• Cendrine Godet, Anne-Laure Brun, Francis Couturaud, François Laurent, Jean-Pierre Frat, Sylvain Marchand-Adam, Frédéric Gagnadoux, Elodie Blanchard, Camille Taillé, Bruno Philippe, Sandrine Hirschi, Claire Andréjak, Arnaud Bourdin, Cécile Chenivesse, Stéphane Dominique, Gilles Mangiapan, Marlène Murris-Espin, Frédéric Rivière, Gilles Garcia, François-Xavier Blanc, François Goupil, Anne Bergeron, Thomas Flament, Pascaline Priou, Hervé Mal, Joe de Keizer, Stéphanie Ragot, Jacques Cadranel, and NebuLamB Study Group and GREPI Network.
• Service de Pneumologie B et Transplantation pulmonaire, Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Bichat, Paris, France. Electronic address: cendrine.godet@aphp.fr.
• Chest. 2024 Jun 1; 165 (6): 130713181307-1318.

BackgroundOne of the major challenges in managing allergic bronchopulmonary aspergillosis remains consistent and reproducible assessment of response to treatment.Research QuestionWhat are the most relevant changes in CT scan parameters over time for assessing response to treatment?Study Design And MethodsIn this ancillary study of a randomized clinical trial (NebuLamB), patients with asthma with available CT scan and without exacerbation during a 4-month allergic bronchopulmonary aspergillosis exacerbation treatment period (corticosteroids and itraconazole) were included. Changed CT scan parameters were assessed by systematic analyses of CT scan findings at initiation and end of treatment. CT scans were assessed by two radiologists anonymized to the clinical data. Radiologic parameters were determined by selecting those showing significant changes over time. Improvement of at least one, without worsening of the others, defined the radiologic response. Agreement between radiologic changes and clinical and immunologic responses was likewise investigated.ResultsAmong the 139 originally randomized patients, 132 were included. We identified five CT scan parameters showing significant changes at end of treatment: mucoid impaction extent, mucoid impaction density, centrilobular micronodules, consolidation/ground-glass opacities, and bronchial wall thickening (P < .05). These changes were only weakly associated with one another, except for mucoid impaction extent and density. No agreement was observed between clinical, immunologic, and radiologic responses, assessed as an overall response, or considering each of the parameters (Cohen κ, -0.01 to 0.24).InterpretationChanges in extent and density of mucoid impaction, centrilobular micronodules, consolidation/ground-glass opacities, and thickening of the bronchial walls were found to be the most relevant CT scan parameters to assess radiologic response to treatment. A clinical, immunologic, and radiologic multidimensional approach should be adopted to assess outcomes, probably with a composite definition of response to treatment.Trial RegistrationClinicalTrials.gov; No.: NCT02273661; URL: www.Clinicaltrialsgov).Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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