Computed tomography reflects lower airway inflammation and tracks changes in early cystic fibrosis

Stephanie D. Davis, Lynn A. Fordham, Alan S. Brody, Terry L. Noah, George Z. Retsch-Bogart, Bahjat F. Qaqish, Bonnie C. Yankaskas, Robin C. Johnson, Margaret W. Leigh

Research output: Contribution to journalArticle

145 Scopus citations

Abstract

Rationale: Detecting and tracking early cystic fibrosis (CF) lung disease are difficult due to lack of sensitive markers of airway dysfunction. Objectives: The goals were to detect regional distribution of airway disease through high-resolution computed tomography, correlate abnormalities to lower airway inflammation/infection, and compare computed tomography findings before and after intravenous antibiotic therapy in children with CF younger than 4 years experiencing a pulmonary exacerbation. Methods: High-resolution computed tomography was performed in 17 children scheduled for bronchoscopy. The radiologist identified the lobes with the "greatest" and "least" disease based on computed tomography, and bronchoalveolar lavage was performed in these areas. In 13 subjects, imaging was repeated after antibiotic completion. Modified Brody scores were assigned by two radiologists. Measurements and Main Results: The lobe with greatest disease was predominantly localized to the right and had higher modified Brody scores, indicating more severe abnormalities (p < 0.01), compared with the lobe with least disease. The total modified Brody score (p < 0.01), hyperinflation subscore (p < 0.01), and bronchial dilatation/bronchiectasis subscore (p < 0.01) improved after antibiotics and intensified airway clearance. Interleukin-8 levels (p < 0.01) and % neutrophils (p = 0.04) were increased in the lobe with greatest disease compared with the lobe with least disease. Conclusions: These results indicate that, in young children with CF experiencing a pulmonary exacerbation, computed tomography detects regional differences in airway inflammation, may be a sensitive outcome to evaluate therapeutic interventions, and identifies early lung disease as being more prominent on the right.

Original languageEnglish (US)
Pages (from-to)943-950
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Volume175
Issue number9
DOIs
StatePublished - May 1 2007
Externally publishedYes

Keywords

  • Bronchoalveolar lavage
  • Bronchopneumonia
  • Child
  • Computed tomography scanners, X-ray
  • Infant

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    Davis, S. D., Fordham, L. A., Brody, A. S., Noah, T. L., Retsch-Bogart, G. Z., Qaqish, B. F., Yankaskas, B. C., Johnson, R. C., & Leigh, M. W. (2007). Computed tomography reflects lower airway inflammation and tracks changes in early cystic fibrosis. American journal of respiratory and critical care medicine, 175(9), 943-950. https://doi.org/10.1164/rccm.200603-343OC