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Assessment of Airway Remodeling in Allergic Asthma using Optical Coherence Tomography

Melissa J. Suter, PhD

It has long been recognized that asthma is not a single disease, but rather a heterogeneous group of disorders that exhibit the clinical symptoms of reversible airway obstruction and hyperresponsiveness. Accurately phenotyping/subphenotyping asthmatic patients will likely become increasingly important as advances in novel targeted therapies and pharmaceuticals occur. We have developed a catheter-based imaging system, termed orientation-resolved optical coherence tomography (OR-OCT) that enables us to assess airway wall microstructure, including airway smooth muscle (ASM) mass and 3D distribution, in vivo. We conducted endobronchial OR-OCT in subjects with mild allergic asthma (AA) and in allergic controls (AC) to assess early airway remodeling metrics including epithelial thickness, mucosal thickness, airway folding, mucus density and heterogeneity, ASM thickness, and ASM band width. Statistically significant differences between the groups were observed in all measures of airway remodeling. In addition, epithelial thickness, mucosal thickness and mucosal buckling were found to directly correlate with lung function. The ability to accurately assess airway remodeling in vivo may lead to improved patient phenotyping. If we are able to accurately phenotype/subphenotype asthma, we may be able to better match individuals to appropriate therapeutics, such as bronchial thermoplasty, and therefore reduce the high morbidity associated with this disease.

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