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Am J Respir Crit Care Med. 2018 Jul 1;198(1):39-50. doi: 10.1164/rccm.201712-2426OC.

Pruning of the Pulmonary Vasculature in Asthma. The Severe Asthma Research Program (SARP) Cohort.

Author information

1
1 Division of Pulmonary and Critical Care Medicine and.
2
2 Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, Massachusetts.
3
3 College of Medicine, University of Florida, Gainesville, Florida.
4
4 Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, Florida.
5
5 St. Vincent's University Hospital, University College Dublin, Dublin, Ireland.
6
6 Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, Arizona.
7
7 Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, Missouri.
8
8 Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California.
9
9 Department of Medical Physics.
10
10 Department of Radiology.
11
11 Department of Biomedical Engineering, and.
12
12 Division of Pediatric Allergy/Immunology and.
13
13 Division of Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, Ohio.
14
14 Department of Radiology.
15
15 Department of Biomedical Engineering, and.
16
16 Department of Medicine, University of Iowa, Iowa City, Iowa.
17
17 Division of Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, Wisconsin.
18
18 Division of Biostatistics and Bioinformatics, Eberly College of Science, Penn State University, University Park, Pennsylvania; and.
19
19 Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania.

Abstract

RATIONALE:

Loss of the peripheral pulmonary vasculature, termed vascular pruning, is associated with disease severity in patients with chronic obstructive pulmonary disease.

OBJECTIVES:

To determine if pulmonary vascular pruning is associated with asthma severity and exacerbations.

METHODS:

We measured the total pulmonary blood vessel volume (TBV) and the blood vessel volume of vessels less than 5 mm2 in cross-sectional area (BV5) and of vessels less than 10 mm2 (BV10) in cross-sectional area on noncontrast computed tomographic scans of participants from the Severe Asthma Research Program. Lower values of the BV5 to TBV ratio (BV5/TBV) and the BV10 to TBV ratio (BV10/TBV) represented vascular pruning (loss of the peripheral pulmonary vasculature).

MEASUREMENTS AND MAIN RESULTS:

Compared with healthy control subjects, patients with severe asthma had more pulmonary vascular pruning. Among those with asthma, those with poor asthma control had more pruning than those with well-controlled disease. Pruning of the pulmonary vasculature was also associated with lower percent predicted FEV1 and FVC, greater peripheral and sputum eosinophilia, and higher BAL serum amyloid A/lipoxin A4 ratio but not with low-attenuation area or with sputum neutrophilia. Compared with individuals with less pruning, individuals with the most vascular pruning had 150% greater odds of reporting an asthma exacerbation (odds ratio, 2.50; confidence interval, 1.05-5.98; Pā€‰=ā€‰0.039 for BV10/TBV) and reported 45% more asthma exacerbations during follow-up (incidence rate ratio, 1.45; confidence interval, 1.02-2.06; Pā€‰=ā€‰0.036 for BV10/TBV).

CONCLUSIONS:

Pruning of the peripheral pulmonary vasculature is associated with asthma severity, control, and exacerbations, and with lung function and eosinophilia.

KEYWORDS:

eosinophilia; pruning; pulmonary vascular; severe asthma

PMID:
29672122
PMCID:
PMC6034125
[Available on 2019-07-01]
DOI:
10.1164/rccm.201712-2426OC

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