Peripheral and proximal lung ventilation in asthma: Short-term variation and response to bronchodilator inhalation - 03/06/21
, J. Chris Kenworthy, BMedSci a, Felix C. Horn, PhD a, Steven Thomas, PhD b, Andrew J. Swift, PhD a, Salman Siddiqui, FRCP, PhD c, Christopher E. Brightling, FMedSci, PhD c, Jim M. Wild, PhD aAbstract |
Background |
The relative involvement of the large and small airways in asthma is not clear. Hyperpolarized gas magnetic resonance imaging (MRI) provides high-resolution 3-dimensional images of ventilation distribution that can be quantified by the ventilated volume percentage (VV%) of the lungs.
Objective |
Our aims were to (1) quantify the baseline reproducibility of VV%, (2) assess the ventilation distribution between the proximal and peripheral lungs, and (3) investigate regional ventilation response to bronchodilator inhalation in a cohort of patients with asthma.
Methods |
A total of 33 patients with poorly controlled, moderate-to-severe asthma were scanned with hyperpolarized 3He MRI. Two image data sets were acquired at baseline, and 1 image data set was acquired after bronchodilator inhalation. Images were divided into proximal and peripheral regions for analysis.
Results |
Bland-Altman analysis showed strong reproducibility of VV% (bias = 0.12%; LOA = –1.86% to 2.10%). VV% variation at baseline was greater in the periphery than in the proximal lung. The proximal lung was better ventilated than the peripheral lung. Ventilation increased significantly in response to bronchodilator inhalation, globally and regionally, and the ventilation increase in response to bronchodilator inhalation was greater in the peripheral lung than in the proximal lung. Hyperpolarized gas MRI was more sensitive to changes in response to bronchodilator inhalation (58%) than spirometry (33%).
Conclusion |
The peripheral lung showed reduced ventilation and a greater response to bronchodilator inhalation than the proximal lung. The high level of baseline reproducibility and sensitivity of hyperpolarized gas MRI to bronchodilator reversibility suggests that it is suitable for low subject number studies of therapy response.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : Hyperpolarized gas MRI, ventilation, asthma, proximal, peripheral, reproducibility, bronchodilator response
Abbreviations used : 2D, FVC, LOA, MCID, MRI, PET, TLV, VDP, VV, VV%
Plan
| Supported by EU FP7 AirPROM, Novartis, and the MRC (grant MR/M008894/1). |
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| Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. |
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| Some aspects of this work were previously published in abstract form at the 2013 European Respiratory Society Congress (“Quantifying peripheral and central lung response to bronchodilator in asthma with hyperpolarized 3-helium MRI”) and the 2014 American Thoracic Society Conference (“Reproducibility of lung ventilation volume from helium-3 and proton MRI in asthmatics"). |
Vol 147 - N° 6
P. 2154 - juin 2021 Retour au numéro
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