CT Imaging Analysis Before and After Biologic Therapy in Severe Asthma

Le résumé fourni par la source

Abstract Background: Biologics for severe asthma have been shown to reduce exacerbations and reduce or discontinue oral steroids. Moreover, biologic therapy has been reported to be associated with mucus plug reduction. In contrast, it has been suggested that in severe asthma, as in chronic obstructive pulmonary disease, not only airway obstruction but also airflow limitation due to parenchymal destruction may be causing a decline in lung function. It has been reported that lung parenchyma and airways can be evaluated by using parameters measured on multidetector row computed tomography (MDCT), such as Low-attenuation volume (LAV), but few reports have showed the relationships of MDCT-measured parameters and biologics. We aimed to analyze lung structural parameters on MDCT, including peripheral airway lesions, related to the use of biologics in severe asthma, associating with treatment effects. Methods: Thirty-two patients (16 males and 16 females) diagnosed with severe asthma based on ATS/ERS criteria were included in the study. The patients were treated with benralizumab (Benra) or dupilumab (Dupi) at Niigata University Medical and Dental Hospital from April 2018 to April 2022. They underwent a physical examination, and the following parameters were examined: Asthma Control Test, Asthma Quality of Life Questionnaire, pulmonary function test, measurement of the fraction of exhaled nitric oxide (FeNO) level, peripheral blood eosinophil (PBE) count, measurement of total immunoglobulin E (IgE) levels and MDCT scans before and 4-6 months after induction of biologics. Results: Clinical symptoms, exacerbation frequency, and respiratory function improved significantly in both groups after biologics. There were decreases in FeNO and IgE in the Dupi group, and a decrease in PBE in the Benra group. MDCT analysis showed decreases in mucus plug score in both groups, an increase in total airway count in the Dupi group, and an increase in LAV in the Benra group. The total number of airways in the Dupi group correlated with low respiratory function. Exponent D, fractal dimension based on cumulative frequency of LAC size distribution, was not significantly different before and after treatment.Conclusion: Both biologics may contribute to the improvement of respiratory function in patients with asthma by improving not only mucus plugs in the central airways but also small airway dysfunction. However, further large-scale and detailed studies are warranted.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.