Qualitative Analysis of High-Resolution CT Scans in Severe Asthma

Gupta, Sumit; Siddiqui, Salman; Haldar, Pranabashis; Raj, Vimal; Entwisle, James; Wardlaw, Andrew J.; Bradding, Peter; Pavord, Ian D.; Green, Ruth H.; Brightling, Christopher E.

doi:10.1378/chest.09-0174

Cited by 198 publications

(162 citation statements)

References 39 publications

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“…High resolution computed tomographic (HRCT) studies of airway structure are providing quantitative morphometry of the airways and distal lung in adults with severe asthma, but less is known in children [115][116][117][118]. In adults, there are relationships to lung function and more severe exacerbation-prone disease.…”

Section: Structural Abnormalitiesmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

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Section: Structural Abnormalitiesmentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

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“…The prevalence of bronchiectasis in patients with severe asthma is relatively high; with 25–40% of patients having radiological signs of bronchiectasis [91,92], compared to 3% in a population of generally milder asthma [93]. …”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

“…Bronchiectasis per se may cause obstructive airflow limitation [92], and is thus a also a differential diagnosis of asthma [95]. Furthermore, bronchiectasis increases the susceptibility to infections [95].…”

Section: Systematic Assessment Of Severe Asthmamentioning

confidence: 99%

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Porsbjerg

Ulrik

Skjold

et al. 2018

European Clinical Respiratory Journal

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Although a minority of asthma patients suffer from severe asthma, they represent a major clinical challenge in terms of poor symptom control despite high-dose treatment, risk of exacerbations, and side effects. Novel biological treatments may benefit patients with severe asthma, but are expensive, and are only effective in appropriately targeted patients. In some patients, symptoms are driven by other factors than asthma, and all patients with suspected severe asthma (‘difficult asthma’) should undergo systematic assessment, in order to differentiate between true severe asthma, and ‘difficult-to-treat’ patients, in whom poor control is related to factors such as poor adherence or co-morbidities. The Nordic Consensus Statement on severe asthma was developed by the Nordic Severe Asthma Network, consisting of members from Norway, Sweden, Finland, Denmark, Iceland and Estonia, including representatives from the respective national respiratory scientific societies with the aim to provide an overview and recommendations regarding the diagnosis, systematic assessment and management of severe asthma. Furthermore, the Consensus Statement proposes recommendations for the organization of severe asthma management in primary, secondary, and tertiary care.

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“…HRCT showed that the airway wall thickening was well correlated with thickening of the RBM as shown by bronchial biopsy, and thickening of the airway wall had a good correlation with the deterioration of pulmonary function. Gupta et al [22] found that HRCT scan abnormalities were present in 80% of subjects with severe asthma and often coexisted with bronchial wall thickening (62%), bronchiectasis (40%), and emphysema (8%). HRCT scans can reliably predict important bronchial wall changes.…”

Section: Discussionmentioning

confidence: 99%

Effects of formoterol-budesonide on airway remodeling in patients with moderate asthma

Wang

Liu

et al. 2010

Acta Pharmacol Sin

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Aim: To evaluate the effect of inhaled formoterol-budesonide on airway remodeling in adult patients with moderate asthma. Methods: Thirty asthmatic patients and thirty control subjects were enrolled. Asthmatic subjects used inhaled Symbicort 4.5/160 µg twice daily for one year. The effect of formoterol-budesonide on airway remodeling was assessed with comparing high-resolution computer tomography (HRCT) images of asthmatic patients and controls, as well as expression levels of cytokines and growth factors, inflammatory cell count in induced sputum, and airway hyper-responsiveness. Results: The differences in age and gender between the two groups were not significant. However, differences in FVC %pred, FEV 1 %pred, and PC 20 between the two groups were significant. After treatment with formoterol-budesonide, the asthma patients' symptoms were relieved, and their lung function was improved. The WT and WA% of HRCT images in patients with asthma was increased, whereas treatment with formoterol-budesonide caused these values to decrease. The expression of MMP-9, TIMP-1, and TGF-β 1 in induced sputum samples increased in patients with asthma and decreased dramatically after treatment with formoterol-budesonide. The WT and WA% are correlated with the expression levels of cytokines and growth factors, inflammatory cell count in induced sputum, and airway hyper-responsiveness, while these same values are correlated negatively with FEV 1 /FVC and FEV 1 %. Conclusion: Formoterol-budesonide might interfere in chronic inflammation and airway remodeling in asthmatic patients. HRCT can be used to effectively evaluate airway remodeling in asthmatic patients.

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Qualitative Analysis of High-Resolution CT Scans in Severe Asthma

Abstract: HRCT scan abnormalities are common in patients with severe asthma. Nonradiologic assessments fail to reliably predict important bronchial wall changes; therefore, CT scan acquisition may be required in all patients with severe asthma.

Cited by 198 publications

References 39 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

Effects of formoterol-budesonide on airway remodeling in patients with moderate asthma

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