Structural lung abnormalities on computed tomography correlate with asthma inflammation in bronchoscopic alveolar lavage fluid.

: Image scoring systems have been developed to assess the severity of specific lung abnormalities in patients diagnosed with various pulmonary diseases except for asthma. A comprehensive asthma imaging scoring system may identify specific abnormalities potentially linking these to inflammatory phenotypes.: Computed tomography (CT) images of 88 children with asthma (50 M/38 F, mean age 7.8 ± 5.4 years) acquired within 12 months of bronchoscopic alveolar lavage fluid (BALF) sampling that assessed airway inflammation cell types were reviewed along with CT images of 49 controls (27 M/22 F, mean age 3.4 ± 2.2 years). Images were scored using a comprehensive scoring system to quantify bronchiectasis (BR), bronchial wall thickening (BWT), ground glass opacity, mucus plugging (MP), consolidations, linear densities (LD), and air trapping (AT). Each category was scored 0-2 in each of six lobar regions (with lingula separated from left upper lobe).: Absolute average overall scores of the controls and children with asthma were 0.72 ± 1.59 and 5.39 ± 5.83, respectively ( < 0.0001). Children with asthma scored significantly higher for BR ( = 20, 0.33 ± 0.80,  = 0.0002), BWT ( = 28, 0.72 ± 1.40,  < 0.0001), MP ( = 28, 0.37 ± 1.12,  = 0.0052), consolidation ( = 31, 0.67 ± 1.22,  < 0.0001), LD ( = 58, 1.12 ± 1.44,  < 0.0001), and AT ( = 52, 1.78 ± 2.31,  < 0.0001). There was a significant difference between the BR score of children with positive inflammatory response in BALF ( = 53) and those who were negative for airway inflammation cells (0.14 ± 0.36,  = 0.040).: Significant lung structural abnormalities were readily identified on CT of children with asthma, with image differentiation of those with an inflammatory response on BALF. Chest imaging demonstrates potential as a noninvasive clinical tool for additional characterization of asthma phenotypes.