Asthma CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]


In asthmatics, high-resolution CT may reveal several structural changes related to small-airway disease including cylindrical bronchiectasis, bronchial wall thickening, and air trapping.[1] CT markers valid for small-airway disease can be derived from quantitative lung density measurements and these markers correlate with clinical severity, lung function test results and are also sensitive to demonstrate therapeutic effects.[2] An FEV1/FVC ratio of 75% or more has been shown to be an important predictor of bronchial wall thickening and bronchiectasis; but has a low discriminatory utility for patients without structural airway changes (sensitivity, 67%; specificity, 65%). Thereby, suggesting the importance of radiological assessment of bronchial wall changes in patients with severe asthma.[3]


  • Bronchial wall thickening,[4][5][6]
  • Patients with mild asthma have one or more dilated bronchi,[5][6]
  • Cylindrical bronchiectasis with the bronchoarterial- diameter ratio is less than 1.5,[7]
  • Bronchiolar mucus statis and constrictive bronchiolitis,
  • Centrilobular opacities subsequent to bronchiolar mucus stasis or peri- bronchiolar inflammation,
  • Areas of decreased attenuation and vascularity, as demonstrated at end-inspiration,
  • Air trapping, as demonstrated after maximal expiration.


  1. Robards VL, Lubin EN, Medlock TR (1975) Renal transplantation and placement of ileal stoma. Urology 5 (6):787-9. PMID: 1094668
  2. Laurent F, Tunon de Lara M (2011) Assessment of imaging techniques for evaluating small-airway disease in asthma. Rev Mal Respir 28 (6):e7-10. DOI:10.1016/j.rmr.2011.05.001 PMID: 21742230
  3. Gupta S, Siddiqui S, Haldar P, Raj JV, Entwisle JJ, Wardlaw AJ et al. (2009) Qualitative analysis of high-resolution CT scans in severe asthma. Chest 136 (6):1521-8. DOI:10.1378/chest.09-0174 PMID: 19542254
  4. Lynch DA, Newell JD, Tschomper BA, Cink TM, Newman LS, Bethel R (1993) Uncomplicated asthma in adults: comparison of CT appearance of the lungs in asthmatic and healthy subjects. Radiology 188 (3):829-33. PMID: 8351357
  5. 5.0 5.1 Grenier P, Mourey-Gerosa I, Benali K, Brauner MW, Leung AN, Lenoir S et al. (1996) Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability. Eur Radiol 6 (2):199-206. PMID: 8797980
  6. 6.0 6.1 Park CS, Müller NL, Worthy SA, Kim JS, Awadh N, Fitzgerald M (1997) Airway obstruction in asthmatic and healthy individuals: inspiratory and expiratory thin-section CT findings. Radiology 203 (2):361-7. PMID: 9114089
  7. Mitchell TA, Hamilos DL, Lynch DA, Newell JD (2000) Distribution and severity of bronchiectasis in allergic bronchopulmonary aspergillosis (ABPA). J Asthma 37 (1):65-72. PMID: 10724299

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