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Capaldi DPI, Konyer NB, Kjarsgaard M, Dvorkin-Gheva A, Dandurand RJ, Nair P, Svenningsen S. Specific Ventilation in Severe Asthma Evaluated with Noncontrast Tidal Breathing 1H MRI. Radiol Cardiothorac Imaging 2023; 5:e230054. [PMID: 38166343 DOI: 10.1148/ryct.230054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Purpose To determine if proton (1H) MRI-derived specific ventilation is responsive to bronchodilator (BD) therapy and associated with clinical biomarkers of type 2 airway inflammation and airways dysfunction in severe asthma. Materials and Methods In this prospective study, 27 participants with severe asthma (mean age, 52 years ± 9 [SD]; 17 female, 10 male) and seven healthy controls (mean age, 47 years ± 16; five female, two male), recruited between 2018 and 2021, underwent same-day spirometry, respiratory oscillometry, and tidal breathing 1H MRI. Participants with severe asthma underwent all assessments before and after BD therapy, and type 2 airway inflammatory biomarkers were determined (blood eosinophil count, sputum eosinophil percentage, sputum eosinophil-free granules, and fraction of exhaled nitric oxide) to generate a cumulative type 2 biomarker score. Specific ventilation was derived from tidal breathing 1H MRI and its response to BD therapy, and relationships with biomarkers of type 2 airway inflammation and airway dysfunction were evaluated. Results Mean MRI specific ventilation improved with BD inhalation (from 0.07 ± 0.04 to 0.11 ± 0.04, P < .001). Post-BD MRI specific ventilation (P = .046) and post-BD change in MRI specific ventilation (P = .006) were greater in participants with asthma with type 2 low biomarkers compared with participants with type 2 high biomarkers of airway inflammation. Post-BD change in MRI specific ventilation was correlated with change in forced expiratory volume in 1 second (r = 0.40, P = .04), resistance at 5 Hz (r = -0.50, P = .01), resistance at 19 Hz (r = -0.42, P = .01), reactance area (r = -0.54, P < .01), and reactance at 5 Hz (r = 0.48, P = .01). Conclusion Specific ventilation evaluated with tidal breathing 1H MRI was responsive to BD therapy and was associated with clinical biomarkers of airways disease in participants with severe asthma. Keywords: MRI, Severe Asthma, Ventilation, Type 2 Inflammation Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Moore and Chandarana in this issue.
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Affiliation(s)
- Dante P I Capaldi
- From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Norman B Konyer
- From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Melanie Kjarsgaard
- From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Anna Dvorkin-Gheva
- From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Ronald J Dandurand
- From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Parameswaran Nair
- From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Sarah Svenningsen
- From the Department of Radiation Oncology, Division of Physics, University of California San Francisco, San Francisco, Calif (D.P.I.C.); Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health (M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital, Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit of the Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Canada (R.J.D.)
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Menzella F, Antonicelli L, Cottini M, Imeri G, Corsi L, Di Marco F. Oscillometry in severe asthma: the state of the art and future perspectives. Expert Rev Respir Med 2023; 17:563-575. [PMID: 37452692 DOI: 10.1080/17476348.2023.2237872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Approximately 3-10% of people with asthma have severe asthma (SA). Patients with SA have greater impairment in daily life and much higher costs. Even if asthma affects the entire bronchial tree, small airways have been recognized as the major site of airflow limitation. There are several tools for studying small airway dysfunction (SAD), but certainly the most interesting is oscillometry. Despite several studies, the clinical usefulness of oscillometry in asthma is still in question. This paper aims to provide evidence supporting the use of oscillometry to improve the management of SA in clinical practice. AREAS COVERED In the ATLANTIS study, SAD was strongly evident across all severity. Various tools are available for evaluation of SAD, and certainly an integrated use of these can provide complete and detailed information. However, the most suitable method is oscillometry, implemented for clinical routine by using either small pressure impulses or small pressure sinusoidal waves. EXPERT OPINION Oscillometry, despite its different technological implementations is the best tool for determining the impact of SAD on asthma and its control. Oscillometry will also be increasingly useful for choosing the appropriate drug, and there is ample room for a more widespread diffusion in clinical practice.
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Affiliation(s)
| | | | | | - Gianluca Imeri
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Corsi
- Pulmonology Unit, S. Valentino Hospital, Treviso, Italy
| | - Fabiano Di Marco
- Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Health Sciences, University of Milan, Bergamo, Italy
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Rutting S, Thamrin C, Cross TJ, King GG, Tonga KO. Fixed Airflow Obstruction in Asthma: A Problem of the Whole Lung Not of Just the Airways. Front Physiol 2022; 13:898208. [PMID: 35677089 PMCID: PMC9169051 DOI: 10.3389/fphys.2022.898208] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract Asthma with irreversible or fixed airflow obstruction (FAO) is a severe clinical phenotype that is difficult to treat and is associated with an accelerated decline in lung function and excess morbidity. There are no current treatments to reverse or prevent this excessive decline in lung function in these patients, due to a lack of understanding of the underlying pathophysiology. The current paradigm is that FAO in asthma is due to airway remodeling driven by chronic inflammation. However, emerging evidence indicates significant and critical structural and functional changes to the lung parenchyma and its lung elastic properties in asthma with FAO, suggesting that FAO is a ‘whole lung’ problem and not just of the airways. In this Perspective we draw upon what is known thus far on the pathophysiological mechanisms contributing to FAO in asthma, and focus on recent advances and future directions. We propose the view that structural and functional changes in parenchymal tissue, are just as (if not more) important than airway remodeling in causing persistent lung function decline in asthma. We believe this paradigm of FAO should be considered when developing novel treatments.
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Affiliation(s)
- Sandra Rutting
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Troy J. Cross
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gregory G. King
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- The Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Katrina O. Tonga
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Department of Thoracic and Transplant Medicine, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Healthcare Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- *Correspondence: Katrina O. Tonga,
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Verbanck SAB, Foy BH. In asthma positive phase III slopes result from structural heterogeneity of the bronchial tree. J Appl Physiol (1985) 2022; 132:947-955. [PMID: 35175103 DOI: 10.1152/japplphysiol.00687.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We have previously identified bronchial generations 5-7 as the locus of maximum contribution to the convective portion of the phase III slope in CT-based lung models of asthma patients. In the present study, we examined how exactly phase III slope is generated locally, by specifically interrogating at individual branch points, the necessary condition for a phase III slope to occur : some degree of convective flow sequencing between any two daughter branches that have a heterogeneity in gas washout concentration between them. Flow sequencing at individual branch points showed a wide range of values, including branch points where flow sequencing was such that phase III slopes were negative locally. Yet, the net effect in the 24 bronchial trees that we studied was that flow sequencing between least and best ventilated units was of the correct sign to generate a positive phase III slope in generations 5-7. By investigating the link of local flow sequencing between any two daughter branches to the corresponding heterogeneity of mechanical lung properties, heterogeneity of compliance was seen to be a major determinant of flow sequencing. In these structures bronchial structures, compliance heterogeneity was essentially brought about by volume asymmetry resulting from terminating pathways within the 3D confines of the lung contours. We conclude that the serial and parallel combination of lung mechanical properties at individual branch points in an asymmetrical branching network generate flow sequencing in mid-range conductive airways, so as to obtain positive at-mouth phase III slopes.
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Affiliation(s)
- Sylvia A B Verbanck
- Respiratory Division, University Hospital (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Brody Harry Foy
- Center for Systems Biology and Dept of Pathology, Massachusetts General Hospital, Boston, MA, United States.,Dept of Systems Biology, Harvard Medical School, Boston, MA, United States
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