Quantitative CT Metrics for the Prediction of Therapeutic Effect in Asthma

Abstract

Background: Few studies have explored the correlation between asthma medication and features on HRCT images. We aim to analyse the differences and temporal changes of lung function and airway resistance in asthma with diverse HRCT phenotypes in a short period after inhalation of budesonide/formoterol. Method: This observational study recruited 55 adult patients with varying severities of asthma. We performed detailed airway metrics measurements of chest CT scans, such as airway wall thickness (WT), wall area percentage (WA%), wall thickness percentage (T/OR), and airways with an inner perimeter of 10 mm (Pi10). The effect of lung structural features on asthma medication response was explored according to the WA% and T/OR twelve hours post-drug administration. Using multivariable regression models, we then assessed the influence of WA% on lung function. Results: WA% (p < 0.001) and T/OR (p < 0.001) significantly increased in asthma than in healthy control subjects. Compared to mild asthma, airway walls were further thickened (WA%, p = 0.023; T/OR: p = 0.029) and associated with lumen narrowing (Pi10, p = 0.055) in moderate to severe asthma. WA% and T/OR correlated well with lung function (FEV1, FVC, MMEF, and PEF) and airway resistance (R5, R20, Rp, and Fres). Regression analysis showed that MEF25 decreased with increasing age and WA% (R2 = 0.58, p < 0.001). Patients with thickened airway walls experienced a maximal increase in FVC, FEV1, and PEF at 2 h (p < 0.001) and a maximal decrease of R5, Z5, and Rp at 2 h (p < 0.001) in those with a thickened airway pattern. Conclusions: Asthma patients with different bronchial wall thicknesses exhibited variable lung function changes. Specifically, patients with thick airway wall patterns were more sensitive to inhaled budesonide in the short term.

Utilizing chest CT to assess the impact of omalizumab treatment on airway remodeling in refractory asthma

“…HRCT scans of the chest can display the ratio of bronchial wall thickness to bronchial diameter, which is associated with subepithelial brosis in bronchial pathology [28]. Previous research has found that asthma patients exhibit an increased ratio of bronchial wall thickness to outer diameter compared to normal individuals, allowing a more visual and intuitive display of airway remodeling levels [11].…”

“…This study utilized imaging software, 3D Slicer [11], to reconstruct the bronchial wall structure and automatically measure bronchial wall parameters. A comparative analysis was performed to investigate the changes in bronchial wall thickness, bronchial lumen area, and other related parameters in asthma patients before and after treatment with omalizumab.…”