Airway Wall Thickening in Patients With Cough Variant Asthma and Nonasthmatic Chronic Cough

Matsumoto, Hisako; Niimi, Akio; Tabuena, Rollin P.; Takemura, Masashi; Ueda, Tetsuya; Yamaguchi, Masafumi; Matsuoka, Hiroaki; Jinnai, Makiko; Chin, Kazuo; Mishima, Michiaki

doi:10.1378/chest.06-1025

Cited by 57 publications

(36 citation statements)

References 38 publications

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“…[3][4][5]22 Airway wall thickening was observed in mild, moderate, and severe asthma, 4,5,18,22,23 but also in patients with cough-variant asthma. 24 Awadh et al found that patients with moderate and severe asthma had greater airway wall thickening than those with mild disease. 4 It has also been reported that structural changes (airway thickening) in both large and small airways may develop in spite of optimal asthma treatment.…”

Section: Discussionmentioning

confidence: 99%

Airway Dimensions in Asthma and COPD in High Resolution Computed Tomography: Can We See the Difference?

et al. 2013

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BACKGROUND: Airway remodeling in asthma and COPD results in bronchial wall thickening. The thickness of the bronchial wall can be measured in high-resolution computed tomography. The objectives of the study were to assess the bronchial lumen and wall dimensions in asthma and COPD patients, in relation to disease severity, and to compare the airway dimensions in patients with asthma and COPD. METHODS: Ten asthma subjects and 12 COPD subjects with stable, mild to moderate disease were investigated. All subjects underwent chest high-resolution computed tomography (window level ؊ 450 Hounsfield units, window width 1,500 Hounsfield units). Cross-sections of bronchi (external diameter 1.0 -5.0 mm) were identified on enlarged images. The following variables were measured: external and internal diameter, wall area, lumen area, total airway area, the percentage of airway wall area, wall thickness, and the ratio of wall thickness to external diameter. Separate sub-analyses were performed for airways with external diameter < 2.0 mm and external diameter > 2.0 mm. RESULTS: We measured 261 and 348 cross-sections of small airways in subjects with asthma and COPD, respectively. There was a significant difference in wall thickness and wall area, which were both greater in asthmatics than in COPD patients. In bronchi with external diameter > 2.0 mm, all measured parameters were significantly higher in asthma than COPD. In individual asthmatics the airway wall thickness was similar in all the assessed bronchi, while in COPD it was related to the external airway diameter. CONCLUSIONS: Our results indicate that bronchial walls are thicker in asthmatics than in patients with COPD. It seems that airway wall thickness and the lumen diameter in patients with asthma are related to disease severity. There is no such a relationship in COPD patients. High-resolution computed tomography may be a useful tool in the assessment of airway structure in obstructive lung disease.

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Section: Discussionmentioning

confidence: 99%

Airway Dimensions in Asthma and COPD in High Resolution Computed Tomography: Can We See the Difference?

et al. 2013

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“…Patients with cough as the sole or predominant symptom (CVA or cough-predominant asthma) were included and were categorized as having asthmatic cough. The others were categorized as having nonasthmatic cough caused by the following [16]: sinobronchial syndrome (chronic sinusitis complicated by neutrophilic airway inflammation of the lower airways) [17,24] diagnosed based on positive sinus images, and symptoms related to chronic sinusitis improved with macrolides; gastroesophageal reflux disease (GERD) based on response to treatment with proton pump inhibitors; postinfectious cough based on a history of upper respiratory tract infection followed by cough that spontaneously subsided; atopic cough based on findings suggesting an atopic predisposition or induced sputum eosinophilia as well as a response to antihistamines [16,25]; cough due to pertussis based on the typical clinical course of pertussis and a positive antipertussis toxin antibody reaction, and idiopathic cough for which extensive examinations and intensive therapeutic trials were negative or failed to reveal any conclusive findings. The numbers of patients who underwent more specialized and detailed examinations or assessment were as follows: 9 for thoracic CT, 4 for sinus CT, 3 for esophageal endoscopy, 3 for bronchoscopy, and 3 for ENT consultations.…”

Section: Methodsmentioning

confidence: 99%

“…Cough sensitivity was tested by continuous inhalation of capsaicin as described [34], with a slight modification of capsaicin concentrations [24]. Ten doubling concentrations of capsaicin solution (0.61–312 µ M ) were inhaled until ≥5 coughs were induced.…”

Section: Methodsmentioning

confidence: 99%

“…Ten doubling concentrations of capsaicin solution (0.61–312 µ M ) were inhaled until ≥5 coughs were induced. Each concentration of capsaicin was inhaled for 15 s during tidal breathing every 60 s. The concentration of capsaicin causing ≥5 coughs is referred to as C5 [24,34]. Fifty-nine patients with asthmatic cough and all 21 patients with nonasthmatic cough underwent the test.…”

Section: Methodsmentioning

confidence: 99%

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Plasma Substance P Levels in Patients with Persistent Cough

et al. 2011

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Background: Substance P (SP) is involved in the pathogenesis of cough in animal models. However, few studies in humans have been reported and the roles of SP in clinical cough remain obscure. Objectives: To clarify the relevance of plasma levels of SP in patients with persistent cough. Methods: We studied 82 patients with cough persisting for at least 3 weeks and 15 healthy controls. Patients were classified as having asthmatic cough (cough-variant asthma and cough-predominant asthma; n = 61) or nonasthmatic cough (n = 21; postinfectious cough, n = 6; gastroesophageal reflux disease, n = 5; idiopathic cough, n = 5, and others, n = 5). Correlations were evaluated between plasma SP levels as measured with ELISA and methacholine airway hyperresponsiveness (airway sensitivity and airway reactivity), capsaicin cough sensitivity, sputum eosinophil and neutrophil counts, and pulmonary function. Results: Plasma SP levels were significantly elevated in patients with both asthmatic and nonasthmatic cough compared with controls [31.1 pg/ml (range 18.0–52.2) and 30.0 pg/ml (range 15.1–50.3) vs. 15.4 pg/ml (range 11.3–23.7); p = 0.003 and p = 0.038, respectively] but did not differ between the two patient groups (p = 0.90). Plasma SP levels correlated with airway sensitivity (threshold dose of methacholine) in the patients with asthmatic cough (r = –0.37, p = 0.005) but not with airway reactivity, cough sensitivity, FEV₁ values, or sputum eosinophil and neutrophil counts in either group. Conclusions: Increased levels of SP in plasma are associated with persistent cough in humans and might be related to airway sensitivity in asthmatic cough.

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“…Such an assessment is crucial before using these methods in longitudinal studies. To do so, we reported results obtained with a semiautomated method-the full width at half maximum (FWHM) [4,6,8,21]-and those obtained with a fully automated method-energy-driven contour estimation (EDCE) [18,22,23]. We then evaluated the ability of each method to detect serial changes in LA and WA by calculating the coefficient of measurement variation (CV 10 ).…”

Section: Introductionmentioning

confidence: 99%

Variability of bronchial measurements obtained by sequential CT using two computer-based methods

Brillet

Fétita

Capderou³

et al. 2009

Eur Radiol

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This study aimed to evaluate the variability of lumen (LA) and wall area (WA) measurements obtained on two successive MDCT acquisitions using energy-driven contour estimation (EDCE) and full width at half maximum (FWHM) approaches. Both methods were applied to a database of segmental and subsegmental bronchi with LA > 4 mm(2) containing 42 bronchial segments of 10 successive slices that best matched on each acquisition. For both methods, the 95% confidence interval between repeated MDCT was between -1.59 and 1.5 mm(2) for LA, and -3.31 and 2.96 mm(2) for WA. The values of the coefficient of measurement variation (CV(10), i.e., percentage ratio of the standard deviation obtained from the 10 successive slices to their mean value) were strongly correlated between repeated MDCT data acquisitions (r > 0.72; p < 0.0001). Compared with FWHM, LA values obtained using EDCE were higher for LA < 15 mm(2), whereas WA values were lower for bronchi with WA < 13 mm(2); no systematic EDCE underestimation or overestimation was observed for thicker-walled bronchi. In conclusion, variability between CT examinations and assessment techniques may impair measurements. Therefore, new parameters such as CV(10) need to be investigated to study bronchial remodeling. Finally, EDCE and FWHM are not interchangeable in longitudinal studies.

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Airway Wall Thickening in Patients With Cough Variant Asthma and Nonasthmatic Chronic Cough

Cited by 57 publications

References 38 publications

Airway Dimensions in Asthma and COPD in High Resolution Computed Tomography: Can We See the Difference?

Airway Dimensions in Asthma and COPD in High Resolution Computed Tomography: Can We See the Difference?

Plasma Substance P Levels in Patients with Persistent Cough

Variability of bronchial measurements obtained by sequential CT using two computer-based methods

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