Characterization of acinar airspace involvement in asthmatic patients by using inert gas washout and hyperpolarized 3helium magnetic resonance

Gonem, Sherif; Hardy, Steven; Buhl, Niels; Hartley, Ruth; Soares, Marta O; Kay, Richard; Costanza, Rino; Gustafsson, Per; Brightling, Christopher E.; Owers‐Bradley, J. R.; Siddiqui, Salman

doi:10.1016/j.jaci.2015.06.027

Cited by 34 publications

(32 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The current findings in this report add to our previous observations that have identified that both the degree and heterogeneity of small-airway obstruction promote abnormal R5-R20 values 45 and that S acin can be driven by asymmetries in the lung at length scales that equate to the level of the alveolar duct. 9 Specifically, here we show that ventilation gradients in the lung are a major discriminant factor associated with both abnormal IOSderived R5-R20 and MBW-derived S acin values.…”

Section: Discussionmentioning

confidence: 51%

“…We have previously identified that 2 specific markers of VH, resistance at 5 Hz minus resistance at 20 Hz measured by using impulse oscillometry (R5-R20) and acinar VH (S acin ; measured by using phase 3 slope analysis of multiple-breath washout data), derived from IOS and MBW, respectively, are associated with impaired asthma control, quality of life, and 9,13 These observations have been replicated by other groups in parallel studies of adult asthma. 14,15 Additionally, using computational small-airway models and diffusion MRI, we have previously demonstrated that IOS-derived R5-R20 and MBW-derived S acin values are anatomically grounded measures of small and acinar airway anatomic disease, respectively, in adult asthmatic patients.…”

mentioning

confidence: 79%

“…The phase III slope indices S cond (conductive zone VH) and S acin (acinar zone VH) were calculated by using custom software written with Test-Point (Measurement Computing, Norton, Mass), as previously described. 9,13 Body plethysmography was performed with a constant-volume plethysmograph, according to the ATS/ERS recommendation. 30 A minimum of 3 acceptable tests were performed, and the test ended when the repeatability criterion was achieved (FRC within 10% between the highest and lowest values).…”

Section: Lung Function Measurementsmentioning

confidence: 99%

“…1,2 Ventilation heterogeneity (VH) can be captured by using imaging approaches that can quantify and regionalize lung ventilation, such as hyperpolarized helium-3/xenon-129 magnetic resonance imaging (MRI), oxygen-enhanced magnetic resonance, and single-photon emission computed tomography (CT). [3][4][5][6][7] Additionally, VH can be measured clinically in patients by using physiologic tidal breathing techniques that measure heterogeneities in lung ventilation (captured by using multiple-breath washout [MBW]) 8,9 and mechanical behavior (captured by using impulse oscillometry [IOS]). 10 International guidelines for quality control and assurance of tidal breathing markers of VH derived from IOS and MBW have been proposed, 11,12 supporting their potential role as tools to study early airways disease.…”

mentioning

confidence: 99%

“…14,15 Additionally, using computational small-airway models and diffusion MRI, we have previously demonstrated that IOS-derived R5-R20 and MBW-derived S acin values are anatomically grounded measures of small and acinar airway anatomic disease, respectively, in adult asthmatic patients. 9 Heterogeneity of ventilation within the lungs is likely to be influenced by both gravitational effects and airway branching, as well as other factors that affect regional lung compliance. 16 However, little is known about the spatial lung determinants of clinical measurements of VH derived by using MBW and IOS.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Functional CT imaging for identification of the spatial determinants of small-airways disease in adults with asthma

Bell

Foy

Richardson

et al. 2019

Journal of Allergy and Clinical Immunology

Self Cite

View full text Add to dashboard Cite

Background: Asthma is a disease characterized by ventilation heterogeneity (VH). A number of studies have demonstrated that VH markers derived by using impulse oscillometry (IOS) or multiple-breath washout (MBW) are associated with key asthmatic patient-related outcome measures and airways hyperresponsiveness. However, the topographical mechanisms of VH in the lung remain poorly understood. Objectives: We hypothesized that specific regionalization of topographical small-airway disease would best account for IOSand MBW-measured indices in patients. Methods: We evaluated the results of paired expiratory/ inspiratory computed tomography in a cohort of asthmatic (n 5 41) and healthy (n 5 11) volunteers to understand the determinants of clinical VH indices commonly reported by

show abstract

Section: Discussionmentioning

confidence: 51%

mentioning

confidence: 79%

Section: Lung Function Measurementsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Functional CT imaging for identification of the spatial determinants of small-airways disease in adults with asthma

Bell

Foy

Richardson

et al. 2019

Journal of Allergy and Clinical Immunology

Self Cite

View full text Add to dashboard Cite

show abstract

Lung clearance index and steroid response in pediatric severe asthma

Irving

Fleming

Ahmad

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

Introduction Lung clearance index (LCI) is a measure of airway disease that has been shown to be abnormal in asthma. We hypothesized that LCI would be higher (worse) in children with severe therapy‐resistant asthma (STRA) compared with difficult asthma (DA) and healthy controls and that LCI would fall in response to parenteral steroids in STRA. Methods Sixty‐four children with asthma who were prescribed high‐dose asthma therapy (GINA steps 4 or 5) performed LCI and spirometry. Forty‐three had STRA and 21 DA. Thirty‐nine of forty‐three STRA patients attended for a clinically indicated bronchoscopy during which an intramuscular injection of triamcinolone was given. LCI, spirometry, and fractional exhaled nitric oxide (FeNO) were performed on the day of the bronchoscopy and repeated 4 weeks later. Results LCI was more abnormal in STRA (median: 7.40, range: 5.58‐12.34) than in DA (6.55, 5.77‐7.75), P = .0006, and healthy controls (6.53, 5.57‐7.35), P = .005. In contrast to the first second forced expired volume (FEV1), LCI improved following systemic steroids; of 20 STRA patients with an abnormal LCI at baseline, 13 improved following triamcinolone. LCI and FeNO responses were concordant. Conclusions There is a subgroup of children with STRA in whom LCI is elevated who improve following parenteral steroids. LCI may be a valuable additional domain in assessing steroid response in pediatric asthma.

show abstract