, limited instrumental availability in many regions, increasing prevalence of the disease, etc...).
What is ? provides clinically validated web-based applications and on-demand custom web services to support the assessment of specific phenotypes / subtypes in COPD patients. The application software is suitable for research and routine clinical practice, clinical trials, decision-making support, telemedicine applications, specialists and family doctors needs, precision medicine platforms, personalized care and precision respiratory medicine. is accessible by PC or Mac, laptops, smartphones, tablet and it's possible to establish custom on demand data connections with any digital clinical instrumentation (laboratory spirometry, portable spirometry, PFTs setup, etc...). The output results are provided to the user directly through the web-based app interface and a standard report can be saved or printed on local client devices. Custom reports or data integration / interoperability with other systems or medical equipment is available on request.
System overview
Available applications

This application (CE mark is in progress) was developed to support the evaluation of  emphysema severity in COPD patients. The analysis is based on data acquired by basic spirometry instrumentation. The application calculates a quantitative Emphysema Severity Index (ESI) reflecting the severity of emphysema as assessed by CT. The advanced clinical experimentation of the ESI software was performed, in cooperation with the University of Florence, on a dataset of hundreds of consecutive COPD patients.
The application software is based uniquely on data derived by flow-volume curve without any standardization or previous normalization (i.e. % pred. or LLN, z-scores, etc …). In particular, this version works without CO diffusion data and is compatible with portable or basic spirometry instrumentation.
Evaluation of emphysema severity by spirometry
(The software is now available for research only, the CE mark certification is in progress for clinical applications)
For info and accounts please visit:
This application was developed to dissect and quantify the relative contribution of functional gas-trapping and emphysematous gas trapping by using standard inspiratory and expiratory CT attenuation thresholds indexes (%LAA-950insp and %LAA-856exp). The output report provides numeric results and graphics to support the assessment of specific CT phenotypes / subtypes according to the relative contribution of functional and emphysematous gas trapping. The validation of the software was recently performed by the University of Florence on a dataset of hundreds of consecutive COPD patients.
(This software is available for research only)
For info and accounts please visit:
Pistolesi M, Camiciottoli G, Paoletti M, Marmai C, Lavorini F, Meoni E, Marchesi C, Giuntini C. Identification of a predominant COPD phenotype in clinical practice. Respiratory Medicine 2008; 102:367-76.

Paoletti M, Camiciottoli G, Meoni E, Bigazzi F, Cestelli L, Pistolesi M, Marchesi C. Explorative data analysis techniques and unsupervised clustering methods to support clinical assessment of Chronic Obstructive Pulmonary Disease (COPD) phenotypes. Journal of Biomedical Informatics 2009; 42:1013-1021.

Paoletti M, Cestelli L, Bigazzi F, Camiciottoli G. Pulmonary function and CT lung density are not linearly correlated in chronic obstructive pulmonary disease. Radiology 2015; 266:571-578.

Occhipinti M, Paoletti M, Bigazzi F, Camiciottoli G, Inchingolo R, Larici AR, Pistolesi M. Emphysematous and non-emphysematous gas trapping in COPD: quantitative CT findings and pulmonary function. Radiology 2018; 287:683-692. (c) 2017-2019, All Rights Reserved
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