Detection of Airway Remodeling in Asthma Using Bronchoscopic Optical Coherence Tomography

CHEST pulmonary Pub Date : 2025-09-01 DOI:10.1016/j.chpulm.2025.100143

Pieta C. Wijsman MD , Lisa H. van Smoorenburg MD , Richard M. van den Elzen MSc , Annika W.M. Goorsenberg MD, PhD , Julia N.S. d’Hooghe MD, PhD , Orestes A. Carpaij MD, PhD , Martijn C. Nawijn PhD , Paul R. Bloemen , Inge A.H. van den Berk MD , Craig J. Galban PhD , Alex J. Bell PhD , Oliver Weinheimer PhD , Daniel M. de Bruin PhD , Jouke T. Annema MD, PhD , Maarten van den Berge MD, PhD , Peter I. Bonta MD, PhD

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Abstract

Background

Airway remodeling is an asthma disease hallmark that relates to asthma severity and progression. We investigated airway wall remodeling using bronchoscopic optical coherence tomography (OCT) to assess airway wall composition reflecting its extracellular matrix components and high-resolution CT (HRCT) imaging to assess airway wall thickness (AWT).

Research Question

Can OCT and HRCT imaging be used to detect differences in airway remodeling among healthy control participants, patients with mild to moderate asthma, and patients with severe asthma, and how does remodeling correlate with clinical disease severity and other parameters?

Study Design and Methods

The study population included 16 healthy control participants, 15 patients with mild to moderate asthma, and 18 patients with severe asthma. All participants were characterized extensively clinically, and both OCT and HRCT imaging were performed.

Results

OCT imaging high-intensity scattering area was increased in patients with severe asthma in medium airways compared with patients with mild to moderate asthma and healthy control participants. HRCT imaging-derived AWT was significantly higher in patients with asthma when compared with that of healthy control participants, but did not differentiate between levels of asthma severity. Overall in patients with asthma, a higher HRCT imaging AWT and OCT imaging high-intensity scattering area were associated with poor asthma control. Additionally, a thicker airway wall was associated with more severe airflow obstruction and higher blood eosinophil and neutrophil counts, whereas a larger high-intensity scattering area was associated with a lower number of blood eosinophils.

Interpretation

OCT and HRCT imaging provide different and additional information on airway wall remodeling in asthma. Bronchoscopic OCT imaging high-intensity area increases with asthma severity and correlates with poor asthma control, which emphasizes the potential of OCT imaging for assessing disease severity and therapeutic responses in patients with asthma.

Trial Registry

ClinicalTrials.gov; Nos.: NCT03141814 and NCT02225392; URL: www.clinicaltrials.gov

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支气管镜光学相干断层扫描检测哮喘气道重构

背景：气道重塑是哮喘疾病的标志，与哮喘的严重程度和进展有关。我们使用支气管镜光学相干断层扫描（OCT）来评估反映其细胞外基质成分的气道壁成分，并使用高分辨率CT （HRCT）成像来评估气道壁厚度（AWT）来研究气道壁重塑。研究问题：OCT和HRCT成像是否可以检测健康对照组、轻中度哮喘患者和重度哮喘患者气道重塑的差异，以及气道重塑与临床疾病严重程度等参数之间的关系？研究设计与方法研究人群包括16名健康对照者、15名轻中度哮喘患者和18名重度哮喘患者。所有参与者都进行了广泛的临床特征，并进行了OCT和HRCT成像。结果重度哮喘患者中气道的soct成像高强度散射面积较轻、中度哮喘患者和健康对照组增加。与健康对照组相比，哮喘患者HRCT成像衍生的AWT显著高于健康对照组，但哮喘严重程度之间没有差异。总体而言，在哮喘患者中，较高的HRCT成像AWT和OCT成像高强度散射面积与哮喘控制不良相关。此外，更厚的气道壁与更严重的气流阻塞和更高的血嗜酸性粒细胞和中性粒细胞计数有关，而更大的高强度散射区域与较低的血嗜酸性粒细胞数量有关。oct和HRCT成像为哮喘气道壁重塑提供了不同的和额外的信息。支气管镜下OCT成像高强度区域随着哮喘严重程度的增加而增加，并与哮喘控制不良相关，这强调了OCT成像在评估哮喘患者疾病严重程度和治疗反应方面的潜力。审判RegistryClinicalTrials.gov;编号：NCT03141814、NCT02225392；URL: www.clinicaltrials.gov

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CHEST pulmonary

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