Structural lung abnormalities on computed tomography correlate with asthma inflammation in bronchoscopic alveolar lavage fluid.

Objective: Image scoring systems have been developed to assess the severity of specific lung abnormalities in patients diagnosed with various pulmonary diseases except for asthma. A comprehensive asthma imaging scoring system may identify specific abnormalities potentially linking these to inflammatory phenotypes. Methods: Computed tomography (CT) images of 88 children with asthma (50 M/38 F, mean age 7.8 +/- 5.4 years) acquired within 12 months of bronchoscopic alveolar lavage fluid (BALF) sampling that assessed airway inflammation cell types were reviewed along with CT images of 49 controls (27 M/22 F, mean age 3.4 +/- 2.2 years). Images were scored using a comprehensive scoring system to quantify bronchiectasis (BR), bronchial wall thickening (BWT), ground glass opacity, mucus plugging (MP), consolidations, linear densities (LD), and air trapping (AT). Each category was scored 0-2 in each of six lobar regions (with lingula separated from left upper lobe). Results: Absolute average overall scores of the controls and children with asthma were 0.72 +/- 1.59 and 5.39 +/- 5.83, respectively (P < 0.0001). Children with asthma scored significantly higher for BR (N = 20, 0.33 +/- 0.80, P = 0.0002), BWT (N = 28, 0.72 +/- 1.40, P < 0.0001), MP (N = 28, 0.37 +/- 1.12, P = 0.0052), consolidation (N = 31, 0.67 +/- 1.22, P < 0.0001), LD (N = 58, 1.12 +/- 1.44, P < 0.0001), and AT (N = 52, 1.78 +/- 2.31, P < 0.0001). There was a significant difference between the BR score of children with positive inflammatory response in BALF (N = 53) and those who were negative for airway inflammation cells (0.14 +/- 0.36, P = 0.040). Conclusions: Significant lung structural abnormalities were readily identified on CT of children with asthma, with image differentiation of those with an inflammatory response on BALF. Chest imaging demonstrates potential as a noninvasive clinical tool for additional characterization of asthma phenotypes.