The effect of disease and respiration on airway shape in patients with moderate persistent asthma

PLoS One. 2017 Jul 31;12(7):e0182052. doi: 10.1371/journal.pone.0182052. eCollection 2017.

Abstract

Computational models of gas transport and aerosol deposition frequently utilize idealized models of bronchial tree structure, where airways are considered a network of bifurcating cylinders. However, changes in the shape of the lung during respiration affect the geometry of the airways, especially in disease conditions. In this study, the internal airway geometry was examined, concentrating on comparisons between mean lung volume (MLV) and total lung capacity (TLC). A set of High Resolution CT images were acquired during breath hold on a group of moderate persistent asthmatics at MLV and TLC after challenge with a broncho-constrictor (methacholine) and the airway trees were segmented and measured. The airway hydraulic diameter (Dh) was calculated through the use of average lumen area (Ai) and average internal perimeter (Pi) at both lung volumes and was found to be systematically higher at TLC by 13.5±9% on average, with the lower lobes displaying higher percent change in comparison to the lower lobes. The average internal diameter (Din) was evaluated to be 12.4±6.8% (MLV) and 10.8±6.3% (TLC) lower than the Dh, for all the examined bronchi, a result displaying statistical significance. Finally, the airway distensibility per bronchial segment and per generation was calculated to have an average value of 0.45±0.28, exhibiting high variability both between and within lung regions and generations. Mixed constriction/dilation patterns were recorded between the lung volumes, where a number of airways either failed to dilate or even constricted when observed at TLC. We conclude that the Dh is higher than Din, a fact that may have considerable effects on bronchial resistance or airway loss at proximal regions. Differences in caliber changes between lung regions are indicative of asthma-expression variability in the lung. However, airway distensibility at generation 3 seems to predict distensibility more distally.

MeSH terms

  • Adolescent
  • Asthma / diagnostic imaging*
  • Asthma / physiopathology
  • Case-Control Studies
  • Female
  • Humans
  • Lung / diagnostic imaging*
  • Lung / physiology
  • Lung Volume Measurements
  • Male
  • Respiration*
  • Tomography, X-Ray Computed
  • Young Adult

Grants and funding

The study was conducted, among others, by member of the scientific team of Medical R&D, Air Liquide Santé International, Paris Saclay, France. The funder provided support in the form of salaries of authors Spyridon Montesantos (SM), Ira Katz (IK), Marine Pichelin (MP) and Georges Cailliobotte (GC) but did not have any additional role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. The Specific roles of these authors are articulated in the “author contributions” section. The authors’ employment by the Air Liquide corporation does not alter our adherence to PLOS One policies on sharing data and materials. No other possible competing interests are declared.