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Sack C, Wang M, Knutson V, Gassett A, Hoffman EA, Sheppard L, Barr RG, Kaufman JD, Smith B. Airway Tree Caliber and Susceptibility to Pollution-associated Emphysema: MESA Air and Lung Studies. Am J Respir Crit Care Med 2024; 209:1351-1359. [PMID: 38226871 PMCID: PMC11146562 DOI: 10.1164/rccm.202307-1248oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024] Open
Abstract
Rationale: Airway tree morphology varies in the general population and may modify the distribution and uptake of inhaled pollutants. Objectives: We hypothesized that smaller airway caliber would be associated with emphysema progression and would increase susceptibility to air pollutant-associated emphysema progression. Methods: MESA (Multi-Ethnic Study of Atherosclerosis) is a general population cohort of adults 45-84 years old from six U.S. communities. Airway tree caliber was quantified as the mean of airway lumen diameters measured from baseline cardiac computed tomography (CT) (2000-2002). Percentage emphysema, defined as percentage of lung pixels below -950 Hounsfield units, was assessed up to five times per participant via cardiac CT scan (2000-2007) and equivalent regions on lung CT scan (2010-2018). Long-term outdoor air pollutant concentrations (particulate matter with an aerodynamic diameter ⩽2.5 μm, oxides of nitrogen, and ozone) were estimated at the residential address with validated spatiotemporal models. Linear mixed models estimated the association between airway tree caliber and emphysema progression; modification of pollutant-associated emphysema progression was assessed using multiplicative interaction terms. Measurements and Main Results: Among 6,793 participants (mean ± SD age, 62 ± 10 yr), baseline airway tree caliber was 3.95 ± 1.1 mm and median (interquartile range) of percentage emphysema was 2.88 (1.21-5.68). In adjusted analyses, 10-year emphysema progression rate was 0.75 percentage points (95% confidence interval, 0.54-0.96%) higher in the smallest compared with largest airway tree caliber quartile. Airway tree caliber also modified air pollutant-associated emphysema progression. Conclusions: Smaller airway tree caliber was associated with accelerated emphysema progression and modified air pollutant-associated emphysema progression. A better understanding of the mechanisms of airway-alveolar homeostasis and air pollutant deposition is needed.
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Affiliation(s)
- Coralynn Sack
- Department of Medicine
- Department of Environmental and Occupational Health Sciences, and
| | - Meng Wang
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Victoria Knutson
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Amanda Gassett
- Department of Environmental and Occupational Health Sciences, and
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, and
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - R. Graham Barr
- Department of Medicine and
- Department of Epidemiology, Columbia University, New York, New York; and
| | - Joel D. Kaufman
- Department of Medicine
- Department of Environmental and Occupational Health Sciences, and
| | - Benjamin Smith
- Department of Medicine and
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Rajaraman PK, Choi J, Babiskin A, Walenga R, Lin CL. Transport and deposition of beclomethasone dipropionate drug aerosols with varying ethanol concentration in severe asthmatic subjects. Int J Pharm 2023; 636:122805. [PMID: 36898619 DOI: 10.1016/j.ijpharm.2023.122805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
This study aims to assess the effects of varying an ethanol co-solvent on the deposition of drug particles in severe asthmatic subjects with distinct airway structures and lung functions using computational fluid dynamics. The subjects were selected from two quantitative computed tomography imaging-based severe asthmatic clusters, differentiated by airway constriction in the left lower lobe. Drug aerosols were assumed to be generated from a pressurized metered-dose inhaler (MDI). The aerosolized droplet sizes were varied by increasing the ethanol co-solvent concentration in the MDI solution. The MDI formulation consists of 1,1,2,2-tetrafluoroethane (HFA-134a), ethanol, and beclomethasone dipropionate (BDP) as the active pharmaceutical ingredient. Since HFA-134a and ethanol are volatile, both substances evaporate rapidly under ambient conditions and trigger condensation of water vapor, increasing the size of aerosols that are predominantly composed of water and BDP. The average deposition fraction in intra-thoracic airways for severe asthmatic subjects with (or without) airway constriction increased from 37%±12 to 53.2%±9.4 (or from 20.7%± 4.6 to 34.7%±6.6) when the ethanol concentration was increased from 1 to 10%wt/wt. However, when the ethanol concentration was further increased from 10 to 20%wt/wt, the deposition fraction decreased. This indicates the importance of selecting appropriate co-solvent amounts during drug formulation development for the treatment of patients with narrowed airway disease. For severe asthmatic subjects with airway narrowing, the inhaled aerosol may benefit from a low hygroscopic effect by reducing ethanol concentration to penetrate the peripheral region effectively. These results could potentially inform the selection of co-solvent amounts for inhalation therapies in a cluster-specific manner.
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Affiliation(s)
- Prathish K Rajaraman
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA; IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, IA, USA
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Andrew Babiskin
- Division of Quantitative Methods and Modeling, Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Ross Walenga
- Division of Quantitative Methods and Modeling, Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Ching-Long Lin
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA; IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, IA, USA.
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Farkas Á, Tomisa G, Kugler S, Nagy A, Vaskó A, Kis E, Szénási G, Gálffy G, Horváth A. The effect of exhalation before the inhalation of dry powder aerosol drugs on the breathing parameters, emitted doses and aerosol size distributions. Int J Pharm X 2023; 5:100167. [PMID: 36824288 PMCID: PMC9941374 DOI: 10.1016/j.ijpx.2023.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/06/2023] Open
Abstract
Airway deposition of aerosol drugs is highly dependent on the breathing manoeuvre of the patients. Though incorrect exhalation before the inhalation of the drug is one of the most common mistakes, its effect on the rest of the manoeuvre and on the airway deposition distribution of aerosol drugs is not explored in the open literature. The aim of the present work was to conduct inhalation experiments using six dry powder inhalers in order to quantify the effect of the degree of lung emptying on the inhalation time, inhaled volume and peak inhalation flow. Another goal of the research was to determine the effect of the exhalation on the aerodynamic properties of the drugs emitted by the same inhalers. According to the measurements, deep exhalation before drug inhalation increased the volume of the inhaled air and the average and maximum values of the inhalation flow rate, but the extent of the increase was patient and inhaler specific. For different inhalers, the mean value of the relative increase in peak inhalation flow due to forceful exhalation was between 15.3 and 38.4% (min: Easyhaler®, max: Breezhaler®), compared to the case of normal (tidal) exhalation before the drug inhalation. The relative increase in the inhaled volume was between 36.4 and 57.1% (min: NEXThaler®, max: Turbuhaler®). By the same token, forceful exhalation resulted in higher emitted doses and smaller emitted particles, depending on the individual breathing ability of the patient, the inhalation device and the drug metered in it. The relative increase in the emitted dose varied between 0.2 and 8.0% (min: Foster® NEXThaler®, max: Bufomix® Easyhaler®), while the relative enhancement of fine particle dose ranged between 1.9 and 30.8% (min: Foster® NEXThaler®, max: Symbicort® Turbuhaler®), depending on the inhaler. All these effects and parameter values point toward higher airway doses due to forceful exhalation before the inhalation of the drug. At the same time, the present findings highlight the necessity of proper patient education on the importance of lung emptying, but also the importance of patient-specific inhaler-drug pair choice in the future.
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Key Words
- AF, aerosolized fraction
- Aerosol drug delivery
- BMI, body mass index
- Breathing parameters
- CAD, computer aided design
- COPD, chronic obstructive pulmonary disease
- CT, computed tomography
- DPI, dry powder inhaler
- Dry powder inhalers
- ED, emitted dose
- FEV1, expiratory volume at the end of the first second of forced exhalation
- FPF, fine particle fraction
- FVC, forced vital capacity
- GSD, geometric standard deviation
- ICS, inhalation cortico-steroid
- IV, inhaled volume
- IVC, inspiratory vital capacity
- IVdev, inhaled volume through an inhalation device
- Inhalation therapy
- LABA, long-acting beta-agonist
- Lung emptying
- MMAD, mass median aerodynamic diameter
- PEF, peak expiratory flow
- PIF, peak inhalation flow
- PIFdev, peak inhalation flow through an inhalation device
- PIL, patient information leaflet
- Q, mean inhalation flow rate
- Qdev, mean inhalation flow rate through an inhalation device
- SPC, summary of product characteristics
- tin, inhalation time
- tin-dev, inhalation time through an inhalation device
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Affiliation(s)
- Árpád Farkas
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary,Corresponding author at: Centre for Energy Research, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary.
| | - Gábor Tomisa
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
| | - Szilvia Kugler
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Nagy
- Wigner Research Centre for Physics, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Vaskó
- Pulmonology Clinic, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary
| | - Erika Kis
- Babes-Bolyai University, Hungarian Department of Biology and Ecology, Cluj-Napoca, Romania
| | | | - Gabriella Gálffy
- County Institute of Pulmonology, Department of Pulmonology, Munkácsy M. u. 70, 2045 Törökbálint, Hungary
| | - Alpár Horváth
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
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Zhang X, Li F, Rajaraman PK, Choi J, Comellas AP, Hoffman EA, Smith BM, Lin CL. A computed tomography imaging-based subject-specific whole-lung deposition model. Eur J Pharm Sci 2022; 177:106272. [PMID: 35908637 PMCID: PMC9477651 DOI: 10.1016/j.ejps.2022.106272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
Abstract
The respiratory tract is an important route for beneficial drug aerosol or harmful particulate matter to enter the body. To assess the therapeutic response or disease risk, whole-lung deposition models have been developed, but were limited by compartment, symmetry or stochastic approaches. In this work, we proposed an imaging-based subject-specific whole-lung deposition model. The geometries of airways and lobes were segmented from computed tomography (CT) lung images at total lung capacity (TLC), and the regional air-volume changes were calculated by registering CT images at TLC and functional residual capacity (FRC). The geometries were used to create the structure of entire subject-specific conducting airways and acinar units. The air-volume changes were used to estimate the function of subject-specific ventilation distributions among acinar units and regulate flow rates in respiratory airway models. With the airway dimensions rescaled to a desired lung volume and the airflow field simulated by a computational fluid dynamics model, particle deposition fractions were calculated using deposition probability formulae adjusted with an enhancement factor to account for the effects of secondary flow and airway geometry in proximal airways. The proposed model was validated in silico against existing whole-lung deposition models, three-dimensional (3D) computational fluid and particle dynamics (CFPD) for an acinar unit, and 3D CFPD deep lung model comprising conducting and respiratory regions. The model was further validated in vivo against the lobar particle distribution and the coefficient of variation of particle distribution obtained from CT and single-photon emission computed tomography (SPECT) images, showing good agreement. Subject-specific airway structure increased the deposition fraction of 10.0-μm particles and 0.01-μm particles by approximately 10%. An enhancement factor increased the overall deposition fractions, especially for particle sizes between 0.1 and 1.0 μm.
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Affiliation(s)
- Xuan Zhang
- Department of Mechanical Engineering, 2406 Seamans Center for the Engineering Art and Science, University of Iowa, Iowa City, Iowa 52242, USA; IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Frank Li
- IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | | | - Jiwoong Choi
- Department of Mechanical Engineering, 2406 Seamans Center for the Engineering Art and Science, University of Iowa, Iowa City, Iowa 52242, USA; Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Alejandro P Comellas
- Department of Mechanical Engineering, 2406 Seamans Center for the Engineering Art and Science, University of Iowa, Iowa City, Iowa 52242, USA; Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Eric A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA; Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, Kansas, USA; Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Medicine, McGill University Health Centre Research Institute, Montreal, Canada
| | - Ching-Long Lin
- Department of Mechanical Engineering, 2406 Seamans Center for the Engineering Art and Science, University of Iowa, Iowa City, Iowa 52242, USA; IIHR-Hydroscience and Engineering, University of Iowa, Iowa City, Iowa, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA; Department of Radiology, University of Iowa, Iowa City, Iowa, USA.
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5
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Hoffman EA. Origins of and lessons from quantitative functional X-ray computed tomography of the lung. Br J Radiol 2022; 95:20211364. [PMID: 35193364 PMCID: PMC9153696 DOI: 10.1259/bjr.20211364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 12/16/2022] Open
Abstract
Functional CT of the lung has emerged from quantitative CT (qCT). Structural details extracted at multiple lung volumes offer indices of function. Additionally, single volumetric images, if acquired at standardized lung volumes and body posture, can be used to model function by employing such engineering techniques as computational fluid dynamics. With the emergence of multispectral CT imaging including dual energy from energy integrating CT scanners and multienergy binning using the newly released photon counting CT technology, function is tagged via use of contrast agents. Lung disease phenotypes have previously been lumped together by the limitations of spirometry and plethysmography. QCT and its functional embodiment have been imbedded into studies seeking to characterize chronic obstructive pulmonary disease, severe asthma, interstitial lung disease and more. Reductions in radiation dose by an order of magnitude or more have been achieved. At the same time, we have seen significant increases in spatial and density resolution along with methodologic validations of extracted metrics. Together, these have allowed attention to turn towards more mild forms of disease and younger populations. In early applications, clinical CT offered anatomic details of the lung. Functional CT offers regional measures of lung mechanics, the assessment of functional small airways disease, as well as regional ventilation-perfusion matching (V/Q) and more. This paper will focus on the use of quantitative/functional CT for the non-invasive exploration of dynamic three-dimensional functioning of the breathing lung and beating heart within the unique negative pressure intrathoracic environment of the closed chest.
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Affiliation(s)
- Eric A Hoffman
- Departments of Radiology, Internal Medicine and Biomedical Engineering University of Iowa, Iowa, United States
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6
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Niedbalski PJ, Choi J, Hall CS, Castro M. Imaging in Asthma Management. Semin Respir Crit Care Med 2022; 43:613-626. [PMID: 35211923 DOI: 10.1055/s-0042-1743289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Asthma is a heterogeneous disease characterized by chronic airway inflammation that affects more than 300 million people worldwide. Clinically, asthma has a widely variable presentation and is defined based on a history of respiratory symptoms alongside airflow limitation. Imaging is not needed to confirm a diagnosis of asthma, and thus the use of imaging in asthma has historically been limited to excluding alternative diagnoses. However, significant advances continue to be made in novel imaging methodologies, which have been increasingly used to better understand respiratory impairment in asthma. As a disease primarily impacting the airways, asthma is best understood by imaging methods with the ability to elucidate airway impairment. Techniques such as computed tomography, magnetic resonance imaging with gaseous contrast agents, and positron emission tomography enable assessment of the small airways. Others, such as optical coherence tomography and endobronchial ultrasound enable high-resolution imaging of the large airways accessible to bronchoscopy. These imaging techniques are providing new insights in the pathophysiology and treatments of asthma and are poised to impact the clinical management of asthma.
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Affiliation(s)
- Peter J Niedbalski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Chase S Hall
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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7
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Zou C, Li F, Choi J, Haghighi B, Choi S, Rajaraman PK, Comellas AP, Newell JD, Lee CH, Barr RG, Bleecker E, Cooper CB, Couper D, Han M, Hansel NN, Kanner RE, Kazerooni EA, Kleerup EC, Martinez FJ, O’Neal W, Paine R, Rennard SI, Smith BM, Woodruff PG, Hoffman EA, Lin CL. Longitudinal Imaging-Based Clusters in Former Smokers of the COPD Cohort Associate with Clinical Characteristics: The SubPopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). Int J Chron Obstruct Pulmon Dis 2021; 16:1477-1496. [PMID: 34103907 PMCID: PMC8178702 DOI: 10.2147/copd.s301466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Quantitative computed tomography (qCT) imaging-based cluster analysis identified clinically meaningful COPD former-smoker subgroups (clusters) based on cross-sectional data. We aimed to identify progression clusters for former smokers using longitudinal data. PATIENTS AND METHODS We selected 472 former smokers from SPIROMICS with a baseline visit and a one-year follow-up visit. A total of 150 qCT imaging-based variables, comprising 75 variables at baseline and their corresponding progression rates, were derived from the respective inspiration and expiration scans of the two visits. The COPD progression clusters identified were then associated with subject demography, clinical variables and biomarkers. RESULTS COPD severities at baseline increased with increasing cluster number. Cluster 1 patients were an obese subgroup with rapid progression of functional small airway disease percentage (fSAD%) and emphysema percentage (Emph%). Cluster 2 exhibited a decrease of fSAD% and Emph%, an increase of tissue fraction at total lung capacity and airway narrowing over one year. Cluster 3 showed rapid expansion of Emph% and an attenuation of fSAD%. Cluster 4 demonstrated severe emphysema and fSAD and significant structural alterations at baseline with rapid progression of fSAD% over one year. Subjects with different progression patterns in the same cross-sectional cluster were identified by longitudinal clustering. CONCLUSION qCT imaging-based metrics at two visits for former smokers allow for the derivation of four statistically stable clusters associated with unique progression patterns and clinical characteristics. Use of baseline variables and their progression rates enables identification of longitudinal clusters, resulting in a refinement of cross-sectional clusters.
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Affiliation(s)
- Chunrui Zou
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
| | - Frank Li
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Jiwoong Choi
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Babak Haghighi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanghun Choi
- School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Prathish K Rajaraman
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
| | | | - John D Newell
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Chang Hyun Lee
- Department of Radiology, University of Iowa, Iowa City, IA, USA
- Department of Radiology, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - R Graham Barr
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Eugene Bleecker
- Department of Medicine, The University of Arizona, Tucson, AZ, USA
| | | | - David Couper
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Meilan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Wanda O’Neal
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Robert Paine
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephen I Rennard
- Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Medicine, McGill University Health Centre Research Institute, Montreal, Canada
| | - Prescott G Woodruff
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Eirc A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
- Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Ching-Long Lin
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience & Engineering, University of Iowa, Iowa City, IA, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Radiology, University of Iowa, Iowa City, IA, USA
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8
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Nagpal P, Guo J, Shin KM, Lim JK, Kim KB, Comellas AP, Kaczka DW, Peterson S, Lee CH, Hoffman EA. Quantitative CT imaging and advanced visualization methods: potential application in novel coronavirus disease 2019 (COVID-19) pneumonia. BJR Open 2021; 3:20200043. [PMID: 33718766 PMCID: PMC7931412 DOI: 10.1259/bjro.20200043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Increasingly, quantitative lung computed tomography (qCT)-derived metrics are providing novel insights into chronic inflammatory lung diseases, including chronic obstructive pulmonary disease, asthma, interstitial lung disease, and more. Metrics related to parenchymal, airway, and vascular anatomy together with various measures associated with lung function including regional parenchymal mechanics, air trapping associated with functional small airways disease, and dual-energy derived measures of perfused blood volume are offering the ability to characterize disease phenotypes associated with the chronic inflammatory pulmonary diseases. With the emergence of COVID-19, together with its widely varying degrees of severity, its rapid progression in some cases, and the potential for lengthy post-COVID-19 morbidity, there is a new role in applying well-established qCT-based metrics. Based on the utility of qCT tools in other lung diseases, previously validated supervised classical machine learning methods, and emerging unsupervised machine learning and deep-learning approaches, we are now able to provide desperately needed insight into the acute and the chronic phases of this inflammatory lung disease. The potential areas in which qCT imaging can be beneficial include improved accuracy of diagnosis, identification of clinically distinct phenotypes, improvement of disease prognosis, stratification of care, and early objective evaluation of intervention response. There is also a potential role for qCT in evaluating an increasing population of post-COVID-19 lung parenchymal changes such as fibrosis. In this work, we discuss the basis of various lung qCT methods, using case-examples to highlight their potential application as a tool for the exploration and characterization of COVID-19, and offer scanning protocols to serve as templates for imaging the lung such that these established qCT analyses have the best chance at yielding the much needed new insights.
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Affiliation(s)
- Prashant Nagpal
- Department of Radiology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | | | | | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ki Beom Kim
- Department of Radiology, Daegu Fatima Hospital, Daegu, South Korea
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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9
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Chae KJ, Choi J, Jin GY, Hoffman EA, Laroia AT, Park M, Lee CH. Relative Regional Air Volume Change Maps at the Acinar Scale Reflect Variable Ventilation in Low Lung Attenuation of COPD patients. Acad Radiol 2020; 27:1540-1548. [PMID: 32024604 DOI: 10.1016/j.acra.2019.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate regional air volume changes at the acinar scale of the lung in chronic obstructive pulmonary disease (COPD) patients using an image registration technique. MATERIALS AND METHODS Thirty-four emphysema patients and 24 subjects with normal chest CT and pulmonary function test (PFT) results were included in this retrospective study for which informed consent was waived by the institutional review board. After lung segmentation, a mass-preserving image registration technique was used to compute relative regional air volume changes (RRAVCs) between inspiration and expiration CT scans. After determining the appropriate thresholds of RRAVCs for low ventilation areas (LVAs), they were displayed and analyzed using color maps on the background inspiration CT image, and compared with the low attenuation area (LAA) map. Correlations between quantitative CT parameters and PFTs were assessed using Pearson's correlation test, and parameters were compared between emphysema and normal-CT patients using the Student's t-test. RESULTS LVA percentage with an RRAVC threshold of 0.5 (%LVA0.5) showed the strongest correlations with FEV1/FVC (r = -0.566), FEV1 (r = -0.534), %LAA-950insp (r = 0.712), and %LAA-856exp (r = 0.775). %LVA0.5 was significantly higher (P < 0.001) in COPD patients than normal subjects. Despite the identical appearance of emphysematous lesions on the LAA-950insp map, the RRAVC map depicted a wide range of ventilation differences between these LAA clusters. CONCLUSION RRAVC-based %LVA0.5 correlated well with FEV1/FVC, FEV1, %LAA-950insp and %LAA-856exp. RRAVC holds the potential for providing additional acinar scale functional information for emphysematous LAAs in inspiratory CT images, providing the basis for a novel set for emphysematous phenotypes.
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Rajaraman PK, Choi J, Hoffman EA, O'Shaughnessy PT, Choi S, Delvadia R, Babiskin A, Walenga R, Lin CL. Transport and deposition of hygroscopic particles in asthmatic subjects with and without airway narrowing. JOURNAL OF AEROSOL SCIENCE 2020; 146:105581. [PMID: 32346183 PMCID: PMC7187883 DOI: 10.1016/j.jaerosci.2020.105581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 05/30/2023]
Abstract
This study numerically investigates the effect of hygroscopicity on transport and deposition of particles in severe asthmatic lungs with distinct airway structures. The study human subjects were selected from two imaging-based severe asthmatic clusters with one characterized by non-constricted airways and the other by constricted airways in the lower left lobe (LLL). We compared the deposition fractions of sodium chloride (NaCl) particles with a range of aerodynamic diameters (1-8 μm) in cluster archetypes under conditions with and without hygroscopic growth. The temperature and water vapor distributions in the airways were simulated with an airway wall boundary condition that accounts for variable temperature and water vapor evaporation at the interface between the lumen and the airway surface liquid layer. On average, the deposition fraction increased by about 6% due to hygroscopic particle growth in the cluster subjects with constricted airways, while it increased by only about 0.5% in those with non-constricted airways. The effect of particle growth was most significant for particles with an initial diameter of 2 μm in the cluster subjects with constricted airways. The effect diminished with increasing particle size, especially for particles with an initial diameter larger than 4 μm. This suggests the necessity to differentiate asthmatic subjects by cluster in engineering the aerosol size for tailored treatment. Specifically, the treatment of severe asthmatic subjects who have constricted airways with inhalation aerosols may need submicron-sized hygroscopic particles to compensate for particle growth, if one targets for delivering to the peripheral region. These results could potentially inform the choice of particle size for inhalational drug delivery in a cluster-specific manner.
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Affiliation(s)
- Prathish K. Rajaraman
- Department of Mechanical Engineering, The University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA, USA
| | - Jiwoong Choi
- Department of Mechanical Engineering, The University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA, USA
| | - Eric A. Hoffman
- Department of Radiology, The University of Iowa, Iowa City, IA, USA
| | | | - Sanghun Choi
- School of Mechanical Engineering, Kyungpook National University, Daegu, 41566, Republic of Korea
| | - Renishkumar Delvadia
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Andrew Babiskin
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Ross Walenga
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Ching-Long Lin
- Department of Mechanical Engineering, The University of Iowa, Iowa City, IA, USA
- IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA, USA
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Svenningsen S, Eddy RL, Kjarsgaard M, Parraga G, Nair P. Effects of Anti-T2 Biologic Treatment on Lung Ventilation Evaluated by MRI in Adults With Prednisone-Dependent Asthma. Chest 2020; 158:1350-1360. [PMID: 32428511 DOI: 10.1016/j.chest.2020.04.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The functional consequence of airway obstruction in asthma can be regionally measured using inhaled gas MRI. Ventilation defects visualized by MRI persist post-bronchodilator in patients with severe asthma with uncontrolled sputum eosinophilia and may be due to eosinophil-driven airway pathology that is responsive to "anti-T2" therapy. RESEARCH QUESTION Do anti-T2 therapies that clear eosinophils from the airway lumen decrease ventilation defects, measured by inhaled gas MRI, in adults with prednisone-dependent asthma? STUDY DESIGN AND METHODS Inhaled hyperpolarized gas MRI was performed before and after bronchodilation in 10 prednisone-dependent patients with asthma with uncontrolled eosinophilic bronchitis (sputum eosinophils ≥3%) at baseline and 558 (100-995) days later when their eosinophilic bronchitis had been controlled (sputum eosinophils <3%) by additional anti-T2 therapy. The effect of anti-T2 therapy on ventilation defects, quantified as the MRI ventilation-defect-percent (VDP), was evaluated before and after bronchodilation for all patients and compared between patients dichotomized based on the median percentage of sputum eosinophils at baseline (15.8%). RESULTS MRI VDP was improved pre- (ΔVDP+anti-T2: -3% ± 4%, P = .02) and post-bronchodilator (ΔVDP+anti-T2: -3% ± 4%; P = .04) after additional anti-T2 therapy that controlled eosinophilic bronchitis (n = 2 mepolizumab, n = 2 reslizumab, n = 3 benralizumab, n = 1 dupilumab, n = 2 increased daily prednisone). A greater post-bronchodilator ΔVDP+anti-T2 was observed in those patients with median or higher percentage of sputum eosinophils at baseline (≥15.8%; P = .01). In 7 of 10 patients with asthma, residual ventilation defects persisted despite bronchodilator and anti-T2 therapy. INTERPRETATION Controlling sputum eosinophilia with anti-T2 therapies improves ventilation defects, measured by inhaled gas MRI, in adults with prednisone-dependent asthma.
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Affiliation(s)
- Sarah Svenningsen
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Rachel L Eddy
- Robarts Research Institute, University of Western Ontario, ON, Canada; Department of Medical Biophysics, Western University, London, ON, Canada
| | - Melanie Kjarsgaard
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Grace Parraga
- Robarts Research Institute, University of Western Ontario, ON, Canada; Department of Medical Biophysics, Western University, London, ON, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Kannan R, Chen ZJ, Przekwas A, Segars P, Martin F, Kuczaj AK, Hoeng J. Anthropometry-based generation of personalized and population-specific human airway models. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3324. [PMID: 32053266 DOI: 10.1002/cnm.3324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
Understanding aerosol deposition in the human lung is of great significance in pulmonary toxicology and inhalation pharmacology. Adverse effects of inhaled environmental aerosols and pharmacological efficacy of inhaled therapeutics are dependent on aerosol properties as well as person-specific respiratory tract anatomy and physiology. Anatomical geometry and physiological function of human airways depend on age, gender, weight, fitness, health, and disease status. Tools for the generation of the population- and subject-specific virtual airway anatomical geometry based on anthropometric data and physiological vitals are invaluable in respiratory diagnostics, personalized pulmonary pharmacology, and model-based management of chronic respiratory diseases. Here we present a novel protocol and software framework for the generation of subject-specific airways based on anthropometric measurements of the subject's body, using the anatomical input, and the conventional spirometry, providing the functional (physiological) data. This model can be used for subject-specific simulations of respiration physiology, gas exchange, and aerosol inhalation and deposition.
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Affiliation(s)
- Ravishekar Kannan
- Computational Medicine and Biology Division, CFD Research Corporation, Huntsville, Alabama
| | - Z J Chen
- Computational Medicine and Biology Division, CFD Research Corporation, Huntsville, Alabama
| | - Andrzej Przekwas
- Computational Medicine and Biology Division, CFD Research Corporation, Huntsville, Alabama
| | - Paul Segars
- Carl E. Ravin Advanced Imaging Laboratories, Duke University School of Medicine, Duke University, Durham, North Carolina
| | - Florian Martin
- PMI R&D, Philip Morris Products S.A, Neuchatel, Switzerland
| | - Arkadiusz K Kuczaj
- PMI R&D, Philip Morris Products S.A, Neuchatel, Switzerland
- Faculty EEMCS, University of Twente, Enschede, The Netherlands
| | - Julia Hoeng
- PMI R&D, Philip Morris Products S.A, Neuchatel, Switzerland
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13
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Multiscale in silico lung modeling strategies for aerosol inhalation therapy and drug delivery. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019; 11:130-136. [DOI: 10.1016/j.cobme.2019.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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