Irreversiblity of Remodeled Features on High-Resolution Computerized Tomography Scans of Asthmatic Patients on Conventional Therapy: A 6-Year Longitudinal Study

Kurt, Emel; Özkan, Ragıp; Orman, Ayşe; Çalışır, Cüneyt; Metintaş, Muzaffer

doi:10.1080/02770900902718837

Cited by 10 publications

(14 citation statements)

References 31 publications

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“…The pathogenesis of bronchial wall thickening may be airway remodeling, namely subepithelial fibrosis, hypertrophy of the smooth muscle cell, mucus gland hyperplasia, and angiogenesis. Otherwise some reversible elements such as chronic airway inflammation and edema may play roles (15,33). Whether or not the structural changes such as subepithelial fibrosis, hypertrophy of the smooth muscle cell are reversible is still controversial (6,14,15,33).…”

Section: Discussionmentioning

confidence: 99%

“…Bronchial dilation were divided into three types according to the morphology of bronchi: (I) cylindric bronchial dilation, defined as the lack of bronchial tapering or the presence of smooth bronchial dilatation, and bronchial lumen greater than that of the accompanying pulmonary artery ( Figure 2A,B); (II) varicose bronchial dilation, identified when irregular or beaded dilatation of the bronchus were recognized ( Figure 2B,C); and (III) cystic bronchial dilation, diagnosed by presence of evident strings or clusters of cysts (15,33,34). Based on the established computed tomography (CT) criteria (35)(36)(37), the extent of bronchial dilation was scored as follows: grade 0 = no disease; grade 1 = localized bronchiectasis affecting one or part of one bronchopulmonary segment (localized); grade 2 = bronchiectasis in more than one bronchopulmonary segment (extensive); and grade 3 = generalized cystic bronchiectasis.…”

Section: Assessment Of Bronchial Dilationmentioning

confidence: 99%

“…Different types of emphysema could be displayed independently or simultaneously, which included centrilobular, panlobular, paraseptal emphysema or irregular (paracicatricial) emphysema (15,(31)(32)(33)38) ( Figure 3A). Centrilobular emphysema was defined as focal areas of low attenuation up to 1 cm in diameter within a homogeneous background of lung parenchyma.…”

Section: Assessment Of Emphysemamentioning

confidence: 99%

“…Bronchial wall thickening was further graded by severity as none (<1 mm), mild (1 to 2 mm), moderate (2 to 3 mm), and severe (≥3 mm), which are illustrated in Figure 1 (15,33).…”

Section: Assessment Of Bronchial Wall Thickeningmentioning

confidence: 99%

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A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

Wang¹,

Luo²,

Du³

et al. 2016

J. Thorac. Dis.

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Background: Airway structure changes, termed as airway remodeling, are common in asthma patients due to chronic inflammation, which can be assessed by high-resolution computed tomography (HRCT).Considering the controversial conclusions in the correlation of morphologic abnormalities with clinical feature and outcome, we aimed to further specify and evaluate the structural abnormalities of Chinese asthmatics by HRCT.Methods: From August 2012 to February 2015, outpatients with asthma were recruited consecutively in the Asthma Center of West China Hospital, Sichuan University. Standard HRCT and pulmonary function test (PFT) were performed to collect information of bronchial wall thickening, bronchial dilatation, mucus impaction, emphysema, mosaic perfusion, atelectasis, and spirometric parameters. We reported the incidence of each structural abnormality in HRCT and compared it among different asthmatic severities.Results: A total of 123 asthmatics were enrolled, among which 84 (68.3%) were female and 39 (31.7%) were male. At least one structural abnormality was detected by HRCT in 85.4% asthmatics, and the incidence of bronchial wall thickening, bronchial dilatation, mucus impaction, emphysema, mosaic perfusion, and atelectasis was 57.7%, 51.2%, 22%, 24.4%, 5.7% and 1.6%, respectively. The incidences of bronchial wall thickening, bronchial dilation and emphysema were significantly increased by asthma severity (P<0.05), while incidences of mucus impaction (26/27, 96.30%), mosaic perfusion (6/7, 85.71%) and atelectasis (2/2, 100%) were mainly found in severe asthma. We found a longer asthma history (28.13±18.55 years, P<0.001, P=0.035, respectively).Conclusions: The incidences of structural abnormalities detected by HRCT are fairly high in Chinese asthma populations, especially the bronchial wall thickening and bronchial dilation, which are significantly increased in severe asthma, and are potential risk factors of pulmonary function decline in asthmatics.

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Section: Discussionmentioning

confidence: 99%

Section: Assessment Of Bronchial Dilationmentioning

confidence: 99%

Section: Assessment Of Emphysemamentioning

confidence: 99%

“…Bronchial wall thickening was further graded by severity as none (<1 mm), mild (1 to 2 mm), moderate (2 to 3 mm), and severe (≥3 mm), which are illustrated in Figure 1 (15,33).…”

Section: Assessment Of Bronchial Wall Thickeningmentioning

confidence: 99%

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A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

Wang¹,

Luo²,

Du³

et al. 2016

J. Thorac. Dis.

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“…Key diagnostic tools are dynamic evaluation of airway physiology and high-resolution computed tomography (70). The use of bronchial biopsies in this setting needs to be determined.…”

Section: Extensive Remodeling Asthmamentioning

confidence: 99%

Untangling asthma phenotypes and endotypes

Agache

Akdiş

Jutel

et al. 2012

Allergy

287

235

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Asthma phenotypes have been developed to address the complexities of the disease. However, owing to a lack of longitudinal studies, little is known about the onset as well as the stability of phenotypes. Distinguishing phenotypes with regard to the severity or duration of the disease is essential. A phenotype covers the clinically relevant properties of the disease, but does not show the direct relationship to disease etiology and pathophysiology. Different pathogenetic mechanisms might cause similar asthma symptoms and might be operant in a certain phenotype. These putative mechanisms are addressed by the term 'endotype'. Classification of asthma based on endotypes provides advantages for epidemiological, genetic, and drug-related studies. A successful definition of endotypes should link key pathogenic mechanisms with the asthma phenotype. Thus, the identification of corresponding molecular biomarkers for individual pathogenic mechanism underlying phenotypes or subgroups within a phenotype is important. Whether newly defined asthma endotypes predict the individual course of asthma has to be validated in longitudinal studies. The accurate endotyping reflects natural history of asthma and should help to predict treatment response. Thus, understanding asthma endotypes might be useful in clinical practice.

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Longitudinal Changes in Airway Remodeling and Air Trapping in Severe Asthma

et al. 2014

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Rationale and Objectives Previous cross-sectional studies have demonstrated that airway wall thickness and air trapping are greater in subjects with severe asthma than in those with mild-to-moderate asthma. However, a better understanding of how airway remodeling and lung density change over time is needed. This study aims to evaluate predictors of airway wall remodeling and change in lung function and lung density over time in severe asthma. Materials and Methods Phenotypic characterization and quantitative multidetector computed tomography (MDCT) of the chest was performed at baseline and ∼2.6 years later in 38 participants with asthma (severe n=24, mild-moderate n=14) and 9 normal controls from the Severe Asthma Research Program. Results Subjects with severe asthma had a significant decline in post-bronchodilator FEV1% predicted over time (p = <0.001). Airway wall thickness measured by MDCT was increased at multiple airway generations in severe asthma compared to mild-to-moderate asthma (wall area percent (WA%): p <0.05) and normals (p <0.05) at baseline and year 2. Over time, there was an increase in WA% and wall thickness (WT%) in all subjects (p = 0.030 and 0.009 respectively) with no change in emphysema-like lung or air trapping. Baseline pre-bronchodilator FEV1% inversely correlated with WA% and WT% (both p = <0.05). In a multivariable regression model, baseline WA%, race and healthcare utilization were predictors of subsequent airway remodeling. Conclusions Severe asthma subjects have a greater decline in lung function over time than normal subjects or those with mild-to-moderate asthma. MDCT provides a noninvasive measure of airway wall thickness that may predict subsequent airway remodeling.

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Irreversiblity of Remodeled Features on High-Resolution Computerized Tomography Scans of Asthmatic Patients on Conventional Therapy: A 6-Year Longitudinal Study

Cited by 10 publications

References 31 publications

A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

A morphologic study of the airway structure abnormalities in patients with asthma by high-resolution computed tomography

Untangling asthma phenotypes and endotypes

Longitudinal Changes in Airway Remodeling and Air Trapping in Severe Asthma

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