• Chad A Witt, Ajay Sheshadri, Luke Carlstrom, Jaime Tarsi, James Kozlowski, Brad Wilson, David S Gierada, Eric Hoffman, Sean B Fain, Janice Cook-Granroth, Geneline Sajol, Oscar Sierra, Tusar Giri, Michael O'Neill, Jie Zheng, Kenneth B Schechtman, Leonard B Bacharier, Nizar Jarjour, William Busse, Mario Castro, and NHLBI Severe Asthma Research Program (SARP).
• Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Campus Box 8052, 660 S. Euclid Ave, St. Louis, MO 63110-1093.
• Acad Radiol. 2014 Aug 1; 21 (8): 986-93.

Rationale And ObjectivesPrevious cross-sectional studies have demonstrated that airway wall thickness and air trapping are greater in subjects with severe asthma than in those with mild-to-moderate asthma. However, a better understanding of how airway remodeling and lung density change over time is needed. This study aimed to evaluate predictors of airway wall remodeling and change in lung function and lung density over time in severe asthma.Materials And MethodsPhenotypic characterization and quantitative multidetector-row computed tomography (MDCT) of the chest were performed at baseline and ∼2.6 years later in 38 participants with asthma (severe n = 24 and mild-to-moderate n = 14) and nine normal controls from the Severe Asthma Research Program.ResultsSubjects with severe asthma had a significant decline in postbronchodilator forced expiratory volume in 1 second percent (FEV1%) predicted over time (P < .001). Airway wall thickness measured by MDCT was increased at multiple airway generations in severe asthma compared to mild-to-moderate asthma (wall area percent [WA%]: P < .05) and normals (P < .05) at baseline and year 2. Over time, there was an increase in WA% and wall thickness percent (WT%) in all subjects (P = .030 and .009, respectively) with no change in emphysema-like lung or air trapping. Baseline prebronchodilator FEV1% inversely correlated with WA% and WT% (both P < .05). In a multivariable regression model, baseline WA%, race, and health care utilization were predictors of subsequent airway remodeling.ConclusionsSevere asthma subjects have a greater decline in lung function over time than normal subjects or those with mild-to-moderate asthma. MDCT provides a noninvasive measure of airway wall thickness that may predict subsequent airway remodeling.Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

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