Published ahead of print on June 23, 2005, doi:10.1164/rccm.200411-1463OC Am. J. Respir. Crit. Care Med., Volume 172, Number 7, October 2005, 817-823 A more recent version of this article appeared on October 1, 2005
Submitted on November 3, 2004 Fractal Geometry of Airway Remodeling in Human AsthmaStacey R Boser1,1 Dalhousie University, Halifax, Nova Scotia, Canada, 2 Respiratory Research Group, University of Calgary, Calgary, Alberta, Canada, 3 Morphology and Systematics, Universitat Bonn, Institut fur Zoologie, Bonn, Germany, 4 Pediatrics Division, University of New Mexico, School of Medicine, Albuquerque, NM, USA * To whom correspondence should be addressed. E-mail: fgreen{at}ucalgary.ca.
Airway wall remodeling is an important aspect of human asthma. In this study fractal analysis was used to provide a relatively simple method for developing a quantitative index of airway wall remodeling in asthmatic and non-asthmatic airways. Negative pressure silicone rubber casts of lungs were made using autopsy material from three groups: fatal asthma, non-fatal asthma and non-asthma control. All subjects were lifelong non-smokers. Non-asthma control casts had smooth walls and dichotomous branching patterns with non-tapering segments. Asthmatic casts showed many abnormalities including airway truncation from mucous plugs, longitudinal ridges and horizontal corrugations corresponding to elastic bundles and smooth muscle hypertrophy, respectively, and surface projections associated with ectatic mucous gland ducts. Fractal dimensions were calculated from digitized images using an information method. The average fractal dimensions of the airways of both the fatal asthma (1.72) and non-fatal asthma (1.76) groups were significantly (p<0.01; p=0.032, respectively) lower than that of the non-asthma control group (1.83). The lower fractal dimension of asthmatic airways correlated with a decreased overall structural complexity and pathologic severity of disease. This is the first study to use fractal analysis to assess the chronic structural changes of airway remodeling in asthma. Key words: asthma pathology, airway remodeling, fractal dimension, silicone casts
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