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Published ahead of print on June 26, 2003, doi:10.1164/rccm.200211-1268OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 8, October 2003, 983-988

A more recent version of this article appeared on October 15, 2003
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Submitted on November 4, 2002
Accepted on June 25, 2003

Relation of airway wall thickness to airway sensitivity and airway reactivity in asthma

Akio Niimi1*, Hisako Matsumoto1, Masaya Takemura1, Tetsuya Ueda1, Kazuo Chin2, and Michiaki Mishima1

1 Respiratory Medicine, Kyoto University, Postgraduate School of Medicine, Kyoto, Japan, 2 Physical Therapy, Kyoto University, Postgraduate School of Medicine, Kyoto, Japan

* To whom correspondence should be addressed. E-mail: a.niimi{at}imperial.ac.uk.

Airway wall thickening has been assumed to cause airway hyperresponsiveness, but a protective effect against airway narrowing has also been suggested. We investigated the relation between airway wall thickness as assessed by helical computed tomography and two components of airway responsiveness, airway sensitivity and reactivity, in stable asthmatics with (n=23) and without (n=22) inhaled steroid treatment. A cross-section of the apical bronchus of the right upper lobe was obtained. Airway wall area corrected by body-surface area was measured as an index of wall thickness. Airway sensitivity and reactivity were measured by continuous inhalation of methacholine, on the basis of the methacholine-respiratory resistance dose-response curve. The eosinophil count in sputum was determined in 16 and 14 patients of each group. In both groups of patients, airway sensitivity was not related to airway reactivity. Airway sensitivity was related to eosinophil count (r=0.57 in steroid (+) group and r=0.49 in steroid (-) group), but not to airway wall thickness. In contrast, airway reactivity negatively correlated with airway wall thickness (r=-0.56 and r=-0.55) but not with eosinophil count. Our results suggest that airway wall thickening attenuates airway reactivity in asthmatic patients. These findings may provide important implication on pathophysiology and treatment of airway remodeling.
Key words: airway remodeling, airway wall thickening, excessive airway narrowing, airway hyperresponsiveness




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