The Journal of Allergy and Clinical Immunology
Volume 116, Issue 4 , Pages 750-754, October 2005

High-resolution computed tomography scan and airway remodeling in children with severe asthma

  • Jacques de Blic, MD

      Affiliations

    • From Service de pneumologie et d'allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Université René Descartes, Paris
    • Corresponding Author InformationReprint requests: Professor Jacques de Blic, Service de Pneumologie et d'allergologie Pédiatriques, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.
    • ,
  • Isabelle Tillie-Leblond, MD, PhD

      Affiliations

    • Institut National de la Santé et de la Recherche Médicale U 416, Institut Pasteur de Lille
    • ,
  • Sophie Emond, MD

      Affiliations

    • Service de Radiologie, Hôpital Necker-Enfants Malades, Paris
    • ,
  • Bruno Mahut, MD

      Affiliations

    • Laboratoire d'Exploration Fonctionnelle Respiratoire—Radio Isotope, Hôpital Européen Georges Pompidou, Paris
    • ,
  • Thanh Lan Dang Duy, MD

      Affiliations

    • From Service de pneumologie et d'allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Université René Descartes, Paris
    • ,
  • Pierre Scheinmann, MD

      Affiliations

    • From Service de pneumologie et d'allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Université René Descartes, Paris

Received 21 April 2005; received in revised form 1 July 2005; accepted 13 July 2005. published online 03 September 2005.

Paris and Lille, France

Background

Children with severe asthma have a significantly higher bronchial wall thickness (BWT) on high-resolution computed tomography scan than control children.

Objective

We sought to determine whether a BWT score correlates with markers of airway remodeling and inflammation.

Methods

In 37 children with severe asthma, we determined reticular basement membrane thickness; number of intraepithelial neutrophils and eosinophils on bronchial biopsy; IFN-γ, IL-4, IL-5, and eosinophil cationic protein levels and IFN-γ/IL-4 ratio on bronchoalveolar lavage specimen; and alveolar nitric oxide (NO) concentration and the maximum airway wall NO flux.

Results

The BWT score significantly correlated with reticular basement membrane thickening (r = 0.34; P = .04) and NO production by the airway wall (r = 0.45; P = .02). The correlation with the eosinophil cationic protein level was just significant (r = 0.40; P = .05), whereas there was no correlation with IFN-γ/IL-4 ratio (r = −0.31; P = .08). The BWT score did not correlate with FEV1 or forced expiratory flow at 25% to 75% of forced vital capacity.

Conclusion

High-resolution computed tomography scan is a noninvasive technique that might be valuable for quantifying airway remodeling in children with severe asthma. The new generations of multislice computed tomography scanners will allow higher definition and lower radiation exposure and probably give a better assessment of airway remodeling and efficacy of treatment in children with asthma.

Key words: Severe asthma, nitrous oxide, HRCT scan, bronchial wall thickening, reticular basement membrane, remodeling, airway inflammation, ECP, IFN-γ, IL-4

Abbreviations used: ATS, American Thoracic Society, BWT, Bronchial wall thickening, CalvNO, Alveolar nitric oxide concentration, ECP, Eosinophil cationic protein, eNO, Exhaled nitric oxide, HRCT, High-resolution computed tomography, J'awNO, Maximum airway wall nitric oxide flux, NO, Nitric oxide, RBM, Reticular basement membrane

 

 Supported by a grant from GlaxoSmithKline, Paris.

PII: S0091-6749(05)01646-5

doi:10.1016/j.jaci.2005.07.009

The Journal of Allergy and Clinical Immunology
Volume 116, Issue 4 , Pages 750-754, October 2005

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