Evaluation of Emphysema in Patients with Asthma Using High - resolution CT

Abstract

BackgroundBronchial asthma is a clinical syndrome characterized by reversibility of airway obstruction. However, many asthmatics have evidence of residual airway obstruction. It has become evident that the repair of the chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for the change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characteristics in asthmatics with emphysema.MethodsWe studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthmatics with emphysema and the ones without emphysema.ResultsOf the 58 patients, 7 were revealed to have emphysema. (1) 6 asthmatics with emphysema were smokers, but one patient was a nonsmoker. (2) Highly significant differences between asthmatics with and without emphysema were found in cigarette smoking (p<0.01) and smoking consumption (p<0.01. (3) There were no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There were no significant differences in FEV1(%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%) and DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickeness (p<0.05) and in total IgE levels (p=0.07).ConclusionThese results indicate that smoking is a main factor in causing emphysema in asthmatics.

Quantitative Low-Dose Computed Tomography of the Lung Parenchyma and Airways for the Differentiation between Chronic Obstructive Pulmonary Disease and Asthma Patients

“…These findings led us to conclude that there was more damage to the lung tissues in the COPD patients than in the asthma patients that then was resulting in more severe emphysema. This result is consistent with previous studies that show that emphysema is a more prominent phenotype in COPD patients [22] but less so for asthmatic patients [23] . Our findings indicate that using inspiratory phase EI -950 (%) as a criterion can lead to successful differentiation between COPD and asthma.…”

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

“…However, a few studies have suggested that emphysema in asthmatic patients is likely secondary to smoking. 29 In our study we did not find any evidence of emphysema in asthmatic patients because the Perc15 value was comparable with that in healthy control subjects. Perc15 values in the asthma subgroup with severe airflow limitation were similar to those in the COPD subgroup with matched airflow limitation, which might suggest that these asthmatic patients have emphysema.…”

Eosinophilic Otitis Media Is Associated with Asthma Severity and Smoking History

“…In addition, it was once thought that emphysematous lesions were rare in asthma patients [31], but recently it has been elucidated that they are actually often seen in asthma patients. It has also become clear that almost all patients with emphysematous lesions have a history of smoking [32]. However, in the present study, the EOM group included a significantly greater percentage of patients with a history of smoking (BI) compared with the non-EOM group, and the percentage of patients with airway wall thickening was also greater.…”