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High-resolution CT pulmonary findings in children with severe asthma
Thiago Krieger Bento da Silva1, Matheus Zanon2, Stephan Altmayer3
1Postgraduate Program in Pediatrics, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil.
Insights
Children with severe asthma show distinct quantitative CT scan results, including increased air trapping and airway wall thickness, compared to healthy children. These CT findings strongly correlate with reduced lung function and a history of asthma-related hospitalizations.
Area of Science:
- Radiology
- Pediatric Pulmonology
- Medical Imaging
Background:
- Severe asthma in children presents unique challenges in diagnosis and monitoring.
- Quantitative computed tomography (CT) offers detailed insights into lung structure and function.
- Understanding CT parameters in pediatric severe asthma is crucial for improved clinical management.
Purpose of the Study:
- To compare quantitative CT parameters between children with severe asthma and healthy controls.
- To correlate CT findings with clinical features, including pulmonary function tests and hospitalization history.
Main Methods:
- Retrospective analysis of CT data from 19 children with severe asthma and 19 healthy controls.
- Evaluation of parameters: total lung volume (TLV), mean lung density (MLD), CT air trapping index (AT%), airway wall thickness (AWT).
- Correlation of CT parameters with forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), FEF 25-75%, FEV1/FVC ratio, and hospitalization history.
Main Results:
- Children with severe asthma exhibited significantly higher AT% and AWT compared to controls.
- Mean AT% was notably higher in children with a history of hospitalization.
- AT% showed strong negative correlations with FVC and FEV1, and moderate correlation with FEF 25-75%.
Conclusions:
- Quantitative CT reveals significant differences in lung structure in children with severe asthma.
- CT-derived air trapping index (AT%) is a valuable marker correlating with pulmonary function deficits.
- CT parameters can aid in assessing disease severity and predicting outcomes in pediatric severe asthma.
Objective:
To compare quantitative CT parameters between children with severe asthma and healthy subjects, correlating to their clinical features.
Methods:
We retrospectively analyzed CT data from 19 school-aged children (5-17 years) with severe asthma and 19 control school-aged children with pectus excavatum. The following CT parameters were evaluated: total lung volume (TLV), mean lung density (MLD), CT air trapping index (AT%) (attenuation ≤856 HU), airway wall thickness (AWT), and percentage of airway wall thickness (AWT%). Multi-detector computed tomography (MDCT) data were correlated to the following clinical parameters: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% (FEF 25-75%), FEV1/FVC ratio, sputum and bronchoalveolar lavage analysis, serum IgE levels, and previous hospitalizations due to asthma.
Results:
Asthma patients presented higher mean values of AT% (23.8 ± 6.7% vs. controls, 9.7 ± 3.2%), AWT (1.46 ± 0.22 mm vs. controls, 0.47 ± -735 ± 28 HU vs. controls, -666 ± 19 HU). Mean AT% was 29.0 ± 4.7% in subjects with previous hospitalization against 19.2 ± 5.0% in those with no prior hospitalization (p < 0.001). AT% presented very strong negative correlations with FVC (r = -0.933, p < 0.001) and FEV1 (r = -0.841, p < 0.001) and a moderate correlation with FEF 25-75% (r = -0.608, p = 0.007). AT% correlation with FEV1/FVC ratio and serum IgE was weak (r = -0.184, p = 0.452, and r = -0.363, p = 0.202) CONCLUSION: Children with severe asthma present differences in quantitative chest CT scans compared to healthy controls with strong correlations with pulmonary function tests and previous hospitalizations due to asthma.
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