Abstract
Airway remodeling is an important factor in persistent obstruction in severe asthma. High resolution computed tomography (HRCT) is an effective method of detecting changes in airway structure. Our aim was to use HRCT to assess changes in airway remodeling in patients with severe allergic asthma who are treated with omalizumab. In 12 patients with severe allergic asthma, HRCT was performed before and after treatment with omalizumab. In selected bronchi airways, parameters were calculated: bronchial wall area (BA), also corrected for body surface area (BSA); percentage of wall area (WA%); and the ratio of luminal area to total bronchial area (Ai/Ao). Clinical response to treatment was assessed using an asthma control questionnaire (ACQ), asthma quality of life questionnaire (AQLQ), and number of exacerbations per year. Assessment included spirometry and blood eosinophilia. Treatment resulted in significant improvement in ACQ (p = 0.035) and AQLQ (p = 0.001). We observed significant reduction in exacerbations per year (p = 0.002) and reduction of daily systemic steroid dose (p = 0.032). FEV₁ and peripheral blood eospinophilia did not change (p = 0.846 and p = 0.221). Airway dimensions (Ai/Ao) of particular bronchi were consistent with the mean of the parameters calculated for all bronchi measured. Although we observed a significant decrease in WA (p = 0.002) and WA/BSA (p = 0.002), WA% and Ai/Ao did not improve (p = 0.39 and p = 0.49). We found no correlations between changes in airways and changes in spirometry or clinical parameters. Despite clinical effectiveness of omalizumab, its effect on airway remodeling may be limited.
Highlights
Airway remodeling is an important factor in persistent obstruction in severe asthma
Omalizumab, a humanized monoclonal anti-Immunoglobulin E (IgE) antibody, is a proven effective add-on therapy in treatment of severe allergic asthma, resulting in significant improvement in asthma control, quality of life, and reduction in exacerbations and use of systemic corticosteroids [4, 5]
Serum total IgE concentration between 30 and 1500 IU/ml was required, as well as meeting at least three of the following criteria: uncontrolled asthma according to the Asthma Control Questionnaire (ACQ); Asthma Quality of Life Questionnaire (AQLQ) score < 5.0 points; three or more exacerbations in the preceding 12 months requiring starting or increasing oral corticosteroid (OCS) dose; at least one hospitalization due to asthma exacerbation in the preceding 12 months; life-threatening asthma exacerbation in the past; or persistent airway obstruction with forced expiratory volume (FEV1) < 60% of predicted value
Summary
Airway remodeling is an important factor in persistent obstruction in severe asthma. High resolution computed tomography (HRCT) is an effective method of detecting changes in airway structure. Omalizumab, a humanized monoclonal anti-IgE antibody, is a proven effective add-on therapy in treatment of severe allergic asthma, resulting in significant improvement in asthma control, quality of life, and reduction in exacerbations and use of systemic corticosteroids [4, 5]. Both experimental and clinical studies demonstrate the positive effect of biological treatment with anti-IgE on airway remodeling, expressed as RBM thickening or increased deposition of extracellular matrix proteins in bronchial biopsies [3, 6, 7]. Chest high resolution computed tomography (HRCT) has emerged as a useful non-invasive method of airway remodeling assessment in asthma [8]
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