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Original Research: Asthma |

Poor Symptom Control Is Associated With Reduced CT Scan Segmental Airway Lumen Area in Smokers With AsthmaNarrowed Segmental Airways in Smokers With Asthma

Neil C. Thomson, MD; Rekha Chaudhuri, MD; Mark Spears, PhD; Claudia-Martina Messow, PhD; William MacNee, MD; Martin Connell, BSc; John T. Murchison, MD; Michael Sproule, MBChB; Charles McSharry, PhD
Author and Funding Information

From the Institute of Infection, Immunity and Inflammation (Drs Thomson, Chaudhuri, Spears, and McSharry), and the Robertson Centre for Biostatistics (Dr Messow), University of Glasgow, Glasgow; the UoE/MRC Centre for Inflammation Research, Medical Physics and Clinical Radiology (Drs MacNee and Murchison and Mr Connell), University of Edinburgh, Edinburgh; and the Department of Radiology (Dr Sproule), Gartnavel General Hospital, Glasgow, Scotland.

CORRESPONDENCE TO: Neil C. Thomson, MD, Institute of Infection, Immunity and Inflammation, University of Glasgow and Respiratory Medicine, Gartnavel General Hospital, Glasgow, G12 OYN Scotland; e-mail: neil.thomson@glasgow.ac.uk


Part of this article has been presented previously at the 2014 American Thoracic Society International Conference, May 16-21, 2014, San Diego, CA.

FUNDING/SUPPORT: This work was funded by an award [INF-GU-090] from the Translational Medicine Research Collaboration, a consortium made up of the Universities of Glasgow, Edinburgh, Aberdeen, and Dundee; the four associated National Health Service (NHS) Health Boards (Greater Glasgow and Clyde, Lothian, Grampian, and Tayside); Scottish Enterprise; and Pfizer (formerly Wyeth). This study was also supported financially by NHS Research Scotland (NRS) through the Scottish Primary Care Research Network.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):735-744. doi:10.1378/chest.14-1119
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BACKGROUND:  Cigarette smoking is associated with worse symptoms in asthma and abnormal segmental airways in healthy subjects. We tested the hypothesis that current symptom control in smokers with asthma is associated with altered segmental airway dimensions measured by CT scan.

METHODS:  In 93 subjects with mild, moderate, and severe asthma (smokers and never smokers), we recorded Asthma Control Questionnaire-6 (ACQ-6) score, spirometry (FEV1; forced expiratory flow rate, midexpiratory phase [FEF25%-75%]), residual volume (RV), total lung capacity (TLC), and CT scan measures of the right bronchial (RB) and left bronchial (LB) segmental airway dimensions (wall thickness, mm; lumen area, mm2) in the RB3/LB3, RB6/LB6, and RB10/LB10 (smaller) airways.

RESULTS:  The CT scan segmental airway (RB10 and LB10) lumen area was reduced in smokers with asthma compared with never smokers with asthma; RB10, 16.6 mm2 (interquartile range, 12.4-19.2 mm2) vs 19.6 mm2 (14.7-24.2 mm2) (P = .01); LB10, 14.8 mm2 (12.1-19.0 mm2) vs 19.9 mm2 (14.5-25.0 mm2) (P = .003), particularly in severe disease, with no differences in wall thickness or in larger airway (RB3 and LB3) dimensions. In smokers with asthma, a reduced lumen area in fifth-generation airways (RB10 or LB10) was associated with poor symptom control (higher ACQ-6 score) (−0.463 [−0.666 to −0.196], P = .001, and −0.401 [−0.619 to −0.126], P = .007, respectively) and reduced postbronchodilator FEF25%-75% (0.521 [0.292-0.694], P < .001, and [0.471 [0.236-0.654], P = .001, respectively) and higher RV/TLC %.

CONCLUSIONS:  The CT scan segmental airway lumen area is reduced in smokers with asthma compared with never smokers with asthma, particularly in severe disease, and is associated with worse current symptom control and small airway dysfunction.

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