Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders

Maanasi Samant; James G. Krings; Daphne Lew; Charles W. Goss; Tammy Koch; Mary Clare McGregor; Jonathan Boomer; Chase S. Hall; Ken B. Schechtman; Ajay Sheshadri; Samuel Peterson; Serpil Erzurum; Zachary DePew; Lee E. Morrow; D. Kyle Hogarth; Richard Tejedor; Jennifer Trevor; Michael E. Wechsler; Afshin Sam; Xiaosong Shi; Jiwoong Choi; Mario Castro

doi:10.1016/j.chest.2023.12.015

Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders

Maanasi Samant, James G. Krings, Daphne Lew, Charles W. Goss, Tammy Koch, Mary Clare McGregor, Jonathan Boomer, Chase S. Hall, Ken B. Schechtman, Ajay Sheshadri, Samuel Peterson, Serpil Erzurum, Zachary DePew, Lee E. Morrow, D. Kyle Hogarth, Richard Tejedor, Jennifer Trevor, Michael E. Wechsler, Afshin Sam, Xiaosong ShiJiwoong Choi, Mario Castro

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Abstract

Background: Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. Research Question: Do baseline radiographic and clinical characteristics exist that predict response to BT? Study Design and Methods: We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. Results: From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). Interpretation: To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. Trial Registry: ClinicalTrials.gov; No.: NCT01185275; URL: www.clinicaltrials.gov

Original language	English
Pages (from-to)	775-784
Number of pages	10
Journal	CHEST
Volume	165
Issue number	4
DOIs	https://doi.org/10.1016/j.chest.2023.12.015
State	Published - Apr 2024

Keywords

air trapping
bronchial thermoplasty
lung deformation
quantitative CT
severe asthma

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Samant, M., Krings, J. G., Lew, D., Goss, C. W., Koch, T., McGregor, M. C., Boomer, J., Hall, C. S., Schechtman, K. B., Sheshadri, A., Peterson, S., Erzurum, S., DePew, Z., Morrow, L. E., Hogarth, D. K., Tejedor, R., Trevor, J., Wechsler, M. E., Sam, A., ... Castro, M. (2024). Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders. CHEST, 165(4), 775-784. https://doi.org/10.1016/j.chest.2023.12.015

@article{45ec3e3687a14a1da4d8110d7d4c56ae,

title = "Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders",

abstract = "Background: Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. Research Question: Do baseline radiographic and clinical characteristics exist that predict response to BT? Study Design and Methods: We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. Results: From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). Interpretation: To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. Trial Registry: ClinicalTrials.gov; No.: NCT01185275; URL: www.clinicaltrials.gov",

keywords = "air trapping, bronchial thermoplasty, lung deformation, quantitative CT, severe asthma",

author = "Maanasi Samant and Krings, {James G.} and Daphne Lew and Goss, {Charles W.} and Tammy Koch and McGregor, {Mary Clare} and Jonathan Boomer and Hall, {Chase S.} and Schechtman, {Ken B.} and Ajay Sheshadri and Samuel Peterson and Serpil Erzurum and Zachary DePew and Morrow, {Lee E.} and Hogarth, {D. Kyle} and Richard Tejedor and Jennifer Trevor and Wechsler, {Michael E.} and Afshin Sam and Xiaosong Shi and Jiwoong Choi and Mario Castro",

note = "Publisher Copyright: {\textcopyright} 2023 American College of Chest Physicians",

year = "2024",

month = apr,

doi = "10.1016/j.chest.2023.12.015",

language = "English",

volume = "165",

pages = "775--784",

journal = "CHEST",

issn = "0012-3692",

number = "4",

}

Samant, M, Krings, JG , Lew, D , Goss, CW, Koch, T, McGregor, MC, Boomer, J, Hall, CS, Schechtman, KB, Sheshadri, A, Peterson, S, Erzurum, S, DePew, Z, Morrow, LE, Hogarth, DK, Tejedor, R, Trevor, J, Wechsler, ME, Sam, A, Shi, X, Choi, J & Castro, M 2024, 'Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders', CHEST, vol. 165, no. 4, pp. 775-784. https://doi.org/10.1016/j.chest.2023.12.015

TY - JOUR

T1 - Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders

AU - Samant, Maanasi

AU - Krings, James G.

AU - Lew, Daphne

AU - Goss, Charles W.

AU - Koch, Tammy

AU - McGregor, Mary Clare

AU - Boomer, Jonathan

AU - Hall, Chase S.

AU - Schechtman, Ken B.

AU - Sheshadri, Ajay

AU - Peterson, Samuel

AU - Erzurum, Serpil

AU - DePew, Zachary

AU - Morrow, Lee E.

AU - Hogarth, D. Kyle

AU - Tejedor, Richard

AU - Trevor, Jennifer

AU - Wechsler, Michael E.

AU - Sam, Afshin

AU - Shi, Xiaosong

AU - Choi, Jiwoong

AU - Castro, Mario

PY - 2024/4

Y1 - 2024/4

N2 - Background: Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. Research Question: Do baseline radiographic and clinical characteristics exist that predict response to BT? Study Design and Methods: We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. Results: From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). Interpretation: To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. Trial Registry: ClinicalTrials.gov; No.: NCT01185275; URL: www.clinicaltrials.gov

AB - Background: Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are defined poorly. Research Question: Do baseline radiographic and clinical characteristics exist that predict response to BT? Study Design and Methods: We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across eight academic medical centers. Participants received three separate BT treatments and were monitored at 3-month intervals for 1 year after BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test results of ≥ 3 or Asthma Quality of Life Questionnaire of ≥ 0.5. Regression analyses were used to evaluate the association between pretreatment clinical and quantitative CT scan measures with subsequent BT response. Results: From 2006 through 2017, 88 participants received BT, with 70 participants (79.5%) identified as responders by Asthma Control Test or Asthma Quality of Life Questionnaire criteria. Responders were less likely to undergo an asthma-related ICU admission in the prior year (3% vs 25%; P = .01). On baseline quantitative CT imaging, BT responders showed less air trapping percentage (OR, 0.90; 95% CI, 0.82-0.99; P = .03), a greater Jacobian determinant (OR, 1.49; 95% CI, 1.05-2.11), greater SD of the Jacobian determinant (OR, 1.84; 95% CI, 1.04-3.26), and greater anisotropic deformation index (OR, 3.06; 95% CI, 1.06-8.86). Interpretation: To our knowledge, this is the largest study to evaluate baseline quantitative CT imaging and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on quantitative CT imaging, were predictors of future BT response. Trial Registry: ClinicalTrials.gov; No.: NCT01185275; URL: www.clinicaltrials.gov

KW - air trapping

KW - bronchial thermoplasty

KW - lung deformation

KW - quantitative CT

KW - severe asthma

UR - http://www.scopus.com/inward/record.url?scp=85187646699&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2023.12.015

DO - 10.1016/j.chest.2023.12.015

M3 - Article

C2 - 38123124

AN - SCOPUS:85187646699

SN - 0012-3692

VL - 165

SP - 775

EP - 784

JO - CHEST

JF - CHEST

IS - 4

ER -

Use of Quantitative CT Imaging to Identify Bronchial Thermoplasty Responders

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