Quantitative CT metrics are associated with longitudinal lung function decline and future asthma exacerbations: Results from SARP-3

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:148

Article

Krings, James G.¹  Goss, Charles W.²  Lew, Daphne²  Samant, Maanasi¹  McGregor, Mary Clare¹  Boomer, Jonathan³  Bacharier, Leonard B.⁴  Sheshadri, Ajay⁵  Hall, Chase³  Brownell, Joshua⁶  Schechtman, Ken B.²  Peterson, Samuel⁷  McEleney, Stephen⁷  Mauger, David T.⁸  V. Fahy, John⁹  Fain, Sean B.¹⁰  Denlinger, Loren C.⁶  Israel, Elliot¹¹  Washko, George¹¹  Hoffman, Eric¹²  Wenzel, Sally E.¹³  Castro, Mario³ 

[1] Washington Univ St Louis Sch Med, Div Pulm & Crit Care Med, Dept Med, Washington, DC USA

[2] Washington Univ St Louis Sch Med, Div Biostat, Washington, DC USA

[3] Univ Kansas Sch Med, Div Pulm Crit Care & Sleep Med, Dept Med, 3901 Rainbow Blvd, Kansas City, KS 66103 USA

[4] Vanderbilt Univ Sch Med, Dept Pediat, Nashville, TN USA

[5] Univ Texas MD Anderson Canc Ctr, Dept Med, Div Pulm & Crit Care Med, Houston, TX 77030 USA

[6] Univ Wisconsin, Dept Med, Div Allergy Pulm & Crit Care Med, Madison, WI USA

[7] VIDA Diagnost, Coralville, IA USA

[8] Penn State Univ, Dept Publ Hlth Sci, Div Stat & Bioinformat, Hershey, PA USA

[9] Univ Calif San Francisco, Div Pulm & Crit Care Med, Dept ofMedicine, San Francisco, CA 94143 USA

[10] Univ Wisconsin, Dept Radiol & Biomed Engn, Madison, WI 53706 USA

[11] Brigham & Womens Hosp, Div Pulm & Crit Care Med, Dept Med, Boston, MA USA

[12] Univ Iowa, Dept Radiol Biomed Engn & Med, Iowa City, IA USA

[13] Univ Pittsburgh, Div Pulm Allergy & Crit Care, Dept Med, Pittsburgh, PA 15260 USA

关键词: Asthma;    severe asthma;    CT imaging;    asthma morbidity;    asthma exacerbations;    longitudinal;    lung function;   

DOI  :  10.1016/j.jaci.2021.01.029

来源: Elsevier

【 摘 要 】

Background: Currently, there is limited knowledge regarding which imaging assessments of asthma are associated with accelerated longitudinal decline in lung function. Objectives: We aimed to assess whether quantitative computed tomography (qCT) metrics are associated with longitudinal decline in lung function and morbidity in asthma. Methods: We analyzed 205 qCT scans of adult patients with asthma and calculated baseline markers of airway remodeling, lung density, and pointwise regional change in lung volume (Jacobian measures) for each participant. Using multivariable regression models, we then assessed the association of qCT measurements with the outcomes of future change in lung function, future exacerbation rate, and changes in validated measurements of morbidity. Results: Greater baseline wall area percent (13 = -0.15 [95% CI = -0.26 to -0.05]; P < .01), hyperinflation percent (13 = -0.25 [95% CI = -0.41 to -0.09]; P < .01), and Jacobian gradient measurements (cranial-caudal 13 = 10.64 [95% CI = 3.7917.49]; P <.01; posterior-anterior 13 = -9.14, [95% CI = -15.49 to -2.78]; P <.01) were associated with more severe future lung function decline. Additionally, greater wall area percent (rate ratio = 1.06 [95% CI = 1.01-1.10]; P = .02) and air trapping percent (rate ratio =1.01 [95% CI = 1.00-1.02]; P = .03), as well as lower decline in the Jacobian determinant mean (rate ratio = 0.58 [95% CI = 0.41-0.82]; P <.01) and Jacobian determinant standard deviation (rate ratio = 0.52 [95% CI = 0.32-0.85]; P = .01), were associated with a greater rate of future exacerbations. However, imaging metrics were not associated with clinically meaningful changes in scores on validated asthma morbidity questionnaires. Conclusions: Baseline qCT measures of more severe airway remodeling, more small airway disease and hyperinflation, and less pointwise regional change in lung volumes were associated with future lung function decline and asthma exacerbations.

【 授权许可】

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