Pruning of the pulmonary vasculature in asthma the Severe Asthma Research Program (SARP) cohort

Samuel Y. Ash, Farbod N. Rahaghi, Carolyn E. Come, James C. Ross, Alysha G. Colon, Juan Carlos Cardet-Guisasola, Eleanor M. Dunican, Eugene R. Bleecker, Mario Castro, John V. Fahy, Sean B. Fain, Benjamin M. Gaston, Eric A. Hoffman, Nizar N. Jarjour, David T. Mauger, Sally E. Wenzel, Bruce D. Levy, Raul San Jose Estepar, Elliot Israel, George R. Washko

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Rationale: Loss of the peripheral pulmonary vasculature, termed vascular pruning, is associated with disease severity in patients with chronic obstructive pulmonary disease. Objectives: To determine if pulmonary vascular pruning is associated with asthma severity and exacerbations. Methods:Wemeasured the total pulmonary blood vessel volume (TBV) and the blood vessel volume of vessels less than 5mm2 in cross-sectional area (BV5) and of vessels less than 10 mm2 (BV10) in cross-sectional area on noncontrast computed tomographic scans of participants from the Severe Asthma Research Program. Lower values of the BV5 to TBV ratio (BV5/TBV) and the BV10 to TBV ratio (BV10/TBV) represented vascular pruning (loss of the peripheral pulmonary vasculature). Measurements and Main Results: Compared with healthy control subjects, patients with severe asthma had more pulmonary vascular pruning. Among those with asthma, those with poor asthma control had more pruning than those with well-controlled disease. Pruning of the pulmonary vasculature was also associated with lower percent predicted FEV1 and FVC, greater peripheral and sputum eosinophilia, and higher BAL serum amyloid A/lipoxin A4 ratio but not with low-attenuation area or with sputum neutrophilia. Compared with individuals with less pruning, individuals with the most vascular pruning had 150% greater odds of reporting an asthma exacerbation (odds ratio, 2.50; confidence interval, 1.05-5.98; P = 0.039 for BV10/TBV) and reported 45% more asthma exacerbations during follow-up (incidence rate ratio, 1.45; confidence interval, 1.02-2.06; P = 0.036 for BV10/TBV). Conclusions: Pruning of the peripheral pulmonary vasculature is associated with asthma severity, control, and exacerbations, and with lung function and eosinophilia.

Original languageEnglish (US)
Pages (from-to)39-50
Number of pages12
JournalAmerican journal of respiratory and critical care medicine
Issue number1
StatePublished - Jul 1 2018


  • Eosinophilia
  • Pruning
  • Pulmonary vascular
  • Severe asthma

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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