[Use of computerized tomography in asthmatic patients]

This study was aimed at assessing the role of high resolution Computed Tomography (HRCT) in the asthmatic patient, during disease worsening. Chest radiography plays a major role in the assessment of the most common complications of asthma, such as pneumothorax, pneumomediastinum, or lobar collapse. Conventional CT and HRCT are sometimes used when a complication is suspected, particularly chronic eosinophilic pneumonia and allergic bronchopulmonary aspergillosis. We prospectively examined 31 asthmatic patients with clinical and functional worsening submitting them to chest radiographs and HRCT scans. In 5 of them, radiographic findings were suggestive of a complication: 3 patients presented allergic bronchopulmonary aspergillosis and 2 chronic eosinophilic pneumonia; in these cases HRCT confirmed the diagnosis and yielded other useful pieces of information, but did not change the prognosis or the therapeutic approach. In the remaining 26 patients, HRCT findings were abnormal in 61% of cases, while chest films were abnormal in 26% of cases only. An outstanding diagnostic contribution came from HRCT which demonstrated a high incidence of small airway disease and, above all, cylindrical bronchiectasis (53.8%), especially in the upper lobes. HRCT also demonstrated that asthma does not usually cause emphysematous destruction in the patients that never smoked. Even though our study enrolled only a small number of patients, the results suggest that asthma is a more destructive disease than previously believed and that HRCT could be a useful examination to perform even when chest film findings are normal.