European Radiology

, Volume 23, Issue 6, pp 1594–1602 | Cite as

Relationship between the airway wall area and asthma control score in moderate persistent asthma

  • Pierre-Yves Brillet
  • Philippe A. Grenier
  • Catalin I. Fetita
  • Catherine Beigelman-Aubry
  • Yahya Ould-Hmeidi
  • Margarete Ortner
  • Gaëlle Nachbaur
  • Lukasz Adamek
  • Pascal Chanez
Computed Tomography



To assess the association between airway wall area and clinical asthma control, assessed by the Asthma Control Test (ACT).


This cross-sectional study evaluated 96 adults for asthma control [“at least well controlled” (ACT ≥ 20; n = 52) or “not well controlled” (ACT < 20; n = 44) and airway dimensions: luminal area (LA), wall area (WA) and WA%], obtained using automated dedicated software measurements from volumetric CT images. Results were analysed for segmental bronchi, subsegmental bronchi in the right upper lobe and basilar segments, both uncorrected and corrected for body surface area (BSA).


For all bronchi corrected for BSA, there was no correlation between airway wall area and ACT score. There was a weak but statistically significant correlation between uncorrected WA and ACT score (r = -0.203; P = 0.047); WA values were numerically higher in the “not well-controlled” versus the “at least well-controlled asthma” subgroups. For sub-segmental bronchi, there was a correlation between the ACT score and both WA/BSA (r = -0.204; P = 0.047) and WA (r = -0.249; P = 0.014), and for upper lobe bronchi, between the ACT score and WA (r = -0.207; P = 0.044).


We demonstrated a correlation between subsegmental bronchial airway measurements and clinical control of asthma; this is probably a reflection of airway remodelling and structural changes in chronic poorly controlled asthma.

Key Points

• Volumetric computed tomography offers new insights into bronchial morphology.

• The relationship between current asthma control and airway wall abnormalities is assessed.

• Some relationships between airway wall area and clinical control were demonstrated.

• We observed less shape variation of bronchi in “not well-controlled” asthma patients.


Multidetector row computed tomography Quantitative evaluation Asthma control Asthma Control Test Adults 



This study was funded by GlaxoSmithKline (study no. 111750). The authors would like to thank the investigators who recruited and cared for patients in this study. Thanks are also extended to Marc Poterre for his input into the original concept and design of the study and to Kate Hollingworth for editorial support in the form of developing a draft outline and first draft, assembling tables and figures, and collating author comments (funded by GlaxoSmithKline)


  1. 1.
    Global initiative for asthma (GINA). Global strategy for asthma management and prevention (updated 2009).
  2. 2.
    Jeffery PK (2001) Remodeling in asthma and chronic obstructive lung disease. Am J Respir Crit Care Med 164:S28–S38PubMedCrossRefGoogle Scholar
  3. 3.
    Bergeron C, Al-Ramli W, Hamid Q (2009) Remodeling in asthma. Proc Am Thorac 6:301–305CrossRefGoogle Scholar
  4. 4.
    Ward C, Pais M, Bish R et al (2002) Airway inflammation, basement membrane thickening and bronchial hyperresponsiveness in asthma. Thorax 57:309–316PubMedCrossRefGoogle Scholar
  5. 5.
    Cohn L, Elias JA, Chupp GL (2004) Asthma: mechanisms of disease persistence and progression. Annu Rev Immunol 22:789–815PubMedCrossRefGoogle Scholar
  6. 6.
    Vignola A, Mirabella F, Costanzo G et al (2003) Airway remodeling in asthma. Chest 123:417S–422SPubMedCrossRefGoogle Scholar
  7. 7.
    Tillie-Leblond I, Montani D, Crestani B et al (2009) Relation between inflammation and symptoms in asthma. Allergy 64:354–367PubMedCrossRefGoogle Scholar
  8. 8.
    Bateman ED, Boushey HA, Bousquet J et al (2004) Can guideline-asthma control be achieved? The gaining optimal asthma ControL study. Am J Respir Crit Care Med 170:836–844PubMedCrossRefGoogle Scholar
  9. 9.
    Wadsworth S, Sin D, Dorscheid D (2011) Clinical update on the use of biomarkers of airway inflammation in the management of asthma. J Asthma Allergy 4:77–86PubMedCrossRefGoogle Scholar
  10. 10.
    Schatz M, Sorkness CA, Li JT et al (2006) Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol 117:549–556PubMedCrossRefGoogle Scholar
  11. 11.
    Juniper EF, Bousquet J, Abetz L, Bateman ED, The GOAL Committee (2006) Identifying ‘well-controlled’ and ‘not well-controlled’ asthma using the Asthma Control Questionnaire. Respir Med 100:616–621PubMedCrossRefGoogle Scholar
  12. 12.
    Demoly P, Gueron B, Annunziata K, Adamek L, Walters RD (2010) Update on asthma control in five European countries: results of a 2008 survey. Eur Respir Rev 19:150–157PubMedCrossRefGoogle Scholar
  13. 13.
    Niimi A, Matsumoto H, Amitani R et al (2002) Airway wall thickness in asthma assessed by computed tomography. Relation to clinical indices. Am J Respir Crit Care Med 162:1518–1523CrossRefGoogle Scholar
  14. 14.
    Little SA, Sproule MW, Cowan MD et al (2002) High resolution computed tomographic assessment of airway wall thickness in chronic asthma: reproducibility and relationship with lung function and severity. Thorax 57:247–253PubMedCrossRefGoogle Scholar
  15. 15.
    Niimi A, Matsumoto H, Takemura M, Ueda T, Chin K, Mishima M (2003) Relationship of airway wall thickness to airway sensitivity and airway reactivity in asthma. Am J Respir Crit Care Med 168:983–988PubMedCrossRefGoogle Scholar
  16. 16.
    Niimi A, Matsumoto H, Amitani R et al (2004) Effect of short-term treatment with inhaled corticosteroid on airway wall thickening in asthma. Am J Med 116:725–731PubMedCrossRefGoogle Scholar
  17. 17.
    Aysola RS, Hoffman EA, Gierada D et al (2008) Airway remodeling measured by multidetector CT is increased in severe asthma and correlates with pathology. Chest 134:1183–1191PubMedCrossRefGoogle Scholar
  18. 18.
    Busacker A, Newell JD, Keefe T et al (2009) A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis. Chest 135:48–56PubMedCrossRefGoogle Scholar
  19. 19.
    Chae EJ, Kim T-B, Cho YS et al (2011) Airway measurement for airway remodeling defined by post-bronchodilator FEV1/FVC in asthma: investigation using inspiration-expiration computed tomography. Allergy Asthma Immunol Res 3:111–117PubMedCrossRefGoogle Scholar
  20. 20.
    Brillet PY, Fetita CI, Beigelman-Aubry C et al (2007) Quantification of bronchial dimensions using dedicated software. Eur Radiol 17:1483–1489PubMedCrossRefGoogle Scholar
  21. 21.
    Saragaglia A, Fetita C, Prêteux F, Brillet PY, Grenier PA (2005) Accurate 3D quantification of bronchial parameters in MDCT. Proc SPIE 5916:323–334Google Scholar
  22. 22.
    Boyden EA (1955) Segmental anatomy of the lungs: a study of the patterns of the segmental bronchi and related pulmonary vessels. McGraw-Hill, New YorkGoogle Scholar
  23. 23.
    Matsuoka S, Kurihara Y, Nakajima Y, Niimi H, Ashida H, Kaneoya K (2005) Serial change in airway lumen and wall thickness at thin-section CT in asymptomatic subjects. Radiology 234:595–603PubMedCrossRefGoogle Scholar
  24. 24.
    Brillet PY, Attali V, Nachbaur G et al (2011) Multidetector row computed tomography to assess changes in airways linked to asthma control. Respiration 81:461–468PubMedCrossRefGoogle Scholar
  25. 25.
    Gupta S, Siddiqui S, Haldar P et al (2010) Quantitative analysis of high-resolution computed tomography scans in severe asthma subphenotypes. Thorax 65:775–781PubMedCrossRefGoogle Scholar
  26. 26.
    Brillet PY, Fetita CI, Capderou A et al (2009) Variability of bronchial measurements obtained by sequential CT using two computer-based methods. Eur Radiol 19:1139–1147PubMedCrossRefGoogle Scholar
  27. 27.
    Taylor DR, Bateman ED, Boulet L-P et al (2008) A new perspective on concepts of asthma severity and control. Eur Respir J 32:545–554PubMedCrossRefGoogle Scholar
  28. 28.
    Reddel HK, Robin Taylor D, Bateman ED et al (2009) An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 180:59–99PubMedCrossRefGoogle Scholar
  29. 29.
    Bumbacea D, Campbell D, Nguyen L et al (2004) Parameters associated with persistent airflow obstruction in chronic severe asthma. Eur Respir J 24:122–128PubMedCrossRefGoogle Scholar
  30. 30.
    Vonk JM, Jongepier H, Panhuysen CIM, Schouten JP, Bleecker ER, Postma DS (2003) Risk factors associated with the presence of irreversible airflow limitation and reduced transfer coefficient in patients with asthma after 26 years of follow up. Thorax 58:322–327PubMedCrossRefGoogle Scholar
  31. 31.
    James AL, Bai TR, Mauad T et al (2009) Airway smooth muscle thickness in asthma is related to severity but not duration of asthma. Eur Respir J 34:1040–1045PubMedCrossRefGoogle Scholar
  32. 32.
    Kasahara K, Shiba K, Ozawa T, Okuda K, Adachi M (2002) Correlation between the bronchial subepithelial layer and whole airway wall thickness in patients with asthma. Thorax 57:242–246PubMedCrossRefGoogle Scholar
  33. 33.
    Cohen J, Douma WR, Ten Hacken NH, Oudkerk M, Postma DS (2008) Physiology of the small airways: a gender difference? Respir Med 102:1264–1271PubMedCrossRefGoogle Scholar
  34. 34.
    Grainger CL, Lau PG, Ward JA et al (2011) Effect of bronchoconstriction on airway remodeling in asthma. N Engl J Med 364:2006–2015CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Pierre-Yves Brillet
    • 1
  • Philippe A. Grenier
    • 2
  • Catalin I. Fetita
    • 3
  • Catherine Beigelman-Aubry
    • 2
  • Yahya Ould-Hmeidi
    • 1
  • Margarete Ortner
    • 3
  • Gaëlle Nachbaur
    • 4
  • Lukasz Adamek
    • 5
  • Pascal Chanez
    • 6
  1. 1.Université Paris 13, Sorbonne Paris Cité, UPRES EA 2363, Service de radiologie, Assistance Publique – Hôpitaux de ParisHôpital AvicenneBobignyFrance
  2. 2.Université Pierre et Marie Curie, INSERM U678, Service de radiologie, Assistance Publique–Hôpitaux de ParisHôpital Pitié-SalpêtrièreParisFrance
  3. 3.ARTEMIS Department, CNRS UMR 8145Telecom SudParis/Institut Mines-TelecomEvryFrance
  4. 4.Operational Medical Excellence DepartmentGlaxoSmithKlineFrance
  5. 5.Respiratory Centre of ExcellenceGlaxoSmithKlineUxbridgeUK
  6. 6.Département des Maladies Respiratoires, AP-HM, Laboratoire d’immunologie INSERM CNRS U 1067, UMR7733Aix Marseille UniversitéMarseilleFrance

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