Similarities in Quantitative Computed Tomography Imaging of the Lung in Severe Asthma with Persistent Airflow Limitation and Chronic Obstructive Pulmonary Disease

Abstract

Background: Severe asthma with persistent airflow limitation (SA-PAL) and chronic obstructive pulmonary disease (COPD) are characterised by irreversible airflow limitation and the remodelling of the airways. The phenotypes of the diseases overlap and may cause diagnostic and therapeutic concerns. Methods: There were 10 patients with SA-PAL, 11 patients with COPD, and 10 healthy volunteers (HV) enrolled in this study. The patients were examined with a 128-multislice scanner at full inspiration. Measurements were taken from the third to ninth bronchial generations. Results: The thickness of the bronchial wall was greater in the SA-PAL than in the COPD group for most bronchial generations (p < 0.05). The mean lung density was the lowest in the SA-PAL group (−846 HU), followed by the COPD group (−836 HU), with no statistical difference between these two groups. The low-attenuation volume percentage (LAV% < −950 HU) was significantly higher in the SA-PAL group (15.8%) and COPD group (10.4%) compared with the HV group (7%) (p = 0.03). Conclusion: Severe asthma with persistent airflow limitation and COPD become similar with time within the functional and morphological dimensions. Emphysema qualities are present in COPD and in SA-PAL patients.

Artificial Intelligence–Based Emphysema Quantification in Routine Chest Computed Tomography: Correlation With Spirometry and Visual Emphysema Grading

“…The existing literature does not provide consistent data regarding an optimal LAV% cutoff value that would indicate diagnosis of emphysema, with studies using different values ranging from 5% to 15%. 7,20,21 To address this issue, we also used the visual grading system proposed by the Fleischner Society. Our findings revealed an optimal cutoff value for LAV% in predicting a visual emphysema grade of 3 (moderate) or higher at 4.7% with good predictivity (AUC = 0.802).…”

“…The existing literature does not provide consistent data regarding an optimal LAV% cutoff value that would indicate diagnosis of emphysema, with studies using different values ranging from 5% to 15% 7,20,21 . To address this issue, we also used the visual grading system proposed by the Fleischner Society.…”

Early Diagnosis of High-Risk Chronic Obstructive Pulmonary Disease Based on Quantitative High-Resolution Computed Tomography Measurements

“…The overlap of the clinical presentation of severe asthma and COPD introduces challenges in clinical practice. 10 HRCT could be used to quantify static and dynamic changes in multiple independent airways as small as 1 mm, thus making it possible to study the subtle structure changes in the airway diseases, which is useful in COPD/ asthma phenotyping diagnosis and may raise the diagnosis rate of accuracy. 11 HRCT could also help understand relationships between bronchiectasis and emphysema in the overlap of the clinical presentation of COPD and bronchiectasis.…”

A Rounded Approach to the Management and Treatment of Obstructive Lung Diseases

“…Interestingly, it is known that some forms of severe asthma and COPD may present similar characteristics and are difficult to distinguish. In this regard, Obojski et al evaluated the intensity of the remodeling of the bronchi and the emphysema qualities of the lungs in patients with severe asthma with persistent airflow limitation (SA-PAL), COPD and healthy volunteers by quantitative computed tomography (QCT), showing that emphysema does not only occur in COPD, but also in SA–PAL [ 1 ].…”