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Thoracic CT in Pediatric Patients with Difficult-to-Treat Asthma

¹ Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.
² Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, 75015 Paris, France.
³ Service de Biostatistiques et Informatique Médicale, Hôpital Necker Enfants Malades, 75015 Paris, France.

OBJECTIVE. The aim of this study was to establish objective, simple criteria for bronchial wall thickening in children with difficult-to-treat asthma.

SUBJECTS AND METHODS. Bronchial sections were counted at five levels in both lungs and at three levels in the right lung on high-resolution CT and plotted against lung function. Findings from 27 children with persistent symptoms of asthma (mean age, 11.4 years; SD, ±3.1 years) that were severe (group A, n = 15) or moderate (group B, n = 12) were compared with findings from 21 control subjects (mean age, 10.8 years; SD, ±3.0 years) using the Student's t test, analysis of variance, and Dunn-Bonferroni test.

RESULTS. A bronchial wall thickening score based on the number of visible bronchi at three levels (three-level score) proved to be as valuable as and simpler to obtain than a score based on the number of bronchi at five levels (five-level score). The three-level scores for groups A and B were similar (mean ± SD, 16.8 ± 4.2 vs 18.4 ± 3.4, respectively; p = not significant), but these scores were significantly higher than those for the control subjects (mean ± SD, 8.2 ± 3.4, respectively; p < 0.001). There was no correlation between the three-level score and forced expiratory volume in 1 sec or forced expiratory flow between 25% and 75% of forced vital capacity. In contrast with adults with severe asthma, our pediatric patients with difficult-to-treat asthma did not have CT evidence of mucoid impaction, emphysema, areas of hyperlucency, bronchiectasis, or sequellar line shadows.

CONCLUSION. Bronchial wall thickening visible on high-resolution CT may constitute an additional criterion of asthma severity in children. CT evidence of bronchial wall thickening might help to identify patients with a higher risk of airway remodeling.

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