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Irreversible airway obstruction assessed by high-resolution computed tomography (HRCT), exhaled nitric oxide (FENO), and biological markers in induced sputum in patients with asthma

Erfassung einer irreversiblen Atemwegsobstruktion durch hochauflösende Computertomographie (HRCT), ausgeatmetes NO (FENO) und biologische Marker im induzierten Sputum bei Patienten mit Asthma bronchiale

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Summary

Objective

The objective of this study was to explore the significance of assessing irreversible airway obstruction (IAO) in asthma patients by high-resolution computed tomography (HRCT), biological markers in induced sputum, and exhaled nitric oxide (FENO).

Methods

The study was conducted in 34 patients with IAO, 46 patients with reversible airway obstruction (RAO), 40 patients who did not have airway obstruction (NAO), and 40 healthy subjects serving as controls. These patients received a step therapy for at least 3 months based on the guidelines for the prevention and treatment of asthma. After achieving complete or partial control of asthma, HRCT, lung function, FENO, and chemokine levels in induced sputum were measured.

Results

The airway wall area (WA; %) correlated with forced expiratory volume-1 (FEV-1(L); r = −0.67, p < 0.0001), and significant differences in bronchial wall thickening (BWT) of the LEVEL E generation airways were observed between the asthma and control groups (p < 0.01). FENO levels correlated with FEV-1 (%) in the IAO group (r = 0.49, p = 0.01). The levels of matrix metalloproteases-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in asthma patients with IAO, RAO, and NAO were significantly higher than those in the controls (p < 0.05). The level of neutrophilia in the sputum from the IAO group was higher than that from the RAO, NAO and control groups.

Conclusion

Asthma patients with IAO have an increased BWT. Airway measurements with HRCT scans appear to be valuable in the evaluation of airway remodeling in asthma patients with IAO.

Zusammenfassung

Ziel

der Studie war es, die Bedeutung der Erfassung einer irreversiblen Atemwegsobstruktion (IAO) bei Pati-enten mit Asthma bronchiale durch eine HRCT, durch biologische Marker im induzierten Sputum und durch Messung des ausgeatmeten NO zu evaluieren.

Methodik

Die Studie wurde an 34 Patienten mit IAO, 46 Patienten mit reversibler Atemwegsobstruktion (RAO), 40 Patienten ohne Atemwegsobstruktion (NAO) und 40 gesunden Kontrollpersonen durchgeführt. Die Patienten erhielten zumindest 3 Monate lang eine Stu-f­entherapie entsprechend den Leitlinien zur Prävention und Behandlung von Asthma bronchiale. Nach Erreichen einer kompletten oder partiellen Kontrolle des Asthmas wurde eine HRCT, eine Lungenfunktionsprüfung, sowie eine Messung der FENO und von Chemokinen im induzierten Sputum durchgeführt.

Ergebnisse

Die Atemwegswandfläche (WA, %) kor­relierte mit den FEV-1 Werten (r = −0,67, p < 0,0001). Weiters wurden signifikante Unterschiede zwischen der Kontrolle und den Asthmapatienten in den Verdickungen der Bronchialwand (BWT) der LEVEL E Generation Atemwege beobachtet (p < 0,001). In der Gruppe der Patienten mit IAO korrelierten die FENO Werte mit den FEV-1 (%) Werten (r = 0,49, p = 0,01). Die Werte der Matrix Metalloprotease-9 (MMP-9) und des Gewebsinhibitors der Matrix Metalloproteinase-1 (TIMP-1) waren bei allen Patienten signifikant höher als bei den Kon­trollen (p < 0,05). Der Grad der Neutrophilie im Sputum war bei den Patienten mit IAO höher als bei den Patienten mit RAO, mit NAO beziehungsweise als bei den Kontrollpersonen.

Schlussfolgerungen

Asthmapatienten mit IAO haben eine erhöhte BWT. Die Messung der Atemwege mittels HRCT scheint bei der Evaluation des Remodelings der Atemwege von Asthmapatienten mit IAO wertvoll zu sein.

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Acknowledgments

We thank Zhang Lanlan and Jin Gang for their assistance in preparing and revising this manuscript, Cao Zhi Gang for his assistance with data analysis, and Zhang Lanlan and Cui Yali for data collection and figure preparation.

Funding

The authors received no specific funding for this study.

Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Department of Respiration Medicine, West China Hospital, Sichuan University, 37 Guoxuexiang, 610041, Chengdu, Sichuan, China

    Lanlan Zhang & Chuntao Liu

  2. The Fourth Clinical College, Harbin Medical University, 37 Yiyuan Street, Nangang District, 150001, Harbin, Heilongjiang, China

    Jin Gang PhD & Shen Baozhong PhD

  3. The Second Clinical College, Harbin Medical University, 150001, Harbin, Heilongjiang, China

    Cao Zhigang

  4. The Third Clinical College, Harbin Medical University, 150001, Harbin, Heilongjiang, China

    Cui Yali

  5. Kai Le Clinic of Shuang Liu, 610000, Shuang Liu, China

    Zhang Fangbiao

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  1. Lanlan Zhang
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  3. Cao Zhigang
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Additional information

Shen Baozhong and Liu Chuntao contributed equally to this article.

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Zhang, L., Gang, J., Zhigang, C. et al. Irreversible airway obstruction assessed by high-resolution computed tomography (HRCT), exhaled nitric oxide (FENO), and biological markers in induced sputum in patients with asthma. Wien Klin Wochenschr 126, 515–523 (2014). https://doi.org/10.1007/s00508-014-0568-7

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  • DOI: https://doi.org/10.1007/s00508-014-0568-7

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