Aims

To evaluate the clinical and functional characteristics and describe the radiological findings of chest HRCT of children with severe asthma.

Methods

We performed a retrospective, monocentric study comparing a group of pediatric patients with severe asthma based on the GINA guidelines with healthy controls who attended our pediatric clinic for reasons other than asthma. Based on these HRCT scans, we analyzed quantitative and qualitative parameters.

Results

A total of 20 children with severe asthma (mean age 10.4 years) and 21 controls (mean age 11.4 years) participated in the study. The mean age at symptom onset was 5.7 years, with an average disease duration of 4.7 years. 70% were atopic. Among the asthmatic children the mean pre-bronchodilator predicted FEV1% was 84.9% with a z-score of -1.11 and the mean bronchodilator responsiveness was 12.5%. 30% were treated by biological therapy for at least 12 months. In univariate analyses, the following radiological findings were significantly associated with the disease severity status: Bronchial Thickening (BT) scores (p<0.001; they were always 0 in the control group), Airway Wall Thickness (AWT%) (p<0.001), bronchiectasis grading and severity (BG, BS) scores (p=0.016), mucus plugging and centrilobular emphysema (p=0.009).

Conclusion
Children with severe asthma have considerable differences in the HRCT parameters compared to healthy controls. Evaluation of these parameters should be integrated into the diagnostic process of pediatric severe asthma and could provide the basis for the creation of disease severity criteria based on chest HRTC imaging, to improve the diagnostic approach and therapeutic management in these patients.