Abstract
BackgroundChest computed tomography (CT) scans have a recognised role in investigating adults with severe asthma to exclude alternative diagnoses, but its role in children is less clear. The objective of this study was to review the CT findings of our local cohort of children with severe asthma and to explore whether clinical or pathobiological parameters predicted CT changes.MethodsRetrospective observational single centre study including all children attending the Leicester difficult asthma clinic (DAC) who underwent a chest CT from 2006 to 2011. Additionally, we recruited eight age-matched, non-asthmatic controls to compare differences in CT findings between asthmatic and non-asthmatic children. All CT images were independently scored by two radiologists.The DAC patients were sub-divided into binary groups for each abnormality identified so that comparisons could be made against recorded clinical variables including age, lung function, serum total IgE levels, and sputum leukocyte differential cell counts.ResultsThirty DAC patients (median 12 yrs., range 5–16) were included.The most common abnormalities were bronchial wall thickening (BWT) and air trapping (AT), observed in 80 and 60% of DAC patients.Bronchiectasis (BE) was identified in 27% of DAC patients. DAC patients with evidence of BE on CT images were older than those without BE (13.9 ± 0.67 vs 11.5 ± 0.61, p = 0.038). We also identified a positive correlation between increasing BE severity and extent with age (r = 0.400, p = 0.028).ConclusionAbnormal CT findings were highly prevalent in our cohort of children with severe asthma, with bronchiectasis identified in approximately one third of children. We found no alternative diagnoses that resulted in a change in clinical management.
Highlights
Chest computed tomography (CT) scans have a recognised role in investigating adults with severe asthma to exclude alternative diagnoses, but its role in children is less clear
Abnormal CT findings were highly prevalent in our cohort of children with severe asthma, with bronchiectasis identified in approximately one third of children
We found no alternative diagnoses that resulted in a change in clinical management
Summary
Chest computed tomography (CT) scans have a recognised role in investigating adults with severe asthma to exclude alternative diagnoses, but its role in children is less clear. Both the European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines recommend high resolution chest computed tomography (HRCT) scanning for adults and children with an atypical presentation of severe asthma, or if there are other specific indications based on the patient’s clinical history, symptoms, or results of other investigations [2]. Chest CT scans already have a recognised role as part of the diagnostic workup of patients with severe asthma [2, 7]. In adults with severe asthma, BWT in particular has been shown to correlate with reticular basement membrane thickening [10]; which is a characteristic feature of airway remodelling and inversely correlates with respiratory function
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