![]() All patients during the asthma exacerbation phase visited our clinic due to the worsening of wheezing with dyspnea and were diagnosed with asthma exacerbation. We evaluated asthma control according to the consensus-based GINA symptom control tool. The asthma severity in the stable phase and exacerbation severity were classified according to the GINA guidelines. There was over 6 months between the CT scans in the exacerbation phase and the recovery phase. CT scans of the subjects were obtained during asthma exacerbation and in the stable phase during the follow-up period. 2012 033), and written informed consent was obtained from all study patients. The Institutional Review Board of Saitama Cardiovascular and Respiratory Center approved this study (IRB No. The findings might provide a new dimension in quantifying asthma severity and asthma heterogeneity. The purpose of this study is to evaluate the changes in Din and the frequency of airway occlusion by mucus plugs from the segmental bronchus (second generation) to the sixth-generation bronchi by comparing HRCT data during asthma exacerbation with those obtained in the stable phase. Airway analysis of MPR images can be used to measure mucus plugs quantitatively as well. Using such a technique, we have shown that small airways with a 1.5-mm Din on a conventional multidetector HRCT or a 0.8-mm Din on ultra-HRCT can be measured in clinical situations. ![]() The recently developed CT technique known as curved multiplanar reconstruction (MPR) can visualize longitudinal airway images and accurately analyze short-axis images of small airways that cannot be recognized in standard high-resolution CT (HRCT) images. Quantitative computed tomography (CT) imaging can provide structural and functional information on asthma. Recently, a quantitative image analysis of airway obstruction due to mucus plugs has been explored in severe asthma. ![]() The mucus plugs, as well as narrowed airways, could be the target of inhaled corticosteroids and bronchodilators during asthma exacerbation. If the inner diameter of the airway (Din) and mucus plugs could be directly observed in acute asthma, it would help us understand how inhalers act on airways in asthmatics. Also, mucus plugs are considered to be one of the mechanisms of airway obstruction in fatal asthma. However, most inhaled therapies do not reach the small airways (airways with internal diameter < 2 mm) that comprise multiple aspects of asthma. In asthma exacerbation, the Global Initiative for Asthma (GINA) guideline recommends inhalation treatments with a short-acting beta-2 agonist (SABA) and ipratropium bromide in addition to systemic corticosteroids. The percentages of airway obstruction due to mucus plugs were notably higher in the fourth- and fifth-generation bronchi (17.9%/18.1% in stable phase and 43.2%/45.9% in the exacerbation phase, respectively) than in the other generations of bronchi. Using a curved multiplanar reconstruction (MPR) software, we reconstructed the longitudinal airway images and the images exactly perpendicular to the airway axis to measure the Din and mucus plugs from the second- (segmental) to sixth-generation bronchi in all segments of the lungs.The ratios of Din (exacerbation/stable) were 0.91( P = 0.016), 0.88 ( P = 0.002), 0.83 ( P = 0.001), 0.80 ( P = 0.001), and 0.87 (NS) in the second-, third-, fourth-, fifth-, and sixth-generation bronchi, respectively. The HRCT study was performed on patients who could safely hold their breath for a short while in a supine position 1 hour after initial treatment for asthma exacerbation. ![]() Thirteen patients with asthma were studied by HRCT during asthma exacerbation and in a stable period.
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