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Quantitative computed tomography–derived clusters : Redefining airway remodeling in asthmatic patients
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Gupta, Sumit, Hartley, Ruth, Khan, Umair T., Singapuri, Amisha, Hargadon, Beverly, Monteiro, William, Pavord, Ian D., Sousa, Ana R., Marshall, Richard P., Subramanian, Deepak , Parr, David, Entwisle, James J., Siddiqui, Salman, Raj, Vimal and Brightling, Christopher E. (2014) Quantitative computed tomography–derived clusters : Redefining airway remodeling in asthmatic patients. Journal of Allergy and Clinical Immunology , Volume 133 (Number 3). 729-738.e18. doi:10.1016/j.jaci.2013.09.039 ISSN 0091-6749.
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Official URL: http://dx.doi.org/10.1016/j.jaci.2013.09.039
Abstract
Background
Asthma heterogeneity is multidimensional and requires additional tools to unravel its complexity. Computed tomography (CT)–assessed proximal airway remodeling and air trapping in asthmatic patients might provide new insights into underlying disease mechanisms.
Objectives
The aim of this study was to explore novel, quantitative, CT-determined asthma phenotypes.
Methods
Sixty-five asthmatic patients and 30 healthy subjects underwent detailed clinical, physiologic characterization and quantitative CT analysis. Factor and cluster analysis techniques were used to determine 3 novel, quantitative, CT-based asthma phenotypes.
Results
Patients with severe and mild-to-moderate asthma demonstrated smaller mean right upper lobe apical segmental bronchus (RB1) lumen volume (LV) in comparison with healthy control subjects (272.3 mm3 [SD, 112.6 mm3], 259.0 mm3 [SD, 53.3 mm3], 366.4 mm3 [SD, 195.3 mm3], respectively; P = .007) but no difference in RB1 wall volume (WV). Air trapping measured based on mean lung density expiratory/inspiratory ratio was greater in patients with severe and mild-to-moderate asthma compared with that seen in healthy control subjects (0.861 [SD, 0.05)], 0.866 [SD, 0.07], and 0.830 [SD, 0.06], respectively; P = .04). The fractal dimension of the segmented airway tree was less in asthmatic patients compared with that seen in control subjects (P = .007). Three novel, quantitative, CT-based asthma clusters were identified, all of which demonstrated air trapping. Cluster 1 demonstrates increased RB1 WV and RB1 LV but decreased RB1 percentage WV. On the contrary, cluster 3 subjects have the smallest RB1 WV and LV values but the highest RB1 percentage WV values. There is a lack of proximal airway remodeling in cluster 2 subjects.
Conclusions
Quantitative CT analysis provides a new perspective in asthma phenotyping, which might prove useful in patient selection for novel therapies.
Item Type: | Journal Article | ||||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Journal of Allergy and Clinical Immunology | ||||||||||
Publisher: | Mosby, Inc. | ||||||||||
ISSN: | 0091-6749 | ||||||||||
Official Date: | March 2014 | ||||||||||
Dates: |
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Volume: | Volume 133 | ||||||||||
Number: | Number 3 | ||||||||||
Page Range: | 729-738.e18 | ||||||||||
DOI: | 10.1016/j.jaci.2013.09.039 | ||||||||||
Status: | Peer Reviewed | ||||||||||
Publication Status: | Published | ||||||||||
Access rights to Published version: | Restricted or Subscription Access |
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