Pruning of the Pulmonary Vasculature in Asthma. The Severe Asthma Research Program (SARP) Cohort.

Abstract

RATIONALE:

Loss of the peripheral pulmonary vasculature, termed vascular pruning, is associated with disease severity in patients with chronic obstructive pulmonary disease.

OBJECTIVES:

To determine if pulmonary vascular pruning is associated with asthma severity and exacerbations.

METHODS:

We measured the total pulmonary blood vessel volume (TBV) and the blood vessel volume of vessels less than 5 mm2 in cross-sectional area (BV5) and of vessels less than 10 mm2 (BV10) in cross-sectional area on noncontrast computed tomographic scans of participants from the Severe Asthma Research Program. Lower values of the BV5 to TBV ratio (BV5/TBV) and the BV10 to TBV ratio (BV10/TBV) represented vascular pruning (loss of the peripheral pulmonary vasculature).

MEASUREMENTS AND MAIN RESULTS:

Compared with healthy control subjects, patients with severe asthma had more pulmonary vascular pruning. Among those with asthma, those with poor asthma control had more pruning than those with well-controlled disease. Pruning of the pulmonary vasculature was also associated with lower percent predicted FEV1 and FVC, greater peripheral and sputum eosinophilia, and higher BAL serum amyloid A/lipoxin A4 ratio but not with low-attenuation area or with sputum neutrophilia. Compared with individuals with less pruning, individuals with the most vascular pruning had 150% greater odds of reporting an asthma exacerbation (odds ratio, 2.50; confidence interval, 1.05-5.98; P = 0.039 for BV10/TBV) and reported 45% more asthma exacerbations during follow-up (incidence rate ratio, 1.45; confidence interval, 1.02-2.06; P = 0.036 for BV10/TBV).

CONCLUSIONS:

Pruning of the peripheral pulmonary vasculature is associated with asthma severity, control, and exacerbations, and with lung function and eosinophilia.

• Authors: Samuel Y Ash, Farbod N Rahaghi, Carolyn E Come, James C Ross, Alysha G Colon, Juan Carlos Cardet-Guisasola, Eleanor M Dunican, Eugene R Bleecker, Mario Castro, John V Fahy, Sean B Fain, Benjamin M Gaston, Eric A Hoffman, Nizar N Jarjour, David T Mauger, Sally E Wenzel, Bruce D Levy, Raul San Jose Estepar, Elliot Israel, George R Washko, SARP Investigators
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 198 Issue 1 Pg. 39-50 (07 01 2018) ISSN: 1535-4970 [Electronic] United States
• PMID: 29672122 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adult
• Aged
• Aged, 80 and over
• Asthma (complications, physiopathology)
• Blood Vessels (physiopathology)
• Cohort Studies
• Cross-Sectional Studies
• Disease Progression
• Female
• Forced Expiratory Volume
• Humans
• Lung (physiopathology)
• Male
• Middle Aged
• Severity of Illness Index