Should we consider paranasal and chest computed tomography in severe asthma patients?

Zamarrón, Ester; Romero, David; Fernández-Lahera, J.; Villasante, C.; Pinilla, Inmaculada; Paredes, Pilar; Domínguez‐Ortega, Javier

doi:10.1016/j.rmed.2020.106013

Cited by 5 publications

(5 citation statements)

References 39 publications

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“…21 Recognizing the predominant male representation in our case cohort, we conducted a sex-controlled case-control analysis as elaborated in supplementary material section 5. Furthermore, participants diagnosed with bronchial asthma exhibited a heightened prevalence of MS opacifications, a trend consistent with findings reported by Hamilos et al 22 and Zamarron et al 23 Our study, akin to prior studies 1,3,5,20 , did not find a link between smoking and MS opacifications. Our results also did not indicate a significant correlation between age and blood parameters in relation to MS opacifications.…”

Section: Discussionsupporting

confidence: 92%

Computer‐Aided Diagnosis of Maxillary Sinus Anomalies: Validation and Clinical Correlation

Bhattacharya,

Becker,

Behrendt

et al. 2024

The Laryngoscope

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ObjectiveComputer aided diagnostics (CAD) systems can automate the differentiation of maxillary sinus (MS) with and without opacification, simplifying the typically laborious process and aiding in clinical insight discovery within large cohorts.MethodsThis study uses Hamburg City Health Study (HCHS) a large, prospective, long‐term, population‐based cohort study of participants between 45 and 74 years of age. We develop a CAD system using an ensemble of 3D Convolutional Neural Network (CNN) to analyze cranial MRIs, distinguishing MS with opacifications (polyps, cysts, mucosal thickening) from MS without opacifications. The system is used to find correlations of participants with and without MS opacifications with clinical data (smoking, alcohol, BMI, asthma, bronchitis, sex, age, leukocyte count, C‐reactive protein, allergies).ResultsThe evaluation metrics of CAD system (Area Under Receiver Operator Characteristic: 0.95, sensitivity: 0.85, specificity: 0.90) demonstrated the effectiveness of our approach. MS with opacification group exhibited higher alcohol consumption, higher BMI, higher incidence of intrinsic asthma and extrinsic asthma. Male sex had higher prevalence of MS opacifications. Participants with MS opacifications had higher incidence of hay fever and house dust allergy but lower incidence of bee/wasp venom allergy.ConclusionThe study demonstrates a 3D CNN's ability to distinguish MS with and without opacifications, improving automated diagnosis and aiding in correlating clinical data in population studies.Level of Evidence3 Laryngoscope, 2024

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Section: Discussionsupporting

confidence: 92%

Computer‐Aided Diagnosis of Maxillary Sinus Anomalies: Validation and Clinical Correlation

Bhattacharya,

Becker,

Behrendt

et al. 2024

The Laryngoscope

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“…10,11 In a recent study, the values of FEV1% predicted in asthma patients with bronchiectasis were worse than those without bronchiectasis (68.9 ± 20.2% versus 78.2 ± 25.2%, p = 0.028). 12 As a noninvasive auxiliary examination, HRCT can serve as a promising method to estimate small and proximal airway morphometry, mucus plugs, bronchiectasis, and emphysema of asthma. However, to the best of our knowledge, the imaging features and the association with clinical characteristics and therapeutic response of untreated early-stage asthma patients have not been systemically investigated using HRCT scans.…”

Section: Introductionmentioning

confidence: 99%

Novel imaging phenotypes of naïve asthma patients with distinctive clinical characteristics and T2 inflammation traits

Yang

Qin

Qiao

et al. 2022

Therapeutic Advances in Chronic Disease

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Objective: This study aims to describe the imaging features of naïve asthma patients, defined as not receiving corticosteroids or other asthma medications for at least 1 month, and their association with therapeutic response, and to discover novel unbiased imaging phenotypes. Methods: A total of 109 naïve asthma patients and 50 healthy controls were enrolled in this study. Clinical data and imaging indices of high-resolution computed tomography were collected. The correlation between imaging indices and clinical features was analyzed. Cluster analyses were adopted to determine three novel imaging phenotypes. Results: Compared with healthy controls, naïve asthma patients presented higher scores of airway remodeling, bronchiectasis, and mucus plugs. Mean airway wall area (WA)% was inversely correlated with mid-expiratory flow velocity% predicted. The extent score of bronchiectasis was positively correlated with smoking history and significantly increased in the high mucus group. Mucus plugs were related to improving lung function and type 2 (T2) inflammation, as assessed by sputum and blood eosinophils and fraction of exhaled nitric oxide. Cluster 1 patients had a high proportion of emphysema, the best lung function, and the lowest T2 inflammation; cluster 2 patients had severe airway remodeling, relatively good lung function, and moderate T2 inflammation; cluster 3 patients had severe airway remodeling, mucus plugs, and bronchiectasis, and showed the worst lung function and highest T2 inflammation. Conclusion: Naïve asthma patients had the imaging traits of airway remodeling, bronchiectasis, and mucus plugs. The unbiased imaging phenotypes had good consistency with clinical characteristics, therapeutic response, and T2 inflammation expression in naïve asthma patients.

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“…Rhinitis and nasal polyps were the most frequent comorbidities in our study, as was reported by Bagnasco et al (22), although we observed a higher prevalence of bronchiectasis (73%) in our patients, we think it is due to our Asthma Clinic Protocol where every patient is studied with chest computed tomography, however, not all bronchiectasis presented clinical implications in asthma. In 2020, we published a retrospective study (23) performed in patients of our difficult-to-control asthma unit obtaining a similar prevalence of bronchiectasis (60.4%) measured by chest computed tomography. Regarding other comorbidities, one of our patients had a confirmed diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) that was M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n satisfactorily controlled with mepolizumab 100mg every four weeks, despite the results of several open-label or placebo-controlled studies where the effectiveness in the induction and maintenance of remission in EGPA was under mepolizumab 300mg subcutaneously once a month (23)(24)(25).…”

Section: Discussionmentioning

confidence: 98%

“…In 2020, we published a retrospective study (23) performed in patients of our difficult-to-control asthma unit obtaining a similar prevalence of bronchiectasis (60.4%) measured by chest computed tomography. Regarding other comorbidities, one of our patients had a confirmed diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) that was M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n satisfactorily controlled with mepolizumab 100mg every four weeks, despite the results of several open-label or placebo-controlled studies where the effectiveness in the induction and maintenance of remission in EGPA was under mepolizumab 300mg subcutaneously once a month (23)(24)(25). Some real-world studies evaluating the efficacy of mepolizumab, such as Pelaia et al (26), have demonstrated a significant reduction in the annual asthma exacerbation rate (from 3 to 0), with a concomitant reduction in OCS doses (from 6.25 mg/day of prednisone to 0mg/day), which is similar to our findings.…”

Section: Discussionmentioning

confidence: 98%

A real life cohort of mepolizumab treatment in severe eosinophilic asthma

Laorden¹,

Hernández²,

Domínguez-Ortega³

et al. 2024

Eur Ann Allergy Clin Immunol

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Background: Mepolizumab, a monoclonal antibody that interacts with IL-5, was the first anti-IL-5 approved for uncontrolled severe eosinophilic asthma. In several randomised, placebocontrolled trials, treatment with mepolizumab has shown a significant improvement in asthma symptoms and the need to use of oral corticosteroids (OCS). Several studies have correlated blood levels of eosinophil cationic protein (ECP) with the degree of eosinophilic inflammation, which could make it an indirect marker of eosinophilic activity. Methods:This was a single-centre retrospective study that included all patients diagnosed with severe eosinophilic asthma under treatment with mepolizumab. We recorded the number of exacerbations, daily prednisone intake, asthma control test scores and forced expiratory volume in the first second. Results:We followed 22 patients, 14 of whom were OCS-dependent with a mean daily dose of 15.85±15.62 mg prednisone. After 12 months, only five continued taking OCS and the mean daily dose was reduced by up to 2.50±3.84 mg (p<0.007). The exacerbation rate at baseline was 2.91±2.27 and decreased to 0.82±1.14 in the following year (p<0.001). ACT scores increased significantly from 16.00±5.85 to 20.71±4.45 after six months (p=0.003). We also observed a decrease in ECP from 81.46±43.99 µg/L to 19.12± 18.80 µg/L (p>0.001).Discussion: These real-life results are consistent with previous clinical trials demonstrating the efficacy and safety of mepolizumab in routine clinical practice for severe uncontrolled eosinophilic asthma. We observed a significant decrease in blood eosinophil counts and in ECP levels, suggesting a reduction in eosinophil activity following mepolizumab treatment.

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Should we consider paranasal and chest computed tomography in severe asthma patients?

Cited by 5 publications

References 39 publications

Computer‐Aided Diagnosis of Maxillary Sinus Anomalies: Validation and Clinical Correlation

Computer‐Aided Diagnosis of Maxillary Sinus Anomalies: Validation and Clinical Correlation

Novel imaging phenotypes of naïve asthma patients with distinctive clinical characteristics and T2 inflammation traits

A real life cohort of mepolizumab treatment in severe eosinophilic asthma

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