Quantitative CT metrics are associated with longitudinal lung function decline and future asthma exacerbations: Results from SARP-3.
Asthma
CT imaging
asthma exacerbations
asthma morbidity
longitudinal
lung function
severe asthma
Journal
The Journal of allergy and clinical immunology
ISSN: 1097-6825
Titre abrégé: J Allergy Clin Immunol
Pays: United States
ID NLM: 1275002
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
07
08
2020
revised:
02
12
2020
accepted:
08
01
2021
pubmed:
13
2
2021
medline:
11
11
2021
entrez:
12
2
2021
Statut:
ppublish
Résumé
Currently, there is limited knowledge regarding which imaging assessments of asthma are associated with accelerated longitudinal decline in lung function. We aimed to assess whether quantitative computed tomography (qCT) metrics are associated with longitudinal decline in lung function and morbidity in asthma. 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. Greater baseline wall area percent (β = -0.15 [95% CI = -0.26 to -0.05]; P < .01), hyperinflation percent (β = -0.25 [95% CI = -0.41 to -0.09]; P < .01), and Jacobian gradient measurements (cranial-caudal β = 10.64 [95% CI = 3.79-17.49]; P < .01; posterior-anterior β = -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. 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.
Sections du résumé
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 (β = -0.15 [95% CI = -0.26 to -0.05]; P < .01), hyperinflation percent (β = -0.25 [95% CI = -0.41 to -0.09]; P < .01), and Jacobian gradient measurements (cranial-caudal β = 10.64 [95% CI = 3.79-17.49]; P < .01; posterior-anterior β = -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.
Identifiants
pubmed: 33577895
pii: S0091-6749(21)00176-7
doi: 10.1016/j.jaci.2021.01.029
pmc: PMC8349941
mid: NIHMS1671959
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
752-762Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000427
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL109172
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL091762
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL109257
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146002
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL069149
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007317
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002373
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL109086
Pays : United States
Organisme : NIH HHS
ID : S10 OD025214
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL109168
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001102
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL109152
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL109146
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002366
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002345
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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