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

Bell, Alex; Foy, Brody H.; Richardson, Matthew; Singapuri, Amisha; Mirkes, Evgeny M.; Berge, Maarten van den; Kay, David; Brightling, Christopher E.; Gorban, Alexander N.; Galbán, Craig J.; Siddiqui, Salman

doi:10.1016/j.jaci.2019.01.014

Cited by 36 publications

(16 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other studies showed that R5–R20 reflects small airway narrowing [ 70 , 71 ]. Another group showed that small-airway ventilation heterogeneity captured by IOS-derived R5–R20 values is associated with CT density gradient reversal at the lung base, likely a direct consequence of SAD [ 72 ].…”

Section: Introductionmentioning

confidence: 99%

Small airway dysfunction and poor asthma control: a dangerous liaison

Cottini¹,

Licini²,

Lombardi

et al. 2021

Clin Mol Allergy

View full text Add to dashboard Cite

Asthma is a common chronic condition, affecting approximately 339 million people worldwide. The main goal of the current asthma treatment guidelines is to achieve clinical control, encompassing both the patient symptoms and limitations and the future risk of adverse asthma outcomes. Despite randomized controlled trials showing that asthma control is an achievable target, a substantial proportion of asthmatics remain poorly controlled in real life. The involvement of peripheral small airways has recently gained greater recognition in asthma, and many studies suggest that the persistent inflammation at these sites leads to small airway dysfunction (SAD), strongly contributing to a worse asthma control. Overall, the impulse oscillometry (IOS), introduced in the recent years, seems to be able to sensitively assess small airways, while conventional spirometry does not. Therefore, IOS may be of great help in characterizing SAD and guiding therapy choice. The aim of this article is to review the literature on SAD and its influence on asthma control, emphasizing the most recent evidence.

show abstract

Section: Introductionmentioning

confidence: 99%

Small airway dysfunction and poor asthma control: a dangerous liaison

Cottini¹,

Licini²,

Lombardi

et al. 2021

Clin Mol Allergy

View full text Add to dashboard Cite

show abstract

“…Multiple lines of evidence suggest that, within subjects with asthma, the small airways are dysfunctional (3), inflamed (4), and damaged (5). Several in vivo imaging approaches have been used to study the small airways, including hyperpolarized gas, magnetic resonance imaging, and computed tomography (CT) imaging (6,7). These studies have demonstrated that spatial disease in the small airways captured by both magnetic resonance imaging and CT of the lungs may be adequately reflected in more simple measures of small airway disease using the forced oscillation technique (FOT).…”

mentioning

confidence: 99%

Lung Computational Models and the Role of the Small Airways in Asthma

Foy

Soares

Bordas

et al. 2019

Am J Respir Crit Care Med

Self Cite

View full text Add to dashboard Cite

Rationale: Asthma is characterized by disease within the small airways. Several studies have suggested that forced oscillation technique-derived resistance at 5 Hz (R5) 2 resistance at 20 Hz (R20) is a measure of small airway disease; however, there has been limited validation of this measurement to date. Objectives: To validate the use of forced oscillation R5 2 R20 as a measure of small airway narrowing in asthma, and to investigate the role that small airway narrowing plays in asthma. Methods: Patient-based complete conducting airway models were generated from computed tomography scans to simulate the impact of different degrees of airway narrowing at different levels of the airway tree on forced oscillation R5 2 R20 (n = 31). The computational models were coupled with regression models in an asthmatic cohort (n = 177) to simulate the impact of small airway narrowing on asthma control and quality of life. The computational models were used to predict the impact on small airway narrowing of type-2 targeting biologics using pooled data from two similarly design randomized, placebo-controlled biologic trials (n = 137). Measurements and Main Results: Simulations demonstrated that narrowing of the small airways had a greater impact on R5 2 R20 than narrowing of the larger airways and was associated (above a threshold of approximately 40% narrowing) with marked deterioration in both asthma control and asthma quality of life, above the minimal clinical important difference. The observed treatment effect on R5 2 R20 in the pooled trials equated to a predicted small airway narrowing reversal of approximately 40%. Conclusions: We have demonstrated, using computational modeling, that forced oscillation R5 2 R20 is a direct measure of anatomical narrowing in the small airways and that small airway narrowing has a marked impact on both asthma control and quality of life and may be modified by biologics.

show abstract

“…Parametric response mapping (PRM) is a voxel-wise image analysis technique that was implemented on the CT scans. PRM data were analysed according to the methods described in the literature [12, 13].…”

mentioning

confidence: 99%

Assessing small airways dysfunction in asthma, asthma remission and healthy controls using particles in exhaled air

et al. 2019

Self Cite

View full text Add to dashboard Cite

Asthma is a chronic disease, characterised by variable airflow obstruction and airway inflammation [1]. Small airways are thought to be a major site of pathology in asthma [2, 3]. There are different tools to assess small airways dysfunction (SAD), such as spirometry, body plethysmography, impulse oscillometry (IOS), multiple-breath nitrogen washout (MBNW), alveolar fraction of exhaled nitric oxide (FENO) and gas trapping assessed by high-resolution computed tomography (CT). However, there is no golden standard and some tests are difficult to perform [2, 3].

show abstract

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

Cited by 36 publications

References 48 publications

Small airway dysfunction and poor asthma control: a dangerous liaison

Small airway dysfunction and poor asthma control: a dangerous liaison

Lung Computational Models and the Role of the Small Airways in Asthma

Assessing small airways dysfunction in asthma, asthma remission and healthy controls using particles in exhaled air

Contact Info

Product

Resources

About