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Objectives: Idiopathic pulmonary fibrosis (IPF) is a disease with a poor prognosis and a highly variable course. Pathologically increased ventilation—accessible by functional CT—is discussed as a potential predecessor of lung fibrosis. The purpose of this feasibility study was to investigate whether increased regional ventilation at baseline CT and morphological changes in the follow-up CT suggestive for fibrosis indeed occur in spatial correspondence. Methods: In this retrospective study, CT scans were performed at two time points between September 2016 and November 2020. Baseline ventilation was divided into four categories ranging from low, normal to moderately, and severely increased (C1–C4). Correlation between baseline ventilation and volume and density change at follow-up was investigated in corresponding voxels. The significance of the difference of density and volume change per ventilation category was assessed using paired t-tests with a significance level of p ≤ 0.05. The analysis was performed separately for normal (NAA) and high attenuation areas (HAA). Results: The study group consisted of 41 patients (73 ± 10 years, 36 men). In both NAA and HAA, significant increases of density and loss of volume were seen in areas of severely increased ventilation (C4) at baseline compared to areas of normal ventilation (C2, p < 0.001). In HAA, morphological changes were more heterogeneous compared to NAA. Conclusion: Functional CT assessing the extent and distribution of lung parenchyma with pathologically increased ventilation may serve as an imaging marker to prospectively identify lung parenchyma at risk for developing fibrosis. Key Points: • Voxelwise correlation of serial CT scans suggests spatial correspondence between increased ventilation at baseline and structural changes at follow-up. • Regional assessment of pathologically increased ventilation at baseline has the potential to prospectively identify tissue at risk for developing fibrosis. • Presence and extent of pathologically increased ventilation may serve as an early imaging marker of disease activity. [ABSTRACT FROM AUTHOR]

Recent guidelines have suggested the use of fractional exhaled nitric oxide in the diagnosis and monitoring of respiratory disease. Aleksandra Gawlik-Lipinski explains the evidence behind this testing Fractional exhaled nitric oxide (FeNO) is linked to the inflammatory process in the lungs and levels are typically elevated in the eosinophilic asthma phenotype. Therefore, FeNO is useful in the diagnosis of asthma and there is an indication that it could guide corticosteroid treatment in asthma and chronic obstructive pulmonary disease (COPD) patients with eosinophilic inflammation patterns of disease. There is also limited evidence suggesting that FeNO could aid differentiating between asthma, COPD and asthma–COPD overlap. More research is required to establish the role of FeNO measurement in other respiratory diseases. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)