New Frontiers in Asthma Chest Imaging

Modern pulmonary imaging can reveal underlying pathological and pathophysiological changes in the lungs of people with asthma, with important clinical implications. A multitude of imaging modalities are now used to examine underlying structure/function relationships including computed tomography, magnetic resonance imaging, optical coherence tomography, and endobronchial ultrasound. Imaging-based biomarkers from these techniques, including airway dimensions, blood vessel volumes, mucus scores, ventilation defect extent and air trapping extent, often have increased sensitivity compared to traditional lung function measurements, and are increasingly used as endpoints in clinical trials. Imaging has been crucial to recent improvements in our understanding of relationships between T2-inflammation, eosinophilia, and mucus extent. With the advent of effective anti-T2 biologic therapies, computed tomography and magnetic resonance imaging techniques can identify not just which patients benefit from therapy, but why they benefit. Clinical trials have begun to assess the utility of imaging to prospectively plan airway therapy targets in bronchial thermoplasty and have potential to direct future bronchoscopic therapies. Together, imaging techniques provide a diverse set of tools to investigate how spatially-distributed airway, blood, and parenchymal abnormalities shape disease heterogeneity in patients with asthma.