Dismantling the pathophysiology of asthma using imaging

Abstract

Asthma remains an important disease worldwide, causing high burden to patients and healthcare systems and presenting a need for better management and ultimately prevention and cure. Asthma is a very heterogeneous condition, with many different pathophysiological processes. Better measurement of those pathophysiological processes are needed to better phenotype disease, and to go beyond the current, highly limited measurements that are currently used: spirometry and symptoms. Sophisticated three-dimensional lung imaging using computed tomography and ventilation imaging (single photon emission computed tomography and positron emission tomography) and magnetic resonance imaging and methods of lung imaging applicable to asthma research are now highly developed. The body of current evidence suggests that abnormalities in structure and ventilatory function measured by imaging are clinically relevant, given their associations with disease severity, exacerbation risk and airflow obstruction. Therefore, lung imaging is ready for more widespread use in clinical trials and to become part of routine clinical assessment of asthma.

The role of nutrition in asthma prevention and treatment

“… 13 , 14 During an allergic reaction, these cells trigger smooth muscle contraction in the airways, microvascular leakage, and airway mucus secretion. 15 , 16 …”

Visual and Quantitative Assessments of Regional Xenon-Ventilation Using Dual-Energy CT in Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: A Comparison with Chronic Obstructive Pulmonary Disease

“…1 ). We categorized these patterns according to the descriptions in the previous studies ( 13 14 15 17 18 ). If one patient had any two or three intermixed ventilation patterns, the most predominant pattern was used to describe the abnormality.…”

Structure and function of small airways in asthma patients revisited

“…In asthma it was shown that the airway walls, as measured on CT, were thicker compared to healthy subjects. Furthermore, it was shown that increased airway wall thickness observed on CT was related to lower forced expiratory volume in 1 s and higher risk of exacerbations [138,140]. Static CT images acquired during expiration can show regions of low attenuation that are thought to reflect SAD (figure 2).…”

“…An in-depth review by KING et al [140], reported important findings on CT and three-dimensional ventilation imaging in the large airways, small airways and the parenchyma of patients with asthma. In that review, KING et al [140] further elaborate on the current and possible future use of different imaging modalities to improve our understanding of the role of small airways in asthma pathophysiology and on what further research is needed.…”