The role of chest radiography and computed tomography in the diagnosis and management of asthma

Purpose of review The management of asthma is guided by clinical symptoms, physiological measurements, and response to therapy. Recent advances in computed tomography imaging promise to add a new dimension to our diagnostic armamentarium. Accurate representation of airway pathology, visualized by high-resolution chest computed tomography scan, helps to improve the understanding of the pathophysiology of asthma. In addition, findings on computed tomography may help to guide therapies for asthma. As radiologists provide us with sophisticated modalities that may also have a bearing on treatment, clinicians should stay abreast of this evolving noninvasive technology. Recent findings This review focuses on the findings seen on computed tomography imaging as related to asthma. Airway wall thickness is discussed and how it relates to disease progression and pulmonary function test. In addition, indirect findings such as bronchial dilatation and mosaic attenuation, both consequences of air-trapping, are discussed. Other investigational tools, such as endobronchial ultrasound and positron emission tomography, are described. Summary New modalities in radiology hold promise to aid in the understanding and treatment of small-airway disease. Although still considered investigational modalities, research evidence is fast accumulating. It behooves the clinician to have a heightened awareness regarding further advancements in this field.