Multidetector Row Computed Tomography to Assess Changes in Airways Linked to Asthma Control

Abstract

Background: In asthma, multidetector row computed tomography (MDCT) detects abnormalities that are related to disease severity, including increased bronchial wall thickness. However, whether these abnormalities could be related to asthma control has not been investigated yet. Objective: Our goal was to determine which changes in airways could be linked to disease control. Methods: Twelve patients with poor asthma control were included and received a salmeterol/fluticasone propionate combination daily for 12 weeks. Patients underwent clinical, functional, and MDCT examinations before and after the treatment period. MDCT examinations were performed using a low-dose protocol at a controlled lung volume (65% TLC). Bronchial lumen (LA) and wall areas (WA) were evaluated at a segmental and subsegmental level using BronCare software. Lung density was measured at the base of the lung. Baseline and end-of-treatment data were compared using the Wilcoxon signed-rank test. Results: After the 12-week treatment period, asthma control was achieved. Airflow obstruction and air trapping decreased as assessed by the changes in FEV₁ (p < 0.01) and expiratory reserve volume (p < 0.01). Conversely, LA and WA did not vary significantly. However, a median decrease in LA of >10% was observed in half of the patients with a wide intra- and intersubject response heterogeneity. This was concomitant with a decrease in lung density (p < 0.02 in the anteroinferior areas). Conclusions: MDCT is insensitive for demonstrating any decrease in bronchial wall thickness. This is mainly due to changes in bronchial caliber which may be linked to modifications of the elastic properties of the bronchopulmonary system under treatment.

Effects of Adding Omalizumab, an Anti-Immunoglobulin E Antibody, on Airway Wall Thickening in Asthma

“…Multidetector row CT demonstrated that a salmeterol/fluticasone combination did not significantly change either WA or Ai in patients with poor asthma control [37]. We may find that omalizumab, as an add-on to current asthma therapy, offers a potential explanation for decreasing airway wall thickness.…”

In Vivo Computed Tomography as a Research Tool to Investigate Asthma and COPD: Where Do We Stand?

“…Kurashima et al used CT to evaluate the efficacy of inhaled corticosteroid and found a decrease in airway wall thickness among asthmatic patients with duration of symptoms less than 3 years, a minor response among 3 to 5 years and no change in wall thickness in patients with more than 5 years duration of disease [ 41 ]. However, Brillet et al did not found any change of both WA and LA after a combination of salmeterol/flucitasone daily for 12 weeks, though patients displayed clinical and functional improvement, assessed by a decrease in FEV1 and expiratory reserve volume (ERV) [ 42 ].…”

Novel Functional Imaging of Changes in Small Airways of Patients Treated with Extrafine Beclomethasone/Formoterol

“…forced expiratory volume in 1 s (FEV 1 ) and peak expiratory flow (PEF)] performed in these studies did not provide a comprehensive evaluation of the entire bronchial tree as they lack sufficient resolution to describe subtle changes in the small airways [5,6]. This has prompted the need for developing new image-based [7,8] techniques capable of detecting functional changes occurring in the more distal part of the lung following the administration of drugs able to reach and treat small airways [9,10,11]. …”