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      The role of radiological imaging in the management of severe and difficult-to-treat asthma

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          Abstract

          Radiological imaging has proven to be a useful tool in the assessment of asthma, its comorbidities and potential complications. Characteristic chest radiograph and computed tomography scan findings can be seen in asthma and in other conditions that can coexist with or be misdiagnosed as asthma, including chronic rhinosinusitis, inducible laryngeal obstruction, excessive dynamic airway collapse, tracheobronchomalacia, concomitant COPD, bronchiectasis, allergic bronchopulmonary aspergillosis, eosinophilic granulomatosis with polyangiitis, and eosinophilic pneumonia. The identification of the characteristic radiological findings of these conditions is often essential in making the correct diagnosis and provision of appropriate management and treatment. Furthermore, radiological imaging modalities can be used to monitor response to therapy.

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          Imaging plays a vital role in asthma diagnosis and detection or exclusion of comorbidities. Further research is required to standardise the application of imaging in asthma and allied diseases. https://bit.ly/3WIWSN9

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          Most cited references68

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          Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction.

          The link between mucus plugs and airflow obstruction has not been established in chronic severe asthma, and the role of eosinophils and their products in mucus plug formation is unknown.
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            Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria.

            Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus, manifesting with poorly controlled asthma, recurrent pulmonary infiltrates and bronchiectasis. There are estimated to be in excess of four million patients affected world-wide. The importance of recognizing ABPA relates to the improvement of patient symptoms, and delay in development or prevention of bronchiectasis, one manifestation of permanent lung damage in ABPA. Environmental factors may not be the only pathogenetic factors because not all asthmatics develop ABPA despite being exposed to the same environment. Allergic bronchopulmonary aspergillosis is probably a polygenic disorder, which does not remit completely once expressed, although long-term remissions do occur. In a genetically predisposed individual, inhaled conidia of A. fumigatus germinate into hyphae with release of antigens that activate the innate and adaptive immune responses (Th2 CD4(+) T cell responses) of the lung. The International Society for Human and Animal Mycology (ISHAM) has constituted a working group on ABPA complicating asthma (www.abpaworkinggroup.org), which convened an international conference to summarize the current state of knowledge, and formulate consensus-based guidelines for diagnosis and therapy. New diagnosis and staging criteria for ABPA are proposed. Although a small number of randomized controlled trials have been conducted, long-term management remains poorly studied. Primary therapy consists of oral corticosteroids to control exacerbations, itraconazole as a steroid-sparing agent and optimized asthma therapy. Uncertainties surround the prevention and management of bronchiectasis, chronic pulmonary aspergillosis and aspergilloma as complications, concurrent rhinosinusitis and environmental control. There is need for new oral antifungal agents and immunomodulatory therapy. © 2013 John Wiley & Sons Ltd.
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              British Thoracic Society Guideline for bronchiectasis in adults

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                Author and article information

                Journal
                Breathe (Sheff)
                Breathe (Sheff)
                BREATHE
                breathe
                Breathe
                European Respiratory Society
                1810-6838
                2073-4735
                June 2024
                16 July 2024
                : 20
                : 2
                : 240033
                Affiliations
                [1 ]Department of Respiratory Medicine, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
                [2 ]Medical School, Lancaster University, Lancaster, UK
                [3 ]Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
                Author notes
                Corresponding author: Adel H. Mansur ( adel.mansur@ 123456uhb.nhs.uk )
                Author information
                https://orcid.org/0000-0003-4755-9859
                Article
                EDU-0033-2024
                10.1183/20734735.0033-2024
                11249838
                39015661
                65d14cce-bf50-4227-b5c3-78c05a072a46
                Copyright ©ERS 2024

                Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ 123456ersnet.org

                History
                : 29 January 2024
                : 12 May 2024
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