Mechanisms of limited airway dimension with lung inflation

Spirometer guided chest imaging in children: It is worth the effort!

PURPOSE

Computed tomography (CT) and magnetic resonance imaging (MRI) scans are used to assess and monitor several pediatric lung diseases. It is well recognized that lung volume at the moment of acquisition has a major impact on the appearance of lung parenchyma and airways. Importantly, the sensitivity of chest CT and MRI to detect bronchiectasis and gas trapping is highly dependent on adequate volume control during the image acquisition. This paper describes a feasible method to obtain accurate control of lung volume during chest imaging in pediatric patients with lung disease.

PROCEDURE

A procedure to obtain maximal respiratory manoeuvres with spirometry guidance during image acquisition for CT and MRI is described. This procedure requires training of the subject, an MRI compatible spirometer and close collaboration between a lung function scientist and the radiographer. A good to excellent target volume level for the inspiratory or expiratory scan can be achieved in around 90% of children. An important condition for this success rate is the training of the subject, executed prior to each chest CT or MRI, and instructions by the lung function scientist during the chest CT.

CONCLUSION

Implementing lung volume guidance with a spirometer is an important and feasible step to standardize chest imaging and to optimize the diagnostic yield of chest CT and MRI in children with lung disease. Training and the collaborative effort by a lung function scientist and radiographer is the key factor for success of this procedure. Pediatr Pulmonol. 2017;52:48-56. © 2016 Wiley Periodicals, Inc.

"Asthma isn't an excuse, it's just a condition": youths' perceptions of physical activity and screen time

OBJECTIVE

During puberty, physical activity patterns begin to decline, while sedentary time increases. These changes may be confounded by asthma. The purpose of this study was to gain insight into youths' perceptions of screen time and physical activity by asthma status.

METHODS

Four interviews and seven focus groups with boys only or girls only were conducted with 15- to 16-year-old youth enrolled in either of two asthma-focused cohorts in Manitoba, Canada. Using a semi-structured interview guide, youth were asked about their perceptions of physical activity and screen time such as texting, watching television, electronic games, and Internet chatting and about their perceptions of the influence that asthma has on these behaviors. Data were analyzed using thematic coding.

RESULTS

Two themes were common to youth with asthma and without asthma: (1) sports are an integral part of youths' lives and (2) screen time is important to youth. Two themes were identified among youth with asthma only: (1) physical activity used to be more difficult and (2) being active and living with asthma. Youth with asthma described physical activity as neither a hindrance to activity nor an excuse for inactivity, although asthma may still present some challenges. They also acknowledged their reliance on screen time for communication and for entertainment.

CONCLUSIONS

Youth with asthma believe that physical activity has become increasingly easier as they become older and that being active with asthma, despite its challenges, is a key part of their lives.

Neutrophilic asthma has different radiographic features to COPD and smokers

BACKGROUND

Neutrophilic asthma and COPD are obstructive airway diseases common in older age and have a characteristic airway inflammation with neutrophilic bronchitis. The structural differences between neutrophilic asthma and COPD have not been investigated. The aim of this study was to examine the airway and parenchymal abnormalities using high resolution computed tomographic (HRCT) scanning in participants with neutrophilic asthma, COPD and smoking controls.

METHODS

Participants (neutrophilic asthma (n=10), COPD (n=17) and smoking controls (n=8)) underwent clinical assessment and sputum induction. HRCT of the chest was performed and independently scored by a radiologist blinded to the subject group using a modified Bhalla scoring system.

RESULTS

Participants were of a similar age and those with COPD had a similar degree of airflow obstruction to those with neutrophilic asthma. The pattern of radiographic abnormalities differed between groups. Abnormal bronchial wall thickening was significantly more common in neutrophilic asthma, compared to COPD or smoking controls. Emphysema was greatest in the COPD group, and not recorded as a feature of neutrophilic asthma. FEV(1)% predicted was negatively associated with bronchial wall thickening and consolidation while KCO% predicted was negatively associated with the total emphysema score. Bronchiectasis was minimal in all groups.

CONCLUSION

The pattern of radiographic lung abnormality in neutrophilic asthma differs significantly from COPD, and resembles asthma. Neutrophilic asthma is a distinct inflammatory subtype of asthma with a different pathogenesis to COPD.

Advances in therapy for adult asthma

There are >22 million Americans with asthma. Chronic asthma is a worldwide problem with an increasing socioeconomic burden on individuals and on society. Recent advances have been made in diagnostic lung imaging, defining control of asthma, as well as in the education of patients with asthma. Accurate diagnosis of the cause of chronic cough in adults and of asthma in elderly individuals will help affected individuals receive appropriate treatment. Inhaled corticosteroids are the recommended first-line therapy for persistent asthma and can help prevent exacerbations in patients with asthma that are not well controlled. Early intervention and improved management can significantly reduce the socioeconomic burden of asthma. Patient education is an essential part of asthma management.