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Kelmenson DA, Kelly VJ, Winkler T, Kone MT, Musch G, Melo MFV, Venegas JG, Harris RS. The effect of omalizumab on ventilation and perfusion in adults with allergic asthma. Am J Nucl Med Mol Imaging 2013; 3:350-360. [PMID: 23901360 PMCID: PMC3715779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/23/2013] [Indexed: 06/02/2023]
Abstract
Omalizumab promotes clinical improvement in patients with allergic asthma, but its effect on pulmonary function is unclear. One possibility is that omalizumab improves asthma symptoms through effects on the regional distributions of ventilation, perfusion, and ventilation/perfusion matching, metrics which can be assessed with Nitrogen-13-saline Position Emission Tomography (PET). Four adults with moderate to severe uncontrolled allergic asthma underwent symptom assessment, spirometry and functional pulmonary imaging with Nitrogen-13-saline PET before and after 4-5 months of treatment with omalizumab. PET imaging was used to determine ventilation/perfusion ratios, the heterogeneity (coefficient of variation, COV) of ventilation and perfusion, and lung regions with ventilation defects. There were no significant changes in spirometry values after omalizumab treatment, but there was a trend towards an improvement in symptom scores. There was little change in the matching of ventilation and perfusion. The COV of perfusion was similar before and after omalizumab treatment. The COV of ventilation was also similar before (0.57 (0.28)) and after (0.66 (0.13)) treatment, and it was similar to previously published values for healthy subjects. There was a non-significant trend towards an increase in the extent of ventilation defects after omalizumab treatment, from 5 (15)% to 12.8 (14.7)%. Treatment of moderate to severe uncontrolled allergic asthma with omalizumab did not result in a significant improvement in ventilation and perfusion metrics assessed with functional PET imaging. The normal COV of ventilation which was unaffected by treatment supports the hypothesis that omalizumab exerts its clinical effect on lung function during allergen exposure rather than in between exacerbations.
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Affiliation(s)
- Daniel A Kelmenson
- The Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
| | - Vanessa J Kelly
- The Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
| | - Tilo Winkler
- The Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
| | - Mamary T Kone
- The Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
| | - Guido Musch
- The Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
| | - Marcos F Vidal Melo
- The Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
| | - Jose G Venegas
- The Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
| | - R Scott Harris
- The Department of Medicine, Pulmonary and Critical Care Unit, Massachusetts General Hospital and Harvard Medical SchoolBoston, MA, USA
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