The triple radiologic asthma phenotype is associated with worse disease control

Abstract

Background

Efforts have been made to combine radiographic biomarkers such as bronchiectasis or bronchial wall thickness (BWT) for the purpose of identifying asthma subphenotypes and their clinical implications.

Objective

Our aim was to assess whether a composite triple radiologic phenotype measured by high-resolution computed tomography comprising BWT, mucus plug score (MPS), and mediastinal lymph node (MLN) size might provide a better insight into subphenotypes in persistent asthma.

Methods

A total of 112 patients with moderate-to-severe asthma were included in this retrospective observational study. A binary method was used to classify patients according to median values for the following: a pooled mediastinal lymph node size of 3.6 mm or more; a BWT as a pooled wall area of at least 50% of the total airway area; and a mucus plug score of 1 or higher, with a mucus plug considered positive if complete bronchial obstruction was imaged more than 2 cm from a pleural surface.

Results

Patients with the triple imaging phenotype exhibited significantly worse Asthma Control Questionnaire scores, with their scores exceeding minimal clinical important difference, a higher prevalence of concomitant chronic rhinosinusitis with nasal polyps, and a greater total IgE level.

Conclusion

We have demonstrated an association between poorer symptom control and the triple radiologic asthma phenotype.