Deep Learning Algorithms-Based CT Images in Glucocorticoid Therapy in Asthma Children with Small Airway Obstruction

CT image information data under deep learning algorithms was adopted to evaluate small airway function and analyze the clinical efficacy of different glucocorticoid administration ways in asthmatic children with small airway obstruction. The Res-NET in the deep learning algorithm was used to perform feature extraction, summary classification, and other reconstruction of CT images. A deep learning network model Mask-R-CNN was constructed to enhance the ability of image reconstruction. A total of 118 children hospitalized with acute exacerbation of asthma in the hospital were recruited. After acute exacerbation treatment, 96 children with asthma were screened out for small airway obstruction, which were divided into glucocorticoid aerosol inhalation group (group A, 32 cases), glucocorticoid combined with bronchodilator aerosol inhalation group (group B, 32 cases), and oral hormone therapy group (group C, 32 cases). Asthmatic children with small airway obstruction were screened after acute exacerbation treatment and were rolled into glucocorticoid aerosol inhalation group (group A), glucocorticoid combined with bronchodilators aerosol inhalation group (group B), and oral hormone therapy group (group C). Lung function indicators (maximal mid-expiratory flow (MMEF75 and 25), 50% forced expiratory flow (FEF50), and 75% forced expiratory flow (FEF75)), FeNO level, and airway inflammation indicators (IL-6, IL-35, and eosinophilic (EOS)) were compared before and one month after treatment. The ratio of airway wall thickness to outer diameter (T/D) and the percentage of airway wall area to total airway area (WA%) were measured by e-Health high-resolution CT (HRCT). The constructed network model was used to measure the patient's coronary artery plaque and blood vessel volume, and the image was reconstructed on the Res-Net network. It was found that the MSE value of the Res-Net network was the lowest, and the efficiency was very high during the training process. T/D and WA (%) of asthmatic children with small airway obstruction after treatment were significantly lower than those before treatment ( P < 0.01 ). After treatment, MMEF75/25 and FEF75 were significantly higher than those before treatment ( P < 0.05 ). Lung function-related indicator FEF50 was significantly higher than that before treatment ( P < 0.01 ). FeNO level after treatment was remarkably lower than that before treatment ( P < 0.01 ). In addition, lung function-related indicators, airway inflammation indicators, and FeNO level improved the most in group C, followed by group B, and those improvements in group A were the least obvious, with great differences among groups ( P < 0.05 ). In summary, the Res-Net model proposed was of certain feasibility and effectiveness for CT image segmentation and can effectively improve the clinical evaluation of patient CT image information. Glucocorticoids could improve small airway function and airway inflammation in asthmatic children with small airway obstruction, and oral corticosteroids were more effective than aerosol inhalation therapy.

Relationship between nitric oxide levels and the activity of fibrogenic cytokine TGF-β1 and their role in diagnostics of the development of irreversible morphofunctional changes in bronchi of smoking adolescents

The aim is to study the relationship between the level of exhaled nitric oxide (FeNO) and the activity of the fibrogenic cytokine TGF-β1 in blood serum and brush biopsy samples of bronchial mucosa in order to determine their role in the development of irreversible morphological and functional changes in smoking adolescents. Materials and methods. 20 adolescent smokers with chronic bronchitis (CB) (average age – 17.5 ± 0.2 years) were exa­mined. The comparison group consisted of 37 adolescent smokers without respiratory symptoms (average age – 15.9 ± 0.2 years) and 15 healthy adolescents, who never smoked (average age – 15.9 ± 0.4 years). In adolescent smokers the tobacco smoking status was assessed. To confirm active smoking, the nicotine metabolite cotinine was determined in urine. Instrumental methods included spirometry, chest X-ray, tracheobronchoscopy. The FeNO level was measured using a Niox Mino. TGF-β1 level was determined in the blood serum and brush biopsy samples of the bronchial mucosa. Results. The FeNO levels were significantly lower in adolescent smokers with CB in comparison with adolescent smokers without respiratory symptoms (6.1 ± 0.3 ppb versus 8.8 ± 0.6 ppb, P < 0.05). The relationship between the FeNO levels and indicators of the tobacco smoking status has been established in patients with CB and in asymptomatic smokers. There was a significant increase in the TGF-β1 levels in the blood serum in patients with CB compared with asymptomatic smokers (478.7 ± 57.9 pg/ml versus 231.5 ± 23.5 pg/ml, P < 0.05). In smoking adolescents a relationship between a FeNO level and an increased activity of the fibrogenic cytokine TGF-β (r = -0.63; P < 0.05) has been established. In one third of patients the TGF-β1 factor was identified in the bronchial endothelium. The presence of this factor in the bronchial endothelium is a serious prognostic criterion for the risk of developing “inadequate” pneumofibrosis, which can lead to irreversible remodeling processes in the bronchi. Conclusions. Determination of FeNO levels and TGF-β1 in the blood serum in smoking adolescents has a reliable diagnostic value for determining the risk group for the development of irreversible morphological and functional changes in the bronchi and can improve the efficiency of early diagnosis of chronic respiratory pathology.

Evaluation of the peripheral blood eosinophil count as a predictor for fractional exhaled nitric oxide or bronchodilator reversibility test outcome

Objective: This study aimed to explore the usefulness of the peripheral blood eosinophil count (PBEC) in assessing the level of fractional exhaled nitric oxide (FeNO) and predicting bronchodilation test results. Methods: We retrospectively analyzed the data of 384 outpatients who underwent FeNO measurement at our Department of Respiratory and Critical Care Medicine from March to June 2019. The FeNO level was compared among different PBECs to explore the association among them. Furthermore, the sensitivity and specificity of PBECs in predicting bronchodilation test results were assessed by using receiver operating characteristic (ROC) curve analysis. Results: There was a moderate correlation between PBECs and FeNO levels (r = 0.414; p < 0.05). In the subjects with PBECs ≥ 0.3 × 109/L, the median FeNO level was 39 ppb (interquartile range, 22.5‐65.5 ppb), significantly higher than in the subjects with PBECs < 0.3 × 109/L. The area under the ROC curve was 0.707 (p < 0.05). The maximum Youden index (0.348) was at PBECs = 0.205 × 109/L, which achieved sensitivity and specificity of 63% and 71.8%, respectively. Conclusion: PBECs ≥ 0.3 × 109/L can predict a positive bronchodilation test result and a high FeNO level, with a probability of 50% in the subjects with chronic cough and shortness of breath; in the absence of corresponding symptoms and a low PBEC, the predictive value was small. For hospitals not able to conduct FeNO measurements, for outpatients with poor economic conditions, and for patients with confirmed or suspected novel coronavirus disease 2019, the PBEC, in conjunction with a patient's clinical symptoms, can improve the diagnostic accuracy of allergic asthma and assessment of airway inflammation while reducing the risk of infection.

Fractional exhaled nitric oxide could identify early spirometry change in clinically suspected asthma patients without airway obstruction

Fractional exhaled nitric oxide (FeNO) has been proposed as a non-invasive biomarker for allergic inflammation seen in asthma. The aim of this study was to assess the ability of FeNO to discriminate spirometry and lung volume measurements between those with and without airway obstruction among subjects with clinically suspected asthma. A retrospective study was conducted. Diagnostic evaluations including spirometry and FeNO testing (NO electrochemical equipment: NIOX VERO; Aerocrine AB, Solna, Sweden) were performed in all subjects. Airway obstruction was defined according to the Standardization of Spirometry of the American Thoracic Society (ATS)/European Respiratory Society (ERS), and 2014 recommendations of the Chinese National Guidelines of Pulmonary Function Test. It was used the Student t test for analysis of continuous variables and the χ2 test for analysis of discrete variables including FeNO levels and lung function metrics. Of the 138 subjects with clinically suspected asthma, airway obstruction was found in 61. There was no significant difference in the mean FeNO levels among subjects with or without airway obstruction ( p = 0.241) among un-selected subjects. Likewise, there was no difference in the FeNO levels between aged (>50 years) and younger subjects (⩽50 years) ( p = 0.804). A significant proportion of subjects had a normal FeNO level (<25 part per billion, ppb) in spite of having airway obstruction (39/138), 25 had an elevated FeNO level (⩾25 ppb) in spite of having no airway obstruction (25/138). Additionally, the airway-obstructed subjects with increased FeNO level had comparable spirometry to those with normal FeNO level ( p > 0.05). However, among subjects without airway obstruction, the forced expiratory volume in 1 s (FEV1)/predicted (pred), maximal expiratory flow at 25% of forced vital capacity (FVC) (MEF25%)/pred, maximal expiratory flow at 50% of FVC (MEF50%)/pred and maximum mid-expiratory flow (MMEF)/pred were significantly lower in the FeNO ⩾ 25 ppb group compared to those in the FeNO < 25 ppb group. These analyses indicated that increased FeNO levels could help to determinate early spirometry change within clinically suspected asthma subjects without airway obstruction. It is highlighted the importance of FeNO as a phenotype associated with an increased risk of airway obstruction in some subjects in this study.

Optimization of therapy in children with mild bronchial asthma to improve the disease control during seasonal acute respiratory infections

Background. Children with mild bronchial asthma (BA) are prone to poor control of symptoms during seasonal acute respiratory infections (ARIs). Objective. To optimize therapy in children with mild BA to improve disease control during seasonal ARIs. Patients and methods. This single-blind placebo-controlled prospective single-center trial evaluating the efficacy of ammonium glycyrrhizinate (Reglisam, ‘VIFITECH,’ Russia) and lasting 4 months included 63 children with mild BA (21 in the placebo group) aged 5 to 10 years with a disease duration of at least 3 months. We assessed respiratory function, FeNO level, results of the asthma control test, characteristics of BA exacerbations, and the need for betamimetics and budesonide via a nebulizer. We used the Student's t-test and Wilcoxon test to evaluate the differences in mean and median values; the differences were considered significant at р < 0.05. Results. The frequency and mean duration of ARIs were lower in the group of active therapy (1.06 ± 0.35 episodes and 6.52 ± 2.19 days) than in the placebo group (1.77 ± 0.26 episodes and 10.83 ± 3.07 days). The differences were statistically significant (р = 0.036 and р = 0.019, respectively). Patients receiving placebo required longer budesonide administration per one BA exacerbation: 11.72 ± 1.98 days vs 8.65 ± 2.17 days in patients receiving active therapy (р = 0.026). Significant differences in the respiratory function and FeNO level were observed only in the subgroup of patients who had incomplete asthma control upon enrollment. We observed no new adverse events that had not been reported earlier. Conclusion. Our findings suggest high efficacy of ammonium glycyrrhizinate used to enhance basic therapy for mild BA in children, in whom respiratory infections are the most common triggers of BA exacerbations. Key words: ammonium glycyrrhizinate, basic therapy, children, mild bronchial asthma, acute respiratory infections (ARIs)

Serum Levels of Epithelial-Derived Cytokines as Interleukin-25 and Thymic Stromal Lymphopoietin after a Single Dose of Mepolizumab in Patients with Severe Non-Allergic Eosinophilic Asthma: A Short Report

The bronchial epithelium has continuous contact with environmental agents initiating and maintaining airway type 2 inflammation in asthma. However, there is a lack of data on whether reduced airway eosinophilic inflammation can affect the production of epithelial-derived mediators, such as interleukin-25 (IL-25) and thymic stromal lymphopoietin (TSLP). The aim of this study was to investigate the changes in serum levels of IL-25 and TSLP after a single dose of mepolizumab, a humanized monoclonal antibody to interleukin-5 (IL-5), in patients with severe non-allergic eosinophilic asthma (SNEA). We examined 9 SNEA patients before and four weeks after administration of 100 mg mepolizumab subcutaneously. The fractional exhaled nitric oxide (FeNO) level was analysed using an electrochemical assay (NIOX VERO®, Circassia, UK). Serum IL-25 and TSLP levels were measured by ELISA. Four weeks after the single dose of mepolizumab, blood eosinophil count significantly decreased from 0.55 ± 0.20 × 109/l to 0.14 ± 0.04 × 109/l (p=0.01) and FEV1 increased from 2.1 ± 0.5 l (65.4 ± 8.8% of predicted) to 2.6 ± 0.4 l (76.4 ± 9.1% of predicted) (p=0.04), while FeNO level has not changed (32.3 ± 8.4 vs 42.9 ± 12.6 ppb). Serum IL-25 level significantly decreased from 48.0 ± 17.2 pg/mL to 34.8 ± 17.1 pg/mL (p=0.02) with same tendency in TSLP level: from 359.8 ± 71.3 pg/mL to 275.6 ± 47.8 pg/mL (p=0.02). It has also been noticed a significant relation between changes in the blood eosinophil count and serum IL-25 level (r = 0.81, p=0.008), as well as between changes in serum IL-25 and TSLP levels (r = 0.93, p=0.004) after a single dose of mepolizumab. Thus, anti-IL-5 treatment with mepolizumab might diminish the production of bronchial epithelial-derived cytokines IL-25 and TSLP in patients with SNEA which is potentially related to reduced eosinophilic inflammation. This trial is registered in ClinicalTrial.gov with identifier NCT03388359.