High-resolution CT pulmonary findings in children with severe asthma

Silva, Thiago Krieger Bento da; Zanon, Matheus; Altmayer, Stephan; Pacini, Gabriel Sartori; Watte, Guilherme; Stein, Renato T.; Pitrez, Paulo Márcio; Hochhegger, Bruno

doi:10.1016/j.jped.2019.10.011

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…The presence of LAR is therefore considered to be a sensitive indirect indicator of SAD. We observed slightly less LAR than what has been described in another study in children with SA [ 15 ]. However, in this study a stringent cut-off of −856 Hounsfield units was used to determine the age of LAR [ 15 ].…”

Section: Discussioncontrasting

confidence: 67%

“…We observed slightly less LAR than what has been described in another study in children with SA [ 15 ]. However, in this study a stringent cut-off of −856 Hounsfield units was used to determine the age of LAR [ 15 ]. The use of a stringent cut-off for determining LAR in children might not be as accurate because lung density changes with age, lung volume and positioning of the patient in the supine position (anterior versus posterior) [ 27 , 35 ].…”

Section: Discussioncontrasting

confidence: 67%

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Children with severe asthma have substantial structural airway changes on computed tomography

van den Bosch,

Lv,

Andrinopoulou

et al. 2023

ERJ Open Res

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BackgroundIn adults with severe asthma(SA) airway wall thickening, bronchiectasis and low attenuation regions(LAR) have been described on chest computed tomography(CT) scans. The extent to which these structural abnormalities are present in children with SA is largely unknown.AimTo study the presence and extent of airway abnormalities on chest CT of children with SA.Methods161 in-and expiratory CT scans, either spirometer-controlled or technician-controlled, obtained in 131 children with SA (mean age 11.0±3.8 years) were collected retrospectively. Inspiratory scans were analysed manually using a semi-quantitative score and automatically using LungQ (v2.1.0.1, Thirona B.V., The Netherlands). LungQ segments the airway tree, identifies the generation for each airway-artery (AA)-pair, and measures the following AA-dimensions: outer airway wall diameter(Aout), adjacent artery diameter(A) and airway wall thickness(Awt). Bronchiectasis was defined as Aout/A ≥1.1, airway wall thickening as Awt/A ≥0.14. LAR, reflecting small airways disease(SAD) was measured automatically on in- and expiratory scans and manually on expiratory scans. Functional SAD was defined as FEF25–75and/or FEF75z-scores<-1.645. Results are shown as median and interquartile range.ResultsBronchiectasis was present on 95.8% and airway wall thickening on all CT's using the automated method. Bronchiectasis was present on 28% and airway wall thickening on 88.8% of the CT's using the manual semi-quantitative analysis. The percentage of AA-pairs defined as bronchiectasis was 24.62% (12.7–39.3%) and airway wall thickening was 41.7% (24.0–79.8%) per CT using the automated method. LAR was observed on all CT's using the automatic analysis and on 82.9% using the manual semi-quantitative analysis. Patients with LAR or functional SAD had more thickened airways than patients without.ConclusionDespite a large discrepancy between the automated and the manual semi-quantitative analysis, bronchiectasis and airway wall thickening are present on most CT scans of children with SA. SAD is related to airway wall thickening.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussioncontrasting

confidence: 67%

Children with severe asthma have substantial structural airway changes on computed tomography

van den Bosch,

Lv,

Andrinopoulou

et al. 2023

ERJ Open Res

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“…Chest CT is not routinely recommended for patients with difficult-to-treat asthma. 18 In our study, 37 of the patients had chest CT. Silva et al 35 found that children with severe asthma showed differences in airway wall thickness and increased ventilation in high-resolution lung tomography compared with healthy controls. In our study, no significant relationship was found between radiologic imaging and FFB findings.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Flexible Bronchoscopy in Difficult-to-treat Asthma from a Pediatric Pulmonology Perspective

Büyükşahin¹,

Emiralioğlu²,

Tural³

et al. 2022

Turk Arch Pediatrics

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Objective Asthma is the most common chronic lung disease in childhood. Difficult-to-treat asthma is defined as the continuation of symptoms or attacks of patients despite step 4 or 5 of Global Initiative for Asthma therapy. In the differential diagnosis of these patients, flexible fiberoptic bronchoscopy is recommended to exclude other lung diseases. In this study, we aimed to examine the clinical and radiologic features and flexible fiberoptic bronchoscopy findings of patients referred to our pediatric pulmonology department due to difficult-to-treat asthma and determine the effects of flexible fiberoptic bronchoscopy on the differential diagnosis and treatment. Materials and Methods The demographic characteristics and flexible fiberoptic bronchoscopy results of 62 patients who were diagnosed as having difficult-to-treat asthma in our pediatric pulmonology department between January 2015 and June 2020 were evaluated retrospectively. The symptoms, history, medications, physical examination findings, pulmonary function tests, and radiologic findings of patients who underwent flexible fiberoptic bronchoscopy were evaluated. Results The median age of the patients was 69 (interquartile range: 42-108 months). The most common reasons for the referral of these patients were chronic cough, recurrent pulmonary infections, and persistent wheezing. All patients had chest radiography and 37 (59.7%) had chest computed tomography at their first admission; 14 (37.8%) patients had abnormal findings on chest computed tomography. There was no significant difference in terms of age, physical examination findings, pulmonary function test results, and radiologic examinations between patients with and without pathologic bronchoscopy findings. None of the patients had complications during and after flexible fiberoptic bronchoscopy. The most common diagnoses of patients based on flexible fiberoptic bronchoscopy were persistent bacterial bronchitis in 19 (30.6%) patients, tracheomalacia and/or bronchomalacia in 12 (19.4%), and anatomic anomalies in 3 (4.8%) patients (separation of lingula into 3, separation of right upper lobe bronchus into 4, and tracheal dyskinesia). Mycobacterium tuberculosis growth was observed in the tuberculosis culture of 1 patient. According to the flexible fiberoptic bronchoscopy and bronchoalveolar lavage results, antituberculosis treatment was initiated in 1 patient and polypoid mass excision was performed in 1 patient. A proton pump inhibitor was started in 9 (15.5%) patients, physiotherapy in 5 (8.0%), antibiotics in 14 (22.5%), and ipratropium bromide in 7 (11.2%) patients. All patients were followed up with the diagnosis of asthma except for 2 patients. Conclusion To date, there is no prospective study evaluating the importance of flexible fiberoptic bronchoscopy in difficult-to-treat asthma in childhood. In our small cohort, persistent bacterial bronchitis, airway tracheomalacia and/or bronchomalacia, ...

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“…Previous studies performed quantitative CT analyses to detect air trapping in adult patients with COPD [ 13 – 15 ], asthma [ 16 ], and lung transplantation [ 17 ], and in pediatric patients with asthma [ 18 ], and BPD [ 19 ]. To the best of our knowledge, only few quantitative densitometry studies have been conducted in pediatric patients with BO [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

Quantitative CT lung densitometry as an obstructive marker for the diagnosis of bronchiolitis obliterans in children

et al. 2022

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The purpose of this study is to evaluate the quantitative diagnostic performance of computed tomography (CT) densitometry in pediatric patients with bronchiolitis obliterans (BO). We measured the mean lung density (MLD) and represented the difference of MLD in inspiratory and expiratory phases (MLDD), the ratio of the MLD (E/I MLD), and the relative volume percentage of lung density at 50-Hounsfield unit (HU) interval threshold (E600 to E950). We calculated the sensitivity, specificity, and diagnostic accuracy of the lung density indices for the diagnosis of BO. A total of 81 patients, including 51 patients with BO and 30 controls, were included in this study. In the BO patients, expiratory (EXP) MLD and MLDD were significantly lower, and E/I MLD and expiratory low attenuation areas below the threshold of −850 HU to −950 HU (E850, E900, and E950) were statistically significantly higher than controls. Multivariate logistic regression analysis showed that MLDD (odds ratio [OR] = 0.98, p < .001), E/I MLD (OR = 1.39, p < .001), and E850 to E950 were significant densitometry parameters for BO diagnosis. In a receiver-operating characteristic analysis, E900 (cutoff, 1.4%; AUC = 0.920), E/I MLD (cutoff, 0.87; AUC = 0.887), and MLDD (cutoff, 109 HU; AUC = 0.867) showed high accuracy for the diagnosis of BO. In conclusion, the lung CT densitometry can serve as a quantitative marker providing additional indications of expiratory airflow limitation in pediatric patients with BO.

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High-resolution CT pulmonary findings in children with severe asthma

Cited by 9 publications

References 27 publications

Children with severe asthma have substantial structural airway changes on computed tomography

Children with severe asthma have substantial structural airway changes on computed tomography

The Importance of Flexible Bronchoscopy in Difficult-to-treat Asthma from a Pediatric Pulmonology Perspective

Quantitative CT lung densitometry as an obstructive marker for the diagnosis of bronchiolitis obliterans in children

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