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First published online on July 18, 2008
Chest, doi:10.1378/chest.07-2779
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Airway remodeling measured by multidetector computed tomography is increased in severe asthma and correlates with pathology

Ravi S. Aysola, M.D1; Eric A. Hoffman, Ph.D2; David Gierada, M.D3; Sally Wenzel, M.D4; Janice Cook-Granroth2; Jaime Tarsi, R.N., M.P.H1; Jie Zheng5; Kenneth B. Schechtman, Ph.D5; Thiruvamoor P. Ramkumar, Ph.D1; Rebecca Cochran1; E Xueping, M.D., Ph.D1; Chandrika Christie1; John Newell, M.D6; Sean Fain, Ph.D7; Talissa A. Altes, M.D8; Mario Castro, M.D., M.P.H1 and Research Program (SARP) NHLBI Severe Asthm

1Division of Pulmonary and Critical Care Medicine 3Department of Radiology 5Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 2Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA 4University of Pittsburgh Medical Center, Pittsburgh, PA 6National Jewish Medical and Research Center, Denver, CO 7University of Wisconsin, Madison, WI 8Children's Hospital of Philadelphia, Philadelphia, PA

castrom{at}wustl.edu

Abstract

BackgroundTo prospectively apply an automated, quantitative 3-D approach to imaging and airway analysis to assess airway remodeling in asthma.

MethodsUsing the Pulmonary Workstation (VIDA Diagnostics) that enables quantitative airway segment measurements of low-dose, thin section (0.625-1.25 mm) multidetector-row CT (MDCT), we compared airway wall thickness (WT) and area (WA) in 123 subjects participating in a prospective multicenter cohort study, NIH Severe Asthma Research Program (SARP): severe asthma (n=63), mild-moderate asthma (n=35), and normal (n=25). A subset of these subjects underwent fiberoptic bronchoscopy and endobronchial biopsies (n=32). WT and WA were corrected for total airway diameter and area - WT%, WA%.

ResultsSubjects with severe asthma had significantly greater WT% than mild-moderate asthma and normals [17.2±1.5 v 16.5±1.6, p=0.014 and 16.3±1.2, p=0.031, respectively] and greater WA% compared to mild-moderate asthma and normal [56.6±2.9 v 54.7±3.3, p=.005 and 54.6±2.4, p=0.003, respectively]. Both WT% and WA% were inversely correlated with baseline FEV1% (r=–0.39, p<0.0001 and -0.40, p<0.0001, respectively) and positively correlated with response to bronchodilator (r=0.28, p=0.002 and r=0.35, p<0.0001, respectively). Airway epithelial thickness on biopsy correlated with WT% (r=0.47, p=0.007) and WA% (r=0.52, p=0.003). In the same individual, there is considerable regional heterogeneity in airway wall thickness.

ConclusionSevere asthmatics have thicker airway walls on MDCT than mild asthmatics or normals, which correlates with pathologic measures of remodeling and the degree of airflow obstruction. MDCT may be a useful technique for assessing airway remodeling in asthma, but overlap among groups limits the diagnostic value in individual subjects.

Key Words: Asthma • airway remodeling • chest CT






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