Role of small airways in asthma: Investigation using high-resolution computed tomography

Ueda, Tetsuya; Niimi, Akio; Matsumoto, Hisako; Takemura, Masashi; Hirai, Toyohiro; Yamaguchi, Masafumi; Matsuoka, Hiroaki; Jinnai, Makiko; Muro, Shigeo; Chin, Kazuo

doi:10.1016/j.jaci.2006.07.032

Cited by 136 publications

(119 citation statements)

References 51 publications

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“…These authors reported that lung attenuation was significantly higher in asthmatics; interestingly, air trapping scores were higher after metacholine challenge, but air trapping only partially disappeared after salbutamol inhalation [59], suggesting that small airways constriction persisted. In another study, the percentage of lung field occupied by low attenuation area at inspiration showed some correlation with FEV1/FVC, suggesting an association between asthma severity and small airways [60]. Furthermore, MITSUNOBU et al [61] reported decreased CT lung density during asthma exacerbations.…”

Section: Imaging Techniques In the Evaluation Of Small Airways In Obsmentioning

confidence: 93%

The role of small airways in obstructive airway diseases: Figure 1.

Burgel¹

2011

Eur Respir Rev

196

139

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This review article is a summary of a seminar organised by the European Respiratory Society on ''The role of small airways in obstructive airway diseases'' which was held in October 2010 in Amsterdam, the Netherlands.The aims of the seminar were to identify important questions related to small airways involvement in asthma and chronic obstructive pulmonary disease (COPD), and to discuss future approaches based on current and evolving knowledge. Data obtained by pathological and physiological measurements in small airways and their relevance to clinical manifestations and therapeutics in asthma and COPD were reviewed.It was concluded that our knowledge on the roles of small airways in asthma and COPD is limited. Studies of large numbers of well-characterised subjects using multiple methods (genetic characterisation, cell biology and physiology, imaging) and integration of the data using mathematical models are suggested to be of interest. The availability of these techniques coupled with our ability to better target inhaled molecules to small airways provide a unique opportunity for a reappraisal of the relevance of small airways in chronic airway diseases.

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Section: Imaging Techniques In the Evaluation Of Small Airways In Obsmentioning

confidence: 93%

The role of small airways in obstructive airway diseases: Figure 1.

Burgel¹

2011

Eur Respir Rev

196

139

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“…UEDA et al [127] have shown that modifications of lung density at various pulmonary volumes correlated with abnormalities in distal airways and asthma severity. LEE et al [128] showed that centrilobular opacities were more prevalent among subjects with near-fatal asthma, and that these abnormalities were partially reversible after the successful control of asthma symptoms.…”

Section: Assessment Of Distal Airways In Asthma: Imaging High-resolutmentioning

confidence: 99%

Update on the roles of distal airways in asthma

Burgel¹,

Blic²,

Chanez³

et al. 2009

Eur Respir Rev

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The present review is the summary of an expert workshop that took place in Vence (France) in 2007 on the role of distal airways in asthma. The evidence showing inflammation and remodelling in distal airways, and their possible involvement in asthma control and natural history, was reviewed. The usefulness and limitations of various techniques used for assessing distal airways were also evaluated, including pulmonary function tests and imaging. Finally, the available data studying the benefit of treatment better targeting distal airways in asthma was examined. It was concluded that both proximal and distal airways were involved in asthma and that distal airways were the major determinant of airflow obstruction. Inflammation in distal airways appeared more intense in severe and uncontrolled asthma. Distal airways were poorly attained by conventional aerosol of asthma medications owing to their granulometry, being composed of 3-5 mm particles. Both proximal and distal airways might be targeted either by delivering medications systemically or by aerosol of extra-fine particles. Extra-fine aerosols of long-acting b-agonists, inhaled corticosteroids or inhaled corticosteroid/long-acting b-agonist combinations have been shown in short-term studies to be not inferior to non-extra-fine aerosols of comparators. However, available studies have not yet demonstrated that extra-fine inhaled medications offer increased benefit compared with usual aerosols in asthmatic patients.

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“…Regional mosaics of reduced parenchymal density, apparently due to air trapping, are associated with asthma on computed tomography (CT) (8). More recently CT, and especially multi-detector CT (MDCT), have been used to quantitatively measure lung parenchymal density and correlate these measures to obstructive physiology (9,10).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Structure-Function Relationships in Asthma using Multidetector CT and Hyperpolarized He-3 MRI

et al. 2008

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Rationale and Objectives-While multiple detector CT (MDCT) and hyperpolarized gas MRI (HP MRI) have demonstrated ability to detect structural and ventilation abnormalities in asthma, few studies have sought to exploit or cross-validate the regional information provided by these techniques. The purpose of this work is to assess regional disease in asthma by evaluating the association of sites of ventilation defect on HP MRI with other regional markers of airway disease, including air trapping on MDCT and inflammatory markers on bronchoscopy.Materials and Methods-Both HP MRI using helium-3 and MDCT were acquired in the same patients. Supervised segmentation of the lung lobes on MRI and MDCT facilitated regional comparisons of ventilation abnormalities in the lung parenchyma. The percentage of spatial overlap was evaluated between regions of ventilation defect on HP MRI and hyperlucency on MDCT to determine associations between obstruction and likely regions of gas trapping.. Similarly, lung lobes with high defect volume were compared to lobes with low defect volume for differences in inflammatory cell number and percentage using bronchoscopic assessment.Results-There was significant overlap between sites of ventilation defect on HP MRI and hyperlucency on MDCT suggesting that sites of airway obstruction and air trapping are associated in asthma. The percent (r = 0.68; p = 0.0039) and absolute (r = 0.61; p = 0.0125) number of neutrophils on bronchoalveolar lavage (BAL) for the sampled lung lobe also directly correlated with increased defect volume.Conclusion-These results show promise for using image guidance to assess specific regions of ventilation defect or air trapping in heterogeneous obstructive lung diseases such as asthma.

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Role of small airways in asthma: Investigation using high-resolution computed tomography

Abstract: Small airways are an important therapeutic target in asthma.

Cited by 136 publications

References 51 publications

The role of small airways in obstructive airway diseases: Figure 1.

The role of small airways in obstructive airway diseases: Figure 1.

Update on the roles of distal airways in asthma

Evaluation of Structure-Function Relationships in Asthma using Multidetector CT and Hyperpolarized He-3 MRI

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