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2 results on '"Schirm, Joshua"'

1. A Novel Air Trapping Segment Score Identifies Opposing Effects of Obesity and Eosinophilia on Air Trapping in Asthma.

Author

Leung, Clarus, Tang, Monica, Huang, Brendan K., Fain, Sean B., Hoffman, Eric A., Choi, Jiwoong, Dunican, Eleanor M., Mauger, David T., Denlinger, Loren C., Jarjour, Nizar N., Israel, Elliot, Levy, Bruce D., Wenzel, Sally E., Sumino, Kaharu, Hastie, Annette T., Schirm, Joshua, McCulloch, Charles E., Peters, Michael C., Woodruff, Prescott G., and Sorkness, Ronald L.

Subjects
EOSINOPHILIA, ASTHMA, ASTHMATICS, BODY mass index, COMPUTED tomography
Abstract

Rationale: Density thresholds in computed tomography (CT) lung scans quantify air trapping (AT) at the whole-lung level but are not informative for AT in specific bronchopulmonary segments. Objectives: To apply a segment-based measure of AT in asthma to investigate the clinical determinants of AT in asthma. Methods: In each of 19 bronchopulmonary segments in CT lung scans from 199 patients with asthma, AT was categorized as present if lung attenuation was less than −856 Hounsfield units at expiration in ⩾15% of the lung area. The resulting AT segment score (0–19) was related to patient outcomes. Measurements and Main Results: AT varied at the lung segment level and tended to persist at the patient and lung segment levels over 3 years. Patients with widespread AT (⩾10 segments) had more severe asthma (P < 0.05). The mean (±SD) AT segment score in patients with a body mass index ⩾30 kg/m2 was lower than in patients with a body mass index <30 kg/m2 (3.5 ± 4.6 vs. 5.5 ± 6.3; P = 0.008), and the frequency of AT in lower lobe segments in obese patients was less than in upper and middle lobe segments (35% vs. 46%; P = 0.001). The AT segment score in patients with sputum eosinophils ⩾2% was higher than in patients without sputum eosinophilia (7.0 ± 6.1 vs. 3.3 ± 4.9; P < 0.0001). Lung segments with AT more frequently had airway mucus plugging than lung segments without AT (48% vs. 18%; P ⩽ 0.0001). Conclusions: In patients with asthma, air trapping is more severe in those with airway eosinophilia and mucus plugging, whereas those who are obese have less severe trapping because their lower lobe segments are spared. [ABSTRACT FROM AUTHOR]

Published
2024
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2. Quantitative CT Characteristics of Cluster Phenotypes in the Severe Asthma Research Program Cohorts

Author

Trivedi, Abhaya P., Hall, Chase, Goss, Charles W., Lew, Daphne, Krings, James G., McGregor, Mary Clare, Samant, Maanasi, Sieren, Jered P., Li, Huashi, Schechtman, Ken B., Schirm, Joshua, McEleney, Stephen, Peterson, Sam, Moore, Wendy C., Bleecker, Eugene R., Meyers, Deborah A., Israel, Elliot, Washko, George R., Levy, Bruce D., Leader, Joseph K., Wenzel, Sally E., Fahy, John V., Schiebler, Mark L., Fain, Sean B., Jarjour, Nizar N., Mauger, David T., Reinhardt, Joseph M., Newell, John D., Hoffman, Eric A., Castro, Mario, and Sheshadri, Ajay

Abstract

BackgroundClustering key clinical characteristics of participants in the Severe Asthma Research Program (SARP), a large, multicenter prospective observational study of patients with asthma and healthy controls, has led to the identification of novel asthma phenotypes.PurposeTo determine whether quantitative CT (qCT) could help distinguish between clinical asthma phenotypes.Materials and MethodsA retrospective cross-sectional analysis was conducted with the use of qCT images (maximal bronchodilation at total lung capacity [TLC], or inspiration, and functional residual capacity [FRC], or expiration) from the cluster phenotypes of SARP participants (cluster 1: minimal disease; cluster 2: mild, reversible; cluster 3: obese asthma; cluster 4: severe, reversible; cluster 5: severe, irreversible) enrolled between September 2001 and December 2015. Airway morphometry was performed along standard paths (RB1, RB4, RB10, LB1, and LB10). Corresponding voxels from TLC and FRC images were mapped with use of deformable image registration to characterize disease probability maps (DPMs) of functional small airway disease (fSAD), voxel-level volume changes (Jacobian), and isotropy (anisotropic deformation index [ADI]). The association between cluster assignment and qCT measures was evaluated using linear mixed models.ResultsA total of 455 participants were evaluated with cluster assignments and CT (mean age ± SD, 42.1 years ± 14.7; 270 women). Airway morphometry had limited ability to help discern between clusters. DPM fSAD was highest in cluster 5 (cluster 1 in SARP III: 19.0% ± 20.6; cluster 2: 18.9% ± 13.3; cluster 3: 24.9% ± 13.1; cluster 4: 24.1% ± 8.4; cluster 5: 38.8% ± 14.4; P< .001). Lower whole-lung Jacobian and ADI values were associated with greater cluster severity. Compared to cluster 1, cluster 5 lung expansion was 31% smaller (Jacobian in SARP III cohort: 2.31 ± 0.6 vs 1.61 ± 0.3, respectively, P< .001) and 34% more isotropic (ADI in SARP III cohort: 0.40 ± 0.1 vs 0.61 ± 0.2, P< .001). Within-lung Jacobian and ADI SDs decreased as severity worsened (Jacobian SD in SARP III cohort: 0.90 ± 0.4 for cluster 1; 0.79 ± 0.3 for cluster 2; 0.62 ± 0.2 for cluster 3; 0.63 ± 0.2 for cluster 4; and 0.41 ± 0.2 for cluster 5; P< .001).ConclusionQuantitative CT assessments of the degree and intraindividual regional variability of lung expansion distinguished between well-established clinical phenotypes among participants with asthma from the Severe Asthma Research Program study.© RSNA, 2022Online supplemental material is available for this article.See also the editorial by Verschakelenin this issue.

Published
2022
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