A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis.
BACKGROUND
Patients with severe asthma have increased physiologically measured air trapping; however, a study using CT measures of air trapping has not been performed. This study was designed to address two hypotheses: (1) air trapping measured by multidetector CT (MDCT) quantitative methodology would be a predictor of a more severe asthma phenotype; and (2) historical, clinical, allergic, or inflammatory risk factors could be identified via multivariate analysis.


METHODS
MDCT scanning of a subset of Severe Asthma Research Program subjects was performed at functional residual capacity. Air trapping was defined as >or= 9.66% of the lung tissue < - 850 Hounsfield units (HU). Subjects classified as having air trapping were then compared to subjects without air trapping on clinical and demographic factors using both univariate and multivariate statistical analyses.


RESULTS
Subjects with air trapping were significantly more likely to have a history of asthma-related hospitalizations, ICU visits, and/or mechanical ventilation. Duration of asthma (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.08 to 1.87), history of pneumonia (OR, 8.55; 95% CI, 2.07 to 35.26), high levels of airway neutrophils (OR, 8.67; 95% CI, 2.05 to 36.57), airflow obstruction (FEV(1)/FVC) [OR, 1.61; 95% CI, 1.21 to 2.14], and atopy (OR, 11.54; 95% CI, 1.97 to 67.70) were identified as independent risk factors associated with the air-trapping phenotype.


CONCLUSIONS
Quantitative CT-determined air trapping in asthmatic subjects identifies a group of individuals at high risk for severe disease. Several independent risk factors for the presence of this phenotype were identified: perhaps most interestingly, history of pneumonia, neutrophilic inflammation, and atopy.
Busacker
Ashley
A
Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO. Electronic address: Ashley.Busacker@colostate.edu.
Newell
John D
JD
Division of Radiology, National Jewish Medical and Research Center, Denver, CO.
Keefe
Thomas
T
Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO.
Hoffman
Eric A
EA
Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA.
Granroth
Janice Cook
JC
Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA.
Castro
Mario
M
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO.
Fain
Sean
S
University of Wisconsin, Madison, WI.
Wenzel
Sally
S
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
D000328:Adult; D001249:Asthma / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D005652:Functional Residual Capacity; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011656:Pulmonary Emphysema / Q000209:etiology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity; D055815:Young Adult