BELLIA, Maria

BELLIA, Vincenzo

Benfante, A

Brown ,R

Cannizzaro, F

MIDIRI, Massimo

SCICHILONE, Nicola Alessandro

Archivio istituzionale della ricerca - Università di Palermo

-å"ELLIAå.å3CICHILONEå!å"ENFANTEå&å#ANNIZZAROå6å"ELLIAå2å"ROWNå-å-IDIRIå0ALERMOå0!	)4å0ALERMO)4(2#4åEVALUATIONåOFåBRONCHIALåRESPONSEåTOåDEEPåINSPIRATIONåINåASTHMAåANDåCHRONICOBSTRUCTIVEåPULMONARYåDISEASEå#/0$	ECR#6IENNAå*ANUARYåPage 1 of 9HRCT evaluation of bronchial response to deep inspirationin asthma and chronic obstructive pulmonary disease(COPD)Poster No.: C-0779Congress: ECR 2012Type: Scientific ExhibitAuthors: M. Bellia1, N. Scichilone2, A. Benfante2, F. Cannizzaro2, V. Bellia2,R. Brown2, M. Midiri3; 1Palermo (PA)/IT, 2Palermo/IT, 3PALERMO/ITKeywords: Lung, Respiratory system, Thorax, CT-High Resolution, ComputerApplications-Detection, diagnosis, Chronic obstructive airwaysdiseaseDOI: 10.1594/ecr2012/C-0779Any information contained in this pdf file is automatically generated from digital materialsubmitted to EPOS by third parties in the form of scientific presentations. Referencesto any names, marks, products, or services of third parties or hypertext links to third-party sites or information are provided solely as a convenience to you and do not inany way constitute or imply ECR's endorsement, sponsorship or recommendation of thethird party, information, product or service. ECR is not responsible for the content ofthese pages and does not make any representations regarding the content or accuracyof material in this file.As per copyright regulations, any unauthorised use of the material or parts thereof aswell as commercial reproduction or multiple distribution by any traditional or electronicallybased reproduction/publication method ist strictly prohibited.You agree to defend, indemnify, and hold ECR harmless from and against any and allclaims, damages, costs, and expenses, including attorneys' fees, arising from or relatedto your use of these pages.Please note: Links to movies, ppt slideshows and any other multimedia files are notavailable in the pdf version of presentations.www.myESR.orgPage 2 of 9PurposeIn asthma and chronic obstructive pulmobnary disease (COPD) functional disorder maybe defined not only in terms of bronchial obstruction, but also by airway response tostimuli including deep inhalation (DI). DIs exert their effects on airways through the radialtraction that is applied to the airway wall by virtue of the interdependence betweenintraparenchymal airways and the surrounding parenchyma. DI effect decreases withseverity of diseases and correlates with changes in airway distensibility (AD) evaluatedby HRCT. Our study aimed at assessing the variables that affect such AD.Methods and MaterialsWe studied twelve asthmatics (M/F: 7/5) and eight COPD patients (7/1) with similardegree of obstruction. None of the study subjects were current smokers. None of themhad acute exacerbation within the previous three months, and all of them were clinicallystable at the time of the study. The study was performed on two days. The first visitincluded clinical and functional assessments. On a separate occasion, within seven days,the imaging assessment was carried out. Each subject underwent HRCT evaluation,which was performed by spiral computed tomography (multidetector 64 channels, PhilipsMedical System, Cleveland, OH), with a setting of 120 kVp, 200 mAs, a 0.9-mm slicethickness, a rotation time 0.5s, and a reconstruction interval of 0.45 mm, pitch 0.923,during a single breath and moved caudally. Images were reconstructed at a windowlevel of - 600 Hounsfield units (HU) and a window width of 1600 HU. Two sets of scanswere obtained: the first one was acquired at the end of the expiratory phase of thetidal volume (functional residual capacity, FRC) and the second one at maximal lunginspiration (total lung capacity, TLC). The airway diameter, airway wall thicknesses (asa fraction of airway diameter; AWF) and lung parenchyma density were analyzed usingthe validated Pulmonary Workstation 2 software package (VIDA Diagnostics, Inc, IowaCity, IA) (Fig. 1-2). AD was calculated as the ratio of the difference in bronchial lumendiameter at TLC and FRC over the diameter at FRC.Images for this section:Page 3 of 9Fig. 1: Images relevant to phases of post processing procedure of lung CT scans.Page 4 of 9Fig. 2: Further phases of post-processing of pulmonary airways leading to virtualbronchoscopy.Page 5 of 9ResultsWe evaluated 701 airways. The degree of obstruction did not differ between asthmaand COPD (FEV 1% pred 69.0 +/- 4.8 vs 61.3 +/- 5.9 p= 0.31). AD did not differbetween groups (14+/- 3.5 vs 17+/- 4.3 p=0.58). No significant differences betweenthe two groups were detected when AD was calculated by size for the small (p=0.27),the medium (p=0.94) and the large (p=0.40) airways, respectively. We did not find asignificant difference in the mean AWF between the groups (at TLC: 0.52±0.01% in theasthmatics and 0.51±0.01% in the COPD, p=0.50; at FRC: 0.55±0.01% in the asthmaticsand 0.55±0.01% in the COPD, p=0.94). In asthma AD was correlated to FEV1 % pred(r2= 0.45, p=0.018) (Fig.3), while in COPD it correlated with residual volume (RV) % pred(r2= 0.51, p= 0.046) (Fig.4) and with RV/TLC% (r2= 0.68, p=0.01) (Fig.5).Images for this section:Page 6 of 9Fig. 3: In asthma AD was correlated to FEV1 % pred (r2= 0.45, p=0.018)Page 7 of 9Fig. 4: In COPD AD is correlated with residual volume (RV) % pred (r2= 0.51, p= 0.046).Page 8 of 9Fig. 5: In COPD AD is correlated with RV/TLC% (r2= 0.68, p=0.01).Page 9 of 9ConclusionOur study demonstrated that, for similar level of airway obstruction the degreeof AD induced by DI does not differ between asthma and COPD. The differentcorrelation of AD with functional parameters may be interpreted as due to differentpathogenetics mechanisms (bronchial obstruction and air trapping respectively) thatinfluence bronchodilator response to DI in the two diseases.ReferencesBrown RH, Scichilone N, Mudge B, Diemer FB, Permutt S, Togias A: High-resolutioncomputed tomographic evaluation of airway distensibility and the effects of lung inflationon airway caliber in healthy subjects and individuals with asthma. Am J Respir Crit CareMed 2001, 163(4):994-1001.Scichilone N, Marchese R, Catalano F, Vignola AM, Togias A, Bellia V: Bronchodilatoryeffect of deep inspiration is absent in subjects with mild COPD. Chest 2004,125(6):2029-2035.Scichilone N, La Sala A, Bellia M, Fallano K, Togias A, Brown RH, Midiri M, BelliaV: The airway response to deep inspirations decreases with COPD severity and isassociated with airway distensibility assessed by computed tomography. J Appl Physiol2008, 105(3):832-838.Pyrgos G, Scichilone N, Togias A, Brown RH: Bronchodilation response to deepinspirations in asthma is dependent on airway distensibility and air trapping. J ApplPhysiol 2011, 110(2):472-479.Personal Information

HRCT evaluation of bronchial response to deep inspiration in asthma and chronic 
obstructive pulmonary disease (COPD)

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HRCT evaluation of bronchial response to deep inspiration in asthma and chronic obstructive pulmonary disease (COPD)

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