Lumen area change (Delta Lumen) between inspiratory and expiratory multidetector computed tomography as a measure of severe outcomes in asthmatic patients - 06/12/18
for the
National Heart, Lung, and Blood Institute's Severe Asthma Research Program
Abstract |
Background |
Quantitative computed tomographic (QCT) biomarkers of airway morphology hold potential for understanding and monitoring regional airway remodeling in asthmatic patients.
Objective |
We sought to determine whether the change in airway lumen area between total lung capacity (TLC) and functional residual capacity (FRC) lung volumes measured from CT imaging data was correlated with severe outcomes in asthmatic patients.
Methods |
We studied 152 asthmatic patients (90 female and 62 male patients) and 33 healthy subjects (12 female and 21 male subjects) using QCT. Postprocessing of airways at generations 1 to 5 (1 = trachea) was performed for wall area percentage, wall thickness percentage (WT%), lumen area at baseline total lung capacity (LATLC), lumen area at baseline functional residual capacity (LAFRC), and low attenuation area at FRC. A new metric (reflecting remodeling, distal air trapping, or both), Delta Lumen, was determined as follows: Percentage difference in lumen area (LATLC − LAFRC)/LATLC × 100.
Results |
Postprocessing of 4501 airway segments was performed (3681 segments in the 152 patients with asthma and 820 segments in the 33 healthy subjects; range, 17-28 segments per subject). Delta Lumen values were negatively correlated with WT% and low attenuation area (P < .01) in asthmatic patients. Delta Lumen values were significantly lower for airway generations 3 to 5 (segmental airways) in subjects undergoing hospitalization because of exacerbation and in patients with refractory asthma requiring treatment with systemic corticosteroids. WT% and low attenuation area were positively and Delta Lumen values were negatively associated with systemic corticosteroid treatment (P < .05), suggesting that a reduced Delta Lumen value is a potential outcome biomarker in patients with severe asthma.
Conclusion |
Reduced Delta Lumen value in the central airways measured by using QCT is a promising exploratory biomarker of unstable refractory asthma that warrants further study.
Le texte complet de cet article est disponible en PDF.Key words : Quantitative computed tomography, asthma, airway remodeling, severe asthma, air trapping
Abbreviations used : CT, Delta lumen, FRC, LAA, LAFRC, LATLC, QCT, SARP, TLC, WA%, WT%
Plan
| Supported by National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) grants R01 HL069116 and U10 HL109168 and NIH grants U01 HL114494 and UL1TR000427. |
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| Disclosure of potential conflict of interest: M. L. Schiebler has received a grant and travel support from the National Heart, Lung, and Blood Institute (NHLBI)/National Institutes of Health (NIH); has received grants from the NIH; has a patent through Wisconsin Alumni Research Foundation; and is a stockholder in Healthmyne and Stemina Biomakers. M. D. Evans has received a grant from the NIH. N. Jarjour, R. L. Sorkness, and C.-L. Lin have received a grant from the NHLBI/NIH. L. Denlinger has received a grant from the NIH and has consultant arrangements with GlaxoSmithKline, AstraZeneca, and Sanofi. S. Wenzel has consultant arrangements with Sanofi, AstraZeneca, and TEVA and has received grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Sanofi, and Novartis. E. A. Hoffman has received a grant from the NIH and has stock/stock options with and is a founder and shareholder of VIDA Diagnostics. D. S. Gierada has received a grant from the NIH and has received travel expenses from the IASLC, RSNA, Prevent Cancer Foundation, and Icahn School of Medicine at Mount Sinai. M. Castro has received personal fees from Boston Scientific, Holaira, Genentech, TEVA, GlaxoSmithKline, Sanofi-Aventis, Boehringer Ingelheim, Elsevier, Aviragen, and AstraZeneca and has received grants from TEVA, GlaxoSmithKline, Sanofi-Aventis, Vectura, Boehringer Ingelheim, Invion, AstraZeneca, Gilead, Novartis, and Chiesi. S. B. Fain has received grants from the NIH (NIH U10 HL109168, NIH U01 HL114494, NIH R01 HL069116, and NIH UL1TR000427) and GE Healthcare and has consultant arrangements with COPD Gene Imaging Core. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 142 - N° 6
P. 1773 - décembre 2018 Retour au numéro
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