Study of Airway Remodeling in Pediatric Patients with Bronchial Asthma Using Chest High Resolution Computed Tomography (HRCT) as a Non Invasive Technique
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- Category: Vol. 78, June 2010
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Study of Airway Remodeling in Pediatric Patients with Bronchial Asthma Using Chest High Resolution Computed Tomography (HRCT) as a Non Invasive Technique,MUHAMMAD H. MAEBED, DINA A. EZZAT, ABEER S. MUHAMMAD, OSAMA LAMEI and ELHAM ABDUL MAGEED
Abstract
Background: "Airway remodeling" in bronchial asthma refers to the structural changes that occur in conjunction with, or because of, chronic airway inflammation in asthma. Airway remodeling is induced by cytokines and mediators produced in chronic allergic airway inflammation. Regulation of the repair and remodeling process is not well established, but both the process of repair and its regulation are likely to be key events in explaining the persistent nature of the disease and limitations to a therapeutic response. Recent studies have shown that airway remodeling is present in children as early as 3 years old, indicating processes that begin early in the development of asthma and occur in parallel with, or may be obligatory for, the establishment of persistent inflammation. The endbronchial biopsies (EB) are currently the gold standard of airway remodeling studies. However, they have their limitations. Evidence is accumulating to suggest that HRCT scans are useful for evaluation of the proximal and distal airways in patients with asthma.
Objectives: The present study aims at investigating the airway remodeling in pediatric patients with bronchial asthma using chest high resolution computed tomography as a non invasive technique.
Patients and Methods: Forty one subjects above 6 years old were included in this study. They included 26 bronchial asthma patients, (11 males and 15 females). Their mean age was (8.08±1.87) and 15 age matched healthy controls, their mean age was (8.33±2.02) (8 males and 7 females) Asthmatic patients were classified into 3 subgroups according to the severity of their asthma. All were subjected to: Spirometric measurements (PFTs.) including FVC, FEV!, FEF 25,50,75 & PEF, and Chest high resolution computed tomography (HRCT) scan.
Results: All pulmonary function tests of the asthmatic patients were significantly lower than that of the control (p-value <0.001). There was a statistical significant difference concerning FEV1, FEF25, FEF50 among different groups of asthma; lower values among severe asthmatics. 100% of severe patients, 25% of moderate asthma patients & 18.18% of mild asthma showed abnormal HRCT findings suggesting start of airway remodeling. No significant correlation was found between these findings of and either FEV 1 or FEV1/FVC.
Conclusion: It is possible to assess the airway remodeling by high-resolution computed tomography (HRCT) of the thorax. This technique allows the study of the airway lumen and wall dimensions without invasive techniques.
Early intervention with inhaled corticosteroids (ICS) before serious pathological changes occur, is expected to prevent the development of remodeling and improve asthma outcome.