The effect of combination inhaled therapy on ventilation distribution measured by SPECT/CT imaging in uncontrolled asthma

2021 ◽  
Author(s):  
Sandra Rutting ◽  
David G. Chapman ◽  
Cindy Thamrin ◽  
Francesca S.M. Tang ◽  
Jessica R. Dame Carroll ◽  
...  
Keyword(s):  
Ct Imaging ◽  
Small Airway ◽  
Beta Agonist ◽  
Emission Computed Tomography ◽  
Forced Oscillation Technique ◽  
Small Airways ◽  
Z Score ◽  
Uncontrolled Asthma ◽  
Regional Ventilation ◽  
Wide Range

Background: Asthma is characterised by heterogeneous ventilation as measured by 3-dimensional ventilation imaging. Combination inhaled corticosteroid/long-acting beta agonist (ICS/LABA) treatment response is variable in asthma and effects on regional ventilation are unknown. Our aims were to determine whether regional ventilation defects decrease after ICS/LABA treatment and whether small airways dysfunction predicts response in uncontrolled asthma. Methods: Twenty‐two symptomatic asthmatic participants underwent Single-Photon Emission Computed Tomography (SPECT)/CT imaging with Technegas, before and after 8-week fluticasone/formoterol (1000/40µg/day) treatment. Lung regions that were non-ventilated, low-ventilated or well-ventilated were calculated using an adaptive threshold method and were expressed as a percentage of total lung volume. Multiple-breath nitrogen washout (MBNW) was used to measure diffusion-dependent and convection-dependent small airway function (Sacin and Scond, respectively). Forced Oscillation Technique (FOT) was used to measure respiratory system resistance and reactance. Results: At baseline and post treatment Scond z-score was related to % non-ventilated lung, while Sacin z-score was related to % low-ventilated lung. Although symptoms, spirometry, FOT and MBNW improved following treatment, there was no mean change in ventilation measured by SPECT. There was, however, a wide-range of change in SPECT ventilation such that greater % non-ventilated lung, older age, and higher Scond, predicted a reduction in non-ventilated lung after treatment. Discussion: SPECT ventilation defects are overall unresponsive to ICS/LABA, but the response is variable with improvement occurring when small airway dysfunction and ventilation defects are more severe. Persistent ventilation defects which correlate with Scond suggest that mechanisms such as non-ICS responsive inflammation or remodelling underlie these defects.

scholarly journals Bronchodilator Response Predicts Longitudinal Improvement in Small Airway Function in World Trade Center Dust Exposed Community Members

2019 ◽  
Vol 16 (8) ◽  
pp. 1421 ◽  
Author(s):  
Deepak Pradhan ◽  
Ning Xu ◽  
Joan Reibman ◽  
Roberta M. Goldring ◽  
Yongzhao Shao ◽  
...  
Keyword(s):  
World Trade ◽  
World Trade Center ◽  
Small Airway ◽  
Forced Oscillation Technique ◽  
Small Airways ◽  
Bronchodilator Response ◽  
Airway Injury ◽  
Airway Function ◽  
Trade Center ◽  
Over Time

The evolution of lung function, including assessment of small airways, was assessed in individuals enrolled in the World Trade Center Environmental Health Center (WTC-EHC). We hypothesized that a bronchodilator response at initial evaluation shown by spirometry or in small airways, as measured by forced oscillation technique (FOT), would be associated with improvement in large and small airway function over time. Standardized longitudinal assessment included pre and post bronchodilator (BD) spirometry (forced vital capacity, FVC; forced expiratory volume in 1 second, FEV1) and FOT (resistance at 5 Hz, R5; resistance at 5 minus 20 Hz, R5–20). Longitudinal changes were assessed using linear mixed-effects modelling with adjustment for potential confounders (median follow-up 2.86 years; 95% measurements within 4.9 years). Data demonstrated: (1) parallel improvement in airflow and volume measured by spirometry and small airway function (R5 and R5–20) measured by FOT; (2) the magnitude of longitudinal improvement was tightly linked to the initial BD response; and (3) longitudinal values for small airway function on FOT were similar to residual abnormality observed post BD at initial visit. These findings suggest presence of reversible and irreversible components of small airway injury that are identifiable at initial presentation. These results have implications for treatment of isolated small airway abnormalities that can be identified by non-invasive effort independent FOT particularly in symptomatic individuals with normal spirometry indices. This study underscores the need to study small airway function to understand physiologic changes over time following environmental and occupational lung injury.

scholarly journals Determining Response to Treatment for Drug-Induced Bronchocentric Granulomatosis by the Forced Oscillation Technique

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1315
Author(s):  
Susumu Fukahori ◽  
Yasushi Obase ◽  
Chizu Fukushima ◽  
Daisuke Takao ◽  
Jun Iriki ◽  
...  
Keyword(s):  
Forced Oscillation ◽  
Airway Disease ◽  
Small Airway ◽  
Response To Treatment ◽  
Chronic Obstructive ◽  
Forced Oscillation Technique ◽  
Small Airways ◽  
Small Airway Disease ◽  
Bronchocentric Granulomatosis ◽  
Effect Of Treatment

Anti-tumor necrosis factor alpha (TNFα) therapy is widely used to treat various inflammatory conditions. Paradoxically, there are several case reports describing the development of bronchocentric granulomatosis treated with TNFα inhibitors, and it is difficult to determine the effect of treatment using conventional spirometry because the lesions are located in small airways. However, it has been reported that the forced oscillation technique (FOT) is useful in the evaluation of small airway disease in bronchial asthma or chronic obstructive pulmonary disease. We performed the FOT to determine the effect of treatment on bronchocentric granulomatosis and found it to be useful. We report the case of a 55-year-old female with ulcerative colitis who was treated with golimumab and who developed bronchocentric granulomatosis as a sarcoid-like reaction to golimumab. She was successfully treated with prednisone, and the treatment efficacy was confirmed by the FOT. The FOT may be useful in the evaluation of small airway disease in bronchocentric granulomatosis. This case may help inform clinicians of the usefulness of the FOT to assess small airway disease in various diseases.

scholarly journals Intratracheal budesonide/surfactant attenuates hyperoxia-induced lung injury in preterm rabbits

2020 ◽  
Vol 319 (6) ◽  
pp. L949-L956
Author(s):  
Andre G. Gie ◽  
Yannick Regin ◽  
Thomas Salaets ◽  
Costanza Casiraghi ◽  
Fabrizio Salomone ◽  
...  
Keyword(s):  
Gene Expression ◽  
Lung Function ◽  
Lung Injury ◽  
Bronchopulmonary Dysplasia ◽  
Forced Oscillation ◽  
Small Airway ◽  
Forced Oscillation Technique ◽  
Small Airways ◽  
Inspiratory Capacity ◽  
Intratracheal Administration

Recent clinical trials have shown improvements in neonatal outcomes after intratracheal administration of a combination of budesonide/surfactant (ITBS) in infants at risk of bronchopulmonary dysplasia. However, the effect of ITBS on lung function and alveolar structure is not known. We aimed to determine the effect of ITBS on lung function, parenchymal structure, and inflammatory cytokine expression in a relevant preterm animal model for bronchopulmonary dysplasia. Premature neonatal rabbits were administered a single dose of ITBS on the day of delivery and exposed to 95% oxygen. Following 7 days of hyperoxia, in vivo forced oscillation and pressure-volume maneuvers were performed to examine pulmonary function. Histological and molecular analysis was performed to assess alveolar and extracellular matrix (ECM) morphology, along with gene expression of connective tissue growth factor (CTGF), IL-8, and CCL-2. ITBS attenuated the functional effect of hyperoxia-induced lung injury and limited the change to respiratory system impedance, measured using the forced oscillation technique. Treatment effects were most obvious in the small airways, with significant effects on small airway resistance and small airway reactance. In addition, ITBS mitigated the decrease in inspiratory capacity and static compliance. ITBS restricted alveolar septal thickening without altering the mean linear intercept and mitigated hyperoxia-induced remodeling of the ECM. These structural changes were associated with improved inspiratory capacity and lung compliance. Gene expression of CTGF, IL-8, and CCL-2 was significantly downregulated in the lung. Treatment with ITBS shortly after delivery attenuated the functional and structural consequences of hyperoxia-induced lung injury to day 7 of life in the preterm rabbit.

scholarly journals Motion correction for routine X-ray lung CT imaging

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Doil Kim ◽  
Jiyoung Choi ◽  
Duhgoon Lee ◽  
Hyesun Kim ◽  
Jiyoung Jung ◽  
...  
Keyword(s):  
Motion Estimation ◽  
Motion Correction ◽  
Ct Imaging ◽  
Motion Artifacts ◽  
Ct Scans ◽  
Breath Hold ◽  
X Ray ◽  
Wide Range ◽  
Thorax Ct ◽  
Lung Ct

AbstractA novel motion correction algorithm for X-ray lung CT imaging has been developed recently. It was designed to perform for routine chest or thorax CT scans without gating, namely axial or helical scans with pitch around 1.0. The algorithm makes use of two conjugate partial angle reconstruction images for motion estimation via non-rigid registration which is followed by a motion compensated reconstruction. Differently from other conventional approaches, no segmentation is adopted in motion estimation. This makes motion estimation of various fine lung structures possible. The aim of this study is to explore the performance of the proposed method in correcting the lung motion artifacts which arise even under routine CT scans with breath-hold. The artifacts are known to mimic various lung diseases, so it is of great interest to address the problem. For that purpose, a moving phantom experiment and clinical study (seven cases) were conducted. We selected the entropy and positivity as figure of merits to compare the reconstructed images before and after the motion correction. Results of both phantom and clinical studies showed a statistically significant improvement by the proposed method, namely up to 53.6% (p < 0.05) and up to 35.5% (p < 0.05) improvement by means of the positivity measure, respectively. Images of the proposed method show significantly reduced motion artifacts of various lung structures such as lung parenchyma, pulmonary vessels, and airways which are prominent in FBP images. Results of two exemplary cases also showed great potential of the proposed method in correcting motion artifacts of the aorta which is known to mimic aortic dissection. Compared to other approaches, the proposed method provides an excellent performance and a fully automatic workflow. In addition, it has a great potential to handle motions in wide range of organs such as lung structures and the aorta. We expect that this would pave a way toward innovations in chest and thorax CT imaging.

scholarly journals Small airway dysfunction in patients with cough variant asthma: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Gao ◽  
Haigui Wu ◽  
Feng Wu
Keyword(s):  
Retrospective Cohort ◽  
Bronchial Hyperresponsiveness ◽  
Diagnostic Value ◽  
Small Airway ◽  
Small Airways ◽  
Cough Variant Asthma ◽  
Asthmatic Patients ◽  
Cell Test ◽  
Sputum Eosinophils ◽  
The Relationship

Abstract Background Cough variant asthma (CVA) is one of the special populations of asthma. The aim of the study was to compare small airways, the degree of bronchial hyperresponsiveness (BHR) and airway inflammatory subtypes between CVA and classic asthma (CA), and investigate the relationship between these markers to determine the accuracy as indicators of CVA. Methods A total of 825 asthmatic patients participated in the study and 614 were included. 614 patients underwent spirometry and a bronchial challenge with methacholine and 459 patients performed induction sputum cell test. Results The number of CVA patients showed less small airway dysfunction than those of CA patients (p < 0.005). The degree of small airways dysfunction was higher in the CA group compared with the CVA group (p < 0.001). Small airways dysfunction was severer in the eosinophilic airway inflammatory subtype compared with other subtypes (p < 0.05).The area under curve of MMEF, FEF50 and FEF75 (% predicted) was 0.615, 0.621, 0.606, respectively. 0.17mcg of PD20 and 4.7% of sputum eosinophils was the best diagnostic value for CVA with an AUC of 0.582 and 0.575 (p = 0.001 and p = 0.005, respectively). Conclusions The eosinophilic airway inflammatory subtype may be increased small airway dysfunction. The value of small airways, BHR and induction sputum cells in CVA prediction, which reflected significant, but not enough to be clinically useful.

Small Airway Dysfunction Predicts Asthma Control and Exacerbations : Longitudinal Data from the Assessment of Small Airways Involvement in Asthma (ATLANTIS) Study

2021 ◽  
Author(s):  
Monica Kraft ◽  
Richardson Matthew ◽  
Brian Hallmark ◽  
Dean Billheimer ◽  
Maarten van den Berge ◽  
...  
Keyword(s):  
Longitudinal Data ◽  
Asthma Control ◽  
Small Airway ◽  
Small Airways

scholarly journals Further Observations in Cerebro-Costo-Mandibular Syndrome: Exploration with CT Imaging

2020 ◽  
Vol 10 (01) ◽  
pp. e21-e24
Author(s):  
Venkatraman Bhat ◽  
Vinay Belval ◽  
Santhosh Kumar ◽  
Onkar Auti
Keyword(s):  
Chest Wall ◽  
Structural Changes ◽  
Male Infant ◽  
Ct Imaging ◽  
Imaging Features ◽  
Small Nuclear Ribonucleoprotein ◽  
Wide Range ◽  
Nuclear Ribonucleoprotein ◽  
Osseous Defects ◽  
Airway Abnormalities

AbstractCerebro-costo-mandibular syndrome (CCMS) is a rare syndrome characterized by posterior rib ossification gaps and orofacial anomalies. Posterior rib ossification gaps are the hallmark of the disease and mimic multiple old rib fractures. The condition is caused by heterogeneous mutation of Small Nuclear Ribonucleoprotein Polypeptides B and B1 (SNRPB) gene on the chromosome 20p13. There is scanty literature regarding the extent of bony changes and the associated pulmonary-airway abnormalities on computed tomography (CT) imaging. In this case report, we presented a detailed CT imaging features of a case of CCMS in a male infant. This report highlighted on the nature of osseous defects, structural changes in the chest wall, airways, lungs, and a wide range of spinal anomalies. Some of our observations regarding the changes in the airway and chest wall are likely to have bearing on evaluating the prognosis and the need for respiratory support.

Forced Oscillation Technique and Small Airway Involvement in Chronic Hypersensitivity Pneumonitis

2019 ◽  
Vol 55 (10) ◽  
pp. 519-525
Author(s):  
Olívia Meira Dias ◽  
Bruno Guedes Baldi ◽  
Rodrigo Caruso Chate ◽  
Carlos Roberto Ribeiro de Carvalho ◽  
Raffaele L. Dellacà ◽  
...  
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Forced Oscillation ◽  
Small Airway ◽  
Forced Oscillation Technique ◽  
Chronic Hypersensitivity Pneumonitis

scholarly journals The Expression of NOX4 in Smooth Muscles of Small Airway Correlates with the Disease Severity of COPD

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Xianyan Liu ◽  
Binwei Hao ◽  
Ailing Ma ◽  
Jinxi He ◽  
Xiaoming Liu ◽  
...  
Keyword(s):  
Disease Severity ◽  
Transforming Growth Factor ◽  
Smooth Muscles ◽  
Nicotinamide Adenine Dinucleotide Phosphate ◽  
Small Airway ◽  
Chronic Obstructive ◽  
Small Airways ◽  
Obstructive Pulmonary Disease ◽  
Pulmonary Functions ◽  
Copd Patients

Airway smooth muscle (ASM) remodeling is a hallmark in chronic obstructive pulmonary disease (COPD), and nicotinamide-adenine dinucleotide phosphate (NADPH) oxidases (NOXs) produced reactive oxygen species (ROS) play a crucial role in COPD pathogenesis. In the present study, the expression of NOX4 and its correlation with the ASM hypertrophy/hyperplasia, clinical pulmonary functions, and the expression of transforming growth factorβ(TGF-β) in the ASM of COPD small airways were investigated by semiquantitative morphological and/or immunohistochemistry staining methods. The results showed that an elevated expression of NOX4 and TGF-β, along with an increased volume of ASM mass, was found in the ASM of small airways in COPD patients. The abundance of NOX4 protein in the ASM was increased with disease severity and inversely correlated with the pulmonary functions in COPD patients. In addition, the expression of NOX4 and ASM markerα-SMA was colocalized, and the increased NOX4 expression was found to accompany an upregulated expression of TGF-βin the ASM of small airways of COPD lung. These results indicate that NOX4 may be a key regulator in ASM remodeling of small airway, in part through a mechanism interacting with TGF-βsignaling in the pathogenesis of COPD, which warrants further investigation.

scholarly journals Development of Antibody Immuno-PET/SPECT Radiopharmaceuticals for Imaging of Oncological Disorders—An Update

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1868
Author(s):  
Jonatan Dewulf ◽  
Karuna Adhikari ◽  
Christel Vangestel ◽  
Tim Van Den Wyngaert ◽  
Filipe Elvas
Keyword(s):  
Clinical Decision Making ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Therapy Response ◽  
High Specificity ◽  
Clinical Decision ◽  
Disease Diagnosis ◽  
Emission Computed Tomography ◽  
Wide Range

Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are molecular imaging strategies that typically use radioactively labeled ligands to selectively visualize molecular targets. The nanomolar sensitivity of PET and SPECT combined with the high specificity and affinity of monoclonal antibodies have shown great potential in oncology imaging. Over the past decades a wide range of radio-isotopes have been developed into immuno-SPECT/PET imaging agents, made possible by novel conjugation strategies (e.g., site-specific labeling, click chemistry) and optimization and development of novel radiochemistry procedures. In addition, new strategies such as pretargeting and the use of antibody fragments have entered the field of immuno-PET/SPECT expanding the range of imaging applications. Non-invasive imaging techniques revealing tumor antigen biodistribution, expression and heterogeneity have the potential to contribute to disease diagnosis, therapy selection, patient stratification and therapy response prediction achieving personalized treatments for each patient and therefore assisting in clinical decision making.

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