Uncontrolled asthma phenotypes defined from parameters using quantitative CT analysis

  • Xiaoxian Zhang
  • Tingting Xia
  • Zhengdao Lai
  • Qingling Zhang
  • Yubao GuanEmail author
  • Nanshan ZhongEmail author
Computed Tomography



Asthma is a heterogeneous disease with diverse clinical phenotypes that have been identified via cluster analyses. However, the classification of phenotypes based on quantitative CT (qCT) is poorly understood. The study was conducted to investigate CT determination of uncontrolled asthma phenotypes.


Sixty-five patients with uncontrolled asthma (37 with severe asthma, 28 with non-severe asthma) underwent detailed clinical, laboratory, and pulmonary function tests, as well as qCT analysis. Twenty-five healthy subjects were also included in this study and underwent clinical physical examinations, pulmonary function tests, and low-dose CT scans.


The mean lumen area/body surface area ratio was smaller in patients with severe uncontrolled asthma compared with that in healthy subjects (9.84 mm2 [SD, 2.57 mm2], 11.96 mm2 [SD, 3.09 mm2]; p = 0.026). However, the percentage of mean wall area (WA) was greater (64.39% [SD, 2.55%], 62.09% [SD, 3.81%], p = 0.011). Air trapping (measured based on mean lung density and VI−856 [%] on expiratory scan) was greater in patients with severe uncontrolled asthma than in those with non-severe uncontrolled asthma and was higher in all patients with uncontrolled asthma than that in healthy subjects (all p < 0.001). Three CT-determined uncontrolled asthma phenotypes were identified. Cluster 1 had mild air trapping with or without proximal airway remodeling. Cluster 2 had moderate air trapping with or without proximal airway remodeling. Cluster 3 had severe air trapping with proximal airway remodeling.


There was obvious air trapping and proximal airway remodeling in patients with severe uncontrolled asthma. The three CT-determined uncontrolled asthma phenotypes might reflect underlying mechanisms of disease in patient stratification and in the different stages of disease development.

Key Points

• Obvious air trapping and proximal airway remodeling were present in patients with severe uncontrolled asthma.

• CT air trapping indices showed a good correlation with disease duration, total IgE, atopy, and OCS and ICS doses, and were even more strongly correlated with clinical lung function.

• Three CT-determined uncontrolled asthma phenotypes were identified, which might reflect underlying mechanisms of disease in patient stratification and in the different stages of disease development.


Asthma Airway remodeling Tomography, X-ray computed Phenotype 



Body surface area


Lumen area


The posterior basal segmental bronchus of the left lower lobe


Lung volume


Mean lung density


Mean lung density expiratory/inspiratory ratio


Wall area of a hypothetical airway with an internal perimeter of 10 mm


Quantitative computer tomography


The apical segmental bronchus of the right upper lobe


The posterior basal segmental bronchus of the right lower lobe


Thickness of airway wall


Total area


Voxel index

VI−856 E-I (%)

Voxel index change of percent voxels less than − 856 HU on paired inspiratory and expiratory CT scans

VI−856 (%)

Percent voxels less than − 856 HU

VI−856/−950 E-I (%)

Voxel index change of percent voxels between − 950 and – 856 HU on paired inspiratory and expiratory CT scans

VI−950 (%)

Percent voxels less than – 950 HU


Wall area


Wall area percentage



This study was supported by grants from the National Natural Science Foundation of China (81371633), Department of Education of Guangdong Province (2013KJCX0150), and by Science and Technology Planning Project of Guangdong Province (2013B021800310).

Compliance with ethical standards


The scientific guarantor of this publication is Yubao Guan.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case-control study

• performed at one institution

Supplementary material

330_2018_5913_MOESM1_ESM.docx (326 kb)
ESM 1 (DOCX 326 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
  2. 2.Department of RadiologyThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina

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