Functional CT imaging for identification of the spatial determinants of small-airways disease in adults with asthma
| Autor: | Matthew Richardson, Salman Siddiqui, Alexander N. Gorban, Brody H. Foy, Amisha Singapuri, Evgeny M. Mirkes, Christopher E. Brightling, David Kay, Maarten van den Berge, Craig J. Galbán, Alexander J. Bell |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Vital capacity Vital Capacity Immunology 030204 cardiovascular system & hematology 03 medical and health sciences FEV1/FVC ratio SCANS 0302 clinical medicine Functional residual capacity Forced Expiratory Volume Internal medicine PERFUSION medicine COPD Humans Immunology and Allergy Lung volumes Lung visualization Aged Asthma STATEMENT business.industry small-airways physiology imaging computed tomography STANDARDIZATION Middle Aged medicine.disease Bronchodilator Agents LUNG-FUNCTION Impulse Oscillometry 030228 respiratory system VENTILATION HETEROGENEITY Breathing Cardiology biomarker Tomography X-Ray Computed business parametric response mapping RESISTANCE |
| Zdroj: | Journal of Allergy and Clinical Immunology, 144(1), 83-93. MOSBY-ELSEVIER |
| ISSN: | 0091-6749 |
| DOI: | 10.1016/j.jaci.2019.01.014 |
| Popis: | Background: Asthma is a disease characterized by ventilation heterogeneity (VH). A number of studies have demonstrated that VH markers derived by using impulse oscillometry (IOS) or multiple-breath washout (MBW) are associated with key asthmatic patient related outcome measures and airways hyperresponsiveness. However, the topographical mechanisms of VH in the lung remain poorly understood.Objectives: We hypothesized that specific regionalization of topographical small-airway disease would best account for IOS- and MBW-measured indices in patients.Methods: We evaluated the results of paired expiratory/inspiratory computed tomography in a cohort of asthmatic (n = 41) and healthy (n = 11) volunteers to understand the determinants of clinical VH indices commonly reported by using IOS and MBW. Parametric response mapping (PRM) was used to calculate the functional small-airways disease marker PRMfSAD and Hounsfield unit (HU)-based density changes from total lung capacity to functional residual capacity (Delta HU); gradients of Delta HU in gravitationally perpendicular (parallel) inferior-superior (anterior-posterior) axes were quantified.Results: The Delta HU gradient in the inferior-superior axis provided the highest level of discrimination of both acinar VH (measured by using phase 3 slope analysis of multiple-breath washout data) and resistance at 5 Hz minus resistance at 20 Hz measured by using impulse oscillometry (R5-R20) values. Patients with a high inferior-superior Delta HU gradient demonstrated evidence of reduced specific ventilation in the lower lobes of the lungs and high levels of PRMfSAD. A computational small-airway tree model confirmed that constriction of gravitationally dependent, lower-zone, small airway branches would promote the largest increases in R5-R20 values. Ventilation gradients correlated with asthma control and quality of life but not with exacerbation frequency.Conclusions: Lower lobe predominant small-airways disease is a major driver of clinically measured VH in adults with asthma. |
| Databáze: | OpenAIRE |
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