Bronchial Thermoplasty Improves Ventilation Heterogeneity Measured by Functional Respiratory Imaging in Severe Asthma

IF 3.7 3区医学 Q2 ALLERGY

Journal of Asthma and Allergy Pub Date : 2024-04-22 DOI:10.2147/jaa.s454951

Chuan T Foo, Graham M Donovan, Francis Thien, David Langton, Peter B Noble

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引用次数: 0

Abstract

Purpose: Bronchial thermoplasty (BT) is a bronchoscopic intervention for the treatment of severe asthma. Despite demonstrated symptomatic benefit, the underlying mechanisms by which this is achieved remain uncertain. We hypothesize that the effects of BT are driven by improvements in ventilation heterogeneity as assessed using functional respiratory imaging (FRI).
Patient and Methods: Eighteen consecutive patients with severe asthma who underwent clinically indicated BT were recruited. Patients were assessed at baseline, 4-week after treatment of the left lung, and 12-month after treatment of the right lung. Data collected included short-acting beta-agonist (SABA) and oral prednisolone (OCS) use, asthma control questionnaire (ACQ-5) and exacerbation history. Patients also underwent lung function tests and chest computed tomography. Ventilation parameters including interquartile distance (IQD; measure of ventilation heterogeneity) were derived using FRI.
Results: 12 months after BT, significant improvements were seen in SABA and OCS use, ACQ-5, and number of OCS-requiring exacerbations. Apart from pre-bronchodilator FEV₁, no other significant changes were observed in lung function. Ventilation heterogeneity significantly improved after treatment of the left lung (0.18 ± 0.04 vs 0.20 ± 0.04, p=0.045), with treatment effect persisting up to 12 months later (0.18 ± 0.05 vs 0.20 ± 0.04, p=0.028). Ventilation heterogeneity also improved after treatment of the right lung, although this did not reach statistical significance (0.18 ± 0.05 vs 0.19 ± 0.04, p=0.06).
Conclusion: Clinical benefits after BT are accompanied by improvements in ventilation heterogeneity, advancing our understanding of its mechanism of action. Beyond BT, FRI has the potential to be expanded into other clinical applications.

Keywords: asthma, computed tomography, computational fluid dynamics, imaging, mechanism of action, pathophysiology

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支气管热成形术可改善严重哮喘患者通过功能性呼吸成像测量的通气异质性

目的：支气管热成形术（BT）是一种治疗严重哮喘的支气管镜干预方法。尽管已证实对症状有好处，但其实现的基本机制仍不确定。我们假设 BT 的效果是通过功能性呼吸成像（FRI）评估通气异质性的改善而产生的：我们招募了 18 名连续接受有临床指征的 BT 治疗的重症哮喘患者。分别在基线、左肺治疗 4 周后和右肺治疗 12 个月后对患者进行评估。收集的数据包括短效β-受体激动剂（SABA）和口服泼尼松龙（OCS）的使用情况、哮喘控制问卷（ACQ-5）和病情加重史。患者还接受了肺功能测试和胸部计算机断层扫描。通气参数包括四分位间距（IQD；衡量通气异质性的指标）是通过 FRI 得出的：BT 12 个月后，SABA 和 OCS 的使用、ACQ-5 和需要 OCS 的病情加重次数均有明显改善。除了支气管扩张前的 FEV1 外，肺功能没有其他明显变化。左肺治疗后，通气异质性明显改善（0.18 ± 0.04 vs 0.20 ± 0.04，p=0.045），治疗效果持续到 12 个月后（0.18 ± 0.05 vs 0.20 ± 0.04，p=0.028）。右肺治疗后通气异质性也有所改善，但未达到统计学意义（0.18 ± 0.05 vs 0.19 ± 0.04，p=0.06）：结论：BT 治疗后的临床获益伴随着通气异质性的改善，这加深了我们对其作用机制的理解。除 BT 外，FRI 还有可能扩展到其他临床应用中。关键词：哮喘、计算机断层扫描、计算流体动力学、成像、作用机制、病理生理学

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来源期刊

Journal of Asthma and Allergy Medicine-Immunology and Allergy

CiteScore

5.30

自引率

6.20%

发文量

185

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed journal publishing original research, reports, editorials and commentaries on the following topics: Asthma; Pulmonary physiology; Asthma related clinical health; Clinical immunology and the immunological basis of disease; Pharmacological interventions and new therapies. Although the main focus of the journal will be to publish research and clinical results in humans, preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies.