Severe Asthma Phenotypes Classified by Site of Airway Involvement and Remodeling via Chest CT Scan

Abstract

Depending on the site of airway involvement and remodeling pattern, 3 different structural types can be distinguished in chest CT findings from patients with severe asthma. Remodeling in large-to-medium sized airways revealed an association with systemic eosinophilic inflammation in patients with severe asthma.

Airway Remodeling in Asthma

“…However, this association was not reproduced in a pediatric severe asthma cohort undergoing endobronchial biopsy (48) in spite of consistent identification of bronchial wall thickening on CT in cohorts of children with difficult-to-treat asthma (49). Regardless, CT imaging is now increasingly used to assess airway remodeling in adult asthmatics (50)(51)(52).…”

“…When unbiased clustering of CT airway wall thickness or airway lumen thickness was applied to an adult asthma cohort, all asthma patients manifested air trapping but one cluster with less air trapping and lacking changes consistent with airway remodeling correlated with clinically mild disease (59). Two other cohorts of adult onset asthmatics with severe disease were found to contain a subpopulation (25-30%) lacking both eosinophilic inflammation and airway remodeling (24,50). Unbiased clustering analysis has also revealed an adult severe asthma population, identified as "paucigranulocytic" asthma, with airway remodeling in the absence of airway inflammation (28,29,60).…”

Asthma exacerbation related to viral infections: An up to date summary

“…Viral infections cause exacerbations via multiple mechanisms which include: The enhanced responsiveness of the respiratory tract, the increased eosinophilic inflammation of the airway, the enhanced lower airway neutrophilic inflammation, and the direct lower airway infection. [4754555657585960616263646566676869] Asthma exacerbation was described by Szefler[70] as a volcano explosion from accumulation of airflow obstruction, hyper-responsiveness and inflammation that results from vial respiratory tract infections.…”

Treating “Asthma” With A Scalpel: Achalasia Mimicking Asthma

“…TTC37 deficiency is included in the "predominantly antibody deficiency" group of the IUIS-2017 phenotypic classification of primary immunodeficiency disorders [1,2]. We report the case of a patient with recurrent infections and pyoderma gangrenosum-like lesions.…”

“…When asthma remains partially controlled or even uncontrolled despite qualified treatment, experts stress the need to verify the diagnosis and rule out conditions that can mimic asthma [1,2]. According to some reports, misdiagnosis of nonasthmatic conditions treated as uncontrolled asthma is as frequent as 12%-30%; hence, a certain degree of skepticism is recommended [3].…”