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Lu D, Yu H, Chen L, Lin J, Chen S, Huang Y. Differences in the Quantitative HRCT Characteristics of Patients with Asthma, COPD and Asthma-COPD Overlap and Their Relationships with Pulmonary Function. Int J Chron Obstruct Pulmon Dis 2024; 19:1775-1789. [PMID: 39104543 PMCID: PMC11299721 DOI: 10.2147/copd.s469956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
Purpose We compared pulmonary function indices and quantitative CT parameters of airway remodeling, air trapping, and emphysema in asthmatic patients and patients with COPD and asthma-COPD overlap (ACO) and explored their relationships with airflow limitation. Patients and Methods Patients with asthma (n=48), COPD (n=52), and ACO (n=30) and controls (n=54) who completed pulmonary function tests and HRCT scans were retrospectively enrolled in our study. Quantitative CT analysis software was used to assess emphysema (LAA%), airway wall dimensions (wall area (WA), luminal area (LA), and wall area percentage (WA%)), and air trapping ((relative volume change of -860 HU to -950 HU (RVC-860 to-950) and the expiration-to-inspiration ratio of the mean lung density (MLDE/I))). Differences in pulmonary function and HRCT parameters were compared among the groups. Spearman correlation analysis and regression analysis were utilized to explore structure‒function relationships. Results The LAA% in COPD and ACO patients was significantly greater than that in asthmatic patients and controls. The WA% and WA in COPD and ACO patients were greater than those in controls, whereas the WA% and LA between asthmatic patients and controls reached statistical significance. The RVC-860 to -950 levels decreased in the following order: ACO, COPD, and asthma. RVC-860 to -950 independently predicted FEV1% in asthmatic patients; LAA% and MLDE/I in COPD patients; and LAA%, WA% and RVC-860 to -950 in ACO patients. Conclusion Comparable emphysema was observed in patients with COPD and ACO but not in asthmatic patients. All patients exhibited proximal airway remodeling. The bronchi were thickened outward in COPD and ACO patients but are thickened inward in asthmatic patients. Furthermore, air trapping in ACO patients was the most severe among all the groups. Indirect lung densitometry measurements might be more predictive of the degree of airflow limitation than direct airway measurements in obstructive airway diseases.
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Affiliation(s)
- Dongzhu Lu
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, People’s Republic of China
| | - Huapeng Yu
- Department of Respiratory Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, People’s Republic of China
| | - Lichang Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jinlan Lin
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, People’s Republic of China
| | - Shijie Chen
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, People’s Republic of China
| | - Yunjian Huang
- Department of Thoracic Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, People’s Republic of China
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2
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Flynn C, Brightling C. Picture this: The future of imaging biomarkers in COPD. Respirology 2024. [PMID: 39089710 DOI: 10.1111/resp.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
See related article
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Affiliation(s)
- Cara Flynn
- Institute for Lung Health, NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Chris Brightling
- Institute for Lung Health, NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
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3
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Baglivo I, Quaranta VN, Dragonieri S, Colantuono S, Menzella F, Selvaggio D, Carpagnano GE, Caruso C. The New Paradigm: The Role of Proteins and Triggers in the Evolution of Allergic Asthma. Int J Mol Sci 2024; 25:5747. [PMID: 38891935 PMCID: PMC11171572 DOI: 10.3390/ijms25115747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Epithelial barrier damage plays a central role in the development and maintenance of allergic inflammation. Rises in the epithelial barrier permeability of airways alter tissue homeostasis and allow the penetration of allergens and other external agents. Different factors contribute to barrier impairment, such as eosinophilic infiltration and allergen protease action-eosinophilic cationic proteins' effects and allergens' proteolytic activity both contribute significantly to epithelial damage. In the airways, allergen proteases degrade the epithelial junctional proteins, allowing allergen penetration and its uptake by dendritic cells. This increase in allergen-immune system interaction induces the release of alarmins and the activation of type 2 inflammatory pathways, causing or worsening the main symptoms at the skin, bowel, and respiratory levels. We aim to highlight the molecular mechanisms underlying allergenic protease-induced epithelial barrier damage and the role of immune response in allergic asthma onset, maintenance, and progression. Moreover, we will explore potential clinical and radiological biomarkers of airway remodeling in allergic asthma patients.
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Affiliation(s)
- Ilaria Baglivo
- Centro Malattie Apparato Digerente (CEMAD) Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Vitaliano Nicola Quaranta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70121 Bari, Italy (S.D.)
| | - Silvano Dragonieri
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70121 Bari, Italy (S.D.)
| | - Stefania Colantuono
- Unità Operativa Semplice Dipartimentale Day Hospital (UOSD DH) Medicina Interna e Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital-AULSS2 Marca Trevigiana, 31100 Treviso, Italy
| | - David Selvaggio
- UOS di Malattie dell’Apparato Respiratorio Ospedale Cristo Re, 00167 Roma, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70121 Bari, Italy (S.D.)
| | - Cristiano Caruso
- Unità Operativa Semplice Dipartimentale Day Hospital (UOSD DH) Medicina Interna e Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Hoshino M, Akitsu K, Ohtawa J, Kubota K. Long-term efficacy of house dust mite sublingual immunotherapy on clinical and pulmonary function in patients with asthma and allergic rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100206. [PMID: 38328802 PMCID: PMC10847160 DOI: 10.1016/j.jacig.2024.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 02/09/2024]
Abstract
Background A previous study reported that house dust mite (HDM) sublingual immunotherapy (SLIT) for 48 weeks was effective as add-on treatment for allergic asthma; however, data regarding its long-term efficacy are scarce. Objective We sought to evaluate the effect of HDM SLIT on asthma control, pulmonary function, and airway inflammation and remodeling throughout the 5-year treatment period. Methods A total of 140 patients with asthma and allergic rhinitis sensitized to HDM were randomized to receive either drugs alone or drugs plus SLIT for 5 years. The 5-item Asthma Control Questionnaire (ACQ-5), Asthma Quality of Life Questionnaire (AQLQ), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), spirometry, quantitative computed tomography, and type 2 biomarkers were assessed. Results An improvement in the ACQ-5, AQLQ, and RQLQ scores was observed in the SLIT group compared with the control group. HDM SLIT increased lung function and reduced the percentage of airway wall area. The levels of fractional exhaled nitric oxide (Feno), blood eosinophil, serum specific IgE for HDM, and total IgE decreased and were sustained during the 5 years. The change in type 2 biomarkers correlated with change in the AQLQ score. On the basis of receiver-operating characteristic analysis for predicting responders, the area under the receiver-operating characteristic curve in FEV1% predicted, airway wall area, Feno, and specific IgE was high. Multivariate regression analysis showed that the strongest predictor of responders was Feno. Conclusions HDM SLIT continued to provide sustained efficacy, improve lung function, and prevent progression of airway inflammation and remodeling in asthma throughout the 5-year treatment period.
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Affiliation(s)
- Makoto Hoshino
- Division of Clinical Allergy, Department of Internal Medicine, Atami Hospital, International University of Health and Welfare, Atami, Japan
| | - Kenta Akitsu
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
| | - Junichi Ohtawa
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
| | - Kengo Kubota
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
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5
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Varricchi G, Brightling CE, Grainge C, Lambrecht BN, Chanez P. Airway remodelling in asthma and the epithelium: on the edge of a new era. Eur Respir J 2024; 63:2301619. [PMID: 38609094 PMCID: PMC11024394 DOI: 10.1183/13993003.01619-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/15/2024] [Indexed: 04/14/2024]
Abstract
Asthma is a chronic, heterogeneous disease of the airways, often characterised by structural changes known collectively as airway remodelling. In response to environmental insults, including pathogens, allergens and pollutants, the epithelium can initiate remodelling via an inflammatory cascade involving a variety of mediators that have downstream effects on both structural and immune cells. These mediators include the epithelial cytokines thymic stromal lymphopoietin, interleukin (IL)-33 and IL-25, which facilitate airway remodelling through cross-talk between epithelial cells and fibroblasts, and between mast cells and airway smooth muscle cells, as well as through signalling with immune cells such as macrophages. The epithelium can also initiate airway remodelling independently of inflammation in response to the mechanical stress present during bronchoconstriction. Furthermore, genetic and epigenetic alterations to epithelial components are believed to influence remodelling. Here, we review recent advances in our understanding of the roles of the epithelium and epithelial cytokines in driving airway remodelling, facilitated by developments in genetic sequencing and imaging techniques. We also explore how new and existing therapeutics that target the epithelium and epithelial cytokines could modify airway remodelling.
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Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), School of Medicine, University of Naples Federico II, WAO Center of Excellence, Naples, Italy
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
- G. Varricchi and C.E. Brightling contributed equally
| | - Christopher E. Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- G. Varricchi and C.E. Brightling contributed equally
| | - Christopher Grainge
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Bart N. Lambrecht
- Center for Inflammation Research, Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Ghent, Belgium
| | - Pascal Chanez
- Department of Respiratory Diseases, Aix-Marseille University, Marseille, France
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6
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Choe J, Choi HY, Lee SM, Oh SY, Hwang HJ, Kim N, Yun J, Lee JS, Oh YM, Yu D, Kim B, Seo JB. Evaluation of retrieval accuracy and visual similarity in content-based image retrieval of chest CT for obstructive lung disease. Sci Rep 2024; 14:4587. [PMID: 38403628 PMCID: PMC10894863 DOI: 10.1038/s41598-024-54954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
The aim of our study was to assess the performance of content-based image retrieval (CBIR) for similar chest computed tomography (CT) in obstructive lung disease. This retrospective study included patients with obstructive lung disease who underwent volumetric chest CT scans. The CBIR database included 600 chest CT scans from 541 patients. To assess the system performance, follow-up chest CT scans of 50 patients were evaluated as query cases, which showed the stability of the CT findings between baseline and follow-up chest CT, as confirmed by thoracic radiologists. The CBIR system retrieved the top five similar CT scans for each query case from the database by quantifying and comparing emphysema extent and size, airway wall thickness, and peripheral pulmonary vasculatures in descending order from the database. The rates of retrieval of the same pairs of query CT scans in the top 1-5 retrievals were assessed. Two expert chest radiologists evaluated the visual similarities between the query and retrieved CT scans using a five-point scale grading system. The rates of retrieving the same pairs of query CTs were 60.0% (30/50) and 68.0% (34/50) for top-three and top-five retrievals. Radiologists rated 64.8% (95% confidence interval 58.8-70.4) of the retrieved CT scans with a visual similarity score of four or five and at least one case scored five points in 74% (74/100) of all query cases. The proposed CBIR system for obstructive lung disease integrating quantitative CT measures demonstrated potential for retrieving chest CT scans with similar imaging phenotypes. Further refinement and validation in this field would be valuable.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
| | - Hye Young Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine Kyung, Hee University, Seoul, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea.
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
| | - Hye Jeon Hwang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
- Department of Convergence Medicine, Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihye Yun
- Department of Convergence Medicine, Biomedical Engineering Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, 05505, Seoul, Korea
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7
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Zhang W, Zhao Y, Tian Y, Liang X, Piao C. Early Diagnosis of High-Risk Chronic Obstructive Pulmonary Disease Based on Quantitative High-Resolution Computed Tomography Measurements. Int J Chron Obstruct Pulmon Dis 2023; 18:3099-3114. [PMID: 38162987 PMCID: PMC10757779 DOI: 10.2147/copd.s436803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose Quantitative computed tomography (QCT) techniques, focusing on airway anatomy and emphysema, may help to detect early structural changes of COPD disease. This retrospective study aims to identify high-risk COPD participants by using QCT measurements. Patients and Methods We enrolled 140 participants from the Second Affiliated Hospital of Shenyang Medical College who completed inspiratory high-resolution CT scans, pulmonary function tests (PFTs), and clinical characteristics recorded. They were diagnosed Non-COPD by PFT value of FEV1/FVC >70% and divided into two groups according percentage predicted FEV1 (FEV1%), low-risk COPD group: FEV1% ≥ 95%, high-risk group: 80% < FEV1% < 95%. The QCT measurements were analyzed by the Student's t-test (or Mann-Whitney U-test) method. Then, feature candidates were identified using the LASSO method. Meanwhile, the correlation between QCT measurements and PFTs was assessed by the Spearman rank correlation test. Furthermore, support vector machine (SVM) was performed to identify high-risk COPD participants. The performance of the models was evaluated in terms of accuracy (ACC), sensitivity (SEN), specificity (SPE), F1-score, and area under the ROC curve (AUC), with p <0.05 considered statistically significant. Results The SVM based on QCT measurements achieved good performance in identifying high-risk COPD patients with 85.71% of ACC, 88.34% of SEN, 84.00% of SPE, 83.33% of F1-score, and 0.93 of AUC. Further, QCT measurements integration of clinical data improved the performance with an ACC of 90.48%. The emphysema index (%LAA-950) of left lower lung was negatively correlated with PFTs (P < 0.001). The airway anatomy indexes of lumen diameter (LD) were correlated with PFTs. Conclusion QCT measurements combined with clinical information could provide an effective tool for an early diagnosis of high-risk COPD. The QCT indexes can be used to assess the pulmonary function status of high-risk COPD.
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Affiliation(s)
- Wenxiu Zhang
- Institute of Research and Clinical Innovations, Neusoft Medical Systems Co, Ltd, Shanghai, People’s Republic of China
| | - Yu Zhao
- Radiology Department, Second Affiliated Hospital of Shenyang Medical College, Shenyang, Liaoning, People’s Republic of China
| | - Yuchi Tian
- Institute of Research and Clinical Innovations, Neusoft Medical Systems Co, Ltd, Shanghai, People’s Republic of China
| | - Xiaoyun Liang
- Institute of Research and Clinical Innovations, Neusoft Medical Systems Co, Ltd, Shanghai, People’s Republic of China
| | - Chenghao Piao
- Radiology Department, Second Affiliated Hospital of Shenyang Medical College, Shenyang, Liaoning, People’s Republic of China
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8
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Siddiqui S, Bachert C, Bjermer L, Buchheit KM, Castro M, Qin Y, Rupani H, Sagara H, Howarth P, Taillé C. Eosinophils and tissue remodeling: Relevance to airway disease. J Allergy Clin Immunol 2023; 152:841-857. [PMID: 37343842 DOI: 10.1016/j.jaci.2023.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
The ability of human tissue to reorganize and restore its existing structure underlies tissue homeostasis in the healthy airways, but in disease can persist without normal resolution, leading to an altered airway structure. Eosinophils play a cardinal role in airway remodeling both in health and disease, driving epithelial homeostasis and extracellular matrix turnover. Physiological consequences associated with eosinophil-driven remodeling include impaired lung function and reduced bronchodilator reversibility in asthma, and obstructed airflow in chronic rhinosinusitis with nasal polyps. Given the contribution of airway remodeling to the development and persistence of symptoms in airways disease, targeting remodeling is an important therapeutic consideration. Indeed, there is early evidence that eosinophil attenuation may reduce remodeling and disease progression in asthma. This review provides an overview of tissue remodeling in both health and airway disease with a particular focus on eosinophilic asthma and chronic rhinosinusitis with nasal polyps, as well as the role of eosinophils in these processes and the implications for therapeutic interventions. Areas for future research are also noted, to help improve our understanding of the homeostatic and pathological roles of eosinophils in tissue remodeling, which should aid the development of targeted and effective treatments for eosinophilic diseases of the airways.
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Affiliation(s)
- Salman Siddiqui
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Claus Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Münster, Münster, Germany; First Affiliated Hospital, Sun Yat-Sen University, International Airway Research Center, Guangzhou, China; Division of Ear, Nose, and Throat Diseases, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden; Upper Airways Research Laboratory, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Leif Bjermer
- Department of Clinical Sciences, Respiratory Medicine, and Allergology, Lund University, Lund, Sweden
| | - Kathleen M Buchheit
- Jeff and Penny Vinik Center for Allergic Diseases Research, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass
| | - Mario Castro
- Division of Pulmonary, Critical Care Medicine, University of Kansas School of Medicine, Kansas City, NC
| | - Yimin Qin
- Global Medical Affairs, Global Specialty and Primary Care, GlaxoSmithKline, Research Triangle Park, NC
| | - Hitasha Rupani
- Department of Respiratory Medicine, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University, School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Peter Howarth
- Global Medical, Global Specialty and Primary Care, GlaxoSmithKline, Brentford, Middlesex, United Kingdom
| | - Camille Taillé
- Pneumology Department, Reference Center for Rare Pulmonary Diseases, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unit 1152, University of Paris Cité, Paris, France
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Pompe E, Kwee AK, Tejwani V, Siddharthan T, Mohamed Hoesein FA. Imaging-derived biomarkers in Asthma: Current status and future perspectives. Respir Med 2023; 208:107130. [PMID: 36702169 DOI: 10.1016/j.rmed.2023.107130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023]
Abstract
Asthma is a common disorder affecting around 315 million individuals worldwide. The heterogeneity of asthma is becoming increasingly important in the era of personalized treatment and response assessment. Several radiological imaging modalities are available in asthma including chest x-ray, computed tomography (CT) and magnetic resonance imaging (MRI) scanning. In addition to qualitative imaging, quantitative imaging could play an important role in asthma imaging to identify phenotypes with distinct disease course and response to therapy, including biologics. MRI in asthma is mainly performed in research settings given cost, technical challenges, and there is a need for standardization. Imaging analysis applications of artificial intelligence (AI) to subclassify asthma using image analysis have demonstrated initial feasibility, though additional work is necessary to inform the role of AI in clinical practice.
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Affiliation(s)
- Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Anastasia Kal Kwee
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Trishul Siddharthan
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami (TS), USA.
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Marshall H, Wild JM, Smith LJ, Hardaker L, Fihn-Wikander T, Müllerová H, Hughes R. Functional imaging in asthma and COPD: design of the NOVELTY ADPro substudy. ERJ Open Res 2023; 9:00344-2022. [PMID: 37020837 PMCID: PMC10068571 DOI: 10.1183/23120541.00344-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/17/2022] [Indexed: 01/27/2023] Open
Abstract
The NOVEL observational longiTudinal studY (NOVELTY; ClinicalTrials.gov identifier NCT02760329) is a global, prospective, observational study of ∼12 000 patients with a diagnosis of asthma and/or COPD. Here, we describe the design of the Advanced Diagnostic Profiling (ADPro) substudy of NOVELTY being conducted in a subset of ∼180 patients recruited from two primary care sites in York, UK. ADPro is employing a combination of novel functional imaging and physiological and metabolic modalities to explore structural and functional changes in the lungs, and their association with different phenotypes and endotypes. Patients participating in the ADPro substudy will attend two visits at the University of Sheffield, UK, 12±2 months apart, at which they will undergo imaging and physiological lung function testing. The primary end-points are the distributions of whole lung functional and morphological measurements assessed with xenon-129 magnetic resonance imaging, including ventilation, gas transfer and airway microstructural indices. Physiological assessments of pulmonary function include spirometry, bronchodilator reversibility, static lung volumes via body plethysmography, transfer factor of the lung for carbon monoxide, multiple-breath nitrogen washout and airway oscillometry. Fractional exhaled nitric oxide will be measured as a marker of type-2 airways inflammation. Regional and global assessment of lung function using these techniques will enable more precise phenotyping of patients with physician-assigned asthma and/or COPD. These techniques will be assessed for their sensitivity to markers of early disease progression.
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Affiliation(s)
- Helen Marshall
- POLARIS, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M. Wild
- POLARIS, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J. Smith
- POLARIS, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Titti Fihn-Wikander
- Evidence Delivery, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Hana Müllerová
- Respiratory and Immunology, Medical and Payer Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Rod Hughes
- External Scientific Engagement, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
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Kim JH, Shin KE, Chang HS, Lee JU, Park SL, Park JS, Park JS, Park CS. Relationships Between High-Resolution Computed Tomographic Features and Lung Function Trajectory in Patients With Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:174-185. [PMID: 37021504 PMCID: PMC10079522 DOI: 10.4168/aair.2023.15.2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 04/07/2023]
Abstract
PURPOSE A subset of asthmatics suffers from persistent airflow limitation, known as remodeled asthma, despite optimal treatment. Typical quantitative scoring methods to evaluate structural changes of airway remodeling on high-resolution computed tomography (HRCT) are time-consuming and laborious. Thus, easier and simpler methods are required in clinical practice. We evaluated the clinical usefulness of a simple, semi-quantitative method based on 8 HRCT parameters by comparing asthmatics with a persistent decline of post-bronchodilator (BD)-FEV1 to those with a BD-FEV1 that normalized over time and evaluated the relationships of the parameters with BD-FEV1. METHODS Asthmatics (n = 59) were grouped into 5 trajectories (Trs) according to the changes of BD-FEV1 over 1 year. After 9-12 months of guideline-based treatment, HRCT parameters including emphysema, bronchiectasis, anthracofibrosis, bronchial wall thickening (BWT), fibrotic bands, mosaic attenuation on inspiration, air-trapping on expiration, and centrilobular nodules were classified as present (1) or absent (0) in 6 zones. RESULTS The Tr5 group (n = 11) was older and exhibited a persistent decline in BD-FEV1. The Tr5 and Tr4 groups (n = 12), who had a lower baseline BD-FEV1 that normalized over time, had longer durations of asthma, frequent exacerbations, and higher doses of steroid use compared to the Tr1-3 groups (n = 36), who had a normal baseline BD-FEV1. The Tr5 group had higher emphysema and BWT scores than the Tr4 (P = 8.25E-04 and P = 0.044, respectively). Scores for the other 6 parameters were not significantly different among the Tr groups. BD-FEV1 was inversely correlated with the emphysema and BWT scores in multivariate analysis (P = 1.70E-04, P = 0.006, respectively). CONCLUSIONS Emphysema and BWT are associated with airway remodeling in asthmatics. Our simple, semi-quantitative scoring system based on HRCT may be an easy-to-use method for estimating airflow limitation.
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Affiliation(s)
- Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Eun Shin
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hun Soo Chang
- Department of Anatomy and BK21 FOUR Project, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong-Uk Lee
- Department of Interdisciplinary Program in Biomedical Science Major, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung-Lee Park
- Department of Interdisciplinary Program in Biomedical Science Major, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jai Soung Park
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong Sook Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Choon-Sik Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
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12
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Lin H, Li H. How does cigarette smoking affect airway remodeling in asthmatics? Tob Induc Dis 2023; 21:13. [PMID: 36741543 PMCID: PMC9881586 DOI: 10.18332/tid/156047] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/07/2022] [Accepted: 10/25/2022] [Indexed: 01/30/2023] Open
Abstract
Asthma is a prevalent chronic airway inflammatory disease involving multiple cells, and the prolonged course of the disease can cause airway remodeling, resulting in irreversible or partial irreversible airflow limitation and persistent airway hyperresponsiveness (AHR) in asthmatics. Therefore, we must ascertain the factors that affect the occurrence and development of airway remodeling in asthmatics. Smokers are not uncommon in asthmatics. However, there is no systematic description of how smoking promotes airway remodeling in asthmatics. This narrative review summarizes the effects of smoking on airway remodeling in asthmatics, and the progress of the methods for evaluating airway remodeling.
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Affiliation(s)
- Huihui Lin
- Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Hequan Li
- Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
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13
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Lu D, Yu Q, Chen L, Liao Q, Lan J, Chen SB, Wang C, Zeng W, Wu L, Fan C, Lu P, Yu H. HRCT quantitative analysis of airway remodeling and airway trapping in the small airway asthma phenotype and its correlation with pulmonary function. J Asthma 2023; 60:32-42. [PMID: 34962447 DOI: 10.1080/02770903.2021.2023821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We aimed to explore whether large airway remodeling and small airway structural changes exist in subjects with small airway asthma phenotype and to evaluate the relationships between quantitative high-resolution computed tomography (qHRCT) parameters and lung function. METHODS We enrolled 15 subjects with small airway asthma phenotype and 18 healthy controls. The two groups were matched by age, sex and body square area (BSA) with propensity score matching (PSM). Pulmonary function and qHRCT parameters [wall thickness (WT), wall area (WA), lumen area (LA), wall area percentage (WA%) of the 4th-6th generations in the right upper lobe apical segmental bronchus (RB1), adjusted by BSA, WT/BSA, WA/BSA, and LA/BSA, relative volume change -860 HU to -950 HU (RVC-860 to -950) and the expiration to inspiration ratio of mean lung density (MLDE/I)) were compared between the groups. Correlation analysis was employed to assess the relationship between qHRCT parameters and pulmonary function. RESULTS The small airway asthma phenotype had significantly higher WA%, RVC-860 to -950 and MLDE/I and lower LA/BSA than the healthy control. Additionally, we found moderate to strong correlations between impulse oscillation (IOS) indices and WA6% and WT6/BSA. No significant correlation was found between bronchial parameters and air trapping parameters (p > 0.05). CONCLUSIONS Combining physiological tests with imaging approaches can lead to better evaluation of small airway disfunction (SAD) in asthmatic patients. Additionally, despite nonexistent airflow obstruction in patients with small airway asthma phenotype, large airway remodeling and small airway structural changes may appear simultaneously in the early stage of disease.
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Affiliation(s)
- Dongzhu Lu
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qing Yu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lichang Chen
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qiannuan Liao
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Junkang Lan
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shu-Bing Chen
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Cuilan Wang
- Department of Pulmonary and Critical Medicine, Shenzhen Hospital of Southern Medical University, Southern Medical University, Shenzhen, China
| | - Wenyi Zeng
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lingling Wu
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chaofan Fan
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peifeng Lu
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Huapeng Yu
- Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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14
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Varricchi G, Ferri S, Pepys J, Poto R, Spadaro G, Nappi E, Paoletti G, Virchow JC, Heffler E, Canonica WG. Biologics and airway remodeling in severe asthma. Allergy 2022; 77:3538-3552. [PMID: 35950646 PMCID: PMC10087445 DOI: 10.1111/all.15473] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
Asthma is a chronic inflammatory airway disease resulting in airflow obstruction, which in part can become irreversible to conventional therapies, defining the concept of airway remodeling. The introduction of biologics in severe asthma has led in some patients to the complete normalization of previously considered irreversible airflow obstruction. This highlights the need to distinguish a "fixed" airflow obstruction due to structural changes unresponsive to current therapies, from a "reversible" one as demonstrated by lung function normalization during biological therapies not previously obtained even with high-dose systemic glucocorticoids. The mechanisms by which exposure to environmental factors initiates the inflammatory responses that trigger airway remodeling are still incompletely understood. Alarmins represent epithelial-derived cytokines that initiate immunologic events leading to inflammatory airway remodeling. Biological therapies can improve airflow obstruction by addressing these airway inflammatory changes. In addition, biologics might prevent and possibly even revert "fixed" remodeling due to structural changes. Hence, it appears clinically important to separate the therapeutic effects (early and late) of biologics as a new paradigm to evaluate the effects of these drugs and future treatments on airway remodeling in severe asthma.
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Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
| | - Sebastian Ferri
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy
| | - Jack Pepys
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Remo Poto
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, Naples, Italy
| | - Emanuele Nappi
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Paoletti
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Enrico Heffler
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Walter G Canonica
- Personalized Medicine Asthma and Allergy Unit - IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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15
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Svenningsen S, Kirby M. Imaging in Asthma-Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:601-614. [DOI: 10.1016/j.iac.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Asthma-COPD Overlap Syndrome: Recent Insights and Unanswered Questions. J Pers Med 2022; 12:jpm12050708. [PMID: 35629128 PMCID: PMC9146831 DOI: 10.3390/jpm12050708] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 01/22/2023] Open
Abstract
The term asthma-COPD overlap (ACO) has been used to identify a heterogeneous condition in which patients present with airflow limitation that is not completely reversible and clinical and inflammatory features of both asthma and chronic obstructive pulmonary disease (COPD). ACO diagnosis may be difficult in clinical practice, while controversy still exists regarding its definition, pathophysiology, and impact. Patients with ACO experience a greater disease burden compared to patients with asthma or COPD alone, but in contrast they show better response to inhaled corticosteroid treatment than other COPD phenotypes. Current management recommendations focus on defining specific and measurable treatable clinical traits, according to disease phenotypes and underlying biological mechanisms for every single patient. In this publication, we review the current knowledge on definition, pathophysiology, clinical characteristics, and management options of ACO.
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17
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Verschakelen JA. Quantitative CT of the Lung to Study Asthma. Radiology 2022; 304:460-461. [PMID: 35471116 DOI: 10.1148/radiol.213091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Johny A Verschakelen
- From the Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
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18
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Yang Z, Qin L, Qiao J, Cheng C, Liu Y, Zhang S, Fang X, Li Z, Renz H, Liu X, Xia L, Hu Q, Xie M. Novel imaging phenotypes of naïve asthma patients with distinctive clinical characteristics and T2 inflammation traits. Ther Adv Chronic Dis 2022; 13:20406223221084831. [PMID: 35342537 PMCID: PMC8943467 DOI: 10.1177/20406223221084831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: This study aims to describe the imaging features of naïve asthma patients,
defined as not receiving corticosteroids or other asthma medications for at
least 1 month, and their association with therapeutic response, and to
discover novel unbiased imaging phenotypes. Methods: A total of 109 naïve asthma patients and 50 healthy controls were enrolled in
this study. Clinical data and imaging indices of high-resolution computed
tomography were collected. The correlation between imaging indices and
clinical features was analyzed. Cluster analyses were adopted to determine
three novel imaging phenotypes. Results: Compared with healthy controls, naïve asthma patients presented higher scores
of airway remodeling, bronchiectasis, and mucus plugs. Mean airway wall area
(WA)% was inversely correlated with mid-expiratory flow velocity% predicted.
The extent score of bronchiectasis was positively correlated with smoking
history and significantly increased in the high mucus group. Mucus plugs
were related to improving lung function and type 2 (T2) inflammation, as
assessed by sputum and blood eosinophils and fraction of exhaled nitric
oxide. Cluster 1 patients had a high proportion of emphysema, the best lung
function, and the lowest T2 inflammation; cluster 2 patients had severe
airway remodeling, relatively good lung function, and moderate T2
inflammation; cluster 3 patients had severe airway remodeling, mucus plugs,
and bronchiectasis, and showed the worst lung function and highest T2
inflammation. Conclusion: Naïve asthma patients had the imaging traits of airway remodeling,
bronchiectasis, and mucus plugs. The unbiased imaging phenotypes had good
consistency with clinical characteristics, therapeutic response, and T2
inflammation expression in naïve asthma patients.
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Affiliation(s)
- Zhenyu Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Qin
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhan Qiao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chongsheng Cheng
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiwen Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shengding Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Fang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Xiansheng Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiongjie Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Min Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Ave., Wuhan 430030, Hubei, China
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Moslemi A, Kontogianni K, Brock J, Wood S, Herth F, Kirby M. Differentiating COPD and Asthma using Quantitative CT Imaging and Machine Learning. Eur Respir J 2022; 60:13993003.03078-2021. [PMID: 35210316 DOI: 10.1183/13993003.03078-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
There are similarities and differences between chronic obstructive pulmonary disease (COPD) and asthma patients in terms of computed tomography (CT) disease-related features. Our objective was to determine the optimal subset of CT imaging features for differentiating COPD and asthma using machine learning.COPD and asthma patients were recruited from Heidelberg University Hospital. CT was acquired and 93 features were extracted (VIDA Diagnostics): percentage of low-attenuating-areas below -950HU (LAA950), LAA950 hole count, estimated airway-wall-thickness for a 10 mm internal perimeter airway (Pi10), total-airway-count (TAC), as well as inner/outer perimeter/areas and wall thickness for each of five segmental airways, and the average of those five airways. Hybrid feature selection was used to select the optimum number of features, and support vector machine was used to classify COPD and asthma.Ninety-five participants were included (n=48 COPD; n=47 asthma); there were no differences between COPD and asthma for age (p=0.25) or FEV1 (p=0.31). In a model including all CT features, the accuracy and F1-score was 80% and 81%, respectively. The top features were: LAA950, LAA950 hole count, average outer and inner airway perimeter, outer and inner airway area RB1, and TAC. In the model with only airway features, the accuracy and F1-score were 66% and 68%, respectively. The top features were: inner area RB1, wall thickness RB1, outer area LB1, TAC LB10, average outer/inner perimeter, Pi10, and TAC.In conclusions, COPD and asthma can be differentiated using machine learning with moderate-high accuracy by a subset of only 7 CT features.
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Affiliation(s)
- Amir Moslemi
- Department of Physics, Ryerson University, Toronto, ON, Canada.,Co-first authors
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany.,Co-first authors
| | - Judith Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany
| | | | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), University of Heidelberg, Germany .,Co-senior authors
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, ON, Canada.,Co-senior authors
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20
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Kim S, Choi S, Kim T, Jin KN, Cho SH, Lee CH, Kang HR. Phenotypic clusters on computed tomography reflects asthma heterogeneity and severity. World Allergy Organ J 2022; 15:100628. [PMID: 36091187 PMCID: PMC9419448 DOI: 10.1016/j.waojou.2022.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Asthma is a heterogeneous inflammatory airway disorder with various phenotypes. Quantitative computed tomography (QCT) methods can differentiate among lung diseases through accurate assessment of the location, extent, and severity of the disease. The purpose of this study was to identify asthma clusters using QCT metrics of airway and parenchymal structure, and to identify associations with visual analyses conducted by radiologists. Methods This prospective study used input from QCT-based metrics including hydraulic diameter (Dh), luminal wall thickness (WT), functional small airway disease (fSAD), and emphysematous lung (Emph) to perform a cluster analysis and made comparisons with the visual grouping analysis conducted by radiologists based on site of airway involvement and remodeling evaluated. Results A total of 61 asthmatics of varying severities were grouped into 4 clusters. From C1 to C4, more severe lung function deterioration, higher fixed obstruction rate, and more frequent asthma exacerbations were observed in the 5-year follow-up period. C1 presented non-severe asthma with increased WT, Dh of proximal airways, and fSAD. C2 was mixed with non-severe and severe asthmatics, and showed bronchodilator responses limited to the proximal airways. C3 and C4 included severe asthmatics that showed a reduced Dh of the proximal airway and diminished bronchodilator responses. While C3 was characterized by severe allergic asthma without fSAD, C4 included ex-smokers with high fSAD% and Emph%. These clusters correlated well with the grouping done by radiologists and clinical outcomes. Conclusions Four QCT imaging-based clusters with distinct structural and functional changes in proximal and small airways can stratify heterogeneous asthmatics and can be a complementary tool to predict clinical outcomes.
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Affiliation(s)
- Sujeong Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sanghun Choi
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Taewoo Kim
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Kwang Nam Jin
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Sang-Heon Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang Hyun Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
- Corresponding author. Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul 110-744, South Korea.
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- Corresponding author. Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul 110-744, South Korea,
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21
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Higbee DH, Granell R, Davey Smith G, Dodd JW. Prevalence, risk factors, and clinical implications of preserved ratio impaired spirometry: a UK Biobank cohort analysis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:149-157. [PMID: 34739861 DOI: 10.1016/s2213-2600(21)00369-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is defined as a FEV1 of less than 80% predicted and a FEV1/forced vital capacity (FVC) ratio of 0·70 or higher. Previous research has indicated that PRISm is associated with respiratory symptoms and is a precursor of chronic obstructive pulmonary disease (COPD). However, these findings are based on relatively small selective cohorts with short follow-up. We aimed to determine the prevalence, risk factors, clinical implications, and mortality of PRISm in a large adult general population. METHODS For this cohort analysis, we used data from the UKBiobank to assess PRISm prevalence, risk factors and associated symptoms, and associated comorbidities in a large adult population. Participants with spirometry deemed acceptable by an investigator (best measure FEV1 and FVC values) at baseline were included. Participants were excluded if they did not have acceptable spirometry or were missing data on body-mass index or smoking status. Control spirometry was defined as a FEV1 of 80% or more predicted and a FEV1/FVC ratio of 0·70 or higher. Airflow obstruction was defined as a FEV1/FVC ratio of less than 0·70. We used multivariable regression to determine risk factors for PRISm and associated comorbidities. Individuals who lived within close proximity to an assessment centre were invited for follow-up, with repeat spirometry. Only participants who had been included at baseline were examined in follow-up. This allowed for a longitudinal analysis of PRISm over time and risk factors for transition to airflow obstruction. We also did the survival analysis for a 12-year period. FINDINGS Participants were recruited by UK Biobank between Dec 19, 2006, and Oct 10, 2010. We included 351 874 UK Biobank participants (189 247 women and 162 627 men) in our study, with a median follow-up of 9·0 years (IQR 8·0-10·0). 38 639 (11·0%) of 351 874 participants had PRISm at baseline. After adjustment, PRISm was strongly associated with obesity (odds ratio [OR] 2·40 [2·26-2·55], p<0·0001), current smoking (1·48 [1·36-1·62], p<0·0001), and patient reported doctor-diagnosed asthma (1·76 [1·66-1·88], p<0·0001). Other risk factors identified included female sex, being overweight, trunk fat mass, and trunk fat percentage. PRISm was strongly associated with symptoms and comorbidity including increased risk of breathlessness (adjusted OR 2·0 [95% CI 1·91-2·14], p<0·0001) and cardiovascular disease (adjusted OR 1·71 [1·64-1·83], p<0·0001 for heart attack). Longitudinal analysis showed that 241 (12·2%) of 1973 participants who had PRISm at baseline had transitioned to airflow obstruction consistent with COPD. PRISm was associated with increased all-cause mortality (adjusted hazard ratio 1·61 [95% CI 1·53-1·69], p<0·0001) versus control participants. INTERPRETATION PRISm was associated with breathlessness, multimorbidity, and increased risk of death, which does not seem to be explained by smoking, obesity, or existing lung disease. Although for many patients PRISm is transient, it is important to understand which individuals are at risk of progressive lung function abnormalities. Further research into the genetic, structural and functional pathophysiology of PRISm is warranted. FUNDING UK Medical Research Council and University of Bristol.
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Affiliation(s)
- Daniel H Higbee
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Raquel Granell
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - James W Dodd
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK.
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Similarities in Quantitative Computed Tomography Imaging of the Lung in Severe Asthma with Persistent Airflow Limitation and Chronic Obstructive Pulmonary Disease. J Clin Med 2021; 10:jcm10215058. [PMID: 34768576 PMCID: PMC8584690 DOI: 10.3390/jcm10215058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Severe asthma with persistent airflow limitation (SA-PAL) and chronic obstructive pulmonary disease (COPD) are characterised by irreversible airflow limitation and the remodelling of the airways. The phenotypes of the diseases overlap and may cause diagnostic and therapeutic concerns. Methods: There were 10 patients with SA-PAL, 11 patients with COPD, and 10 healthy volunteers (HV) enrolled in this study. The patients were examined with a 128-multislice scanner at full inspiration. Measurements were taken from the third to ninth bronchial generations. Results: The thickness of the bronchial wall was greater in the SA-PAL than in the COPD group for most bronchial generations (p < 0.05). The mean lung density was the lowest in the SA-PAL group (−846 HU), followed by the COPD group (−836 HU), with no statistical difference between these two groups. The low-attenuation volume percentage (LAV% < −950 HU) was significantly higher in the SA-PAL group (15.8%) and COPD group (10.4%) compared with the HV group (7%) (p = 0.03). Conclusion: Severe asthma with persistent airflow limitation and COPD become similar with time within the functional and morphological dimensions. Emphysema qualities are present in COPD and in SA-PAL patients.
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Lu D, Chen L, Fan C, Zeng W, Fan H, Wu X, Yu H. The Value of Impulse Oscillometric Parameters and Quantitative HRCT Parameters in Differentiating Asthma-COPD Overlap from COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:2883-2894. [PMID: 34703222 PMCID: PMC8541739 DOI: 10.2147/copd.s331853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the value of impulse oscillometry (IOS) and quantitative HRCT parameters for differentiating asthma-COPD overlap (ACO) in COPD patients. Patients and Methods We enrolled 44 controls and 66 COPD patients, divided into the pure COPD group (n=40) and the ACO group (n=26). Spearman correlation analysis was utilized to assess the relationship between the quantitative HRCT and IOS parameters. A binary logistic regression analysis was performed to analyze the associations between the different variables and the risk of ACO. Receiver operating characteristic (ROC) curves were employed to identify the optimal cutoff and assess the diagnostic value of relative volume change -856 HU to -950 HU (RVC-856 to -950), decrease in the resistance from 5 Hz to 20 Hz (R5-R20) and their combination in predicting ACO. Bootstrapping validation was used to evaluate the internal validation. The concordance index (C-index) and calibration plot were calculated to assess the discrimination and calibration of the prediction model. Results Binary logistic regression analysis indicated that RVC-856 to -950 and the IOS parameters (R5-R20, R5, X5) were independently correlated with a higher risk of developing ACO after adjusting for age, sex, body mass index (BMI), history of smoking, exacerbation and atopy or allergic rhinitis. A correlation analysis showed a good correlation between the pulmonary function parameters and RVC-856 to -950, with a weaker correlation with the % area of low attenuation (LAA%) in ACO patients. Combining RVC-856 to -950 and R5-R20 to predict ACO, the AUC was 0.909, and the optimal cutoff value was >-0.62 for RVC-856 to -950 and >0.09 for R5-R20. Good calibration and favorable discrimination were displayed with a higher C-index. Conclusion More serious small airway impairment exists in ACO patients. The combination of RVC-856 to -950 and R5-R20 could be applied to differentiate ACO from COPD patients.
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Affiliation(s)
- Dongzhu Lu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Lichang Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Chaofan Fan
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Wenyi Zeng
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huizhen Fan
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xiping Wu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huapeng Yu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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Fung KY, Louis C, Metcalfe RD, Kosasih CC, Wicks IP, Griffin MDW, Putoczki TL. Emerging roles for IL-11 in inflammatory diseases. Cytokine 2021; 149:155750. [PMID: 34689057 DOI: 10.1016/j.cyto.2021.155750] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022]
Abstract
Interleukin-11 (IL-11) is a cytokine that has been strongly implicated in the pathogenesis of fibrotic diseases and solid malignancies. Elevated IL-11 expression is also associated with several non-malignant inflammatory diseases where its function remains less well-characterized. Here, we summarize current literature surrounding the contribution of IL-11 to the pathogenesis of autoimmune inflammatory diseases, including rheumatoid arthritis, multiple sclerosis, diabetes and systemic sclerosis, as well as other chronic inflammatory conditions such as periodontitis, asthma, chronic obstructive pulmonary disease, psoriasis and colitis.
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Affiliation(s)
- Ka Yee Fung
- Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Victoria 3052, Australia; Department of Medical Biology, University of Melbourne, Victoria 3053, Australia.
| | - Cynthia Louis
- Department of Medical Biology, University of Melbourne, Victoria 3053, Australia; Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Victoria 3052, Australia
| | - Riley D Metcalfe
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Technology Institute, University of Melbourne, Victoria 3010, Australia
| | - Clara C Kosasih
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Technology Institute, University of Melbourne, Victoria 3010, Australia
| | - Ian P Wicks
- Department of Medical Biology, University of Melbourne, Victoria 3053, Australia; Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Victoria 3052, Australia; Rheumatology Unit, The Royal Melbourne Hospital, Victoria 3050, Australia
| | - Michael D W Griffin
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Technology Institute, University of Melbourne, Victoria 3010, Australia
| | - Tracy L Putoczki
- Personalised Oncology Division, The Walter and Eliza Hall Institute of Medical Research, Victoria 3052, Australia; Department of Medical Biology, University of Melbourne, Victoria 3053, Australia.
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25
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Virdee S, Tan WC, Hogg JC, Bourbeau J, Hague CJ, Leipsic JA, Kirby M. Spatial Dependence of CT Emphysema in Chronic Obstructive Pulmonary Disease Quantified by Using Join-Count Statistics. Radiology 2021; 301:702-709. [PMID: 34519575 DOI: 10.1148/radiol.2021210198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Existing CT emphysema measurements quantify the extent or clustering of emphysema voxels in chronic obstructive pulmonary disease (COPD); however, these measurements do not quantify how those voxels are clustered. Purpose To develop a CT measurement to quantify the "compactness" of emphysema voxels, called the normalized join count (NJC), and to determine whether the NJC measurement differentiates COPD disease severity and correlates with lung function and visual emphysema scores. Materials and Methods In this secondary analysis of a prospective study, lung function and CT images were obtained from the Canadian Cohort Obstructive Lung Disease study visit 1 from 2009 to 2013. Participants were categorized as never-smokers, at risk, mild COPD, or moderate-severe COPD. Diffusion capacity for carbon monoxide/alveolar volume was measured. CT emphysema was scored visually by radiologists. CT measurements included the percentage low-attenuation area with attenuation less than -950 HU (%LAA-950insp), low-attenuation cluster (LAC), and lowest 15th percentile point of the CT lung density histogram. NJC was developed to measure compactness of CT emphysema voxels. An analysis of variance determined differences between groups. Multivariable ridge regression determined association between CT measurements with lung function and radiologist scores. Results A total of 1294 participants (750 men; mean age, 67 years ± 10) were analyzed (277 never-smokers, 306 at risk, 427 mild COPD, and 284 moderate-severe COPD). NJC, %LAA-950insp, and LAC measurements were higher in moderate-severe COPD than in never-smokers and at-risk participants (P < .05 for all comparisons), but only NJC was different between mild and ;moderate-severe COPD (mean, 1.98% ± 3.61 vs 1.44% ± 2.14; P < .05). In multivariable regression analysis, among all CT measurements NJC had the greatest relative contribution to diffusion capacity for carbon monoxide/alveolar volume (P = .002) and visual emphysema score (P < .001). Conclusion The relationship of normalized join count with severity of chronic obstructive pulmonary disease may indicate that the assessment of this disease is dependent on the number of low attenuating voxels or the size of clusters and the spatial arrangement of such voxels. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
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Affiliation(s)
- Sukhraj Virdee
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Wan C Tan
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - James C Hogg
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Jean Bourbeau
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Cameron J Hague
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Jonathon A Leipsic
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Miranda Kirby
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
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Li T, Zhou HP, Zhou ZJ, Guo LQ, Zhou L. Computed tomography-identified phenotypes of small airway obstructions in chronic obstructive pulmonary disease. Chin Med J (Engl) 2021; 134:2025-2036. [PMID: 34517376 PMCID: PMC8440009 DOI: 10.1097/cm9.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Indexed: 12/02/2022] Open
Abstract
ABSTRACT Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characteristic of small airway inflammation, obstruction, and emphysema. It is well known that spirometry alone cannot differentiate each separate component. Computed tomography (CT) is widely used to determine the extent of emphysema and small airway involvement in COPD. Compared with the pulmonary function test, small airway CT phenotypes can accurately reflect disease severity in patients with COPD, which is conducive to improving the prognosis of this disease. CT measurement of central airway morphology has been applied in clinical, epidemiologic, and genetic investigations as an inference of the presence and severity of small airway disease. This review will focus on presenting the current knowledge and methodologies in chest CT that aid in identifying discrete COPD phenotypes.
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Affiliation(s)
- Tao Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Department of Respiratory Medicine, Xuzhou First People's Hospital, Xuzhou, Jiangsu 221116, China
| | - Hao-Peng Zhou
- Department of Medicine, Jiangsu University School of Medicine, Zhenjiang, Jiangsu 212013, China
| | - Zhi-Jun Zhou
- Institute of Radio Frequency & Optical Electronics-Integrated Circuits, School of Information and Engineering, Southeast University, Nanjing, Jiangsu 210096, China
| | - Li-Quan Guo
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
| | - Linfu Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
- Institute of Integrative Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Calverley PMA, Walker PP. ACO (Asthma-COPD Overlap) Is Independent from COPD: The Case in Favour. Diagnostics (Basel) 2021; 11:1189. [PMID: 34208874 PMCID: PMC8304638 DOI: 10.3390/diagnostics11071189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Over the last decade interest has been shown in people with symptomatic lung disease who have features both of COPD and asthma. In this review we examine how COPD and asthma are defined and examine clinical characteristics of people defined by researchers as having asthma-COPD overlap (ACO). We look at pathological and physiological features along with symptoms and consider the impact of each diagnosis upon therapeutic management. We highlight challenges in the diagnosis and management of airway disease and the various phenotypes that could be part of ACO, in so doing suggesting ways for the clinician to manage patients with features of both asthma and COPD.
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Affiliation(s)
| | - Paul Phillip Walker
- Liverpool University Hospitals Foundation NHS, University of Liverpool, Liverpool L9 7AL, UK
- Department of Respiratory Medicine, Aintree Hospital, Lower Lane, Liverpool L9 7AL, UK
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29
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Patyk M, Obojski A, Sokołowska-Dąbek D, Parkitna-Patyk M, Zaleska-Dorobisz U. Airway wall thickness and airflow limitations in asthma assessed in quantitative computed tomography. Ther Adv Respir Dis 2021; 14:1753466619898598. [PMID: 31964312 PMCID: PMC6977202 DOI: 10.1177/1753466619898598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Asthma is a frequent chronic disease of the airways. In spite of the fact that symptoms of asthma are well known, the pathogenesis has not yet been fully understood. Quantitative computed tomography (qCT) of the lung allows for the measurment of a set of parameters. The aim of this study was to evaluate the usefulness of quantitative computed tomography in the assessment of airway wall thickness in asthma. Methods: The prospective study was performed on a group of 83 patients with well-defined, long-term asthma between 2016 and 2018. The control group was composed of 30 healthy volunteers. All examined subjects were non-smokers. All computed tomography (CT) studies were performed using a 128 multi-slice CT scanner with no contrast, following a chest scanning protocol in the supine position, at full inspiration and breath-holds. Results: Quantitative bronchial tree measurements were obtained from the third up to the ninth generation of the posterior basal bronchi (B10) of the right lung in a blinded fashion. The value of the wall thickness in patients with asthma was significantly higher in all measured generations of the bronchial tree (third to ninth generation). The lumen area and the inner diameter significantly correlated with the lung function tests and were substantially smaller in the examined group from the seventh to the ninth generation of the bronchi (p < 0.05). Conclusions: We conclude that airway remodelling occurs in most patients with long-term asthma and is associated mainly with the medium and small airways. Imaging techniques, especially qCT can be useful in the diagnosis and management of asthma. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Mateusz Patyk
- Department of General and Paediatric Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Obojski
- Department of Internal Diseases, Pneumology and Allergology, Wroclaw Medical University, Curie-Skłodowskiej 68, Wroclaw 50-369, Poland
| | | | - Martyna Parkitna-Patyk
- Department of Conservative Dentistry and Pedodontics, Wroclaw Medical University, Wroclaw, Poland
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Denlinger LC, Phillips BR, Sorkness RL, Bleecker ER, Castro M, DeBoer MD, Fitzpatrick AM, Hastie AT, Gaffin JM, Moore WC, Peters MC, Peters SP, Phipatanakul W, Cardet JC, Erzurum SC, Fahy JV, Fajt ML, Gaston B, Levy BD, Meyers DA, Ross K, Teague WG, Wenzel SE, Woodruff PG, Zein J, Jarjour NN, Mauger DT, Israel E. Responsiveness to Parenteral Corticosteroids and Lung Function Trajectory in Adults with Moderate-to-Severe Asthma. Am J Respir Crit Care Med 2021; 203:841-852. [PMID: 33290668 DOI: 10.1164/rccm.202002-0454oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rationale: It is unclear why select patients with moderate-to-severe asthma continue to lose lung function despite therapy. We hypothesized that participants with the smallest responses to parenteral corticosteroids have the greatest risk of undergoing a severe decline in lung function.Objectives: To evaluate corticosteroid-response phenotypes as longitudinal predictors of lung decline.Methods: Adults within the NHLBI SARP III (Severe Asthma Research Program III) who had undergone a course of intramuscular triamcinolone at baseline and at ≥2 annual follow-up visits were evaluated. Longitudinal slopes were calculated for each participant's post-bronchodilator FEV1% predicted. Categories of participant FEV1 slope were defined: severe decline, >2% loss/yr; mild decline, >0.5-2.0% loss/yr; no change, 0.5% loss/yr to <1% gain/yr; and improvement, ≥1% gain/yr. Regression models were used to develop predictors of severe decline.Measurements and Main Results: Of 396 participants, 78 had severe decline, 91 had mild decline, 114 had no change, and 113 showed improvement. The triamcinolone-induced difference in the post-bronchodilator FEV1% predicted (derived by baseline subtraction) was related to the 4-year change in lung function or slope category in univariable models (P < 0.001). For each 5% decrement in the triamcinolone-induced difference the FEV1% predicted, there was a 50% increase in the odds of being in the severe decline group (odds ratio, 1.5; 95% confidence interval, 1.3-1.8), when adjusted for baseline FEV1, exacerbation history, blood eosinophils and body mass index.Conclusions: Failure to improve the post-bronchodilator FEV1 after a challenge with parenteral corticosteroids is an evoked biomarker for patients at risk for a severe decline in lung function.
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Affiliation(s)
- Loren C Denlinger
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Brenda R Phillips
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Ronald L Sorkness
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, College of Medicine, The University of Arizona, Tucson, Arizona
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, KU School of Medicine, The University of Kansas, Kansas City, Kansas
| | - Mark D DeBoer
- Divisions of Pediatric Diabetes and Endocrinology and Pediatric Respiratory Medicine, Allergy, Immunology and Sleep, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Anne M Fitzpatrick
- Division of Pulmonary, Allergy and Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Annette T Hastie
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jonathan M Gaffin
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Wendy C Moore
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Michael C Peters
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Stephen P Peters
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Wanda Phipatanakul
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Juan Carlos Cardet
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Serpil C Erzurum
- Lerner Research Institute and the Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
| | - John V Fahy
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Merritt L Fajt
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin Gaston
- Division of Pediatric Pulmonary, Allergy and Sleep Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; and
| | - Bruce D Levy
- Divisions of Pulmonary Medicine and Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, and
| | - Deborah A Meyers
- Section of Pulmonary, Critical Care, Allergy and Immunologic Disease, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kristie Ross
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, UH Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - W Gerald Teague
- Divisions of Pediatric Diabetes and Endocrinology and Pediatric Respiratory Medicine, Allergy, Immunology and Sleep, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Joe Zein
- Lerner Research Institute and the Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Elliot Israel
- Divisions of Pulmonary and Critical Care and of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
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Nagpal P, Guo J, Shin KM, Lim JK, Kim KB, Comellas AP, Kaczka DW, Peterson S, Lee CH, Hoffman EA. Quantitative CT imaging and advanced visualization methods: potential application in novel coronavirus disease 2019 (COVID-19) pneumonia. BJR Open 2021; 3:20200043. [PMID: 33718766 PMCID: PMC7931412 DOI: 10.1259/bjro.20200043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Increasingly, quantitative lung computed tomography (qCT)-derived metrics are providing novel insights into chronic inflammatory lung diseases, including chronic obstructive pulmonary disease, asthma, interstitial lung disease, and more. Metrics related to parenchymal, airway, and vascular anatomy together with various measures associated with lung function including regional parenchymal mechanics, air trapping associated with functional small airways disease, and dual-energy derived measures of perfused blood volume are offering the ability to characterize disease phenotypes associated with the chronic inflammatory pulmonary diseases. With the emergence of COVID-19, together with its widely varying degrees of severity, its rapid progression in some cases, and the potential for lengthy post-COVID-19 morbidity, there is a new role in applying well-established qCT-based metrics. Based on the utility of qCT tools in other lung diseases, previously validated supervised classical machine learning methods, and emerging unsupervised machine learning and deep-learning approaches, we are now able to provide desperately needed insight into the acute and the chronic phases of this inflammatory lung disease. The potential areas in which qCT imaging can be beneficial include improved accuracy of diagnosis, identification of clinically distinct phenotypes, improvement of disease prognosis, stratification of care, and early objective evaluation of intervention response. There is also a potential role for qCT in evaluating an increasing population of post-COVID-19 lung parenchymal changes such as fibrosis. In this work, we discuss the basis of various lung qCT methods, using case-examples to highlight their potential application as a tool for the exploration and characterization of COVID-19, and offer scanning protocols to serve as templates for imaging the lung such that these established qCT analyses have the best chance at yielding the much needed new insights.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | | | | | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ki Beom Kim
- Department of Radiology, Daegu Fatima Hospital, Daegu, South Korea
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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Wilson SJ, Ward JA, Pickett HM, Baldi S, Sousa AR, Sterk PJ, Chung KF, Djukanovic R, Dahlen B, Billing B, Shaw D, Krug N, Sandstrӧm T, Brightling C, Howarth PH. Airway Elastin is increased in severe asthma and relates to proximal wall area: histological and computed tomography findings from the U-BIOPRED severe asthma study. Clin Exp Allergy 2021; 51:296-304. [PMID: 33342006 DOI: 10.1111/cea.13813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Airway remodelling, which may include goblet cell hyperplasia / hypertrophy, changes in epithelial integrity, accumulation of extracellular matrix components, smooth muscle hypertrophy and thickening of the lamina reticularis, is a feature of severe asthma and contributes to the clinical phenotype. OBJECTIVE Within the U-BIOPRED severe asthma study, we have assessed histological elements of airway remodelling and their relationship to computed tomography (CT) measures of proximal airway dimensions. METHODS Bronchial biopsies were collected from two severe asthma groups, one non-smoker (SAn, n = 28) and one current/ex-smoker (SAs/ex, n = 13), and a mild-moderate asthma group (MMA, n = 28) classified and treated according to GINA guidelines, plus a healthy control group (HC, n = 33). Movat's pentachrome technique was used to identify mucin, elastin and total collagen in these biopsies. The number of goblet cells (mucin+) was counted as a percentage of the total number of epithelial cells and the percentage mucin epithelial area measured. The percentage area of elastic fibres and total collagen within the submucosa was also measured, and the morphology of the elastic fibres classified. Participants in the asthma groups also had a CT scan to assess large airway morphometry. RESULTS The submucosal tissue elastin percentage was higher in both severe asthma groups (16.1% SAn, 18.9% SAs/ex) compared with the HC (9.7%) but did not differ between asthma groups. There was a positive relationship between elastin and airway wall area measured by CT (n = 18-20, rho=0.544, p = 0.024), which also related to an increase in elastic fibres with a thickened lamellar morphological appearance. Mucin epithelial area and total collagen were not different between the four groups. Due to small numbers of suitable CT scans, it was not feasible to compare airway morphometry between the asthma groups. CONCLUSION These findings identify a link between extent of elastin deposition and airway wall thickening in severe asthma.
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Affiliation(s)
- Susan J Wilson
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan A Ward
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen M Pickett
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simonetta Baldi
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Ana R Sousa
- Respiratory Therapy Unit, GlaxoSmithKline, Stevenage, UK
| | - Peter J Sterk
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Barbro Dahlen
- Department of Respiratory Medicine and Allergy, The Centre for Allergy Research, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bo Billing
- Department of Respiratory Medicine and Allergy, The Centre for Allergy Research, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Dominick Shaw
- Nottingham Respiratory Research, University of Nottingham, Nottingham, UK
| | - Norbert Krug
- Fraunhofer Institute of Toxicology & Experimental Medicine, Hannover, Germany
| | - Thomas Sandstrӧm
- Department of Respiratory Medicine, Umea University, Stockholm, Sweden
| | | | - Peter H Howarth
- Faculty of Medicine, University of Southampton, Southampton, UK
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Debray MP, Ghanem M, Khalil A, Taillé C. [Lung imaging in severe asthma]. Rev Mal Respir 2021; 38:41-57. [PMID: 33423858 DOI: 10.1016/j.rmr.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/02/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Asthma is a common disease whose diagnosis does not typically rely on the results of imaging. However, chest CT has gained a key place over the last decade to support the management of patients with difficult to treat and severe asthma. STATE OF THE ART Bronchial wall thickening and mild dilatation or narrowing of bronchial lumen are frequently observed on chest CT in people with asthma. Bronchial wall thickening is correlated to the degree of obstruction and to bronchial wall remodeling and inflammation. Diverse conditions which can mimic asthma should be recognized on CT, including endobronchial tumours, interstitial pneumonias, bronchiectasis and bronchiolitis. Ground-glass opacities and consolidation may be related to transient eosinophilic infiltrates, infection or an associated disease (vasculitis, chronic eosinophilic pneumonia). Hyperdense mucous plugging is highly specific for allergic bronchopulmonary aspergillosis. PERSPECTIVES Airway morphometry, air trapping and quantitative analysis of ventilatory defects, with CT or MRI, can help to identify different morphological subgroups of patients with different functional or inflammatory characteristics. These imaging tools could emerge as new biomarkers for the evaluation of treatment response. CONCLUSION Chest CT is indicated in people with severe asthma to search for additional or alternative diagnoses. Quantitative imaging may contribute to phenotyping this patient group.
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Affiliation(s)
- M-P Debray
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, 46, rue Henri Huchard, 75018 Paris; Inserm UMR1152, France.
| | - M Ghanem
- Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France
| | - A Khalil
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, 46, rue Henri Huchard, 75018 Paris; Université de Paris, Inserm UMR1152, France
| | - C Taillé
- Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France; Département Hospitalo-Universitaire FIRE ; Université de Paris ; Inserm UMR 1152 ; LabEx Inflamex, 75018 Paris, France
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Xia T, Zheng W, Lure FYM, Guan Y. CT phenotypes in mild-to-moderate chronic obstructive pulmonary disease: difference before and after the age of 60 years. Clin Radiol 2020; 76:273-280. [PMID: 33358196 DOI: 10.1016/j.crad.2020.11.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
AIM To investigate the pulmonary phenotype of mild-to-moderate chronic obstructive pulmonary disease (COPD) using quantitative computed tomography CT analysis techniques. MATERIALS AND METHODS Sixty-three patients with stable-phase mild-to-moderate COPD and 78 healthy controls, categorised as those aged <60 (28 and 40 patients, respectively) and ≥60 years (35 and 38, respectively), underwent chest low-dose respiratory dual-phase CT and pulmonary function test. Automatic software was used to measure the proximal airway parameters, and the emphysema and air-trapping indices were recorded. The intergroup differences in each parameter were assessed by one-way analysis of variance. RESULTS At <60 years of age, the mean Pi10WA (Wall area of a hypothetical airway with an internal perimeter of 10 mm) was greater in the mild-to-moderate COPD group than in the healthy control group (17.04 ± 1.63 versus 16.03 ± 1.16 mm2; p=0.004). Mild or moderate air-trapping was observed in the mild-to-moderate COPD group aged <60 years. There was no significant difference in the proximal airway parameters and inspiratory VI-950 (percent voxels less than -950 HU) between the two groups at age ≥60 years (all p>0.05); however, the expiratory VI-856 (percent voxels less than -856 HU) and mean lung density expiratory/inspiratory ratio (MLDE/I) were higher in the mild-to-moderate COPD group than those in the healthy control group (26.02 [30.23] versus 6.45 [11.16]; 0.88 ± 0.05 versus 0.84 ± 0.04; p<0.001 and p=0.024). CONCLUSION For patients with mild-to-moderate COPD, the CT phenotype was predominantly the "airway remodelling" type at <60 years of age, and the "air-trapping" type at ≥60 years of age. Thus, pulmonary CT phenotypes of mild-to-moderate COPD patients of different age groups are different.
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Affiliation(s)
- T Xia
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - W Zheng
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - F Y M Lure
- Shenzhen Smart Imaging Healthcare Co., Ltd, Shenzhen, 510800, China
| | - Y Guan
- Department of Radiology, The Fifth Affiliated Hospital of GuangZhou Medical University, Guangzhou, 510120, China.
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Boulet LP, Boulay ME, Coxson HO, Hague CJ, Milot J, Lepage J, Maltais F. Asthma with Irreversible Airway Obstruction in Smokers and Nonsmokers: Links between Airway Inflammation and Structural Changes. Respiration 2020; 99:1-11. [PMID: 33291112 DOI: 10.1159/000508163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of irreversible airway obstruction (IRAO) in asthma is related to lung/airway inflammatory and structural changes whose characteristics are likely influenced by exposure to tobacco smoke. OBJECTIVE To investigate the interplay between airway and lung structural changes, airway inflammation, and smoking exposure in asthmatics with IRAO. METHODS We studied asthmatics with IRAO who were further classified according to their smoking history, those with ≥20 pack-years of tobacco exposure (asthmatics with smoking-related IRAO [AwS-IRAO]) and those with <5 pack-years of tobacco exposure (asthmatics with nonsmoking-related IRAO [AwNS-IRAO]). In addition to recording baseline clinical and lung function features, all patients had a chest computed tomography (CT) from which airway wall thickness was measured and quantitative and qualitative assessment of emphysema was performed. The airway inflammatory profile was documented from differential inflammatory cell counts on induced sputum. RESULTS Ninety patients were recruited (57 AwS-IRAO and 33 AwNS-IRAO). There were no statistically significant differences in the extent of emphysema and gas trapping between groups on quantitative chest CT analysis, although Pi10, a marker of airway wall thickness, was significantly higher in AwS-IRAO (p = 0.0242). Visual analysis showed a higher prevalence of emphysema (p = 0.0001) and higher emphysema score (p < 0.0001) in AwS-IRAO compared to AwNS-IRAO and distribution of emphysema was different between groups. Correlations between radiological features and lung function were stronger in AwS-IRAO. In a subgroup analysis, we found a correlation between airway neutrophilia and emphysematous features in AwS-IRAO and between eosinophilia and both airway wall thickness and emphysematous changes in AwNS-IRAO. CONCLUSIONS Although bronchial structural changes were relatively similar in smoking and nonsmoking patients with asthma and IRAO, emphysematous changes were more predominant in smokers. However, neutrophils in AwS-IRAO and eosinophils in AwNS-IRAO were associated with lung and airway structural changes.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada,
| | - Marie-Eve Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron J Hague
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Milot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Johane Lepage
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
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Myocardial involvement in eosinophilic granulomatosis with polyangiitis evaluated with cardiopulmonary magnetic resonance. Int J Cardiovasc Imaging 2020; 37:1371-1381. [PMID: 33211241 PMCID: PMC8026437 DOI: 10.1007/s10554-020-02091-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/27/2020] [Indexed: 01/09/2023]
Abstract
Patients with eosinophilic granulomatosis with polyangiitis (EGPA) most commonly die from cardiac causes, however, cardiac involvement remains poorly characterised and the relationship between cardiac and pulmonary disease is not known. This study aimed to characterise myocardial and pulmonary manifestations of EGPA, and their relationship. Prospective comprehensive cardiopulmonary investigation, including a novel combined cardiopulmonary magnetic resonance imaging (MRI) technology, was performed in 13 patients with stable EGPA. Comparison was made with 11 prospectively recruited matched healthy volunteers. Stable EGPA was associated with focal replacement and diffuse interstitial myocardial fibrosis (myocardial extracellular volume 26.9% vs. 24.7%; p = 0.034), which drove a borderline increase in left ventricular mass (56 ± 9 g/m2 vs. 49 ± 8 g/m2; p = 0.065). Corrected QT interval was significantly prolonged and was associated with the severity of myocardial fibrosis (r = 0.582, p = 0.037). Stable EGPA was not associated with increased myocardial capillary permeability or myocardial oedema. Pulmonary tissue perfusion and capillary permeability were normal and there was no evidence of pulmonary tissue oedema or fibrosis. Forced expiratory volume in one second showed a strong inverse relationship with myocardial fibrosis (r = -0.783, p = 0.038). In this exploratory study, stable EGPA was associated with focal replacement and diffuse interstitial myocardial fibrosis, but no evidence of myocardial or pulmonary inflammation or pulmonary fibrosis. Myocardial fibrosis was strongly associated with airway obstruction and abnormal cardiac repolarisation. Further investigation is required to determine the mechanisms underlying the association between heart and lung disease in EGPA and whether an immediate immunosuppressive strategy could prevent myocardial fibrosis formation.
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Higaki N, Iwamoto H, Yamaguchi K, Sakamoto S, Horimasu Y, Masuda T, Miyamoto S, Nakashima T, Ohshimo S, Fujitaka K, Hamada H, Hattori N. Correlations of forced oscillometric bronchodilator response with airway inflammation and disease duration in asthma. CLINICAL RESPIRATORY JOURNAL 2020; 15:48-55. [PMID: 32860340 DOI: 10.1111/crj.13268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Airway resistance and reactance, measured by forced oscillometry, are used to measure the airway obstruction in patients with asthma. OBJECTIVES This study aimed to investigate the oscillometric bronchodilator responses in treated and untreated asthma and evaluate its association with airway inflammation and disease duration. MATERIALS AND METHODS This study included 30 nonsmoking patients with mild to moderate treated asthma, 25 patients with newly diagnosed untreated asthma and 29 control subjects. Spirometric and oscillometric measurements were performed before and after inhalation of 400 µg salbutamol. Disease duration was defined as the number of years since asthma diagnosis. RESULTS At airway resistance of 5 Hz (R5) and 20 Hz (R20), bronchodilator responses in patients with untreated and treated asthma were greater than those in control subjects. In patients with untreated asthma, higher fractional exhaled nitric oxide concentration (FeNO) levels were strongly correlated with greater reversibility of R20 (rs = -0.621, P < 0.001). In patients with treated asthma, there was no significant association between FeNO and oscillometric reversibility, whereas longer disease duration was significantly associated with lesser bronchodilator response at R20 (rs = 0.441, P < 0.05). Treated asthma patients with longer disease duration (≥10 years) showed significantly higher post-bronchodilator R5 and R20 than the treated asthma patients with shorter disease duration (<10 years). CONCLUSION The present study provides further evidence of an association between airway inflammation and variable airway obstruction in asthma patients and indicates that long-term disease duration could be related to poorly reversible airway resistance in patients with mild to moderate asthma.
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Affiliation(s)
- Naoko Higaki
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Mathur SK, Modena BD, Coumou H, Barker P, Kreindler JL, Zangrilli JG. Postbronchodilator lung function improvements with benralizumab for patients with severe asthma. Allergy 2020; 75:1507-1510. [PMID: 31925789 PMCID: PMC7317975 DOI: 10.1111/all.14178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Sameer K. Mathur
- Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | | | - Hanneke Coumou
- Department of Pulmonary Medicine Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Peter Barker
- Research and Development AstraZeneca Gaithersburg MD USA
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Chachi L, Diver S, Kaul H, Rebelatto MC, Boutrin A, Nisa P, Newbold P, Brightling C. Computational modelling prediction and clinical validation of impact of benralizumab on airway smooth muscle mass in asthma. Eur Respir J 2019; 54:13993003.00930-2019. [PMID: 31391226 DOI: 10.1183/13993003.00930-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/25/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Latifa Chachi
- IHR Leicester Biomedical Research Centre, Respiratory, Dept of Respiratory Sciences, Glenfield Hospital, University of Leicester, Leicester, UK.,These authors contributed equally
| | - Sarah Diver
- IHR Leicester Biomedical Research Centre, Respiratory, Dept of Respiratory Sciences, Glenfield Hospital, University of Leicester, Leicester, UK.,These authors contributed equally
| | - Himanshu Kaul
- University of British Columbia, Vancouver, BC, Canada.,These authors contributed equally
| | | | | | - Patricia Nisa
- IHR Leicester Biomedical Research Centre, Respiratory, Dept of Respiratory Sciences, Glenfield Hospital, University of Leicester, Leicester, UK
| | | | - Christopher Brightling
- IHR Leicester Biomedical Research Centre, Respiratory, Dept of Respiratory Sciences, Glenfield Hospital, University of Leicester, Leicester, UK
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Brightling C, Greening N. Airway inflammation in COPD: progress to precision medicine. Eur Respir J 2019; 54:13993003.00651-2019. [PMID: 31073084 DOI: 10.1183/13993003.00651-2019] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide, and its prevalence is increasing. Airway inflammation is a consistent feature of COPD and is implicated in the pathogenesis and progression of COPD, but anti-inflammatory therapy is not first-line treatment. The inflammation has many guises and phenotyping this heterogeneity has revealed different patterns. Neutrophil-associated COPD with activation of the inflammasome, T1 and T17 immunity is the most common phenotype with eosinophil-associated T2-mediated immunity in a minority and autoimmunity observed in more severe disease. Biomarkers have enabled targeted anti-inflammatory strategies and revealed that corticosteroids are most effective in those with evidence of eosinophilic inflammation, whereas, in contrast to severe asthma, response to anti-interleukin-5 biologicals in COPD has been disappointing, with smaller benefits for the same intensity of eosinophilic inflammation questioning its role in COPD. Biological therapies beyond T2-mediated inflammation have not demonstrated benefit and in some cases increased risk of infection, suggesting that neutrophilic inflammation and inflammasome activation might be largely driven by bacterial colonisation and dysbiosis. Herein we describe current and future biomarker approaches to assess inflammation in COPD and how this might reveal tractable approaches to precision medicine and unmask important host-environment interactions leading to airway inflammation.
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Affiliation(s)
- Christopher Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Neil Greening
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Dept of Respiratory Sciences, University of Leicester, Leicester, UK
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Physiological and morphological differences of airways between COPD and asthma-COPD overlap. Sci Rep 2019; 9:7818. [PMID: 31127165 PMCID: PMC6534606 DOI: 10.1038/s41598-019-44345-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/14/2019] [Indexed: 01/12/2023] Open
Abstract
Overlap of asthma and COPD has attracted attention recently. We aimed to clarify physiological and morphological differences of the airways between COPD and asthma–COPD overlap (ACO). Respiratory resistance and reactance and three-dimensional computed tomography data were evaluated in 167 patients with COPD. Among them, 43 patients who fulfilled the diagnosis of asthma were defined as having ACO. Among 124 patients with COPD without ACO, 86 with a comparable smoking history and airflow limitation as those with ACO were selected using propensity score matching (matched COPD). The intraluminal area (Ai) and wall thickness (WT) of third- to sixth-generation bronchi were measured and adjusted by body surface area (BSA; Ai/BSA and WT/√BSA, respectively). Patients with ACO had higher respiratory resistance and reactance during tidal breathing, but a smaller gap between the inspiratory and expiratory phases, compared with matched patients with COPD. Patients with ACO had a greater WT/√BSA in third- to fourth-generation bronchi, smaller Ai/BSA in fifth- to sixth-generation bronchi, and less emphysematous changes than did matched patients with COPD. Even when patients with ACO and those with COPD have a comparable smoking history and fixed airflow limitation, they have different physiological and morphological features of the airways.
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Postma DS, Brightling C, Baldi S, Van den Berge M, Fabbri LM, Gagnatelli A, Papi A, Van der Molen T, Rabe KF, Siddiqui S, Singh D, Nicolini G, Kraft M. Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study. THE LANCET RESPIRATORY MEDICINE 2019; 7:402-416. [PMID: 30876830 DOI: 10.1016/s2213-2600(19)30049-9] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/26/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Small airways dysfunction (SAD) is well recognised in asthma, yet its role in the severity and control of asthma is unclear. This study aimed to assess which combination of biomarkers, physiological tests, and imaging markers best measure the presence and extent of SAD in patients with asthma. METHODS In this baseline assessment of a multinational prospective cohort study (the Assessment of Small Airways Involvement in Asthma [ATLANTIS] study), we recruited participants with and without asthma (defined as Global Initiative for Asthma severity stages 1-5) from general practices, the databases of chest physicians, and advertisements at 29 centres across nine countries (Brazil, China, Germany, Italy, Spain, the Netherlands, the UK, the USA, and Canada). All participants were aged 18-65 years, and participants with asthma had received a clinical diagnosis of asthma more than 6 months ago that had been confirmed by a chest physician. This diagnosis required support by objective evidence at baseline or during the past 5 years, which could be: positive airway hyperresponsiveness to methacholine, positive reversibility (a change in FEV1 ≥12% and ≥200 mL within 30 min) after treatment with 400 μg of salbutamol in a metered-dose inhaler with or without a spacer, variability in peak expiratory flow of more than 20% (measured over 7 days), or documented reversibility after a cycle (eg, 4 weeks) of maintenance anti-asthma treatment. The inclusion criteria also required that patients had stable asthma on any previous regular asthma treatment (including so-called rescue β2-agonists alone) at a stable dose for more than 8 weeks before baseline and had smoked for a maximum of 10 pack-years in their lifetime. Control group participants were recruited by advertisements; these participants were aged 18-65 years, had no respiratory symptoms compatible with asthma or chronic obstructive pulmonary disease, normal spirometry, and normal airways responsiveness, and had smoked for a maximum of 10 pack-years. We assessed all participants with spirometry, body plethysmography, impulse oscillometry, multiple breath nitrogen washout, CT (in selected participants), and questionnaires about asthma control, asthma-related quality of life (both in participants with asthma only), and health status. We applied structural equation modelling in participants with asthma to assess the contribution of all physiological and CT variables to SAD, from which we defined clinical SAD and CT SAD scores. We then classified patients with asthma into SAD groups with model-based clustering, and we compared asthma severity, control, and health-care use during the past year by SAD score and by SAD group. This trial is registered with ClinicalTrials.gov, number NCT02123667. FINDINGS Between June 30, 2014, and March 3, 2017, we recruited and evaluated 773 participants with asthma and 99 control participants. All physiological measures contributed to the clinical SAD model with the structural equation modelling analysis. The prevalence of SAD in asthma was dependent on the measure used; we found the lowest prevalence of SAD associated with acinar airway ventilation heterogeneity (Sacin), an outcome determined by multiple breath nitrogen washout that reflects ventilation heterogeneity in the most peripheral, pre-acinar or acinar airways. Impulse oscillometry and spirometry results, which were used to assess dysfunction of small-sized to mid-sized airways, contributed most to the clinical SAD score and differed between the two SAD groups. Participants in clinical SAD group 1 (n=452) had milder SAD than group 2 and comparable multiple breath nitrogen washout Sacin to control participants. Participants in clinical SAD group 2 (n=312) had abnormal physiological SAD results relative to group 1, particularly their impulse oscillometry and spirometry measurements, and group 2 participants also had more severe asthma (with regard to asthma control, treatments, exacerbations, and quality of life) than group 1. Clinical SAD scores were higher (indicating more severe SAD) in group 2 than group 1, and we found that these scores were related to asthma control, severity, and exacerbations. We found no correlation between clinical SAD and CT SAD scores. INTERPRETATION SAD is a complex and silent signature of asthma that is likely to be directly or indirectly captured by combinations of physiological tests, such as spirometry, body plethysmography, impulse oscillometry, and multiple breath nitrogen washout. SAD is present across patients with all severities of asthma, but it is particularly prevalent in severe disease. The clinical classification of SAD into two groups (a milder and a more severe group) by use of impulse oscillometry and spirometry, which are easy to use, is meaningful given its association with GINA severity stages, asthma control, quality of life, and exacerbations. FUNDING Chiesi Farmaceutici SpA.
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Affiliation(s)
- Dirkje S Postma
- Department of Pulmonology, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - Chris Brightling
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Simonetta Baldi
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Global Clinical Development, Chiesi SAS, Bois-Colombes, France
| | - Maarten Van den Berge
- Department of Pulmonology, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Leonardo M Fabbri
- Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy; COPD Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Alberto Papi
- Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Thys Van der Molen
- Department of General Practice, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Klaus F Rabe
- LungenClinic, Grosshansdorf, Germany; Department of Medicine, Christian Albrechts University, Kiel, Germany; Airway Research Center North, German Center for Lung Research (DZL), Hannover, Germany
| | - Salman Siddiqui
- Institute for Lung Health, National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Dave Singh
- Centre for Respiratory Medicine and Allergy, University Hospital of South Manchester, University of Manchester, Manchester, UK
| | - Gabriele Nicolini
- Department of Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Monica Kraft
- University of Arizona College of Medicine, Department of Medicine, Tucson, AZ, USA
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Uncontrolled asthma phenotypes defined from parameters using quantitative CT analysis. Eur Radiol 2019; 29:2848-2858. [PMID: 30617489 DOI: 10.1007/s00330-018-5913-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/20/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Asthma is a heterogeneous disease with diverse clinical phenotypes that have been identified via cluster analyses. However, the classification of phenotypes based on quantitative CT (qCT) is poorly understood. The study was conducted to investigate CT determination of uncontrolled asthma phenotypes. METHODS Sixty-five patients with uncontrolled asthma (37 with severe asthma, 28 with non-severe asthma) underwent detailed clinical, laboratory, and pulmonary function tests, as well as qCT analysis. Twenty-five healthy subjects were also included in this study and underwent clinical physical examinations, pulmonary function tests, and low-dose CT scans. RESULTS The mean lumen area/body surface area ratio was smaller in patients with severe uncontrolled asthma compared with that in healthy subjects (9.84 mm2 [SD, 2.57 mm2], 11.96 mm2 [SD, 3.09 mm2]; p = 0.026). However, the percentage of mean wall area (WA) was greater (64.39% [SD, 2.55%], 62.09% [SD, 3.81%], p = 0.011). Air trapping (measured based on mean lung density and VI-856 [%] on expiratory scan) was greater in patients with severe uncontrolled asthma than in those with non-severe uncontrolled asthma and was higher in all patients with uncontrolled asthma than that in healthy subjects (all p < 0.001). Three CT-determined uncontrolled asthma phenotypes were identified. Cluster 1 had mild air trapping with or without proximal airway remodeling. Cluster 2 had moderate air trapping with or without proximal airway remodeling. Cluster 3 had severe air trapping with proximal airway remodeling. CONCLUSIONS There was obvious air trapping and proximal airway remodeling in patients with severe uncontrolled asthma. The three CT-determined uncontrolled asthma phenotypes might reflect underlying mechanisms of disease in patient stratification and in the different stages of disease development. KEY POINTS • Obvious air trapping and proximal airway remodeling were present in patients with severe uncontrolled asthma. • CT air trapping indices showed a good correlation with disease duration, total IgE, atopy, and OCS and ICS doses, and were even more strongly correlated with clinical lung function. • Three CT-determined uncontrolled asthma phenotypes were identified, which might reflect underlying mechanisms of disease in patient stratification and in the different stages of disease development.
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Zeng GS, Chen LC, Fan HZ, Wu LL, Wu XP, Fang ZK, He X, Yu HP. The relationship between steps of 6MWT and COPD severity: a cross-sectional study. Int J Chron Obstruct Pulmon Dis 2018; 14:141-148. [PMID: 30643400 PMCID: PMC6312395 DOI: 10.2147/copd.s188994] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and objective The distance of 6-minute walk test (D6MWT) has been widely used in the assessment of functional status in patients with COPD, while very little attention has been paid to the role of steps of 6-minute walk test (S6MWT). The purpose of this study was to investigate the relationship between S6MWT and other physiologic parameters of COPD. Patients and methods Seventy patients with stable COPD were enrolled consecutively in this cross-sectional study. Pulmonary function tests, including spirometry, impulse oscillometry (IOS) and the single-breath diffusing capacity of the lungs for carbon monoxide (DLCO), were carried out at rest. Quality of life was assessed by health-related quality of life (HRQoL) questionnaires, including modified Medical Research Council dyspnea scale (mMRC), St George’s Respiratory Questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test (CAT) and Clinical Chronic Obstructive Pulmonary Questionnaire. Both steps and distance were measured in the following 6-minute walk test (6MWT). Results Both S6MWT and D6MWT showed significant correlation with spirometry, IOS, DLCO parameters and HRQoL questionnaires score. Both pre- and post-6MWT inspiratory capacity showed significant correlation with S6MWT (ρ=0.338, P=0.004; ρ=0.359, P=0.002, respectively), whereas did not correlate with D6MWT (ρ=0.145, P=0.230; ρ=0.160, P=0.189, respectively). In stepwise multiple regression analysis, mMRC grade, age and CAT score remained as significant predictors in the final model for D6MWT (adjusted R2=0.445, P<0.01). DLCO and CAT score remained as significant predictors in the final model for S6MWT (adjusted R2=0.417, P<0.01). Conclusion S6MWT is efficient in the evaluation of functional status and quality of life in COPD and has significant correlation with various parameters indicating disease severity. Additionally, S6MWT might be better in predicting lung hyperinflation in COPD compared with D6MWT.
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Affiliation(s)
- Guan-Sheng Zeng
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Li-Chang Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Hui-Zhen Fan
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Ling-Ling Wu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Xi-Ping Wu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Ze-Kui Fang
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Xi He
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
| | - Hua-Peng Yu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China,
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P2X4R promotes airway remodeling by acting on the phenotype switching of bronchial smooth muscle cells in rats. Purinergic Signal 2018; 14:433-442. [PMID: 30387030 DOI: 10.1007/s11302-018-9625-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022] Open
Abstract
The P2X4 receptor (P2X4R) contributes to airway inflammation and airway remodeling in mice with allergic asthma. However, the molecular mechanism by which P2X4R affects the airway remodeling in allergic asthma remains largely unknown. We established an allergic asthma model by ovalbumin (OVA) inhalation in BALB/c mice. Compared with the mice in the control group, the expression of proliferating cell nuclear antigen (PCNA) increased and that of alpha-smooth muscle actin (α-SMA) decreased in the OVA-challenged mice. 5-BDBD, a P2X4R antagonist, alleviated the OVA-induced changes. To clarify the role of P2X4R in the phenotype switching of the bronchial smooth muscle, bronchial smooth muscle contractility and p38MAPK expression were investigated. Platelet-derived growth factor-BB (PDGF-BB) was used to activate the proliferation of primary-cultured rat bronchial smooth muscle cells (BSMCs). P2X4R, p38MAPK, and phenotype markers were evaluated using Western blotting or immunofluorescence. PDGF-BB administration increased the P2X4R and phospho-p38MAPK expression in BSMCs, and the increased phospho-p38MAPK expression was downregulated by silencing of the P2X4R mRNA. PDGF-BB stimulated the proliferation and synthetic phenotype of BSMCs, which was aggravated by a P2X4R agonist and alleviated by a P2X4R antagonist or silencing the P2X4R mRNA. The decreased contractile phenotype induced by PDGF-BB was alleviated by a P2X4R antagonist or by silencing the P2X4R mRNA. SB203580, p38MAPK inhibitor, inhibited the PDGF-BB-induced increasing of synthetic phenotype and the proliferation of BSMCs. These findings indicate that P2X4R acts directly on the phenotype switching of BSMCs. Inhibiting P2X4R can promote the contractile differentiation of BSMCs via p38MAPK signaling. Thus, the effect of P2X4R on airway remodeling indicates that this receptor could be a target for future drug candidates.
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Airway remodeling in asthma: update on mechanisms and therapeutic approaches. Curr Opin Pulm Med 2018; 24:56-62. [PMID: 29076828 DOI: 10.1097/mcp.0000000000000441] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The term 'airway remodeling' reflects changes in the type, quantity, and nature of airway wall components and their organization. The purpose of this review is to look at recent publications on airway remodeling in asthma. RECENT FINDINGS Animal models and in-vitro studies have confirmed the involvement of airway epithelium, airway smooth muscle (ASM), and extracellular matrix components in asthma-related airway remodeling. They report influences on proliferation of ASM cells, and how their orientation or morphology, in addition to the heterogeneity of ASM mass at different levels of airways could influence their effects. Clinical benefits have been observed following reduction of ASM following bronchial thermoplasty. Asthmatic epithelial cell transcriptome alterations were found to involve metabolism and epigenetics, beyond epithelial mesenchymal trophic unit driven by injury and repair in chronic inflammation. New ways to explore airway remodeling such as imaging or endoscopic techniques have been evaluated. Finally, new data support the role of eosinophils and mast cells in remodeling and show the influence of new asthma drugs on this process. SUMMARY As recently stated by an American Thoracic Society task force, we need more research on airway remodeling, its determinants and clinical relevance, and on the effects of asthma drugs on its various components.
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Ferrari CR, Cooley J, Mujahid N, Costa LR, Wills RW, Johnson ME, Swiderski CE. Horses With Pasture Asthma Have Airway Remodeling That Is Characteristic of Human Asthma. Vet Pathol 2018; 55:144-158. [PMID: 29254472 DOI: 10.1177/0300985817741729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe equine asthma, formerly recurrent airway obstruction (RAO), is the horse counterpart of human asthma, affecting horses maintained indoors in continental climates. Equine pasture asthma, formerly summer pasture RAO, is clinically similar but affects grazing horses during hot, humid conditions in the southeastern United States and United Kingdom. To advance translational relevance of equine pasture asthma to human asthma, histologic features of airway remodeling in human asthma were scored in lung lobes from 15 pasture asthma-affected and 9 control horses of mixed breeds. All noncartilaginous airways were scored using a standardized grading rubric (0-3) in hematoxylin and eosin (HE) and Movat's pentachrome-stained sections; 15 airways were chosen randomly from each lobe for analysis. Logistic regression identified disease, age, and lobe effects on probability of histologic outcomes. Airway smooth muscle (odds ratio [OR] = 2.5, P < .001), goblet cell hyperplasia/metaplasia (OR = 37.6, P < .0001), peribronchiolar elastic system fibers (OR = 4.2, P < .001), peribronchiolar fibrosis (OR = 3.8, P = .01), airway occlusion by mucus/inflammation (OR = 4.2, P = .04), and airway adventitial inflammation (OR = 3.0, P = .01) were significantly greater in diseased airways. A novel complex tissue disorganization, designated terminal bronchiolar remodeling, was overrepresented in diseased airways (OR = 3.7, P < .0001). Distribution of terminal bronchiolar remodeling corresponded to putative sites of air trapping in human asthma, at secondary pulmonary lobules. Age (>15 years) was an independent risk factor for increased peribronchiolar fibrosis, elastic system fibers, and terminal bronchiolar remodeling. Remodeling differed significantly between lung lobes, congruent with nonhomogeneous remodeling in human asthma. Equine pasture asthma recapitulates airway remodeling in human asthma in a manner not achieved in induced animal asthma models, endorsing its translational relevance for human asthma investigation.
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Affiliation(s)
- Claudenir R Ferrari
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, MS, USA.,2 Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA
| | - Jim Cooley
- 2 Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA
| | - Nisma Mujahid
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, MS, USA
| | - Lais R Costa
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, MS, USA
| | - Robert W Wills
- 2 Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA
| | - Melanie E Johnson
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, MS, USA.,2 Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA
| | - Cyprianna E Swiderski
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, MS, USA
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Gove K, Wilkinson T, Jack S, Ostridge K, Thompson B, Conway J. Systematic review of evidence for relationships between physiological and CT indices of small airways and clinical outcomes in COPD. Respir Med 2018; 139:117-125. [DOI: 10.1016/j.rmed.2018.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/21/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022]
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Russell RJ, Chachi L, FitzGerald JM, Backer V, Olivenstein R, Titlestad IL, Ulrik CS, Harrison T, Singh D, Chaudhuri R, Leaker B, McGarvey L, Siddiqui S, Wang M, Braddock M, Nordenmark LH, Cohen D, Parikh H, Colice G, Brightling CE. Effect of tralokinumab, an interleukin-13 neutralising monoclonal antibody, on eosinophilic airway inflammation in uncontrolled moderate-to-severe asthma (MESOS): a multicentre, double-blind, randomised, placebo-controlled phase 2 trial. THE LANCET RESPIRATORY MEDICINE 2018; 6:499-510. [PMID: 29793857 DOI: 10.1016/s2213-2600(18)30201-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of interleukin 13 in airway inflammation and remodelling in asthma is unclear. Tralokinumab is a human monoclonal antibody that neutralises interleukin 13. We aimed to evaluate whether tralokinumab would have an effect on airway eosinophilic infiltration, blood and sputum eosinophil concentrations, eosinophil activation, and airway remodelling. METHODS We did a multicentre, double-blind, randomised, placebo-controlled phase 2 trial at 15 centres across the UK, Denmark, and Canada. We enrolled participants of either sex aged 18-75 years with inadequately controlled moderate-to-severe asthma for 12 months or more, requiring treatment with inhaled corticosteroids at a stable dose. We randomly assigned participants (1:1) to receive tralokinumab (300 mg) or placebo by an interactive web-based system or voice response system. Participants and study personnel were masked to treatment allocation. Both tralokinumab and placebo were administered subcutaneously every 2 weeks. The primary outcome measure was change from baseline to week 12 in bronchial biopsy eosinophil count. Secondary outcome measures included change in blood and sputum eosinophil counts. Exploratory outcomes included fractional exhaled nitric oxide (FENO) and blood IgE concentrations. Safety analyses were carried out in all participants who received study drug. This trial is registered with ClinicalTrials.gov, number NCT02449473, and with the European Clinical Trials Database, EudraCT 2015-000857-19. FINDINGS Between Sept 25, 2015, and June 21, 2017, 224 participants were enrolled and screened. Of these participants, 79 were randomly assigned to receive tralokinumab (n=39) or placebo (n=40). Tralokinumab did not significantly affect bronchial eosinophil count compared with placebo at week 12 (treatment effect ratio 1·43, 95% CI 0·63-3·27; p=0·39). Compared with placebo, tralokinumab did not significantly affect blood eosinophil count (treatment effect ratio 1·21, 95% CI 1·00-1·48; p=0·055) or sputum eosinophil count (0·57, 0·06-6·00; p=0·63), but FENO concentration (0·78, 0·63-0·96; p=0·023) and total blood IgE concentration (0·86, 0·77-0·97; p=0·014) were significantly reduced. 33 (85%) of 39 patients receiving tralokinumab and 32 (80%) of 40 receiving placebo reported at least one adverse event during the treatment period. No deaths in either treatment group were observed. Treatment-related adverse events occurred more frequently in the tralokinumab group than in the placebo group (11 [28%] of 39 vs seven [18%] of 40). INTERPRETATION Tralokinumab did not significantly affect eosinophilic inflammation in bronchial submucosa, blood, or sputum compared with placebo, but did reduce FENO and IgE concentrations. These results suggest interleukin 13 is not crucial for eosinophilic airway inflammation control in moderate-to-severe asthma. FUNDING AstraZeneca.
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Affiliation(s)
- Richard J Russell
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Latifa Chachi
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - J Mark FitzGerald
- Institute for Heart and Lung Health, University of British Columbia, Vancouver, BC, Canada
| | - Vibeke Backer
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | - Ronald Olivenstein
- Respiratory Division, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Ingrid L Titlestad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | | | - Timothy Harrison
- NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rekha Chaudhuri
- Respiratory Medicine Department, Gartnavel General Hospital, Glasgow, UK; Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Brian Leaker
- Respiratory Clinical Trials, Queen Anne Street Medical Centre, London, UK
| | - Lorcan McGarvey
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Salman Siddiqui
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Millie Wang
- Respiratory Global Medicines Development, AstraZeneca, Cambridge, UK
| | - Martin Braddock
- Respiratory Global Medicines Development, AstraZeneca, Cambridge, UK
| | - Lars H Nordenmark
- Respiratory Global Medicines Development, AstraZeneca, Gothenburg, Sweden
| | - David Cohen
- Respiratory Global Medicines Development, AstraZeneca, Gaithersburg, MD, USA
| | - Himanshu Parikh
- Respiratory Global Medicines Development, AstraZeneca, Mississauga, ON, Canada
| | - Gene Colice
- Respiratory Global Medicines Development, AstraZeneca, Gaithersburg, MD, USA
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Abstract
PURPOSE OF REVIEW The present review aims to summarize the most recent evidence related to imaging and severe asthma, both with regard to advances in imaging research and to their current and potential clinical implications. RECENT FINDINGS Recent work in imaging in severe asthma has principally been using computed tomography (CT) and MRI, as well as the integration of the two. Some of the most notable findings include the use of CT imaging biomarkers to create unique clusters of asthmatics, and the use of co-registration to link CT images of airways with regional variation in ventilation in MRI. In addition, temporal studies have shown that some the ventilation defects found using MRI in asthmatics are intermittent and others are persistent, but both are associated with lower lung function. SUMMARY The role of imaging in severe asthma currently is primarily in the exclusion of comorbid or other conditions, or in the assessment for complications in the setting of acute decompensation. A rapidly expanding body of literature using CT and MRI suggests that these tools may soon be of utility in the chronic management of the disease.
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