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An TJ, Kim JH, Park CK, Yoon HK. Tiotropium bromide has a more potent effect than corticosteroid in the acute neutrophilic asthma mouse model. Tuberc Respir Dis (Seoul) 2021; 85:18-24. [PMID: 34727490 PMCID: PMC8743638 DOI: 10.4046/trd.2021.0118] [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: 07/29/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Neutrophilic asthma (NeuA) is usually resistant to corticosteroids. Tiotropium bromide (TIO) is a bronchodilator that is used as an add-on therapy to inhaled corticosteroid and long-acting β2 agonist in asthma treatment. However, the role of TIO in NeuA is not fully known. Thus, the aim of this study was to evaluate the effect of TIO on NeuA compared to that of corticosteroids. Methods C57BL/6 female mice were sensitized with ovalbumin and lipopolysaccharide to induce neutrophilic inflammation. Dexamethasone (DEX) was administered on days 14, 17, 20, and 23. TIO was inhaled on days 21, 21, and 23. On day 24, mice were sacrificed. Airway hyper-responsiveness, levels of cytokines in bronchoalveolar lavage (BAL) and lung homogenates, and lung tissue histopathology were compared between the two groups. Results Neutrophil counts, T helper 2 cells (TH2)/TH17 cytokines, and pro-inflammatory cytokine in BAL fluids were elevated in the NeuA group. TIO group showed lower total cells, neutrophil counts, and eosinophil counts in BAL fluids than the DEX group (p<0.001, p<0.05, and p<0.001, respectively). Airway resistance was attenuated in the TIO group but elevated in the NeuA group (p<0.001). Total protein, interleukin (IL)-5, and IL-17A levels in BAL fluids were lower in the TIO group than in the NeuA group (all p<0.05). Conclusion TIO showed more potent effects than DEX in improving airway inflammation and attenuating airway resistance in NeuA.
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Affiliation(s)
- Tai Joon An
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hye Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kwon Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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2
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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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Haw TJ, Starkey MR, Pavlidis S, Fricker M, Arthurs AL, Nair PM, Liu G, Hanish I, Kim RY, Foster PS, Horvat JC, Adcock IM, Hansbro PM. Toll-like receptor 2 and 4 have opposing roles in the pathogenesis of cigarette smoke-induced chronic obstructive pulmonary disease. Am J Physiol Lung Cell Mol Physiol 2018; 314:L298-L317. [PMID: 29025711 PMCID: PMC5866502 DOI: 10.1152/ajplung.00154.2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 12/18/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of morbidity and death and imposes major socioeconomic burdens globally. It is a progressive and disabling condition that severely impairs breathing and lung function. There is a lack of effective treatments for COPD, which is a direct consequence of the poor understanding of the underlying mechanisms involved in driving the pathogenesis of the disease. Toll-like receptor (TLR)2 and TLR4 are implicated in chronic respiratory diseases, including COPD, asthma and pulmonary fibrosis. However, their roles in the pathogenesis of COPD are controversial and conflicting evidence exists. In the current study, we investigated the role of TLR2 and TLR4 using a model of cigarette smoke (CS)-induced experimental COPD that recapitulates the hallmark features of human disease. TLR2, TLR4, and associated coreceptor mRNA expression was increased in the airways in both experimental and human COPD. Compared with wild-type (WT) mice, CS-induced pulmonary inflammation was unaltered in TLR2-deficient ( Tlr2-/-) and TLR4-deficient ( Tlr4-/-) mice. CS-induced airway fibrosis, characterized by increased collagen deposition around small airways, was not altered in Tlr2-/- mice but was attenuated in Tlr4-/- mice compared with CS-exposed WT controls. However, Tlr2-/- mice had increased CS-induced emphysema-like alveolar enlargement, apoptosis, and impaired lung function, while these features were reduced in Tlr4-/- mice compared with CS-exposed WT controls. Taken together, these data highlight the complex roles of TLRs in the pathogenesis of COPD and suggest that activation of TLR2 and/or inhibition of TLR4 may be novel therapeutic strategies for the treatment of COPD.
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Affiliation(s)
- Tatt Jhong Haw
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Malcolm R Starkey
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
- Priority Research Centre for Grow Up Well, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Stelios Pavlidis
- The Airways Disease Section, National Heart and Lung Institute, Imperial College London , London , United Kingdom
| | - Michael Fricker
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Anya L Arthurs
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Prema M Nair
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Gang Liu
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Irwan Hanish
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor , Malaysia
| | - Richard Y Kim
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Paul S Foster
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Jay C Horvat
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
| | - Ian M Adcock
- The Airways Disease Section, National Heart and Lung Institute, Imperial College London , London , United Kingdom
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs, School of Biomedical Sciences and Pharmacy, Hunter Medical Research Institute and University of Newcastle, Callaghan, New South Wales , Australia
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Airway Evaluation with Multidetector Computed Tomography Post-Processing Methods in Asthmatic Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 934:41-7. [PMID: 27271759 DOI: 10.1007/5584_2016_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Asthma is a chronic inflammatory obstructive airways disease. The disease occurs regardless of age and manifests with cough, attacks of breathlessness, and tightness in the chest. The pathophysiology of asthma is complex and still not fully understood. It is essential to find answers concerning the role of each part of the bronchial tree in asthma, especially the role of small bronchioles. With the development of newer generations of multidetector computed tomography (MDCT) and advanced post-processing methods it is possible to obtain more detailed images and gain insight into further aspects of asthma. MDCT post-processing methods can be divided into two-dimensional (2D) and three-dimensional (3D). In 2D projections, visualized hypodense regions correspond to the airway flow limitations. With the more advanced methods, such as multi planar reconstructions (MPR), images in different planes (axial, coronal, or sagittal) can be created. In the MPR technique only the voxels which are adjacent to each other in the predetermined plane can be extracted from the data set. Using the minimal/maximal intensity projections and shaded surface display, the volume of interest (VOI) can be extracted. High resolution CT scans can be used to create a more advanced imaging tool - the virtual bronchoscopy (VB). Using the VB makes it possible to visualize regions of obturation in the bronchi of up to the 5-8th generation. The MDCT with advanced post-processing methods is likely to assume an important role in the differential diagnosis of asthma, particularly when the diagnosis is dubious or hard to settle due to accompanying other lung diseases.
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Chang HS, Lee TH, Jun JA, Baek AR, Park JS, Koo SM, Kim YK, Lee HS, Park CS. Neutrophilic inflammation in asthma: mechanisms and therapeutic considerations. Expert Rev Respir Med 2016; 11:29-40. [PMID: 27918221 DOI: 10.1080/17476348.2017.1268919] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Neutrophilic airway inflammation represents a pathologically distinct form of asthma and frequently appears in symptomatic adulthood asthmatics. However, clinical impacts and mechanisms of the neutrophilic inflammation have not been thoroughly evaluated up to date. Areas covered: Currently, distinct clinical manifestations, triggers, and molecular mechanisms of the neutrophilic inflammation (namely Toll-like receptor, Th1, Th17, inflammasome) are under investigation in asthma. Furthermore, possible role of the neutrophilic inflammation is being investigated in respect to the airway remodeling. We searched the related literatures published during the past 10 years on the website of Pub Med under the title of asthma and neutrophilic inflammation in human. Expert commentary: Epidemiologic and experimental studies have revealed that the neutrophilic airway inflammation is induced by a wide variety of stimuli including ozone, particulate matters, cigarette smoke, occupational irritants, endotoxins, microbial infection and colonization, and aeroallergens. These triggers provoke diverse immune and inflammatory responses leading to progressive and sometimes irreversible airway obstruction. Clinically, neutrophilic airway inflammation is frequently associated with severe asthma and poor response to glucocorticoid therapy, indicating the need for other treatment strategies. Accordingly, therapeutics will be targeted against the main mediators behind the underlying molecular mechanisms of the neutrophilic inflammation.
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Affiliation(s)
- Hun Soo Chang
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Tae-Hyeong Lee
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Ji Ae Jun
- a Department of Interdisciplinary Program in Biomedical Science Major , Soonchunhyang Graduate School , Bucheon , Gyeonggi-do , Republic of Korea
| | - Ae Rin Baek
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
| | - Jong-Sook Park
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
| | - So-My Koo
- c Division of Allergy and Respiratory Medicine , Soonchunhyang University Seoul Hospital , Seoul , Republic of Korea
| | - Yang-Ki Kim
- c Division of Allergy and Respiratory Medicine , Soonchunhyang University Seoul Hospital , Seoul , Republic of Korea
| | - Ho Sung Lee
- d Division of Respiratory Medicine , Soonchunhyang University CheonAn Hospital , Cheonan , Chungcheongnam-do , Republic of Korea
| | - Choon-Sik Park
- b Division of Allergy and Respiratory Disease , Soonchunhyang University Bucheon Hospital , Bucheon , Gyeonggi-do , Republic of Korea
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Konstantellou E, Papaioannou AI, Loukides S, Patentalakis G, Papaporfyriou A, Hillas G, Papiris S, Koulouris N, Bakakos P, Kostikas K. Persistent airflow obstruction in patients with asthma: Characteristics of a distinct clinical phenotype. Respir Med 2015; 109:1404-9. [PMID: 26412805 DOI: 10.1016/j.rmed.2015.09.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Some patients with asthma present persistent airflow limitation but their clinical and inflammatory characteristics have not been extensively described. In this study we aimed to identify differences in the clinical, functional and inflammatory characteristics between patients with asthma with and without persistent airflow obstruction. METHODS Patients (n = 170) were consecutively recruited from two tertiary Asthma Clinics. Patients' demographics, pulmonary function tests, inflammatory cells in induced sputum, bronchial hyperresponsiveness (BHR, PD15 to methacholine) and treatment regimens were recorded. RESULTS Sixty patients (35.3%) presented persistent airflow obstruction. Besides differences in lung function, patients with persistent obstruction presented, lower methacholine PD20, higher exhaled NO, and higher eosinophil and neutrophil counts in induced sputum. The majority (71.7%) of the patients with persistent obstruction fulfilled the ATS criteria for severe refractory asthma (SRA), in contrast to 4.5% in the group without persistent obstruction. A cluster analysis identified three clinically relevant clusters: Cluster 1 (n = 56, not related to persistent airflow obstruction) included non-atopic patients, who did not receive high-dose ICS without SRA; Cluster 2 (n = 53, related to persistent airflow obstruction) included atopic patients, receiving high-dose ICS and/or oral CS, fulfilling SRA criteria; Cluster 3 (n = 61, not related to persistent airflow obstruction) included atopic patients not receiving high-dose ICS, without SRA. CONCLUSIONS Asthma patients with persistent airflow obstruction present a distinct asthma phenotype, with significant differences in clinical, functional and inflammatory characteristics compared to patients without fixed airway obstruction. These patients present more often severe refractory asthma and require more intense treatment.
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Affiliation(s)
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece.
| | - George Patentalakis
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | | | - Georgios Hillas
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - Spyros Papiris
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - Nikolaos Koulouris
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - Petros Bakakos
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - Konstantinos Kostikas
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
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7
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Lee E, Seo JB, Lee HJ, Chae EJ, Lee SM, Oh SY, Kim N. Quantitative Assessment of Global and Regional Air Trappings Using Non-Rigid Registration and Regional Specific Volume Change of Inspiratory/Expiratory CT Scans: Studies on Healthy Volunteers and Asthmatics. Korean J Radiol 2015; 16:632-40. [PMID: 25995694 PMCID: PMC4435244 DOI: 10.3348/kjr.2015.16.3.632] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 02/12/2015] [Indexed: 01/15/2023] Open
Abstract
Objective The purpose of this study was to compare air trapping in healthy volunteers with asthmatics using pulmonary function test and quantitative data, such as specific volume change from paired inspiratory CT and registered expiratory CT. Materials and Methods Sixteen healthy volunteers and 9 asthmatics underwent paired inspiratory/expiratory CT. ΔSV, which represents the ratio of air fraction released after exhalation, was measured with paired inspiratory and anatomically registered expiratory CT scans. Air trapping indexes, ΔSV0.4 and ΔSV0.5, were defined as volume fraction of lung below 0.4 and 0.5 ΔSV, respectively. To assess the gravity effect of air-trapping, ΔSV values of anterior and posterior lung at three different levels were measured and ΔSV ratio of anterior lung to posterior lung was calculated. Color-coded ΔSV map of the whole lung was generated and visually assessed. Mean ΔSV, ΔSV0.4, and ΔSV0.5 were compared between healthy volunteers and asthmatics. In asthmatics, correlation between air trapping indexes and clinical parameters were assessed. Results Mean ΔSV, ΔSV0.4, and ΔSV0.5 in asthmatics were significantly higher than those in healthy volunteer group (all p < 0.05). ΔSV values in posterior lung in asthmatics were significantly higher than those in healthy volunteer group (p = 0.049). In asthmatics, air trapping indexes, such as ΔSV0.5 and ΔSV0.4, showed negative strong correlation with FEF25-75, FEV1, and FEV1/FVC. ΔSV map of asthmatics showed abnormal geographic pattern in 5 patients (55.6%) and disappearance of anterior-posterior gradient in 3 patients (33.3%). Conclusion Quantitative assessment of ΔSV (the ratio of air fraction released after exhalation) shows the difference in extent of air trapping between health volunteers and asthmatics.
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Affiliation(s)
- Eunsol Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hyun Joo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Eun Jin Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Yii ACA, Tan GL, Tan KL, Lapperre TS, Koh MS. Fixed airways obstruction among patients with severe asthma: findings from the Singapore General Hospital-Severe Asthma Phenotype Study. BMC Pulm Med 2014; 14:191. [PMID: 25467558 PMCID: PMC4265441 DOI: 10.1186/1471-2466-14-191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 11/27/2014] [Indexed: 11/13/2022] Open
Abstract
Background A subset of severe asthma patients has fixed airways obstruction, which is characterized by incomplete reversibility to bronchodilator challenge. We aimed to elucidate the factors associated with fixed airways obstruction in a cohort of patients with severe asthma in Singapore. Methods 245 patients from the Singapore General Hospital-Severe Asthma Phenotype Study (SGH-SAPS) were screened. These patients fulfilled World Health Organization criteria for "treatment-resistant severe asthma" and were all on combination of high-dose inhaled corticosteroids and long-acting beta2 agonists. 76 patients had pre- and postbronchodilator lung function tests and were selected for analysis. They were divided into two groups based on postbronchodilator (Post BD) forced expiratory volume in one second, PostBDFEV1 % predicted: ≥70% (Non-Fixed Obs) and < 70% (Fixed Obs). We compared clinical and demographic parameters between the two groups. Results Patients in the Fixed Obs group were more frequently past or current smokers and had a higher pack-year smoking history. Overall, pack-year smoking history had a modest negative correlation with PostBDFEV1 % predicted. Atopy, allergen sensitization (type and numbers), comorbidities, symptoms, health care utilization and medication use did not differ between the two groups. The prebronchodilator FEV1 % predicted, FEV1/FVC and FVC % predicted were significantly lower in the Fixed Obs group. In addition, prebronchodilator FVC % predicted accounted for more variability than FEV1/FVC in predicting PostBDFEV1% predicted. Conclusion Smoking is associated with fixed airways obstruction in patients with treatment-resistant severe asthma in Singapore. Furthermore, our results suggest that both small and large airways obstruction contribute independently to fixed airways obstruction in severe asthma.
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Affiliation(s)
| | | | | | | | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore.
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Mocelin H, Bueno G, Irion K, Marchiori E, Sarria E, Watte G, Hochhegger B. CT densitovolumetry in children with obliterative bronchiolitis: correlation with clinical scores and pulmonary function test results. J Bras Pneumol 2014; 39:701-10. [PMID: 24473764 PMCID: PMC4075902 DOI: 10.1590/s1806-37132013000600009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 09/21/2013] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE: To determine whether air trapping (expressed as the percentage of air
trapping relative to total lung volume [AT%]) correlates with clinical and
functional parameters in children with obliterative bronchiolitis (OB). METHODS: CT scans of 19 children with OB were post-processed for AT% quantification
with the use of a fixed threshold of −950 HU (AT%950) and of thresholds
selected with the aid of density masks (AT%DM). Patients were divided into
three groups by AT% severity. We examined AT% correlations with oxygen
saturation (SO2) at rest, six-minute walk distance (6MWD),
minimum SO2 during the six-minute walk test
(6MWT_SO2), FVC, FEV1, FEV1/FVC, and
clinical parameters. RESULTS: The 6MWD was longer in the patients with larger normal lung volumes (r =
0.53). We found that AT%950 showed significant correlations (before and
after the exclusion of outliers, respectively) with the clinical score (r =
0.72; 0.80), FVC (r = 0.24; 0.59), FEV1 (r = −0.58; −0.67), and
FEV1/FVC (r = −0.53; r = −0.62), as did AT%DM with the
clinical score (r = 0.58; r = 0.63), SO2 at rest (r = −0.40; r =
−0.61), 6MWT_SO2 (r = −0.24; r = −0.55), FVC (r = −0.44; r =
−0.80), FEV1 (r = −0.65; r = −0.71), and FEV1/FVC (r =
−0.41; r = −0.52). CONCLUSIONS: Our results show that AT% correlates significantly with clinical scores and
pulmonary function test results in children with OB.
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Affiliation(s)
- Helena Mocelin
- Santa Casa Sisters of Mercy Hospital Complex in Porto Alegre, Porto Alegre, Brazil
| | - Gilberto Bueno
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Klaus Irion
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edgar Sarria
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Watte
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Critical review of bronchial thermoplasty: where should it fit into asthma therapy? Curr Allergy Asthma Rep 2014; 14:470. [PMID: 25189294 DOI: 10.1007/s11882-014-0470-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Bronchial thermoplasty is a device-based therapy for treatment of severe refractory asthma that uses radiofrequency energy to reduce airway smooth muscle and decrease bronchoconstriction. BT improves quality of life and decreases the rate of severe exacerbations with no known major long-term complications. The effectiveness of bronchial thermoplasty persists at least 5 years after the treatment is completed. Further investigation is needed to better define the specific subpopulation of patients with severe asthma who would best benefit from this treatment.
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Sheshadri A, Hoffman EA, Castro M. Can computed tomography help us identify asthmatic phenotypes? J Allergy Clin Immunol 2014; 133:739-40. [PMID: 24472625 DOI: 10.1016/j.jaci.2013.12.1036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Ajay Sheshadri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | - Eric A Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, lowa
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Mo.
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12
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Kodgule R, Vanjare N, Brashier B, Salvi S. Is air trapping really a determinant of persistent airway obstruction in asthmatics? Respir Med 2012; 107:156-7. [PMID: 22640771 DOI: 10.1016/j.rmed.2012.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 04/14/2012] [Indexed: 11/25/2022]
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