High resolution computed tomography in asthma

McLean, Andrew N.; Sproule, Michael; Cowan, M. L.; Thomson, Neil C.

doi:10.1136/thx.53.4.308

Cited by 37 publications

(19 citation statements)

References 47 publications

(66 reference statements)

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“…Several authors confirmed these results [2, 4, 18,29,30,31,32]. Bronchial wall thickening observed in HRCT correlated with changes in bronchial wall structure.…”

Section: Discussionsupporting

confidence: 74%

High-Resolution Computed Tomography Evaluation of Peripheral Airways in Asthma Patients: Comparison of Focal and Diffuse Air Trapping

Mikoś

Grzanka²,

Sładek³

et al. 2008

Respiration

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Background: Air trapping evaluated in high-resolution computed tomography (HRCT) reflects changes in small bronchi. We simultaneously evaluated focal and diffuse air trapping in asthmatic patients. Objectives: (1) To evaluate air trapping and bronchial wall thickness in asthmatics. (2) To estimate the relationship between air trapping and bronchial wall thickness, pulmonary function tests (PFTs), age, gender and asthma severity. (3) To compare air trapping between subgroups of asthmatic patients with normal FEV₁ % pred. and FEV₁/FVC % and controls. (4) To compare air trapping and bronchial wall thickness between aspirin-induced asthmatics (AIA) and aspirin-tolerant asthmatics (ATA). Methods: Both groups (asthmatics and controls) included 30 patients. All patients underwent HRCT and PFTs. Results: Focal (p < 0.0001) and diffuse (p = 0.0004) air trappings and bronchial wall thickness (T: p < 0.0001; T/D: p < 0.0001; WA%: p < 0.0001) were significantly greater in asthmatics. Focal and diffuse air trappings were inversely correlated (p = 0.021). Diffuse air trapping correlated with bronchial wall thickness: T/D (p = 0.047), T (p = 0.037), and WA% (p = 0.048). There was a significant difference in the extent of focal air trapping between a subgroup of asthmatics with normal FEV₁ % pred. and FEV₁/FVC % and controls (p < 0.0001). There were no significant differences in focal (p = 0.095) and diffuse air trapping (p = 0.186) and bronchial wall thickness (T: p = 0.086; T/D: p = 0.428; WA%: p = 0.428) between AIA and ATA patients. Conclusions: Both focal and diffuse air trappings provide valuable diagnostic information and therefore deserve to be estimated. The lack of significant differences in air trapping and bronchial wall thickness between AIA and ATA patients needs further investigation.

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“…Several authors confirmed these results [2, 4, 18,29,30,31,32]. Bronchial wall thickening observed in HRCT correlated with changes in bronchial wall structure.…”

Section: Discussionsupporting

confidence: 74%

High-Resolution Computed Tomography Evaluation of Peripheral Airways in Asthma Patients: Comparison of Focal and Diffuse Air Trapping

Mikoś

Grzanka²,

Sładek³

et al. 2008

Respiration

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“…Bronchiectasis or bronchial dilatation detectable on HRCT could be a complication of asthma [44]. Indeed, a high prevalence of asthma has been reported in children with bronchiectasis [5, 16, 45].…”

Section: Discussionmentioning

confidence: 99%

A Descriptive Study of Non-Cystic Fibrosis Bronchiectasis in a Pediatric Population from Central and Southern Italy

et al. 2008

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Background: Non-cystic fibrosis (CF) bronchiectasis is now identified more often than in the past. Objectives: It was the aim of this study to assess the high-resolution computed tomography (HRCT) localization and extent of bronchiectasis and to determine whether asthma status, atopy and bronchiectasis distribution are associated with the etiology of bronchiectasis. Methods: We retrospectively analyzed clinical, laboratory, functional and HRCT data of 105 children with non-CF bronchiectasis at 2 tertiary respiratory units in Italy. Forty cases had bronchiectasis associated with ongoing underlying conditions, namely primary ciliary dyskinesia, primary immunodeficiency or aspiration. Results: Age at the onset of chronic cough/wheeze and at the first X-ray-documented pneumonia as well as atopy prevalence were lower in patients with ongoing underlying conditions than in those without (p = 0.049, p = 0.003 and p = 0.0008, respectively). In most cases, bronchiectasis was multilobar, and a mean of 2.5 lobes were involved. The right side was more often involved than the left (88 vs. 70%; p = 0.002), and the upper lobes were relatively spared (p < 0.000001). Right lung involvement and multilobar disease were more prevalent in children younger than 2 years at first pneumonia (p < 0.05). Conclusions: Clinical information combined with laboratory data provides additional insights into the characteristics of non-CF bronchiectasis in a large population of Italian children. This study highlights the need for longitudinal evaluations, also using HRCT, of severe and non-resolving pneumonia in children.

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“…An increase in the area of submucosal elastic fibres could alter the mechanical properties of the airway wall. The use of high-resolution computed tomography to assess structural changes in the lungs [86,87] has revealed that the presence of emphysema in smokers with asthma is associated with a greater smoking history [88]. Hyperinflation or emphysematous changes of the lungs are increased in asthmatic ex-smokers, who had a heavy smoking history of 49 pack-yrs, when compared with asthmatic never-smokers [89].…”

Section: Airway Pathologymentioning

confidence: 99%

Asthma and cigarette smoking

Thomson

Chaudhuri²,

Livingston³

2004

European Respiratory Journal

469

269

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In most developed countries y25% of adults with asthma are current cigarette smokers. Asthma and active cigarette smoking interact to cause more severe symptoms, accelerated decline in lung function, and impaired short-term therapeutic response to corticosteroids.Cigarette smoking may modify inflammation that is associated with asthma, although there is limited published data on airway pathology in smokers with asthma. To date, the evidence points towards a combination of both heightened and suppressed inflammatory responses in smokers compared with nonsmokers with asthma.The mechanisms of corticosteroid resistance in asthmatic smokers are unexplained, but could be as a result of alterations in airway inflammatory cell phenotypes (e.g. increased neutrophils or reduced eosinophils), changes in the glucocorticoid receptor-a to -b ratio (e.g. overexpression of glucocorticoid receptor b), and increased activation of pro-inflammatory transcription factors (e.g. nuclear factor-kB) or reduced histone deacetylase activity.In conclusion, every effort should be made to encourage asthmatics who smoke to stop, although the effects of smoking cessation upon reversing the adverse effects of tobacco smoke on asthma control, therapeutic response to corticosteroids and airway pathology have yet to be fully elucidated. Alternative or additional therapies to inhaled corticosteroids are needed for asthmatic patients who are unable to quit smoking.

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High resolution computed tomography in asthma

Cited by 37 publications

References 47 publications

High-Resolution Computed Tomography Evaluation of Peripheral Airways in Asthma Patients: Comparison of Focal and Diffuse Air Trapping

High-Resolution Computed Tomography Evaluation of Peripheral Airways in Asthma Patients: Comparison of Focal and Diffuse Air Trapping

A Descriptive Study of Non-Cystic Fibrosis Bronchiectasis in a Pediatric Population from Central and Southern Italy

Asthma and cigarette smoking

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