Marshall, H. orcid.org/0000-0002-7425-1449, Kenworthy, C., Horn, F. et al. (5 more authors) (2021) Peripheral and proximal lung ventilation in asthma; short-term variation and response to bronchodilator. Journal of Allergy and Clinical Immunology, 147 (6). 2154-2161.e6. ISSN 0091-6749
Abstract
Background
The relative involvement of the large and small airways in asthma is not clear. Hyperpolarised gas MRI provides high resolution three-dimensional images of ventilation distribution which can be quantified by the ventilated volume percentage of the lungs (VV%).
Objective
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
33 patients with poorly controlled, moderate-to-severe asthma were scanned with hyperpolarised 3He MRI. Two image datasets were acquired at baseline, and one image dataset 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, 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, globally and regionally, and the ventilation increase in response to bronchodilator was greater in the peripheral lung than in the proximal lung. Hyperpolarised gas MRI was more sensitive to changes in response to bronchodilator (58%) than spirometry (33%).
Conclusion
The peripheral lung showed reduced ventilation and a greater response to bronchodilator than the proximal lung. The high level of baseline reproducibility and sensitivity of hyperpolarised gas MRI to bronchodilator reversibility suggests that it is suitable for low subject number studies of therapy response.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 American Academy of Allergy, Asthma and Immunology. This is an author produced version of a paper subsequently published in Journal of Allergy and Clinical Immunology. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Hyperpolarised gas MRI; ventilation; asthma; proximal; peripheral; reproducibility; bronchodilator response |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 10 Dec 2020 16:27 |
Last Modified: | 01 Feb 2022 12:23 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.jaci.2020.11.035 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:168771 |
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Licence: CC-BY-NC-ND 4.0