Persistent asthma in adults: comparison of high resolution computed tomography of the lungs after one year of follow-up.
OBJECTIVE
The aims of this study were to evaluate the role of high resolution computed tomography of the thorax in detecting abnormalities in chronic asthmatic patients and to determine the behavior of these lesions after at least one year.


METHODS
Fourteen persistent asthmatic patients with a mean forced expiratory volume in 1-second that was 63% of predicted and a mean forced expiratory volume in 1-second /forced vital capacity of 60% had two high resolution computed tomographies separated by an interval of at least one year.


RESULTS
All 14 patients had abnormalities on both scans. The most common abnormality was bronchial wall thickening, which was present in all patients on both computed tomographies. Bronchiectasis was suggested on the first computed tomography in 5 of the 14 (36%) patients, but on follow-up, the bronchial dilatation had disappeared in 2 and diminished in a third. Only one patient had any emphysematous changes; a minimal persistent area of paraseptal emphysema was present on both scans. In 3 patients, a "mosaic" appearance was observed on the first scan, and this persisted on the follow-up computed tomography. Two patients had persistent areas of mucoid impaction. In a third patient, mucus plugging was detected only on the second computed tomography.


CONCLUSIONS
We conclude that there are many abnormalities on the high resolution computed tomography of patients with persistent asthma. Changes suggestive of bronchiectasis, namely bronchial dilatation, frequently resolve spontaneously. Therefore, the diagnosis of bronchiectasis by high resolution computed tomography in asthmatic patients must be made with caution, since bronchial dilatation can be reversible or can represent false dilatation. Nonsmoking chronic asthmatic subjects in this study had no evidence of centrilobular or panacinar emphysema.
Cukier
A
A
Division of Respiratory Diseases of the Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of Sao Paulo.
Stelmach
R
R
Kavakama
J I
JI
Terra Filho
M
M
Vargas
F
F
D000328:Adult; D001249:Asthma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D001987:Bronchiectasis / Q000000981:diagnostic imaging / Q000209:etiology; D002908:Chronic Disease; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*