A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis

Ashley Busacker; John D Newell Jr; Thomas Keefe; Eric A Hoffman; Janice Cook Granroth; Mario Castro; Sean Fain; Sally Wenzel

doi:10.1378/chest.08-0049

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A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis

Journal article

Open access

Peer reviewed

A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis

Ashley Busacker, John D Newell Jr, Thomas Keefe, Eric A Hoffman, Janice Cook Granroth, Mario Castro, Sean Fain and Sally Wenzel

Chest, Vol.135(1), pp.48-56

01/2009

DOI: 10.1378/chest.08-0049

PMCID: PMC2849984

PMID: 18689585

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Abstract

Patients with severe asthma have increased physiologically measured air trapping; however, a study using CT measures of air trapping has not been performed. This study was designed to address two hypotheses: (1) air trapping measured by multidetector CT (MDCT) quantitative methodology would be a predictor of a more severe asthma phenotype; and (2) historical, clinical, allergic, or inflammatory risk factors could be identified via multivariate analysis. MDCT scanning of a subset of Severe Asthma Research Program subjects was performed at functional residual capacity. Air trapping was defined as >or= 9.66% of the lung tissue < - 850 Hounsfield units (HU). Subjects classified as having air trapping were then compared to subjects without air trapping on clinical and demographic factors using both univariate and multivariate statistical analyses. Subjects with air trapping were significantly more likely to have a history of asthma-related hospitalizations, ICU visits, and/or mechanical ventilation. Duration of asthma (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.08 to 1.87), history of pneumonia (OR, 8.55; 95% CI, 2.07 to 35.26), high levels of airway neutrophils (OR, 8.67; 95% CI, 2.05 to 36.57), airflow obstruction (FEV(1)/FVC) [OR, 1.61; 95% CI, 1.21 to 2.14], and atopy (OR, 11.54; 95% CI, 1.97 to 67.70) were identified as independent risk factors associated with the air-trapping phenotype. Quantitative CT-determined air trapping in asthmatic subjects identifies a group of individuals at high risk for severe disease. Several independent risk factors for the presence of this phenotype were identified: perhaps most interestingly, history of pneumonia, neutrophilic inflammation, and atopy.

Multivariate Analysis

Pulmonary Emphysema - etiology

Asthma - physiopathology

Humans

Middle Aged

Risk Factors

Linear Models

Male

Tomography, X-Ray Computed

Asthma - diagnostic imaging

Functional Residual Capacity

Case-Control Studies

Forced Expiratory Volume

Young Adult

Vital Capacity

Asthma - complications

Adult

Female

Cohort Studies

Details

Title: Subtitle: A multivariate analysis of risk factors for the air-trapping asthmatic phenotype as measured by quantitative CT analysis
Creators: Ashley Busacker - Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO. Electronic address: Ashley.Busacker@colostate.edu
John D Newell Jr - Division of Radiology, National Jewish Medical and Research Center, Denver, CO
Thomas Keefe - Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO
Eric A Hoffman - Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
Janice Cook Granroth - Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
Mario Castro - Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
Sean Fain - University of Wisconsin, Madison, WI
Sally Wenzel - Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
Resource Type: Journal article
Publication Details: Chest, Vol.135(1), pp.48-56
DOI: 10.1378/chest.08-0049
PMID: 18689585
PMCID: PMC2849984
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Publisher: United States
Grant note: HL69130 / NHLBI NIH HHS R01 HL069130 / NHLBI NIH HHS R01 HL069170-01 / NHLBI NIH HHS R01 HL069116-01 / NHLBI NIH HHS R01 HL069170 / NHLBI NIH HHS U10 HL109250 / NHLBI NIH HHS HL69170 / NHLBI NIH HHS R01 HL069167 / NHLBI NIH HHS HL69149 / NHLBI NIH HHS R01 HL069149-01 / NHLBI NIH HHS HL-69155 / NHLBI NIH HHS R01 HL069349-01 / NHLBI NIH HHS U10 HL109164 / NHLBI NIH HHS R01 HL059337 / NHLBI NIH HHS R01 HL069174-01 / NHLBI NIH HHS HL69349 / NHLBI NIH HHS R01 HL069149 / NHLBI NIH HHS HL64368 / NHLBI NIH HHS R01 HL069349 / NHLBI NIH HHS R01 HL069155-01 / NHLBI NIH HHS R01 HL069174-05 / NHLBI NIH HHS R01 HL069155 / NHLBI NIH HHS HL69174 / NHLBI NIH HHS R01 HL064368 / NHLBI NIH HHS HL69174-05 / NHLBI NIH HHS HL69116 / NHLBI NIH HHS R01 HL069167-01 / NHLBI NIH HHS R01 HL069116 / NHLBI NIH HHS R01 HL064368-01 / NHLBI NIH HHS R01 HL069130-01 / NHLBI NIH HHS HL69167 / NHLBI NIH HHS R01 HL069174 / NHLBI NIH HHS
Language: English
Date published: 01/2009
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Electrical and Computer Engineering; Iowa Neuroscience Institute; Health, Sport, and Human Physiology ; Internal Medicine
Record Identifier: 9984051555402771

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