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Qualitative Analysis of High Resolution Computed Tomography Scans in Severe Asthma
Chest, 10/08/09

Gupta S et al. – HRCT abnormalities are common in severe asthma. Nonradiologic assessments fail to reliably predict important bronchial wall changes and therefore CT acquisition may be required in all severe asthmatics.

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Sumit Gupta and Christopher E. Brightling, 10/09/09

We report here the largest qualitative study of high resolution computed tomography (HRCT) findings in severe asthma. Of the 185 subjects with severe asthma assessed as part of this study, bronchial wall thickening (BWT) and bronchiectasis (BE) was reported in 62% and 40% respectively. We found that presence of BE independent of presence of BWT was associated with airflow limitation and longer disease duration in this cohort. The sensitivity and specificity of detecting bronchiectasis clinically was 74% and 45% respectively. FEV1/FVC ratio emerged as an important predictor for both bronchiectasis and bronchial wall thickening, but had poor discriminatory utility for subjects without airway structural changes (FEV1/FVC ? 75%; sensitivity 67%, specificity 65%). Therefore, CT acquisition in all severe asthmatics, to detect bronchiectasis may help alter management strategies and improve treatment outcomes.

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