Department of Thoracic Medicine, Frankston Hospital, Peninsula Health, Victoria, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
J Appl Physiol (1985). 2021 Apr 1;130(4):1205-1213. doi: 10.1152/japplphysiol.00959.2020. Epub 2021 Feb 25.
Bronchial thermoplasty (BT) is a treatment for moderate-to-severe asthma, which generally improves quality-of-life scores but not conventional measures of lung function. Newer methodologies have begun to demonstrate the underlying physiological changes and elucidate the mechanism of action. We postulated that systematic, computed tomography (CT)-based assessment of the response of airways to BT is feasible, and our aim was to determine the distribution of these responses and the relationship with airway size. Twenty patients meeting the European Respiratory Society/American Thoracic Society (ERS/ATS) definition of severe asthma underwent BT and assessment including CT, Asthma Control Questionnaire (ACQ), and spirometry. Treatment was structured so that the left and right lungs are treated sequentially with a midtreatment assessment providing an internal control. Pairs of CT scans were analyzed using a new semiautomatic processing algorithm that matched individual segmented airways for quantitative comparison. Cross-sectional airway lumen area from matched airway pairs in treated lungs increased on average by 6.4% after BT ( < 0.02) but showed no change in the untreated lung. Matched airway length was also unchanged. Breakdown by airway size showed amplified response in more distal airways, with the smallest quintile of measured airways dilating by 13.2% ( < 0.001). ACQ improved from 3.5 ± 0.9 to 1.9 ± 1.2 ( < 0.001). These data show that the response to BT in individual airways can be assessed by CT and that dilation is heterogeneous and predominant in distal compared with proximal airways. A CT-based approach may further our understanding of the physiological changes in BT and aid in the development of refined and personalized versions of the therapy. CT scanning was used to evaluate the response of individual airways in patients undergoing bronchial thermoplasty. Airways dilated after treatment by 6.4% on average with substantial heterogeneity and a greater response in the most distal airways measured.
支气管热成形术（BT）是一种治疗中重度哮喘的方法，通常可以提高生活质量评分，但不能改善常规肺功能指标。新的方法学已经开始证明其潜在的生理变化，并阐明其作用机制。我们假设，基于系统的、计算机断层扫描（CT）的支气管对 BT 反应的评估是可行的，我们的目的是确定这些反应的分布及其与气道大小的关系。20 名符合欧洲呼吸学会/美国胸科学会（ERS/ATS）重度哮喘定义的患者接受了 BT 治疗，并进行了包括 CT、哮喘控制问卷（ACQ）和肺功能检查在内的评估。治疗结构使左、右肺依次接受治疗，中间评估提供内部对照。使用新的半自动处理算法分析成对的 CT 扫描，该算法匹配单个分段气道进行定量比较。经过 BT 治疗后，治疗肺中的配对 CT 扫描中气道管腔横截面积平均增加了 6.4%（<0.02），而未治疗的肺中没有变化。匹配气道长度也没有变化。按气道大小进行细分显示，在更远端的气道中反应增强，测量气道中最小的五分位数扩张了 13.2%（<0.001）。ACQ 从 3.5±0.9 改善至 1.9±1.2（<0.001）。这些数据表明，通过 CT 可以评估个体气道对 BT 的反应，扩张是不均匀的，与近端气道相比，远端气道扩张更为明显。基于 CT 的方法可能会进一步了解 BT 中的生理变化，并有助于开发更精细和个性化的治疗方法。CT 扫描用于评估接受支气管热成形术治疗的患者的单个气道的反应。治疗后气道平均扩张 6.4%，具有显著的异质性，且测量的最远端气道的反应更大。
