scholarly journals Phenotypic Clusters On Computed Tomography Reflects Asthma Heterogeneity And Severity

2021 ◽  
Author(s):  
Sujeong Kim ◽  
Sanghun Choi ◽  
Taewoo Kim ◽  
Kwang Nam Jin ◽  
Sang-Heon Cho ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Severe Asthma ◽  
Visual Analysis ◽  
Quantitative Computed Tomography ◽  
Airway Disease ◽  
Small Airways ◽  
Functional Changes ◽  
Severe Allergic Asthma ◽  
Emphysematous Lung ◽  
Severity Of The Disease

Abstract Background: Asthma comprises heterogeneous inflammatory airway disorders whose classification has not been established. Quantitative computed tomography (QCT) methods can differentiate lung disease using accurate assessment of location, extent, and severity of the disease. This study aimed to identify heterogeneous asthmatic groups by QCT metrics of airway and parenchymal structure, which is associated with radiologists’ visual analysis and bronchodilator responses in a prospective design.Methods: Using the input from QCT-based metrics, including hydraulic diameter (Dh), luminal wall thickness (WT), functional small airway disease (fSAD), and emphysematous lung (Emph), a cluster analysis was performed and compared with grouping based on site of airway involvement and remodeling evaluated by radiologists.Results: 61 asthmatics were grouped into four clusters with different clinical severities. From C1 to C4, more severe lung function deterioration, higher fixed obstruction rate, and more frequent asthma exacerbation in 5-year follow-up were observed. C1 presented non-severe asthma with increased WT, Dh of proximal airways, and fSAD. C2 was mixed with non-severe and severe asthma, which had reserved bronchodilator responses of proximal airways. C3 and C4 presented severe asthmatics that exhibited reduced Dh of proximal airway and its bronchodilator responsiveness; C3 was severe allergic asthma without fSAD, while C4 was ex-smokers with significantly high fSAD% and Emph%. These clusters were correlated with the grouping by radiologists and their clinical outcomes.Conclusions: Four QCT imaging-based clusters with distinct structural and functional changes in proximal and small airways can stratify heterogeneous asthmatics and may serve as complementary tools for predicting future asthma outcomes.

scholarly journals Temporal Assessment of Airway Remodeling in Severe Asthma Using Quantitative Computed Tomography

2015 ◽  
Vol 191 (1) ◽  
pp. 107-110 ◽  
Author(s):  
Sumit Gupta ◽  
Ruth Hartley ◽  
Amisha Singapuri ◽  
Beverly Hargadon ◽  
William Monteiro ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Severe Asthma ◽  
Airway Remodeling ◽  
Quantitative Computed Tomography ◽  
Temporal Assessment

Quantitative computed tomography detects peripheral airway disease in asthmatic children

2005 ◽  
Vol 40 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Neal Jain ◽  
Ronina A. Covar ◽  
Melanie C. Gleason ◽  
John D. Newell ◽  
Erwin W. Gelfand ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Quantitative Computed Tomography ◽  
Airway Disease ◽  
Asthmatic Children ◽  
Peripheral Airway

Modelling resistance and reactance with heterogeneous airway narrowing in mild to severe asthma

2015 ◽  
Vol 93 (3) ◽  
pp. 207-214 ◽  
Author(s):  
Swati A. Bhatawadekar ◽  
Del Leary ◽  
Geoffrey N. Maksym
Keyword(s):  
Frequency Dependence ◽  
Severe Asthma ◽  
Respiratory System ◽  
Upper Airway ◽  
Airway Disease ◽  
Small Airway ◽  
Small Airways ◽  
Airway Narrowing ◽  
Ventilation Heterogeneity

Ventilation heterogeneity is an important marker of small airway dysfunction in asthma. The frequency dependence of respiratory system resistance (Rrs) from oscillometry is used as a measure of this heterogeneity. However, this has not been quantitatively assessed or compared with other outcomes from oscillometry, including respiratory system reactance (Xrs) and the associated elastance (Ers). Here, we used a multibranch model of the human lung, including an upper airway shunt, to match previously reported respiratory mechanics in mild to severe asthma. We imposed heterogeneity by narrowing a proportion of the peripheral airways to account for patient Ers at 5 Hz, and then narrowed central airways to account for the remaining Rrs at 18 Hz. The model required >75% of the small airways to be occluded to reproduce severe asthma. While the model produced frequency dependence in Rrs, it was upward-shifted below 5 Hz compared with in-vivo results, indicating that other factors, including more distributed airway narrowing or central airway wall compliance, are required. However, Ers quantitatively reflected the imposed heterogeneity better than the frequency dependence of Rrs, independent of the frequency range for the estimation, and thus was a more robust measure of small-airway function. Thus, Ers appears to have greater potential as a clinical measure of early small-airway disease in asthma.

scholarly journals Gene expression profiling of bronchial brushes is associated with the level of emphysema measured by computed tomography-based parametric response mapping

2020 ◽  
Vol 318 (6) ◽  
pp. L1222-L1228
Author(s):  
Senani N. H. Rathnayake ◽  
Firdaus A. A. Mohamed Hoesein ◽  
Craig J. Galban ◽  
Nick H. T. ten Hacken ◽  
Brian G. G. Oliver ◽  
...  
Keyword(s):  
Gene Expression ◽  
Computed Tomography ◽  
Airway Disease ◽  
Small Airway ◽  
Study Cohort ◽  
Small Airways ◽  
Air Trapping ◽  
Response Mapping ◽  
Small Airway Disease ◽  
Parametric Response

Parametric response mapping (PRM) is a computed tomography (CT)-based method to phenotype patients with chronic obstructive pulmonary disease (COPD). It is capable of differentiating emphysema-related air trapping with nonemphysematous air trapping (small airway disease), which helps to identify the extent and localization of the disease. Most studies evaluating the gene expression in smokers and COPD patients related this to spirometric measurements, but none have investigated the relationship with CT-based measurements of lung structure. The current study aimed to examine gene expression profiles of brushed bronchial epithelial cells in association with the PRM-defined CT-based measurements of emphysema (PRMEmph) and small airway disease (PRMfSAD). Using the Top Institute Pharma (TIP) study cohort (COPD = 12 and asymptomatic smokers = 32), we identified a gene expression signature of bronchial brushings, which was associated with PRMEmph in the lungs. One hundred thirty-three genes were identified to be associated with PRMEmph. Among the most significantly associated genes, CXCL11 is a potent chemokine involved with CD8+ T cell activation during inflammation in COPD, indicating that it may play an essential role in the development of emphysema. The PRMEmph signature was then replicated in two independent data sets. Pathway analysis showed that the PRMEmph signature is associated with proinflammatory and notch signaling pathways. Together these findings indicate that airway epithelium may play a role in the development of emphysema and/or may act as a biomarker for the presence of emphysema. In contrast, its role in relation to functional small airways disease is less clear.

scholarly journals Airway wall thickness and airflow limitations in asthma assessed in quantitative computed tomography

2020 ◽  
Vol 14 ◽  
pp. 175346661989859
Author(s):  
Mateusz Patyk ◽  
Andrzej Obojski ◽  
Dąbrówka Sokołowska-Dąbek ◽  
Martyna Parkitna-Patyk ◽  
Urszula Zaleska-Dorobisz
Keyword(s):  
Computed Tomography ◽  
Wall Thickness ◽  
Imaging Techniques ◽  
Quantitative Computed Tomography ◽  
Bronchial Tree ◽  
Control Group ◽  
Small Airways ◽  
Airway Wall ◽  
Airway Wall Thickness

Background: Asthma is a frequent chronic disease of the airways. In spite of the fact that symptoms of asthma are well known, the pathogenesis has not yet been fully understood. Quantitative computed tomography (qCT) of the lung allows for the measurment of a set of parameters. The aim of this study was to evaluate the usefulness of quantitative computed tomography in the assessment of airway wall thickness in asthma. Methods: The prospective study was performed on a group of 83 patients with well-defined, long-term asthma between 2016 and 2018. The control group was composed of 30 healthy volunteers. All examined subjects were non-smokers. All computed tomography (CT) studies were performed using a 128 multi-slice CT scanner with no contrast, following a chest scanning protocol in the supine position, at full inspiration and breath-holds. Results: Quantitative bronchial tree measurements were obtained from the third up to the ninth generation of the posterior basal bronchi (B10) of the right lung in a blinded fashion. The value of the wall thickness in patients with asthma was significantly higher in all measured generations of the bronchial tree (third to ninth generation). The lumen area and the inner diameter significantly correlated with the lung function tests and were substantially smaller in the examined group from the seventh to the ninth generation of the bronchi ( p < 0.05). Conclusions: We conclude that airway remodelling occurs in most patients with long-term asthma and is associated mainly with the medium and small airways. Imaging techniques, especially qCT can be useful in the diagnosis and management of asthma. The reviews of this paper are available via the supplemental material section.

scholarly journals Evaluating small-airways disease in asthmatic patients: The utility of quantitative computed tomography

2017 ◽  
Vol 139 (1) ◽  
pp. 49-51.e2 ◽  
Author(s):  
Donald P. Tashkin ◽  
Hyun J. Kim ◽  
Michelle Zeidler ◽  
Eric Kleerup ◽  
Jonathan Goldin
Keyword(s):  
Computed Tomography ◽  
Quantitative Computed Tomography ◽  
Small Airways ◽  
Asthmatic Patients

Quantitative CT Image-Based Structural and Functional Changes during Asthma Acute Exacerbations

2021 ◽  
Author(s):  
Joonwoo Park ◽  
Sujeong Kim ◽  
Jae-Kwang Lim ◽  
Kwang Nam Jin ◽  
Min Suk Yang ◽  
...  
Keyword(s):  
Pulmonary Function Tests ◽  
Quantitative Computed Tomography ◽  
Airway Disease ◽  
Forced Expiratory Volume ◽  
Imaging Features ◽  
Quantitative Ct ◽  
Functional Changes ◽  
Small Airway Disease ◽  
Acute Exacerbations ◽  
Residual Capacity

Asthma acute exacerbations (AE) have been investigated using quantitative computed tomography (QCT)-based imaging metrics, but QCT has not yet been used to investigate a comprehensive set of imaging metrics during AE. This study aims to explore imaging features, captured both at segmental and parenchymal scales, during asthma AE, compared to stable asthma (SA). Two sets of the QCT images at total lung capacity (TLC) and functional residual capacity (FRC) were captured for 14 subjects during asthma AE and in SA phase, respectively. We calculated airway wall thickness (WT), hydraulic diameter (Dh), and airway circularity (Cr) of the 36 segmental airways, percentage of functional small airway disease (fSAD%), percentage of emphysema, tissue fraction (βtiss), and coefficient of variation of βtiss (CV of βtiss). We performed Spearman correlation tests for changes in QCT metrics and pulmonary function tests, measured in AE and SA. During asthma AE, structural metrics, i.e., WT, Dh, and Cr, were not changed significantly. In functional metrics, CV of βtiss at FRC indicating the heterogeneity of lung tissue distribution was significantly increased, while the mean of βtiss at FRC did not change during AE. An increase of fSAD% during AE was most correlated with a decrease of forced expiratory volume in 1 second and forced vital capacity, especially in the lower lobes. This study demonstrates that the heterogeneous feature of βtiss measured at lower lobes is more noticeable during asthma AE, compared with other traditional imaging metrics. This metric could be utilized to identify unique features during asthma AE.

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