Computed tomography patterns and lung function in patients with severe asthma in a real-world setting

Abstract

<bold>Introduction:</bold> In patients with severe asthma, computed tomography (CT) is a useful tool for identification of airway remodeling patterns and changes related to airway physiopathology <bold>Aims and objectives:</bold> (1) to describe CT patterns in a real-world setting of patients diagnosed and treated for severe asthma in Argentina; (2) to correlate CT patterns with changes in lung function after 12 months of treatment with biologics <bold>Methods:</bold> Data from CT scans and lung function from adolescents and adult subjects with severe asthma treated with biologics from 9 centers in Argentina from 2015 to 2024 were retrieved. Non-parametric tests was performed <bold>Results:</bold> n = 179; 66.48% female; median age 57 years (interquartile range [IQR]:46-65); median asthma duration: 24 years (IQR: 12.5-39); median body mass index (BMI): 28.6 kg/m2 (IQR:24.28-32.35). At least one alteration was identified in the CT scans in 84.53% of the patients. Bronchial wall thickening (BWT, 54.29%) and air trapping (46.29%) were the most frequent findings, followed by mucus plugging (18.29%), centrilobular lung nodules (CLN, 17.71%) and bronchiectasis (17.17%). No significant differences were observed in age, asthma duration and BMI among groups. FEV1% improved significantly in patients with BWT (63% [49–91] to 79% [69–93]; p<0.001), air trapping (62% [51–86] to 78% [67–93]; p=0.001) and CLN (67% [56–81] to 85% [66–95]; p=0.046). A trend was found for bronchiectasis (61% [48.25–75.25] to 77% [65–86]; p=0.068) <bold>Conclusion:</bold> In our real-world cohort, significant changes in FEV1% were observed in patients with BWT, air trapping and CLN. Identification of such CT pattern may lead to early treatment start to avoid disease progression