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Quantitative Mapping of Specific Ventilation in the Human Lung using Proton Magnetic Resonance Imaging and Oxygen as a Contrast Agent
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Sputum Cellularity and MRI Ventilation Defects in Severe Asthma.

Hana Serajeddini1, Ashutosh Thakar1, Melanie Kjarsgaard2

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Severe asthma patients show abnormal airway ventilation across all sputum cellular phenotypes. Paucigranulocytic asthma ventilation defects may stem from mucus, linked to higher exhaled nitric oxide levels.

Keywords:
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Area of Science:

  • Pulmonary Medicine
  • Medical Imaging
  • Immunology

Background:

  • Airway inflammation, marked by eosinophils or neutrophils, is central to asthma.
  • While eosinophils in sputum correlate with ventilation defects, the impact of other cellular types remains unclear.

Purpose of the Study:

  • To investigate the relationship between distinct sputum cellular phenotypes and abnormal airway ventilation in severe asthma patients using 129Xe MRI.

Main Methods:

  • Eighty-five severe asthma patients and 15 controls underwent 129Xe ventilation MRI.
  • Sputum cytometry classified asthma patients into paucigranulocytic, eosinophilic, neutrophilic, and mixed-granulocytic phenotypes.
  • Ventilation defect percent (VDP) was quantified and compared across phenotypes and with controls.

Main Results:

  • Abnormal ventilation (elevated VDP) was observed in 44% of paucigranulocytic, 64% of eosinophilic, 75% of neutrophilic, and 89% of mixed-granulocytic asthma phenotypes.
  • Asthma patients with eosinophilic, neutrophilic, and mixed phenotypes showed significantly higher VDP compared to controls (P < .0001).
  • Paucigranulocytic asthma patients with abnormal ventilation were older and had higher fractional exhaled nitric oxide and CT mucus scores.

Conclusions:

  • Intraluminal cellular inflammation in severe asthma is associated with abnormal airway ventilation, regardless of the specific cellular phenotype.
  • Airway mucus and elevated fractional exhaled nitric oxide may contribute to ventilation abnormalities in paucigranulocytic asthma.