Relationships Between High-Resolution Computed Tomographic Features and Lung Function Trajectory in Patients With Asthma

Purpose A subset of asthmatics suffers from persistent airflow limitation, known as remodeled asthma, despite optimal treatment. Typical quantitative scoring methods to evaluate structural changes of airway remodeling on high-resolution computed tomography (HRCT) are time-consuming and laborious. Thus, easier and simpler methods are required in clinical practice. We evaluated the clinical usefulness of a simple, semi-quantitative method based on 8 HRCT parameters by comparing asthmatics with a persistent decline of post-bronchodilator (BD)-FEV1 to those with a BD-FEV1 that normalized over time and evaluated the relationships of the parameters with BD-FEV1. Methods Asthmatics (n = 59) were grouped into 5 trajectories (Trs) according to the changes of BD-FEV1 over 1 year. After 9–12 months of guideline-based treatment, HRCT parameters including emphysema, bronchiectasis, anthracofibrosis, bronchial wall thickening (BWT), fibrotic bands, mosaic attenuation on inspiration, air-trapping on expiration, and centrilobular nodules were classified as present (1) or absent (0) in 6 zones. Results The Tr5 group (n = 11) was older and exhibited a persistent decline in BD-FEV1. The Tr5 and Tr4 groups (n = 12), who had a lower baseline BD-FEV1 that normalized over time, had longer durations of asthma, frequent exacerbations, and higher doses of steroid use compared to the Tr1–3 groups (n = 36), who had a normal baseline BD-FEV1. The Tr5 group had higher emphysema and BWT scores than the Tr4 (P = 8.25E-04 and P = 0.044, respectively). Scores for the other 6 parameters were not significantly different among the Tr groups. BD-FEV1 was inversely correlated with the emphysema and BWT scores in multivariate analysis (P = 1.70E-04, P = 0.006, respectively). Conclusions Emphysema and BWT are associated with airway remodeling in asthmatics. Our simple, semi-quantitative scoring system based on HRCT may be an easy-to-use method for estimating airflow limitation.

[1]  H. Makita,et al.  Parenchymal destruction in asthma: Fixed airflow obstruction and lung function trajectory. , 2021, The Journal of allergy and clinical immunology.

[2]  G. Washko,et al.  Quantitative CT metrics are associated with longitudinal lung function decline and future asthma exacerbations: results from SARP-3. , 2021, The Journal of allergy and clinical immunology.

[3]  Hae‐Sim Park,et al.  Longitudinal outcomes of severe asthma: real-world evidence of multidimensional analyses. , 2020, The journal of allergy and clinical immunology. In practice.

[4]  Jae Hyun Lee,et al.  Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma , 2020, Allergy, asthma & immunology research.

[5]  M. Pecchiari,et al.  The Relevance of Targeting Treatment to Small Airways in Asthma and COPD , 2020, Respiratory Care.

[6]  Y. Ye,et al.  Increasing Prevalence and Mortality of Asthma With Age in Korea, 2002–2015: A Nationwide, Population-Based Study , 2020, Allergy, asthma & immunology research.

[7]  C. Farah,et al.  Reduced lung elastic recoil and fixed airflow obstruction in asthma , 2020, Respirology.

[8]  K. Jin,et al.  Severe Asthma Phenotypes Classified by Site of Airway Involvement and Remodeling via Chest CT Scan. , 2018, Journal of investigational allergology & clinical immunology.

[9]  Choon-Sik Park,et al.  Lung Function Trajectory Types in Never-Smoking Adults With Asthma: Clinical Features and Inflammatory Patterns , 2018, Allergy, asthma & immunology research.

[10]  P. Busse,et al.  Asthma in the elderly and late‐onset adult asthma , 2018, Allergy.

[11]  Mario Castro,et al.  Quantitative computed tomographic imaging–based clustering differentiates asthmatic subgroups with distinctive clinical phenotypes , 2017, The Journal of allergy and clinical immunology.

[12]  N. Thomson.  Asthma and smoking-induced airway disease without spirometric COPD , 2017, European Respiratory Journal.

[13]  Mario Castro,et al.  Using imaging as a biomarker for asthma , 2017, The Journal of allergy and clinical immunology.

[14]  Jian Luo,et al.  A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography. , 2016, Journal of thoracic disease.

[15]  Kwan Hyung Kim,et al.  Korean Asthma Guideline 2014: Summary of Major Updates to the Korean Asthma Guideline 2014 , 2016, Tuberculosis and respiratory diseases.

[16]  A. Sousa,et al.  Relationship between lung function and quantitative computed tomographic parameters of airway remodeling, air trapping, and emphysema in patients with asthma and chronic obstructive pulmonary disease: A single-center study , 2016, The Journal of allergy and clinical immunology.

[17]  J. Nadel,et al.  Unraveling the Pathophysiology of the Asthma-COPD Overlap Syndrome: Unsuspected Mild Centrilobular Emphysema Is Responsible for Loss of Lung Elastic Recoil in Never Smokers With Asthma With Persistent Expiratory Airflow Limitation. , 2015, Chest.

[18]  N. Thomson,et al.  Poor symptom control is associated with reduced CT scan segmental airway lumen area in smokers with asthma. , 2015, Chest.

[19]  Sun Jin Park,et al.  The Effects of Bronchiectasis on Asthma Exacerbation , 2014, Tuberculosis and respiratory diseases.

[20]  I. Pavord,et al.  Lung function decline and variable airway inflammatory pattern: longitudinal analysis of severe asthma. , 2014, The Journal of allergy and clinical immunology.

[21]  Salman Siddiqui,et al.  Quantitative computed tomography–derived clusters: Redefining airway remodeling in asthmatic patients☆ , 2014, The Journal of allergy and clinical immunology.

[22]  E. Bleecker,et al.  International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma , 2013, European Respiratory Journal.

[23]  J. Ward,et al.  The relationship between eosinophilia and airway remodelling in mild asthma , 2013, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[24]  Choon-Sik Park,et al.  Identification of asthma clusters in two independent Korean adult asthma cohorts , 2012, European Respiratory Journal.

[25]  Robert A Silverman,et al.  Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma. , 2012, The Journal of allergy and clinical immunology.

[26]  L. Edwards,et al.  Changes in forced expiratory volume in 1 second over time in COPD. , 2011, The New England journal of medicine.

[27]  K. Meyer.  Impact of aging on the lung. , 2010, Seminars in respiratory and critical care medicine.

[28]  D. Postma,et al.  Airway epithelial changes in smokers but not in ex-smokers with asthma. , 2009, American journal of respiratory and critical care medicine.

[29]  I. Pavord,et al.  Qualitative analysis of high-resolution CT scans in severe asthma. , 2009, Chest.

[30]  I. Pavord,et al.  An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. , 2009, American journal of respiratory and critical care medicine.

[31]  S. Uh,et al.  The Impact of Smoking on Clinical and Therapeutic Effects in Asthmatics , 2009, Journal of Korean medical science.

[32]  N. Müller,et al.  Fleischner Society: glossary of terms for thoracic imaging. , 2008, Radiology.

[33]  Andrew Bush,et al.  Early detection of airway wall remodeling and eosinophilic inflammation in preschool wheezers. , 2007, American journal of respiratory and critical care medicine.

[34]  P. Chanez,et al.  Specificity of basement membrane thickening in severe asthma. , 2007, The Journal of allergy and clinical immunology.

[35]  F. Laurent,et al.  Air trapping in mild and moderate asthma: effect of inhaled corticosteroids. , 2007, The Journal of allergy and clinical immunology.

[36]  S. Uh,et al.  Differences in radiological/HRCT findings in eosinophilic bronchitis and asthma: implication for bronchial responsiveness , 2005, Thorax.

[37]  N L Müller,et al.  Computed tomographic imaging of the airways: relationship to structure and function , 2005, European Respiratory Journal.

[38]  M Bellia,et al.  Airway remodelling assessed by sputum and high-resolution computed tomography in asthma and COPD , 2004, European Respiratory Journal.

[39]  N. Müller,et al.  Asthma and associated conditions: high-resolution CT and pathologic findings. , 2004, AJR. American journal of roentgenology.

[40]  A. Bush,et al.  Early thickening of the reticular basement membrane in children with difficult asthma. , 2003, American journal of respiratory and critical care medicine.

[41]  M. Metintaş,et al.  High-Resolution Computed Tomography Findings Are Correlated with Disease Severity in Asthma , 2002, Respiration.

[42]  D M Hansell,et al.  A comparison of serial computed tomography and functional change in bronchiectasis , 2002, European Respiratory Journal.

[43]  P. Paré,et al.  Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function. , 2000, American journal of respiratory and critical care medicine.

[44]  D. Hansell,et al.  Airflow obstruction in bronchiectasis: correlation between computed tomography features and pulmonary function tests , 2000, Thorax.

[45]  J. Y. Kim,et al.  Bronchial anthracofibrosis (inflammatory bronchial stenosis with anthracotic pigmentation): CT findings. , 2000, AJR. American journal of roentgenology.

[46]  D. Postma,et al.  Decline of FEV1 by age and smoking status: facts, figures, and fallacies. , 1997, Thorax.

[47]  J Bousquet,et al.  Measurement of the internal size of bronchi using high resolution computed tomography (HRCT) , 1994, The European respiratory journal.

[48]  K. P. Van de Woestijne,et al.  The senile lung. Comparison with normal and emphysematous lungs. 1. Structural aspects. , 1992, Chest.

[49]  K. P. Van de Woestijne,et al.  The senile lung. Comparison with normal and emphysematous lungs. 2. Functional aspects. , 1992, Chest.

[50]  M. Lebowitz,et al.  Characteristics of asthma among elderly adults in a sample of the general population. , 1991, Chest.